Hospital Policies and Documentation

Because Mr. Gomez is in a hospital setting, some of the issues that arise involve hospital policies and procedures for dealing with patients' herbal and dietary supplements. Before we start on all of this, there is some background information you need to know about national guidelines and Joint Commission standards.

A. Background

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i. National guidelines on inpatient use of HDS

Little is currently known about the safety and efficacy of HDS in the inpatient setting. Although many HDS are safe, some may cause side effects or interactions with patients' medications. In some instances, patients want to continue using their own HDS during hospitalization (Beal, 1998; Norstrom, 2002). This practice of using a "home supply" makes identification and reconciliation of HDS use among admitted patients extremely important, particularly because of the risks of HDS-drug interactions or special risks encountered during surgery, e.g. interference with hemostasis, interactions with sedatives or anesthetic agents (Boyer, 2002).

There is currently no universally accepted guideline for managing patients' HDS. However, both the Joint Commission Accreditation of Healthcare Organization's (JCAHO) and American health Systems Pharmacists (ASHP) offer standards and guidelines on the use of HDS in hospitals (Aynomous, 2003; Kroll, 2004). JCAHO requires that dietary supplements conform to the same hospital standards as prescription medications (Aynomous, 2003). Please proceed to the next page for more information about JCAHO.                                          

ii. JCAHO and the Accreditation Manual for Hospitals

In the Joint Commission Comprehensive Accreditation Manual for Hospitals, a medication is defined as:

"any prescription medication, sample medication, herbal remedies, vitamins, nutriceuticals, over the counter drugs, vaccines, diagnostic and contrast agents, used on or administered to person to diagnosis, treat, or prevent disease or other abnormal conditions..." (JACHO, 2004).

Therefore, JCAHO medication management standards equate many types of dietary supplements, such as herbal remedies, vitamins, nutriceuticals, over the counter drug containing HDS on the same level as prescription and nonprescription drugs (Kroll, 2004). JCAHO expects health systems to manage HDS products with the same diligence and care given to any prescription medication brought into the hospital by patients and their families. That is, all HDS should be subjected to medical staff review and approval and governed by institutional policies (Walker, 2000).

JCAHO's National Patient Safety Goal #8 Medical Reconciliation Act, requires documentation of any patient use of herbal remedies, vitamins, nutriceuticals, over the counter drugs, just like any other medication (JCAHO, 2007). This is a standard that applies to all accredited hospitals in the United States.

Here are some resources for you to explore regarding this subject:

www.jcrinc.com/Quality-and-Safety-Risk-Areas/Medication-Safety

www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals

www.macoalition.org/initiatives.shtml#3