Orders - Cancelling and Rewriting Orders Following a Procedure or Transition of Care

Is there a Joint Commission standard that requires all orders to be cancelled, then rewritten following a procedure or when a patient is transferred from one level of care to another?

No, there is no specific accreditation requirement that states all orders must be canceled, then rewritten following a procedure or when a patient is transferred from one level of care to the next.  Such a requirement would be an organizational decision, or unless specifically required by individual state law/regulation.
Organizations are expected to have a process in place to ensure that the orders used following a procedure or transition of care are the most recent and reflect the current assessed needs of the patient.  The requirement found at PC.02.01.03 EP 7 requires that care, treatment, and services are provided using the most recent patient order(s).

During transitions of care, there must be a process in place to ensure coordination of care among care providers – also referred to as "hand off communication".  The following requirements are found in the Provision of Care (PC) chapter of the accreditation manual:  PC.02.02.01 EP 1 states "The hospital has a process to receive or share patient information when the patient is referred to other internal or external providers of care, treatment, and services" and PC.02.02.01 EP 2 states "The hospital’s process for hand-off communication provides for the opportunity for discussion between the giver and receiver of patient information. Note: Such information may include the patient’s condition, care, treatment, medications, services, and any recent or anticipated changes to any of these."

Conducting a risk assessment allows organizations to identify risk points associated with these processes, and to ensure that such processes do not include any summary (blanket) orders for resuming medication (see MM.04.01.01 EP 8). A proactive risk assessment (sometimes referred to as an FMEA) examines a process in detail, including sequencing of events, actual and potential risks, and failure or points of vulnerability. Risk points are then prioritized through a logical process, then process improvements - based on the actual or potential impact (that is, criticality) on quality and safety – are implemented to reduce or eliminate risk.  The introductory section of the Leadership (LD) chapter provides an example of a pro-active risk assessment model that an organization may use.  However, this specific approach is not mandated as there are other risk assessment tools available that may better meet the needs of the organization.

Last updated on January 18, 2017
Manual: Hospital and Hospital Clinics
Chapter: Provision of Care Treatment and Services PC

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