AUTOMATIC STOP ORDERS

To advocate that the Centers for Medicare & Medicaid Services (1) remove the requirement in the Hospital Conditions of Participation that all medication orders automatically stop after an arbitrarily assigned period to include other options to protect patients from indefinite, open-ended medication orders, and (2) revise the remainder of the medication management regulations and interpretive guidelines to be consistent with this practice; further,

To affirm that the requirement for automatic stop orders for all medications is a potential source of medication errors and patient harm; further,

To encourage pharmacists to participate in interprofessional efforts to establish standardized methods to assure appropriate duration of therapy.

Rationale

Automatic stop orders on medications are intended to safeguard patients against unnecessary or prolonged drug therapy, yet they also have been shown to cause medication errors when critical therapy is inadvertently and arbitrarily discontinued. The Centers for Medicare & Medicaid Services Hospital Conditions of Participation (CMS COP) continue to require automatic stop orders for all orders, including medications, not accounting for shorter lengths of stay and other means of reviewing drug therapy for appropriateness. The CMS COP should be revised to reflect better, more effective approaches to re-evaluating the appropriateness of medications. Because the CMS COP refers to all orders, advocating for this change represents an opportunity to engage with multiple stakeholders, including but not limited to the Institute for Safe Medication Practices, to advocate for the CMS COP revisions and ensure safe implementation and interpretation of the requirements.