Q: My hospital is revamping titration guidelines for vaso-active medications with the goal of allowing nurses the freedom to treat patients while staying within the requirements of The Joint Commission guidelines. How can the hospital provide enough latitude for nurses to treat patients effectively?

A: Allison Mikula, MSN, RN-BC, CCRN, CHSE, replies:

Providing latitude in order to treat patients effectively and meet the requirements of The Joint Commission (TJC) is an excellent way to frame this question. Efforts to improve the quality of health care have rapidly transformed since the 1999 landmark report To Err Is Human by the Institute of Medicine.1  The aim of that report was to raise awareness, increase efforts to identify and learn from systems errors, establish performance standards, and develop safer health care systems.

Medication errors account for approximately 700 000 emergency department visits and 100 000 hospitalizations annually, and 5% of all hospitalized...

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