Variance of Chapter HFS 124,
Wisconsin Administrative Code: Authentication of Physician Orders
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Date: May 2, 2006 DSL-BQA 06-006
Supersedes 06-002
To: Hospitals HOSP 04
From: Otis Woods, Director,
Bureau of Quality Assurance
This memo supersedes DDES-BQA-06-002, issued February 2, 2006. The
variance granted in DDES-BQA-06-002 is revoked and replaced by the
variance in this memo, which clarifies the Department's position on
authentication of physician orders in hospitals and further aligns the
state requirements with federal Medicare regulations.
History
DSL-BQA-05-010 updated the Department of Health and Family Services'
(DHFS) memo and statewide variance previously described in DSL-BQA-00-015.
The State rule governing physician authentication, section HFS
124.12(5)(b)11, Wisconsin Administrative Code HFS124.12(5)(b)11), states
that:
"Medical staff by-laws and rules shall include…a statement
specifying categories of personnel duly authorized to accept and implement
medical staff orders. All orders shall be recorded and authenticated. All
verbal and telephone orders shall be authenticated by the prescribing
member of the medical staff in writing within 24 hours of receipt."
On September 4, 1998, the Department issued DSL-BQA-98-050, which
extended the requirement for physician authentication from 24 hours to 72
hours. DSL-BQA-00-015, issued February 1, 2000, further revised the
statewide variance of HFS 124.12(5)(b)11. That variance stated that
hospitals could:
- Continue to comply with the existing statewide variance granted
September 4, 1998; or
- Could choose to comply with alternative measures, which required
authentication "promptly," if the hospital also implemented
quality improvement strategies with the active participation of the
medical staff to reduce medical errors.
Subsequent to the issuance of these variances, the federal Centers for
Medicare and Medicaid Services (CMS) implemented two changes affecting
both authentication of orders and hospital participation in quality
improvement programs. First, CMS promulgated 42 CFR 482.21, establishing a
new Condition of Participation for all hospitals that participate in
Medicare: Quality Assessment and Performance Improvement (QAPI). QAPI
includes and expands the goals of medical error reduction that were
addressed in the variance issued in DSL-BQA-00-015. Second, CMS altered
the federal Interpretive Guidelines for 42 CFR 482.23(c)(2)(ii), which
requires that all orders for drugs and biologicals must be signed by the
prescribing practitioner as soon as possible. The new federal guidelines
define "as soon as possible" as follows:
"As soon as possible would be the earlier of the following:
- The next time the prescribing practitioner provides care to the
patient, assesses the patient, or documents information in the
patient's medical record,
- The prescribing practitioner signs or initials the verbal order
within time frames consistent with Federal and State law or regulation
and hospital policy, or
- Within 48 hours of when the order was given."
As a matter of public policy, DHFS does not intend to have rules, rule
interpretations, variances, or waivers that, if implemented, would put a
hospital out of compliance with Medicare regulations. Therefore, the
previous variances allowing either (1) 72 hours, or (2) an unspecified
period with adherence to quality improvement criteria to elapse before
orders are authenticated, are hereby revoked. However, the 24-hour time
frame in HFS 124.12(5)(b)11 continues to be recognized as more stringent
than necessary for patient protection.
DDES-BQA-06-002 addressed the discrepancy between state and federal
regulations that existed in DSL-BQA-00-015 by creating a variance of HFS
124.12(5)(b)11 that altered the time frame for authentication in writing
of all verbal and telephone orders to within 48 hours of receipt. The
change now being implemented is that, similar to Medicare requirements,
only orders for drugs and biologicals must be authenticated within 48
hours. Other medical orders must be authenticated promptly.
Current Variance:
The current statewide variance of the State rule governing physician
authentication found at section HFS 124.12(5)(b)11, Wisconsin
Administrative Code, effective immediately, is:
"Medical staff by-laws and rules shall include…a statement
specifying categories of personnel duly authorized to accept and implement
medical staff orders. All orders shall be recorded and authenticated. All
verbal and telephone orders for drugs and biologicals shall be
authenticated by the prescribing member of the medical staff in writing
within 48 hours of receipt."
A condition of the variance is that hospitals develop and implement
policies and procedures approved by the medical staff for prompt
authentication of verbal and telephone orders that do not involve drugs
and biologicals.
Please note that HFS 124.12(5)(b)11 applies to inpatient orders. BQA is
retaining the previous State interpretation of this provision as it
concerns authentication by physicians other than the prescribing
physician, as follows: The hospital may develop medical staff by-laws and
hospital policies delineating circumstances under which a physician, who
is a member of the medical staff, may sign verbal or telephone orders, as
well as the histories and physicals done by other physicians who are
members of the medical staff. This is done with the understanding that the
signing physician is then professionally and legally responsible for the
treatments and medications prescribed under the orders, as well as the
diagnostics on which the orders are based.
Federal standards for authentication of orders include 42 CFR
482.23(c)(2), 42 CFR 482.24(c)(1), and the Interpretive Guidelines for
those regulations.
Any questions regarding this memo may be directed to the Bureau of
Quality Assurance, Health Services Section, at (608) 243-2024, or the
Bureau Director, Otis Woods, at (608) 267-7185.
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Last Revised: October 11, 2011 |
