Survey of Nurses’ Experiences Applying The Joint Commission’s Medication Management Titration Standards

Author:

Davidson Judy E.1,Doran Neal2,Petty Amber3,Arellano Daniel L.4,Henneman Elizabeth A.5,Hanneman Sandra K.6,Schell-Chaple Hildy7,Glann Judy8,Smith Lisa W.9,Derry Katrina L.10,McNicholl Marigene11,Warren Mary Lou12,Scott Sue S.13,Slazinski Tess14,Ahrens Thomas15,McLean Barbara16,Chechel Laura17,Rincon Teresa18

Affiliation:

1. Judy E. Davidson is a nurse scientist, University of California San Diego Health, San Diego, California.

2. Neal Doran is a professor, Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California.

3. Amber Petty is an intensive care unit staff nurse and an advanced practice nurse, Hospitalist Department, IU Health Ball Memorial Hospital, Muncie, Indiana.

4. Daniel L. Arellano is an advanced practice nurse, Division of Anesthesiology, Critical Care, and Pain Medicine, Department of Critical Care, University of Texas MD Anderson Cancer Center, Houston, Texas.

5. Elizabeth A. Henneman is a professor, College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts.

6. Sandra K. Hanneman is the Jerold B. Katz Distinguished Professor for Nursing Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas.

7. Hildy Schell-Chaple is a clinical nurse specialist, Department of Quality and Patient Safety, University of California San Francisco Health, San Francisco, California.

8. Judy Glann is a nurse practitioner, Harborview Medical Center, Seattle, Washington.

9. Lisa W. Smith is a nursing professional development specialist, Veterans Health Administration Western New York Healthcare System at Buffalo, Buffalo, New York.

10. Katrina L. Derry is a pharmacist specialist, medication use policy, University of California San Diego Health, La Jolla, California.

11. Marigene McNicholl is a nurse practitioner and patient safety officer, Riverside University Health System Medical Center, Moreno Valley, California.

12. Mary Lou Warren is a clinical effectiveness specialist, University of Texas MD Anderson Cancer Center.

13. Sue S. Scott is a critical care nurse and an assistant professor, School of Nursing and Allied Health, Westfield State University, Westfield, Massachusetts.

14. Tess Slazinski is a neuroscience/critical care clinical nurse specialist, Cedars-Sinai Medical Center, Los Angeles, California.

15. Thomas Ahrens is a research scientist, Viven Health, St Louis, Missouri.

16. Barbara McLean is a critical care clinical specialist, Critical Care Division, Grady Health Systems, Atlanta, Georgia.

17. Laura Chechel is manager of the cardiovascular intensive care unit, Sulpizio Cardiovascular Center, University of California San Diego Health, La Jolla, California.

18. Teresa Rincon is the director of clinical operations and innovation, UMass Memorial Health Care, and an assistant professor, University of Massachusetts Medical School, Graduate School of Nursing, Worcester.

Abstract

Background Critical care nurses titrate continuous infusions of medications to achieve clinical end points. In 2017, The Joint Commission (TJC) placed restrictions on titration practice, decreasing nurses’ autonomous decision-making. Objectives To describe the practice and perceptions of nurses regarding the 2017 TJC accreditation/regulatory standards for titration of continuous medication infusions. Methods A survey of nurses’ experiences titrating continuous medication infusions was developed, validated, and distributed electronically to members of the American Association of Critical-Care Nurses. Results The content validity index for the survey was 1.0 for relevance and 0.95 for clarity. A total of 781 nurses completed the survey; 625 (80%) perceived titration standards to cause delays in patient care, and 726 (93%) experienced moral distress (mean [SD], 4.97 [2.67]; scale, 0-10). Among respondents, 33% could not comply with titration orders, 68% reported suboptimal care resulting from pressure to comply with orders, 70% deviated from orders to meet patient needs, and 84% requested revised orders to ensure compliance. Suboptimal care and delays in care significantly and strongly (regression coefficients ≥0.69) predicted moral distress. Conclusions Critical care nurses perceive TJC medication titration standards to adversely impact patient care and contribute to moral distress. The improved 2020 updates to the standards do not address delays and inability to comply with orders, leading to moral distress. Advocacy is indicated in order to mitigate unintended consequences of TJC medication management titration standards.

Publisher

AACN Publishing

Subject

Critical Care Nursing,General Medicine

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