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Amid COVID-19, small and rural U.S. hospitals can expect new challenges and requirements ahead in terms of meeting Joint Commission standards, an expert suggested.

The Joint Commission surveys are normally conducted at least once every 3 years to evaluate standards compliance at each center. The Commission had been behind on its regular facility surveys entering 2021 and, despite slowdowns from the pandemic, was making progress to close the backlog as late as October.

This is possible because separate audits are being combined into single, shorter sessions, according to medication system consultant Jeannell Mansur, RPh, PharmD, of Joint Commission Resources in Oak Brook, Illinois, who spoke at the American Society of Health-System Pharmacists (ASHP) .

Now, the Joint Commission is expected to amp up medication management standards for hospitals seeking accreditation in 2022.

Mansur said that changes in antimicrobial stewardship standards are on the table next year. While they haven't been finalized, a field review and published draft standards from the Joint Commission suggest an emphasis on leadership support for antimicrobial stewardship, guideline implementation for community-acquired pneumonia and other infections, and reporting of antibiotic usage to the CDC.

Additionally, the standards for pharmaceutical compounding used in the Joint Commission's evaluation of hospitals and other sites, USP chapter 797, are being revamped with new rules, for example, for organizations wishing to extend the beyond-use dates of their compounded preparations. The public comments period on the draft standards ends in January 2022, after which the new USP 797 rules may be passed and the Joint Commission allowed to survey to them, according to Mansur.

These developments are anticipated at a time when the threat of the Omicron variant looms over the country, especially the small and rural hospitals that had already been stretched to their limits due to surges of COVID-19 patients and healthcare staff shortages.

Mansur presented data showing that from January 2020 to September 2021, a period roughly coinciding with the pandemic, the Joint Commission found Medicare-designated critical access hospitals (CAHs) to be most frequently noncompliant for the following standards:

• MM.06.0101 EP3: Medication administration in accordance with prescribers' order, namely the management of titration orders (35%)

• MM.05.01.01 EP11: Issues related to medication order resolved prior to dispensing (15%)

• MM.04.01.01 EP2: Hospital follows written policy on medication order elements (11%)

• MM.03.01.01 EP2: Storage of medications (10%)

• MM.03.01.01 EP7: Medications labeled with contents and expiration date (6%)

These rates of noncompliance are better than what is typically seen in hospital accreditation surveys, which tend to find greater noncompliance at non-CAH hospitals. It may be that a CAH administers fewer titration orders, for example, Mansur explained.

The Joint Commission's 2018 titration standards had been called "profoundly unrealistic" and were softened with new clarifications in 2020.

Nevertheless, Mansur said, small and rural hospitals should still pay attention to following medication orders as written, having pharmacists review medication orders, storing and labeling medications properly, sterile compounding, and preventing controlled substance diversion.

"Surveyors are telling us they're seeing more and more controlled substance diversion, and they very much want to bring that into the conversation during survey," Mansur emphasized at the ASHP session, citing that 10% of surveyed hospitals are noncompliant in storage of controlled substances.

She noted that she was recently in a hospital where medications were not secured in an automatic dispensing cabinet. People could just retrieve a drug without a pharmacist review, she observed.

It is important to have a chain of custody, where one individual is responsible at each step of a drug's storage or use, and a robust review of discrepancies, Mansur said.

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