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Interpretation and Implementation of Range, Titration, and PRN Orders in Hospice

McPherson, Mary Lynn PharmD, BCPS; Kaiser, Karen S. PhD, RN, AOCN; Burns, Cameron PharmD

Journal of Hospice & Palliative Nursing: September-October 2005 - Volume 7 - Issue 5 - p 289–298

For safety reasons, the 2004–2005 Joint Commission on Accreditation of Healthcare Organizations standards require organizations to develop policy addressing various types of medication orders that have the potential for being ambiguous to those dispensing or administering medications. This includes range, titration, and as needed orders for analgesics and other medications used in palliative care. One sample policy that addresses prescribing and interpretation of these types of orders is presented, as well as case examples illustrating this process. These types of orders should contain an indication, a minimum dosing frequency, the dose range if appropriate (not to exceed a doubling for patient/family medication administration), titration instructions, and clinical parameters to guide dose administration. Hospice and palliative care organizations should develop their own policy for accepting orders of this nature to enhance patient safety.

Mary Lynn McPherson, PharmD, BCPS, is a Professor at University of Maryland School of Pharmacy, Baltimore.

Karen S. Kaiser, PhD, RN, AOCN, is a clinical practice coordinator at the University of Maryland Medical Center, Baltimore.

Cameron Burns, PharmD, is a pharmacist in the Department of Pharmacy Practice at the University of Maryland Medical Center, Baltimore.

Address correspondence and reprint requests to Mary Lynn McPherson, PharmD, BCPS, University of Maryland School of Pharmacy, 20 N Pine St, Room 443, Baltimore, MD 21201 (e-mail:

The authors have no conflict of interest.

© 2005 The Hospice and Palliative Nurses Association