Medication Administration - Range Orders

Does The Joint Commission prohibit the use of ‘range’ or ‘double-range’ orders?

Examples included in this response are for illustrative purposes only.

No, there are no Joint Commission standards that prohibit the use of range orders as long as such orders are permitted by the organization’s medication management policy (see MM.04.01.01).  In addition, range orders may be a component of other order types, such as taper orders and titration orders, unless prohibited by hospital policy.

The glossary of the accreditation manual describes a ‘range order’ as “Orders in which the dose or dosing interval varies over a prescribed range, depending on the situation or the individual’s status.”
Example of range orders may be:
Hydromorphone 2mg tablets 1 – 2 tablets PO every 4 hours prn mild pain.
Morphine 2 mg to 4 mg IV every 4 hours prn severe pain.
 
Example of a double-range order may be:
Hydromorphone 2mg tablets 1 – 2 tablets PO every 4 – 6 hours prn mild pain.
Morphine 2 mg to 4 mg IV every 4 - 6 hours prn severe pain.

Organizations are responsible for determining the implementation process for how range orders are entered into the medical record and that staff are properly trained to ensure consistent implementation.  It is also the responsibility of the organization’s leadership and medical staff to determine how these orders are interpreted.  For example, if an order is written ‘Morphine 2mg-4mg every 6 hours’ and the patient is given 2mg, must the nurse wait until the 6 hours has passed to give another dose or may they give the remaining 2mg if the pain is not adequately controlled prior to the 6-hour interval ?

Compliance with applicable law/regulation, recommendations from professional organizations (state pharmacy boards, ISMP, etc) and evidence-based resources should be incorporated into applicable policies, procedures, etc.
Last updated on December 12, 2019
Manual: Home Care
Chapter: Medication Management MM

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