JCI Standards Research Articles

Improving the Provision of Medical Care to Patients With Stroke Using JCI Standards. First Results

AIM OF THE STUDY To compare the dynamics of thrombolytic therapy effectiveness in patients with stroke after the reorganization of medical care using JCI standards.MATERIAL AND METHODS In 2022, a new system for routing patients with stroke at the level of the emergency department was introduced in the Emergency Care Hospital; and 976 patients with the diagnosis of brain infarction were treated. The analysis of the results was carried out by comparing the mortality rates from ischemic stroke, the number of thrombolytic therapies and procedures of mechanical methods of revascularization, as well as the indicators “Door-CT”, “DoorNeedle”, “Door-Opening” for 2021 and 10 months of 2022.RESULTS After the introduction of the new routing system for patients with stroke at the emergency department level, there appeared the first positive results. Thus, the mortality rate from brain infarction in 10 months of 2022 decreased by 5.6% compared to 2021. The number of thrombolytic therapies performed increased by 5.2%, and mechanical revascularization procedures by 1.62% over the same period, while the “Door-CT” indicator decreased by 27 minutes, “DoorNeedle” by 22 minutes, “Door-Opening” by 31.6 minutes.CONCLUSIONS The immediate results of the introduction of the new patient routing system at the level of the emergency department have proved successful, primarily due to the significant reduction in the mortality rate of patients with cerebral infarction by 5.6%. However, the process requires further investigation and has application points for further improvement.

Knowledge mapping of hospital accreditation research: a coword analysis

PurposeHospital accreditation has been adopted internationally as a way and solution for healthcare quality improvement in hospitals. The purpose of this study was to review and knowledge mapping of bibliographic data about “Hospital Accreditation” and assess the current quantitative trends.Design/methodology/approachScientometric methods and knowledge visualization using the coword analysis techniques conducted in three steps based on the data related to the field of hospital accreditation from 1975 to 2018 obtained from the MEDLINE database. Bibliographic data for titles, abstracts and keywords articles were saved in CSV format and MEDLINE templates by applying filters. Data extracted were exported into an Excel spreadsheet and were preprocessed. The authors applied the text mining and visualization using VOSviewer software.FindingsHospital accreditation studies have been increased rapidly over the past 30 years. 6,661 documents in the field of hospital accreditation had been published from 1975 to 2018. Hospitals or organizations active in the field of hospital accreditation were in the United States, Italy and Canada. The 10 most productive authors identified in the area of hospital accreditation with a higher influence were identified. “The United States”, “accreditation”, “Joint commission on accreditation” and “quality assurance, healthcare” had, respectively, the highest frequency. The cluster analysis identified and categorized them into four major clusters. Hospital accreditation field had a close relationship with the quality improvement, patient safety, risk and standards.Originality/valueHospital accreditation had focused on the scopes of implementation of accreditation programs, adherence to JCI standards, and focus on safety and quality improvement. Future studies are recommended to be conducted on design interventions and paying attention to all dimensions of hospital accreditation.

Patient-centered approaches applied in inpatient and outpatient TB services in Armenia

Abstract Background Healthcare system performance indicators are common instruments measuring and facilitating quality improvement. The End-TB strategy urges provision of integrated patient-centered (PC) care for all forms of tuberculosis (TB). This study aimed to assess and compare quality of inpatient and outpatient TB services using international standards on specific PC indicators to identify potential targets for improvement. Methods Joint Commission International (JCI) accreditation standards, adapted to local needs and context, were used as a basic instrument for qualitative and quantitative data collection. We utilized Patient and Family Right (PFR) and Patient and Family Education (PFE) 15 standards with 49 measurable elements as PC indicators for the nationwide assessment of TB services. A scoring system and a scaling approach were used to convert all-source-data and present the overall performance of services. Results We reviewed and analyzed data from 10 legal documents, 34 medical records and 155 interviews and focus group discussions with TB healthcare providers, patients and family members from inpatient and outpatient TB services to define the degree of compliance of their practices and treatment experiences to JCI standards. Outpatient TB services met the PFR and PFE standards at the 51%-level receiving a grading of partially performed and requiring improvements. The inpatient services met the PFR and PFE standards at 39%- and 26%-level respectively, receiving a grading of minimally performed for the JCI standards, showing statistically significantly less patient centeredness compared to the outpatient services (p = 0.007, CI 0.234; 0.4234), and requiring major improvements. Conclusions Strengthening interventions towards patient-centeredness are essential in both inpatient and outpatient services, but Armenia needs to put more emphasis on inpatient care to bridge the gap between the existing and recommended practices.

Hemşirelerin oryantasyon programında kullanılan kardiyovasküler modül eğitiminin etkinliği

Amaç: Oryantasyon amacıyla yapılan eğitim; kurumda yeni işe başlayan veya çalıştığı alandan farklı bir bölümde görevlendirilen bireylere, çalışacakları alana özgü bilgi, beceri ve tutum kazandırmak için planlanan eğitimlerdir. Çalışma, hemşirelik oryantasyon programı dahilinde gerçekleştirilen kardiyovasküler modül eğitiminin etkinliğini değerlendirmek amacıyla yapıldı. Yöntem: Tanımlayıcı ve retrospektif olarak tasarlanan araştırmanın evrenini 138 hemşirenin veri kayıtları oluşturdu. Çalışma, JCI standartları doğrultusunda hazırlanmış bir hastanenin oryantasyon programı dahilinde gerçekleştirildi. Hemşirelere ait demografik veriler kurum kayıtlardan elde edilirken, hemşirelerin eğitim öncesi ve sonrası kardiyovasküler bilgi düzeyi ise 25 soruyu içeren ön test-son test puanlarından hesaplandı. Her soru dört puan üzerinden toplam 100 puan olarak değerlendirildi. Veriler SPSS 17.0 programında, tanımlayıcı istatistik, ANOVA ve bağımlı örneklerde t testi kullanılarak belirlendi. Bulgular: Çalışmaya dahil edilen hemşirelerin yaş ortalaması 24.0±3.1 (19-37 yaş) bulundu. Çalışmaya katılanların %68.1’ini (n=94) lisans mezunu hemşireler oluştururken, %55.1’i (n=76) daha önce herhangi bir kurumda çalışmadığını bildirdi. Ön testten alınan puanların ortalaması 58.5±15.1 iken, son test puanlarının ortalaması 89.4±10.3 olarak saptandı. Alt gruplara göre yapılan analizlerin tamamında kardiyovasküler modül eğitimin etkili olduğu belirlendi. Sonuç: Oryantasyon programlarında yer alan kardiyovasküler modül eğitimlerin kardiyovasküler kliniklerde (yetişkin ve pediatrik) görev alacak hemşirelerin eğitim düzeyini arttırdığı görüldü.

Health Care Providers’ Compliance to Joint Commission International Patient Safety Goals during the Pre and Post Accreditation Period (2015-2016) in Public Hospitals in the United Arab Emirates

Background: Preparing for JCI accreditation is a complex task. The work has to be based on JCI standards and requirements and usually lasts for two years. Patient safety is considered a fundamental principle of excellence in healthcare. However, the International Patient Safety Goals (IPSG) are considered as the most important chapter in the Joint Commission International standards and staff compliance is extremely required. Purpose: The purpose of the study is to assess the compliance of healthcare providers to the JCI Patient Safety Goals during the pre and post JCIA survey period (2015-2016) and to develop a model to assist healthcare providers to have better compliance with the JCI standards. 2015 represents the period within 2 years post accreditation and 2016 represents the period of one-year pre-accreditation. Methods: This is a descriptive, cross-sectional study. Two convenience samples from two governmental hospitals in the United Arab Emirates. The participants were selected at two points of time (2015 and 2016). The sample consisted of nurses, doctors and other healthcare providers who were questioned and observed to check their compliance to JCI Patient Safety Goals. Results: In terms of IPSG survey, the results reflected a decline in healthcare providers’ awareness post-JCIA survey from mean of (88.48) to (76.48), with (p< 0.001). Regarding health care providers’ compliance to IPSG documentation in patients’ files, the mean of compliance decreased from (M=94.6) to (M=84.39) post JCIA survey, (p< 0.001). Moreover, healthcare provider’s adherence to hospital policies related to JCI safety goals declined from (M= 100) pre JCIA to (M=45) post JCIA with (p< 0.001). Thus, the overall compliance and knowledge to JCI safety goals shows significant decline during the period of post survey (2015) compared to pre-survey (2016). Conclusion and Recommendations: The study found increase in compliance and adherence to International Patient Safety Goals standards prior to the accreditation surveys and with a marked decline in compliance and knowledge post accreditation. The author suggested a model of recommendations that emphasizes on the need for unannounced surveys by JCI after the accreditation and reaccreditation to ensure that compliance is not just for the purpose of the accreditation but is embedded in the daily routine and culture of the organization. It is extremely important to change from a survey preparation approach to continual readiness.

RISK MANAGEMENT AS A NEW VECTOR IN THE MEDICAL INSTITUTION COORDINATE SYSTEM

Risk management practice becomes an integral part of the management system of the medical institution. The deployment of risk management system contributes to the sustainable development of the organization by enhancing the decision making process and ensuring a balance between risks and opportunities. The risk management tools within the approaches of COSO, ISO and JCI standards, which, from the author’s point of view, can be effective for the management of typical risks of a medical diagnostic institution, are considered in the article.

Impact analysis of JCI reform on nursing quality based on performance appraisal reform

This study described the nursing reform at Ningbo No.2 hospital under the guidance of JCI standards. According to the flat network structure, the quality and safety of nursing management was divided into 18 nursing management committees, each assigned to be responsible for a JCI section with specified performance-based distribution reform. Such indexes as nursing sensitivity were also analyzed. Given the workload pushed up by JCI standards, the performance-based reform rationalized the workload of nursing staff in its performance distribution reform, thus conducive to the implementation of the reform, higher nursing quality of care and less turnover rate. Key words: Hospitals; Joint Commission International; Performance appraisal; Nursing quality; Nursing safety

Management of nursing adverse events based on JCI evaluation criteria and evaluation on its effect

Objective To explore the management of nursing adverse events based on JCI evaluation criteria, and to establish a voluntary, non-punitive nursing adverse event reporting system. Methods From January 2014 to December 2015, 680 hospital nurses implemented JCI standards, revision of nursing adverse events management system, created online of nursing adverse events reporting system, to all nursing staff of adverse event management knowledge training and improvement before the analysis of the implementation of the JCI standard, adverse event reporting process and treatment measures of awareness, took the initiative to report rate, nursing adverse events incidence, patient satisfaction rate. Results Before and after nursing staff of adverse event reporting procedure and disposal method of awareness to improve the rate of 39.43% implementation, nursing staff to take the initiative to report to enhance the rate of 7.54%, the incidence of nursing adverse events to reduce the rate of 0.07%, the patients' satisfaction rate increased by 6.15%, there were statistically significant differences(χ2=13.50, 10.15, 12.09, 231.51, all P<0.05). Conclusion Nursing adverse events management constructed based on JCI accreditation standards is helpful to avoid the occurrence of nursing adverse events, to improve the rate of patients' satisfaction to nursing, to create a secure hospital atmosphere. Key words: Crisis intervention; Nursing administration research; Hospitals

Save kids, not all children with minor head injury need CT head, QIP in Hamad General Hospital Emergency Department, Qatar

Background: Whilst Head CT scanning carries an important role in the identification of clinically significant intracranial injuries, there are associated risks of radiation. Our initial audit of clinical notes and survey of EM physicians revealed a rate of 45% CT scans for pediatric minor head injuries with around half of requests not indicated. In 36% there were issues with documentation. The aim is to achieve a sustained compliance with Internationally acceptable guidelines of Head CT scanning for pediatric minor head trauma at Hamad General Hospital Emergency Department (ED). Intervention: We conducted staff education through weekly program of Continuing Medical Education for emergency physicians, prominent display and availability of handouts of the International clinical decision rules (NICE guidelines, PECARN) in all clinical areas within the ED, encourage proper documentation for all head injury cases to meet JCI standards of documentation, and formulate a revised pediatric head injury guideline based on the international clinical decision rules. Methods and results: The audit in August 2014 showed that 62 CT head were done, 45% of them were deemed unnecessary when measured against NICE guidelines. Also there was deficient documentation in 36% of cases due to the unavailability and difficulty accessing the guidelines. We supplied all areas in the ED with handouts of the guidelines, and conducted shop floor education for ED physicians. Regular sessions were conducted during educational activities and emergency seminars. The re-audit in January 2015 showed decreasing rate of CT scans at the rate of 22% achieving a reduction by 33% and improvement in the documentation by 31%. The overall reduction of and decreasing the percentage of unindicated CT head by around 30%. Conclusion and recommendation: Managing minor head injury in pediatric age group becomes more safe by increasing the physician awareness about the evidence based updated guidelines.

Effect of 4-dimensional innovative model basing on JCI standards on health education to elderly patients with CHD

Objective To investigate implementing approach and clinical effect of 4-dimensional innovative model basing on JCI standards on health education to elderly patients with CHD. Methods Following JCI standards, a 4-dimensional model was innovated, regarding 4 aspects of health education for elderly patients with CHD: concept, platform, transmission system and technological application. Totals of 120 elderly patients with CHD were divided randomly into observation group and control group. For the patients in the observation group, health education was conducted according to the 4-dimentional innovative model, while in the control group, routine health education approach for CHD was used, which was to hand out health pamphlets explaining knowledge concerning diet, drug, exercise, follow-up visit, etc. After 5 days of intervention, CHD organism functional status and quality of life of the CHD patients in the two groups were evaluated and compared. Indexes, such as self-management skills, were compared 6 months after discharge. Results In SAQ scoring, there were significant differences between observation group and control group regarding limitation degree of motion, attacking condition of angina or stable condition of angina, scores of satisfaction on treatment and awareness of the disease (P<0.05). Conclusions Conducting health education to elderly patients with CHD with the 4-dimensional innovative model basing on JCI standards plays a significant role in promoting guarantee of medical safety, prevention of harmful cardiac incidents, and enhancement of treatment compliance, patients′ self-management abilities and patients′ satisfaction. Key words: Health education; Elderly patients with CHD; 4-dimensional innovative model; JCI standards

JOINT COMMISSION INTERNATIONAL (JCI) IN THE PEDIATRIC INTENSIVE CARE UNIT (PICU): PREVENTING MEDICATION INCIDENTS THROUGH REMOTE CONTROL

IntroductionMany medical centers worldwide try to get JCI accreditation in order to improve safety and quality of patient care. Review of medication orders for appropriateness is one of the JCI standards. This process is usually performed by clinical pharmacists joining physician rounds. However, in many medical centers there is a shortage of pharmacists.ObjectivesTo prospectively investigate the process of remote reviewing of medication orders in the PICU, with a pharmacist located at the pharmacy, without joining physician rounds. To characterize pharmacist recommendations (PR) and decisions taken by the physician.MethodsThe study was carried out from 6.3.14–6.10.14 in the PICU (7 beds). Patient demographics, diagnosis and medications prescribed were recorded.Results186 review forms were filled in by the pharmacist, regarding 117 admissions(109 children). In 57 (30.6%) forms there was at least one PR. Most common PRs concerned significant interactions (34.5%), dose (26.2%), technical inappropriateness (22.6%) and contraindications (8.3%). Out of all PRs, 51.2% were accepted by the physician, 11.9% rejected and in 36.9% there was no comment. The estimated review time for one medical record was 8.9 min (95% CI, 6.9–10.9), as every additional medication prescribed increased the total review time by 0.8 min (95% CI, 0.49–1.11). Using Monte-Carlo simulation, 108.42 min per day were needed to review all medical records in 95% of the cases.ConclusionsHospitals facing budget shortages can perform a daily remote review of several departments by an experienced pharmacist instead of participation in physician rounds, and still have a considerable effect on patient safety.

Nutrition management for critically ill pediatric patients with mechanical ventilation in PICU based on JCI standards

Objective To observe the effect of the nutrition management according to the JCI(Joint Commission on Accreditation of Healthcare Organizations) management standard for critically ill pediatric patients with mechanical ventilation. Methods A total of 330 cases with mechanical ventilation were enrolled in the control group from Hunan Province Children's Hospital PICU between Jan.2012 and Dec.2012, and these pediatric patients were managed with the conventional nutrient management.A total of 359 pediatric patients with mechanical ventilation were admitted to the experimental group from Jan.2013 to Dec.2013 and these patients were managed with nutrient management based on JCI standards.The length of mechanical ventilation, stay in ICU, stay in hospital were compared between two groups, and the incidence of ventilator-associated pneumonia, abandonment rate and mortality were also compared between experimental group and control group. Results The length of mechanical ventilation in control group[(8.39±1.34) days] was longer than that of experimental group[(5.69±1.12) days]. The length of stay in PICU for control group[(12.32±1.37) days] was more than that in experimental group[(9.42±1.53) days]. The length of stay in hospital for control group[(15.37±2.16) days] was higher than that of experimental group[(12.63±2.29) days]. The incidence of ventilator-associated pneumonia(9.7%) in control group was higher than that of experimental group, and the giving up or mortality rate in control group(8.48%) was higher than that of experimental group(4.35%). And there were significant differences by statistical analysis(P<0.01, respectively). Conclusion According to the nutritional management in JCI standard, the length of mechanical ventilation, stay in PICU and stay in hospital time, the incidence of ventilator-associated pneumonia, and the abandoned or mortality rate were reduced for critically ill pediatric patients with mechanical ventilation. Key words: JCI standards; Nutrition management; Mechanical ventilation

Practice of the JCI certification in hospital informationization and analysis

Command of the JCI standards and lessons learnt from practice and experience in JCI accreditation preparation,can help identify the gap between the hospitals and JCI standards.These standards can also guide the clinical pathway system,pharmacy intravenous admixture services system and medical business intelligence system.The information system built under such guidance not only makes an effective solution to existing problems,but also proves innovative.All these pave the way for successful JCI accreditation. Key words: JCI certification; Hospital information system; Clinical pathway system; Pharmacy intravenous admixture services system; Medical business intelligence system

Building and practice of hospital pharmacy management system based on JCI standard

To set up the pharmacy management organization and improve drug administrative regulations in the hospital based on JCI standards,in the building of the hospital pharmacy management system.Using effective process design principles to implement and improve the drug treatment process in such aspects as drug supply,storage,preparation,distribution,delivery,and drug use monitoring.JCI-based pharmaceutical administrative system prioritizes reasonable and safe drug use to benefit patient drug use safety and improves pharmaceutical service quality. Key words: JCI standard; Pharmacy management; System; Building

Evaluating the average access to care and continuity of care patients in Tehran teaching hospitals

Background: Standards of Joint Commission International emphasize on the organizational performance level in basic functional domains including patient right, patient care, medical safety and infection control. These standards are focused on two principles: expectations of the actual organizational performance and assessment of organizational capabilities to provide high quality and safe health care services. The aim of this study is to evaluate the possibility of improvement in Access to Care and Continuity of Care for patients (ACC) in teaching hospitals of Tehran University of Medical Sciences. Methods: This cross-sectional study was conducted in hospitals affiliated to Tehran University of Medical Sciences during 2012. Data collection was performed using author-designed questionnaire of “Access to Care and Continuity of Care patients” based on JCI standards (2013). A total of 171 questionnaires were sent to 26 hospitals and 154 (90%) questionnaires were successfully completed and used for data analysis. The questionnaire was reviewed by experts and the Cronbach’s alpha was calculated to be 0.967. The effects of the two variables of hospital type (general, specialty) and the number of beds on mean scores of ACC standards and each of its domains were analyzed using T-test or Mann-Whitney test depending on the distribution due to Kolmogorov-Smirnov test result. Results: In general, the mean of ACC standards was found comprehendible and applicable by 82.3 (SD = 11) of the respondents. The highest and lowest mean scores of ACC questions belonged to hospitals H21 (90 ± 6) and H14 (67 ± 12), respectively. There were not any significant effects of hospital type and the number of beds on the ACC scores. Conclusion: There was not any important effect of hospital type and bed numbers on ACC, although there was a 9%-15% possibility of improvement in accreditation scores of ACC standards in hospitals of Tehran University of Medical Sciences. A complete accreditation score in this domain didn’t seem achievable in these hospitals. However, it is proposed that future managerial planning of the studied hospitals lead to a complete accreditation score.

Nursing documentation at the Bambino gesù children's hospital

Introduction During the last ten years new laws have been passed which concern the nursing profession, both in training and education. Nurses now have all the tools necessary to develop nursing care based on customized nursing services. This will lead to activities planning in the nursing sector with autonomy as regards decision making and scientific methodology. Objective To adopt a healthcare model which is customisation-oriented and to develop a joint tool for nursing documentation, meeting the Joint Commission International requirements. Materials and methods After in-depth analysis of the situation by means of a questionnaire submitted to head nurses and after an intense training work aimed at encouraging cultural change, we implemented and worked out a documentation based on the conceptual model of nursing services proposed by Marisa Cantarelli. Results The following issues have emerged: – Lack of homogeneity of the care model – Lack of homogeneity of the nursing documentation – Inadequate nursing report filling – Non-compliance with JCI standards – Resistance to change Conclusions This project also aims at: – being the starting point of a long journey that will probably only be completed in a few years’ time – being a motivating force for all nurses to work towards an improvement in the quality of care for all our little and “big” patients.