Joint Commission On Accreditation Of Healthcare Organizations Requirements Research Articles

Rethinking Experiential Education (or Does Anyone Want a Pharmacy Student?)

Rethinking Experiential Education (or Does Anyone Want a Pharmacy Student?)

Decreasing medication discrepancies between outpatient and inpatient care through the use of computerized pharmacy data.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) instituted a new regulation in 2006 to improve patient safety by decreasing medication errors. This requires a process for obtaining and documenting a complete list of each patient's current medications at hospital admission and communicating this list to the next clinician ("Medication Reconciliation"). We sought to determine whether medication discrepancies between outpatient and inpatient care can be decreased through the use of computerized pharmacy data. We evaluated outpatient medication prescriptions in 2000 and 2004 using computer-generated data for patients admitted from an Emergency Department to a medical ward. The hospital records and pharmacy data were reviewed to determine which ambulatory medications were ordered at admission, continued as an out-patient, and refilled three months after discharge. In 2004 additional computerized pharmacy data were provided to attending physicians. Ambulatory care "essential prescription medication groups" (cardiac, chronic obstructive pulmonary disease, asthma, diabetes, and neurologic) were also evaluated. Medication discrepancies for the years 2000 and 2004 were compared in several categories. Medication discrepancies were found in all evaluated categories in 2000. The follow-up study showed a decrease in discrepancies for nearly all categories. RESULTS show that use of outpatient pharmacy data can decrease medication discrepancies in compliance with current JCAHO requirements.

A Template for Spiritual Assessment: A Review of the JCAHO Requirements and Guidelines for Implementation

Growing consensus exists regarding the importance of spiritual assessment. For instance, the largest health care accrediting body in the United States, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), now requires the administration of a spiritual assessment. Although most practitioners endorse the concept of spiritual assessment, studies suggest that social workers have received little training in spiritual assessment. To address this gap, the current article reviews the JCAHO requirements for conducting a spiritual assessment and provides practitioners with guidelines for its proper implementation. In addition to helping equip practitioners in JCAHO-accredited settings who may be required to perform such an assessment, the spiritual assessment template profiled in this article may also be of use to practitioners in other settings.

Engineering Risk Analysis of a Hospital Oxygen Supply System

Reports from the Food and Drug Administration (FDA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have emphasized the potential for injury to patients caused by failures in oxygen supply systems. This article presents a model of patient risk related to the process of supplying oxygen at a single university hospital. One of the goals of the article is to illustrate how probabilistic risk analysis (PRA) can be used by hospitals to assess and mitigate risk and, therefore, to meet JCAHO requirements. PRA techniques are useful to 1) model the reliability of a complex system and 2) assess the cost-effectiveness of different risk mitigation measures. The authors focus on the risk estimation step, describing in detail their modeling of the oxygen supply system and analysis of the results. For the hospital that the authors study (20,000 admissions yearly), the total expected number of fatalities from oxygen system failure is 44 over a 30-year time horizon. The greatest contribution to the risk (94% of the expected number of fatalities) comes from problems that involve the supply network (e.g., damage to structure and poisoning) as opposed to incidents that occur inside patient rooms. Although the threat to patient safety is not dramatic, health care organizations should be concerned about potential failures of their oxygen system because improving this system could avoid low-probability, high-consequence failures at a low cost.

Advances in postoperative pain management: the pharmacy perspective.

The pharmacist's role in promoting proper use of analgesic drug therapies, by ensuring that Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards for pain management are met, evaluating new analgesic options for formulary addition, and conducting medication-use evaluations, outcomes research, and pharmacoeconomic analyses, is discussed. Pharmacists can be instrumental in meeting JCAHO requirements for educating clinical staff and patients about pain management practices and monitoring compliance with JCAHO pain management standards. They also can thoroughly evaluate new analgesic drug therapies and delivery systems for formulary addition by reviewing published literature and manufacturers' data and conducting medication-use evaluations, outcomes research, and pharmacoeconomic analyses. Cost-effectiveness analysis is the most common among the four types of pharmacoeconomic analyses, which include cost-minimization analysis, cost-benefit analysis, and cost-utility analysis. A ten-step process is used in conducting pharmacoeconomic analyses to increase the validity of the results. Implementation of new analgesic drug delivery technologies, such as an elastomeric infusion pump (a device for continuous wound infiltration with a local anesthetic), a needle-free transdermal patient-controlled analgesia system, and a new sustained-release, liposome-encapsulated form of morphine for epidural injection, offers new postoperative pain management alternatives for patients and clinical staff and involves unique considerations for pharmacists.

The joint commission on accreditation of healthcare organizations revises standards for 2004

RECENTLY, THE JOINT Commission on Accreditation of Healthcare Organizations (JCAHO) unveiled substantially revised accreditation standards for 2004.1 The standards, effective January 1, 2004, are for hospitals, home care organizations, ambulatory care clinics, behavioral health care organizations, laboratories, and long-term care organizations. The standards for assisted living, critical access hospitals, health care networks, and office-based surgery will be revised in 2005.2 The newly revised standards for 2004 are available on the JCAHO Web site (http:\\www.jcaho.org) and allow individuals and organizations to access the standards and become familiar with them prior to the publication of the official accreditation manual in the fall.1,2 A “crosswalk” is also available to help users compare the old standards with the new. The new standards are the result of nearly 2 years of work to substantially consolidate JCAHO requirements to decrease the paperwork and documentation burden of the accreditation process.1 Although the focus of the standards is on processes critical to achieving safe, quality care, the requirements for 2004 are essentially the same.2

Automated medication distribution systems and compliance with Joint Commission standards

One health care institution's experience with an automated medication distribution (AMD) system is described, along with how the system met standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). AMD units were implemented in nearly 50 patient care locations in a medical center with the goal of providing cartless distribution for over 90% of all medications. Planning for the system began in the fall of 1998; the system was fully implemented by mid-2000. In compliance with JCAHO requirements, the system provided medications in unit dose or single unit-of-use packaging, supplied drugs in a ready-to-administer form, ensured that drugs were available only near the time of administration, created a patient-specific medication profile, allowed for pharmacist review of medication orders before dispensing, provided proper storage conditions, prevented unauthorized use, allowed for access in emergencies, and met federal and state regulations. Implementation of the system improved drug distribution at the medical center and saved nursing and pharmacy time. Challenges included waits by nurses trying to access the AMD units and the extensive, ongoing education and training required for users of the system. An AMD system should be fully integrated with the health care institution's medication-use process and comply with applicable JCAHO standards.

The role of staff development in assuring competence.

Leaders and educators from many facilities are struggling to understand what is expected of them, relative to competence assessment, by the joint Commission on Accreditation of Healthcare Organizations (JCAHO). Some have responded to the standards with the creation of a large number of checklists and annual skills fairs, along with a fragmented competence assurance system--all delegated to the staff development department. This article discusses such approaches, reviews JCAHO requirements, and suggests alternative strategies, including the use of the Nursing Interventions Classification.

Emerging threats to drinking water supplies

Background: Practicum training for preventive medicine residents often occurs in agencies whose community is geographically defined and whose governance is closely linked to public election. We were unsure about the financial ability of such departments to support training and are concerned that over-reliance on traditional health departments might not be best for either medically indigent populations or preventive medicine. We, therefore, sought to apply a public health model—based on a strategic partnership between nursing and preventive medicine—to a large health care organization. The result was formation of a mini-health department, suitable for fully accredited preventive medicine practicum training, within the Alvin C. York Veterans Affairs Medical Center, Murfreesboro, TN.This Center serves a defined population of 21,594 patients and about 1600 employees. The theoretical framework for the new department was based on demonstration of a close fit between the competencies expected of preventive medicine physicians by the American College of Preventive Medicine (ACPM) and activities required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Because of JCAHO requirements, many healthcare organizations already pay for preventive medicine services.Conclusions: By placing preventive medicine training faculty into existing budget slots at our institution, systemwide personnel costs for prevention decreased by about $36,000 per year, even as personnel funding for preventive medicine physicians increased from about $24,000 to $376,000 per year. Moreover, there was dramatic, sustained improvement in 17 indicators of preventive care quality as determined by an external peer review organization. In addition to providing a new venue for training, this model may also improve the quality and reach of preventive services, decreased fixed costs for service delivery, and yield new employment opportunities for preventive medicine physicians.

Practical geriatrics: psychiatric consultation to nursing homes.

Patients seen in psychiatric practice in nursing homes, or skilled nursing facilities, differ from those seen in mainstream psychiatry in several ways. First, the practitioner sees patients who have medical as well as psychiatric problems. Second, after the initial diagnostic evaluation, patients generally have infrequent visits with the practitioner. Third, patients are more likely to have impaired judgment and impaired communication skills. Finally, patients have experienced relocation from their personal residence.

Preventive practicum training in healthcare organizations: The Meharry model

Background: Practicum training for preventive medicine residents often occurs in agencies whose community is geographically defined and whose governance is closely linked to public election. We were unsure about the financial ability of such departments to support training and are concerned that over-reliance on traditional health departments might not be best for either medically indigent populations or preventive medicine. We, therefore, sought to apply a public health model—based on a strategic partnership between nursing and preventive medicine—to a large health care organization. The result was formation of a mini-health department, suitable for fully accredited preventive medicine practicum training, within the Alvin C. York Veterans Affairs Medical Center, Murfreesboro, TN. This Center serves a defined population of 21,594 patients and about 1600 employees. The theoretical framework for the new department was based on demonstration of a close fit between the competencies expected of preventive medicine physicians by the American College of Preventive Medicine (ACPM) and activities required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Because of JCAHO requirements, many healthcare organizations already pay for preventive medicine services. Conclusions: By placing preventive medicine training faculty into existing budget slots at our institution, systemwide personnel costs for prevention decreased by about $36,000 per year, even as personnel funding for preventive medicine physicians increased from about $24,000 to $376,000 per year. Moreover, there was dramatic, sustained improvement in 17 indicators of preventive care quality as determined by an external peer review organization. In addition to providing a new venue for training, this model may also improve the quality and reach of preventive services, decreased fixed costs for service delivery, and yield new employment opportunities for preventive medicine physicians.

Implementing smoking bans in American hospitals: results of a national survey

OBJECTIVESTo determine how well hospitals complied with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) tobacco control standards, which required banning smoking in hospital buildings; to explore issues involved...

Quality measurement for health systems: accreditation and report cards.

Efforts to measure the quality of care provided by health systems, including the accreditation processes used by the National Committee for Quality Assurance (NCQA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and three report card systems-NCQA's Health Plan Employer Data and Information Set (HEDIS), JCAHO's requirements for performance data (Oryx), and a consumer-oriented system of performance measures created by the Foundation for Accountability (FACCT)-are described. NCQA reviews and accredits all types of health maintenance organizations, as well as point-of-service health plans and certain physician-hospital organizations. NCQA accreditation survey teams consist primarily of physicians. The fee for the process-oriented survey depends on the size and complexity of the plan. HEDIS was created to standardize the way in which health plans calculate and report information about their performance, thereby enabling comparisons among plans. NCQA is including more outcome measures as HEDIS is revised. Several HEDIS measures relate to medication use. In the future, health plans will be required to submit HEDIS data as part of the NCQA survey process. JCAHO's accreditation program for health care networks began in 1994. Survey teams and fees depend on the size and complexity of the network. A survey covers the central office, all hospitals, and selected components (excluding those that are accredited by other bodies recognized by JCAHO), and practitioners' offices. NCQA and JCAHO have no pharmacy-specific accreditation standards, but pharmacy information may be requested by the surveyors. In 1997 JCAHO began phasing in requirements for performance data as part of its accreditation process; networks must begin collecting data for at least 10 measures from five approved systems. FACCT performance measures are based on patients' health care experiences and outcomes; FACCT hopes these measures will be adopted by NCQA, JCAHO, and others. As health care purchasers and consumers increasingly demand evidence of quality, pharmacists will have ample opportunity to improve health outcomes.

Beyond JCAHO: Using Competency Models to Improve Healthcare Organizations PART I

In 1996 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) required hospitals to assess, prove, track, and improve the competence of all employees. Part 1 of this two-part series discusses competencies, their assessment, and the implications of meeting and going beyond JCAHO's requirements. Part 2, which will appear in the next issue of Hospital Topics, provides specific guidelines for the development of a competence assessment system and its practical application.

Departmental role and scope in infection conrol: Use of a template that meets joint commission requirements

Department specific infection control role and scope is an essential component of providing quality patient care and appropriate health care worker protection. Historically, charts or imprecise narrative descriptions were designed to satisfy the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) surveyor, rather than departmental or customer needs. A combination of JCAHO requirements, needs assessment and customer input resulted in the development of a generic template describing key infection control practices. The template can be modified to meet individual departmental needs

Hospitalwide medication policies and standards

The development and composition of a hospitalwide medication policies and standards manual are described. Medication policies and procedures developed independently by individual hospital departments and services at a 789-bed private teaching institution created problems related to consistency, the approval process, accreditation standards, and retrievability. Therefore, a joint nursing-pharmacy task force was formed to create a master document containing medication policies and standards for the entire institution. The manual also contains departmental medication-related procedures, the formulary of approved drugs, and key drug information. Its format allows for periodic updating and ease of use by nurses, pharmacists, physicians, and other health care professionals. It meets the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirement of a collaborative framework to ensure optimal medication-use outcomes. All medication-related procedures in individual departments must comply with the new policies and standards. A hospitalwide medication policy manual, created through multidisciplinary collaboration, made the policies and procedures consistent and more accessible and met JCAHO and other regulatory requirements.

A national survey of ethics committees in state mental hospitals.

In June 1992, a national mail survey was directed to 204 state inpatient psychiatric institutions. This study was implemented following the 1992 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirement that hospitals put in place some means with which to address ethical issues. The goals of the study were: 1. to examine state mental hospital characteristics and their response to the JCAHO requirements; 2. to describe healthcare ethics committee (HEC) composition, function, and role; 3. to study patient and family access to a HEC; and 4. to discover ethical issues most frequently addressed. The survey response rate was 71%. Of the 145 responders, 62 had HECs in place, and 53 were in the process of implementing HECs. There were no differences between JCAHO accredited institutions and non-accredited facilities with regard to having HECs. Physicians accounted for 22% of HEC membership, followed by nurses (15%), and administrators (12%). Twenty-six percent of facilities systematically notified patients about existence of the HEC; 71% of facilities had no patient request for HEC services in the last year. A patient's danger to others, and resuscitation policy were issues most frequently (23%) heard by HECs.