Oakbrook Terrace, IL-- In an effort to enforce more accurate documentation, The Joint Commission began mandating this month that all peripheral IV dopamine orders contain a dual IV/SQ route of administration. Previously, The Joint Commission only required hospital dopamine orders to be administered through a stable and acceptable intravenous access site.
Dopamine is a medicine frequently used by medical practitioners to support blood pressure or heart rate in the critically ill patient. The Joint Commission says they have been made aware of thousands of incidents where physicians have ordered intravenous dopamine through a dangling 25 gauge IV on the dorsum of the left 4th metatarsal with a blood pressure of 50/10 knowing very well that the IV is going to infiltrate into a fluid filled wheel of necrotic pus... and they order it anyway.
"All physicians know peripheral IV dopamine will eventually infiltrate into a subcutaneous route of administration. We just want them to be honest with their documentation. Providing an order for subcutaneous dopamine satisfies our requirement for accurate documentation and certification," said Mark Chassin, President and Chief Executive Officer of The Joint Commission.
While documentation accuracy may improve, some doctors worry giving subcutaneous dopamine may do more harm than good. When given subcutaneously, dopamine can cause surrounding tissues to lose blood flow and rapidly die.
"I can understand The Joint Commission's desire for more accurate documentation but this policy just gives doctors an excuse for not putting in a central line and being a doctor," said Dan Stefbaum, lead author of The New York Time's Best Seller In Medicine, Shit Always Flows Downhill.
When confronted with concerns from patient advocacy groups, Mark said, "We know giving dopamine only through central invtravenous access is impractical and unrealistic and we would never expect any doctor working in an ER to place a central line when they know the patient is going to be admitted by the hospitalist to make it their problem. As an organization that prides ourself on patient safety, finding middle ground in this policy was the only rational solution we could envision."
Some hospitalist groups have already responded with their own safety protocols to protect patients from this dangerous new policy. "We require 24 hour 1:1 monitoring with a care tech to watch the IV and notify the hospitalist stat when the IV infiltrates," said Devon Fenwick, a hospitalist at the bottom of the hill.
Next week, The Joint Commission will discuss whether or not to allow surgeons to order antibiotics.
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| Peripheral dopamine now requires a 1:1 tech at all times |
"All physicians know peripheral IV dopamine will eventually infiltrate into a subcutaneous route of administration. We just want them to be honest with their documentation. Providing an order for subcutaneous dopamine satisfies our requirement for accurate documentation and certification," said Mark Chassin, President and Chief Executive Officer of The Joint Commission.
While documentation accuracy may improve, some doctors worry giving subcutaneous dopamine may do more harm than good. When given subcutaneously, dopamine can cause surrounding tissues to lose blood flow and rapidly die.
"I can understand The Joint Commission's desire for more accurate documentation but this policy just gives doctors an excuse for not putting in a central line and being a doctor," said Dan Stefbaum, lead author of The New York Time's Best Seller In Medicine, Shit Always Flows Downhill.
When confronted with concerns from patient advocacy groups, Mark said, "We know giving dopamine only through central invtravenous access is impractical and unrealistic and we would never expect any doctor working in an ER to place a central line when they know the patient is going to be admitted by the hospitalist to make it their problem. As an organization that prides ourself on patient safety, finding middle ground in this policy was the only rational solution we could envision."
Some hospitalist groups have already responded with their own safety protocols to protect patients from this dangerous new policy. "We require 24 hour 1:1 monitoring with a care tech to watch the IV and notify the hospitalist stat when the IV infiltrates," said Devon Fenwick, a hospitalist at the bottom of the hill.
Next week, The Joint Commission will discuss whether or not to allow surgeons to order antibiotics.
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