February 10, 2015—Required Information for Medications Ordered for Pain Management
To improve patient safety and adherence to the mandatory requirements of both the Joint Commission and the Centers for Medicare and Medicaid Services (CMS), specific criteria must be defined if a prescriber orders either of the following to manage a patient's pain:
Two PRN orders for the same pain medication, with different administration routes
Multiple PRN medications for pain
Multiple medications for the same patient, to be given as needed for pain, must include clearly described reasons. These might include one or more of the following:
Type of pain—headache, tooth pain, back pain, chest pain, etc.
Clinical reason—when tolerating PO
Level of pain—mild, moderate, severe
Examples
Acceptable: indication based on type of pain (select Other, then type a description)
ACETAMINOPHEN (TYLENOL) 650 MG PO Q6H PRN:Tooth pain
IBUPROFEN 400 MG PO Q8H PRN: Back pain
Acceptable: indication based on severity
OXYCODONE 5 MG PO Q6H PRN: Pain-Moderate
MORPHINE SULFATE 0.25 MG IV Q6H PRN: Pain-Severe
Acceptable: indication based on type or pain or severity
ACETAMINOPHEN (TYLENOL) 650 MG PO Q6H PRN: Tooth pain
MORPHINE SULFATE 0.25 MG IV Q6H PRN: Pain-Severe
Acceptable: indication based on patient status
OXYCODONE 5 MG PO Q6H PRN: Pain-Severe, When tolerating PO
MORPHINE SULFATE 0.25 MG IV Q6H PRN: Pain-Severe, When NOT tolerating PO
Unacceptable: multiple medications for the same indication
ACETAMINOPHEN (TYLENOL) 650 MG PO Q6H PRN: Pain-Moderate
IBUPROFEN 400 MG PO Q8H PRN: Pain-Moderate
Unacceptable orders will NOT be approved by Pharmacy. Inappropriate medication orders may result in delay of approval, availability, and administration or the treatment.
Medication ordering evaluation and approval process
The options for PRN reasons have been enhanced for providers ordering medications to be administered as needed for pain, for inpatients only. See PRN Reasons for pain medications.
Provider: must order pain medications based on the above criteria
Nurse: must evaluate that clear and concise pain medication orders are written prior to administration
Pharmacist: must evaluate each order for accuracy and appropriateness by considering the above criteria prior to approving order
Order sets will be updated over the following weeks. Full Implementation and accountability of established requirements must be established by early spring of 2015.
For additional information, see the Overview of Safe & Effective Pain Management (PDF) from MESAC.
See also: