Is therapeutic duplication prohibited by The Joint Commission ?

Any examples are for illustrative purposes only.

Therapeutic duplication occurs when practitioners order more than one medication for the same indication. When this occurs, there must be a process in place to determine whether the ordering of multiple agents for the same indications is either an accidental prescribing error or intentional multi-modal therapy.   

Joint Commission standards for organization's that dispense medications require medication orders to be reviewed by a pharmacist.  Part of the review is to identify whether or not therapeutic duplication exists.  Once this is identified, it is required that the pharmacist and nurse or staff administering or observing self-administration of medications have a clear understanding of the intent of the prescriber. Organizations may utilize resources such as policies, technology within the electronic medical record or other means necessary to ensure such communication.  

The intent is to ensure that medication orders are clear and accurate for all members of the treatment team involved in medication management. If the intent was that both medications are to be administered and the organizations policy allows for these orders, the pharmacist preparing the medication and the staff administering the medication need to have clear guidance provided. 

• Was the intent of the prescriber to have all ordered medications given known by the prescriber, pharmacist, and the staff administering or observing self-administration of medications?
• When does the staff administering or observing self-administration give each agent based upon the intent of the prescriber?