Automatic end times or stop orders may be implemented and useful in any care setting. The goal of automatic end times—also referred to as autostops, automatic stops, or automated stop orders—is to reduce unnecessarily prolonged treatment or medication regimens in order to prevent unintended consequences from lack of appropriate therapeutic reevaluation. Recently, autostops have increased in prevalence in an effort to limit the exposure of patients to unnecessary and prolonged treatment with addictive medications. In an effort to reduce overprescribing, for example, New York state has implemented an initial limit for opioid regimens: a seven-day automated end time for opioids used to treat acute pain. (New York State Department of Health)
This goal is supported by the Medicare Conditions of Participation. Guideline § 482.25(b)(5) requires that the hospital "medical staff, in coordination and consultation with the pharmacy service, determines and establishes the reasonable time to automatically stop orders for drugs and biologicals not specifically prescribed as to time or number of doses. The hospital must implement, monitor, and enforce this automatic stop system." (CMS) In other care settings, such stops are determined by clinicians and coordinated with information technology (IT) implementation of these recommendations. However, automatic termination of therapies without the appropriate notice can also create hazards.
When a medication is coded with an automated end time in an order-entry system, medication administration record, or EHR, a risk exists that the therapy will be automatically discontinued without the awareness of the appropriate provider. Similarly, the stop order may not be presented in such a way that the provider can adapt it or efficiently continue the medication regimen when needed. (ISMP) Moreover, depending on the medication in question, it may be more harmful to stop the medication abruptly than to give it for an extra day.
Use the self-assessment questionnaire to review your automated end time policies and procedures. Use this self-assessment questionnaire in conjunction with the following resources and references to review your automated end time policies and procedures. Then, use the attached action plan template to track resulting projects, initiatives, and reviews.
* Some materials are included in memberships to ECRI Institute products and services. For information about these reports, contact clientservices@ecri.org.
References
Self-Assessment Questionnaires (SAQs) can be used to identify compliance with best practices and opportunities for improvement. They include questions based on laws, regulations, standards, professional society guidelines and statements, and best practices identified by the clinical literature. Each SAQ also includes an Action Plan to help document next steps and responsible parties.
SAQs are available both as PDFs, for use as-is, or as Microsoft Word documents, which can be edited to suit your organization's custom needs, such as by adding questions regarding local or state requirements that may not be represented.
Complete this SAQ annually and whenever significant organizational changes occur.