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Changes to titration orders

26 May 2019

Joint Commission citation leads to new look in order entry and on the MAR

By: Matthew Tanner, Pharmacy Clinical Coordinator

During the Joint Commission’s recent site visit, we were cited for inadequate titration instructions for Pitocin and oxygen. As a result, we are making changes to all nurse-titratable infusions for both order entry and the MAR. These changes will ensure that affected medications have:

  • Starting dose
  • Titration increments (up and down)
  • Titration intervals
  • Titration targets

These options are laid out as buttons for quick selection with a box to type in free text if the default settings are not appropriate for an individual patient. Please look at the screenshots for the changed order options and finished order on the MAR for a sample Pitocin order.

We are developing these order changes for oxygen, Pitocin and the vasopressor infusions first, followed by antihypertensive, sedative, paralytic and opioid infusions. You can view the entire list of affected medications on the screenshot document.

Action from you

  • Please share this information with providers on your team who order infusions that you want the nurse to titrate. As a clinical leader, we need you to share this information with your team.
  • If you have any questions about your workflow, please escalate these to your leadership so they can bring your concern to the Joint Commission citation work groups.