Years ago, automatic stop orders played an important role. But today, with the patient's shorter length of hospitalization and the expanding role of clinical pharmacists, this tool from the past likely needs adjustment. After reviewing applicable state regulations, evaluate the list of drugs currently governed by automatic stop policies to determine if there is a valid need to continue enforcing the policy. It's likely that you will be able to reduce the list considerably. Another option may be to identify exceptions, such as the ones listed above, exclude them from the policy, and encourage prescribers to include the drug's indication and duration for medications governed by automatic stop orders to prevent unintended discontinuation.
Computerized systems make policy exceptions a realistic option.
Clinical pharmacists should review drug therapy daily and take a leading role in contacting prescribers when necessary to confirm continuation or discontinuation of an order. Consider providing clinical pharmacists with hospital-endorsed authority to extend or remove automatic stop dates for specified drugs and indications. It is equally important to examine the systems in place for notifying prescribers about automatic stop orders, the timing of the notification, and the process for review. As prescribers and nurses review it, unintended discontinuation or continuation of drugs may be promptly recognized and corrected. Patients should also be encouraged to ask questions when a medication is suddenly stopped.