Hello fellow Med Safety officers.

I am looking to see how other institutions manage duplicate pain medications ordered via different routes, but for the same pain scale to comply with JCAHO's "Med orders are clear & accurate" standard.

For example:
Post-op ortho orders:
Oxy IR 10mg po q4hrs prn severe (7-10) pain
Dilaudid 0.5mg IV q2hrs prn severe (7-10) pain

At your facility...
1. Are duplicate pain meds via different routes allowed?
a. If so, how do nurses know which medication to use first or preferentially?
b. If not, how did you implement a one pain med per pain scale, regardless of route, policy? Have you had challenges with prescribers finding work arounds?

2. Do you allow orders for breakthrough pain?
a. If so, what requirements/criteria, if any, are in place to ensure the pain med is being use appropriately?

As always, any information you are willing to share with me is appreciated!

Vee