Therapeutic Duplication: Conflicting Orders That Must be Clarified

Announcement Information


According to The Joint Commission, the risk of therapeutic duplication arises when an order set can be interpreted to allow the nurse or patient to choose the drug or dose. Such a practice violates both TJC and CMS guidelines. Seton is currently working to identify and correct order sets that contain and/or allow for unintended therapeutic duplications.

What Is It?

Therapeutic duplication is the practice of prescribing multiple medications for the same indication without a clear distinction of when one agent should be administered over another – for example, pain, nausea and vomiting, and constipation. If multiple medications from the same therapeutic class are ordered, each medication must include a specific indication or include criteria for which medication to administer first, second, third, etc.

Why Can’t Nurses Select the Most Appropriate Medication from a List of Options?

It’s a patient safety issue! For example, drug potentiating and over-sedation might occur with pain medication duplication. Medication errors especially double dosing and/or ineffective drug therapy also might occur. Seton’s Patient Care Orders Policy and Medical Staff Rules, along with the State Board of Medical Examiners and Boards of Pharmacy and Nursing have requirements that prescribers write clear orders and those receiving those orders clarify them before the medications are administered to the patient

How Do We Fix this Problem?

Teams networkwide are working to revise paper and electronic order sets that contain multiple medications for the same indication. During the process of correcting these order sets, expect you may receive a call to clarify your conflicting orders, from either a nurse or pharmacist.

Even after the order sets are reviewed, it continues to be everyone’s job to ensure orders are clarified.

It’s a job that never goes away.

  • Prescribers MUST write clear orders.
  • Nurses MUST clarify unclear orders upon receipt and before they administer medications.
  • Pharmacists MUST clarify unclear orders before they dispense medications.