Survey of Nurses' Experiences Applying The Joint Commission's Medication Management Titration Standards

Publication Date


UMMS Affiliation

Graduate School of Nursing

Document Type



Critical Care Nursing | Health Policy | Health Services Administration


BACKGROUND: Critical care nurses titrate continuous infusions of medications to achieve clinical end points. In 2017, The Joint Commission (TJC) placed restrictions on titration practice, decreasing nurses' autonomous decision-making.

OBJECTIVES: To describe the practice and perceptions of nurses regarding the 2017 TJC accreditation/regulatory standards for titration of continuous medication infusions.

METHODS: A survey of nurses' experiences titrating continuous medication infusions was developed, validated, and distributed electronically to members of the American Association of Critical-Care Nurses.

RESULTS: The content validity index for the survey was 1.0 for relevance and 0.95 for clarity. A total of 781 nurses completed the survey; 625 (80%) perceived titration standards to cause delays in patient care, and 726 (93%) experienced moral distress (mean [SD], 4.97 [2.67]; scale, 0-10). Among respondents, 33% could not comply with titration orders, 68% reported suboptimal care resulting from pressure to comply with orders, 70% deviated from orders to meet patient needs, and 84% requested revised orders to ensure compliance. Suboptimal care and delays in care significantly and strongly (regression coefficients > /=0.69) predicted moral distress.

CONCLUSIONS: Critical care nurses perceive TJC medication titration standards to adversely impact patient care and contribute to moral distress. The improved 2020 updates to the standards do not address delays and inability to comply with orders, leading to moral distress. Advocacy is indicated in order to mitigate unintended consequences of TJC medication management titration standards.

DOI of Published Version



Davidson JE, Doran N, Petty A, Arellano DL, Henneman EA, Hanneman SK, Schell-Chaple H, Glann J, Smith LW, Derry KL, McNicholl M, Warren ML, Scott SS, Slazinski T, Ahrens T, McLean B, Chechel L, Rincon T. Survey of Nurses' Experiences Applying The Joint Commission's Medication Management Titration Standards. Am J Crit Care. 2021 Sep 1;30(5):365-374. doi: 10.4037/ajcc2021716. PMID: 34467387. Link to article on publisher's site

Journal/Book/Conference Title

American journal of critical care : an official publication, American Association of Critical-Care Nurses


Full author list omitted for brevity. For the full list of authors, see article.

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