Changes to CMS’ 30-Minute Rule on Medication Delivery May be Forthcoming

May 31, 2011

The Institute for Safe Medication Practices (ISMP) has finalized new guidelines on the safe administration of medications in the acute care setting that aim to give health care organizations the flexibility to establish more realistic and safer goals associated with timely medication administration.

This is good news for respiratory therapists and nurses alike, who have often struggled to meet the 30 minute delivery window established by the Centers for Medicare and Medicaid Services (CMS).

AARC survey prompts action
ISMP first became aware of issues with the CMS guideline when it wrote an article about the problems respiratory therapists were having with the delivery of inhaled medications.

Because of the unique methodology incorporated into the administration of inhaled medications, the time standard for these medications can range anywhere from nine to 20 minutes. However, an informal survey conducted by the AARC showed that the standard of practice by respiratory therapists for the delivery of inhaled medications in many hospitals is 60 minutes before or after the scheduled due time. 

This led the AARC to develop a Position Statement on alternative medication scheduling that calls for the inhaled medication delivery schedule window not exceed 60 minutes before or after the scheduled medication delivery due time for medications prescribed at an interval greater than or equal to four hours.

The Position Statement was eventually accepted by CMS as a standard of practice by a nationally recognized organization and published by ISMP. 

National poll raises concerns
The new ISMP guidelines were prompted by a national survey in which close to 18,000 nurses responded to questions about their ability to comply with CMS surveyor guidelines requiring medications to be delivered within 30 minutes before or after the scheduled delivery time, regardless of a patient’s complexity of care or the drug delivery method used.

The results of the survey highlighted the fact that many nurses felt the pressure to take short cuts in order to meet the arbitrary CMS guideline, which could lead to at-risk behaviors and medication errors. 

According to the ISMP, its new guidelines are based on input from a multidisciplinary group of advisors and provide recommendations on time-critical and non-time critical scheduled medications, first doses, and medical approval.  Issues such as automated dispensing cabinets, medication administration record (MAR) documentation, and event reporting are also addressed in the new guidelines.

CMS appears open to change
While the CMS guidelines remain in effect, the ISMP has provided a copy of its final guidelines to CMS at its request, and based on conversations with CMS staff, “is optimistic that positive changes will be made to the current 30-minute rule.”  Hopefully the changes will occur sooner rather than later.

You can read more about the new guidelines in an ISMP Medication Safety Alert! article and ISMP news release on the 30-minute rule survey.