Cutting edge discussions of management, policy, and program issues in emergency care

Abstract

Answer: At a recent national lecture directed to a nursing audience, a Joint Commission for Accreditation of Healthcare Organizations (JCAHO) surveyor discussed the new JCAHO requirement for a verification process. Effective January 1, 2004, a final verification process to confirm the correct patient, procedure, and site using active, not passive, communication must be undertaken before any invasive procedures are performed. According to the surveyor, ‘‘time out’’ is one acceptable verification process. This requirement will be scored at Standard PC.13.20 and EP9. One exception to this requirement is when the physician has a continuous attendance with the patient. The only other exception would be such an emergency that even the time out and/or marking would add more risk than benefit to the patient. The surveyor said that what has changed from the original draft of the standard is a requirement for site marking. Marking should focus on cases involving right/ left distinction, multiple structures (eg, fingers or toes), or multiple levels (eg, the spine). Organizations no longer are required to mark the site for other types of procedures, including mid-line sternotomies, cesarean sections, and interventional procedures for which the insertion site is not predetermined. When a JCAHO surveyor visits, he or she will interview leaders to determine the expectations and how the leaders know they are being met. In addition, they will interview physicians, nurses, and technicians involved in surgery/ procedures to determine how consistently this is done. This inquiry is being done, in part, because inspectors have found