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.  While this is an acceptable practice there must be clarity sought to determine when one agent should be administered over another, if both agents are to be given concurrently or if one therapy was to replace an existing therapy and wasn't discontinued properly.   Such orders are commonly seen in orders for analgesics and anti-emetics but occurs other drug classifications as well (e.g. anti-hypertensives, anticoagulants, etc.)

When more than one medication is prescribed for the same indication, 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 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 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 patient care team involved in medication management.  If the intent was that both medications be administered and the organizations policy allows for these orders, the pharmacy preparing the medication and the staff administering the medication need to have clear guidance provided. 

For example, when a patient is prescribed multiple antiemetic agents, there must be a clear understanding of the following concerns:

• Was the intent of the prescriber to have all ordered medications given known by the prescriber, pharmacist, and the administering provider?
• When does the administering provider give each agent based upon the intent of the prescriber?