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The Debate: Latest Updates
Click here for history of how the JCAHO mandate
to change from the rule of six to standardized drips
evolved.
December 21, 2004: Official JCAHO Stance on Rule of Six
In their publication
This month at the Joint Commission JCAHO reports their latest official
stance on the Rule of Six which confirms the letter we received from the
Standards Interpretations Group earlier this month. Below is text from the
JCAHO publication.
Click here to view the actual page on the JCAHO website.
Transition plan from "Rule of 6"
After consultation with safety experts, the Joint Commission has
reaffirmed the requirement that pediatric hospitals and services which
currently use the "Rule of 6" convert to standardized concentrations, as
required by National Patient Safety Goal 3b, no later than December 31,
2008. The Rule of 6 is a methodology used in pediatrics to simplify IV
preparation of weight-based drugs. A significant number of pediatric
hospitals have requested permission to continue to use the Rule of 6 as an
alternative approach to the NPSG requirement during some or all of the
interim period. A plan that enables these organizations to transition to the
Rule of 6 was developed in collaboration with representatives of American
Academy of Pediatrics, Child Health Corporation of America, Institute for
Safe Medication Practices, and National Association of Children's Hospitals
and Related Institutes, among others, and is supported by the Sentinel Event
Advisory Group.
Requests for alternative approaches to NPSG 3b will continue to be
considered and will require ongoing evidence of progress toward full
implementation by December 31, 2008, of the use of standardized drug
concentrations. The eligibility criteria for participation in the exceptions
process during the transition period are:
 | The exception
applies only to neonatal or pediatric acute care services.
|
| All (emergent and
non-emergent) admixtures are prepared only by pharmacy staff in a sterile
environment.
|
| Calculations of the
drug solutions are validated during the preparation.
|
| The labeling of
solution concentration and drug per milliliter are clear to all
caregivers, and the solution concentration (amount of drug per unit volume
of solution) is clearly indicated on the label.
|
| If the Rule of 6 is
used in a pediatric setting, but standardized drug concentrations are used
in other parts of the hospital, guidance aids are made available to
caregivers who may not be familiar with one of these systems.
|
| If the organization
has a Neonatal Intensive Care Unit, the pharmacy is open 24 hours a day to
support the admixture service.
|
| Smart pumps are
used. (Smart pumps are designed to recognize prescription errors, dose
misinterpretations and keypad programming errors.)
(Contact: Kurt Patton,
kpatton@jcaho.org)
|
December 10, 2004: Letter from Standards
Interpretation Group
In response to numerous queries to our website about
unofficial change in the JCAHO stance on the rule of six to allow
"alternatives" to
National Patient Safety Goal 3b we contacted JCAHO by phone and spoke
with an associate director of the Standards Interpretation Group. Below is
an email reply to us in response to this phone conversation representing
their preliminary stance on the Rule of Six.
"The
JCAHO does not support indefinite continued use of the Rule of 6. Exceptions
to the NPSG are only being allowed on a transitional basis. Therefore, the
Joint commission will require complete conversion to standardized
concentrations by a date certain, specifically, alternatives that rely on
the Rule of 6 will no longer be considered to be in compliance after
December 31, 2008. Prior to that date, however, organizations will need time
to switch software applications as the changes needed in an already highly
automated pharmacy are extensive if their system has built in use of the
Rule of 6. EACH year, organizations using an approved Rule of 6 alternative
must show some demonstrable movement towards the goal of
standardized concentrations. The JCAHO has an alternative review process and
associated form for
considering applications for approval of alternative means of achieving a
NPSG. This process could be used by those pediatric hospitals that want to
continue using Rule of 6. Screening criteria could be designed to evaluate
those requests.
These criteria would include:
1. The emergent and non-emergent admixture are prepared by pharmacy (not
unit) staff using sterile environment.
2.
The solution calculations are validated during the preparation.
3.
The labeling of solution concentrations and drug per ml are clear to all
caregivers. The solution concentration ( amount of drug per unit volume of
solution) is clearly indicated on the label.
4.
If the Rule of 6 is used in a pediatric setting, but standardized
concentrations are used in other parts of the hospital, aides are provided
for caregivers who may not be as familiar with one of those systems.
5.
If the organization has a NICU, the pharmacy is open 24 hours a day to
support the admixture service.
6.
Smart pumps are utilized. ( smart pumps are a parenteral infusion pump
equipped with IV medication error-prone software that is designed to
recognize prescription errors, dose misinterpretations and keypad
programming errors.
I hope this information was helpful. If you have additional questions email
or contact the standards interpretation group at 630-792-5900.
Carol M.Ptasinski RN MSN MBA
Associate Director, Standards Interpretation Group
Accreditation Operations
Joint Commission on Accreditation of Healthcare Organizations"
