Joint Commission Research Articles

Jonathan B. Perlin, MD, PhD, President and CEO, The Joint Commission.

Jonathan B. Perlin, MD, PhD, President and CEO, The Joint Commission.

Workplace Violence and Bullying: You Can Survive.

One of biggest challenges facing the health care industry today is workplace violence and bullying. Sadly, this trend has increased so dramatically that The Joint Commission is tracking these trends and has instituted new requirements in 2022. This Editorial describes the trend and suggests methods to mitigate the situation.

Use of Pasteurized Human Donor Milk to Meet Patients’ Goals of Exclusive Human Milk Feeding

Human milk consumption is recognized by Association of Women’s Health, Obstetric and Neonatal Nursing and the American Academy of Pediatrics as the ideal nutrition of newborns. Exclusive breastfeeding is recommended for the first 6 months of life. The Joint Commission has set a benchmark of 70% of all newborns being exclusively fed with human milk. The role of the nurse for this project was to advocate for patients who desired to exclusively human milk feed, provide the option of pasteurized human donor milk (PHDM) for supplementation when necessary, and increase the exclusive human milk feeding rates aligned with the recommended Joint Commission benchmark. Before the introduction of PHDM, the exclusive use of human milk was not possible with formula use for supplementation. Before partnering with the local Human Milk Banking Association of North America–accredited milk bank, formula was the only option. Formula was not meeting the goal of patients who wanted to continue offering human milk. We recognized the need to advocate for our patients and provide them the option of PHDM to meet their goal of their newborn receiving exclusive human milk.

A call to action for anticoagulation stewardship

A call to action for anticoagulation stewardship

Obstetric Hemorrhage: Understanding The Joint Commission Requirements.

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Each author has indicated that he or she has met the journal's requirements for Authorship.

Joint Commission Survey Preparation—Helpful Resources

Corresponding author: Arif Subhan, MS, CCE, FACCE, is the chief biomedical engineer at VA Greater Los Angeles Healthcare System, 11301Wilshire Blvd, Los Angeles, CA 90073, and past president of the American College of Clinical Engineering. He can be reached at [email protected]. The suggestions and views expressed in this article are those of the author. They do not represent the views of the Department of Veterans Affairs or American College of Engineering. The author declares no conflict of interest.

The Achievements and Future of Information Technology related Patient Safety

<p>隨著科技的進步與智慧醫療的蓬勃發展，因資訊系統問題而導致的病人安全事件層出不窮，引起國際間重視。2020年醫策會與ECRI合作，建置台灣第一個醫療科技問題與病人安全風險學習平台(Information Technology related Patient Safety, ITPS)，由醫院通報以收集因資訊科技所導致的病人安全事件。本平台於2021年共收案50件，事件類別以檢驗／檢查／病理切片事件(40%)及藥物事件(38%)最多，在資通訊事件分類方面，以資訊系統問題(48%)、系統介面問題(26%)最多。為確保通報資料正確性與完整性，由專人客製化進行問題的溝通與釐清，並由專家群進行深度剖析，挖掘資訊系統潛藏的病人安全風險，提供即時的回饋與建議，並辦理醫院通報及改善經驗標竿分享，共同研討此新興領域，共創安全E世代。</p> <p> </p><p>With the rapid technology advancement and intense development of smart healthcare, patient safety incidents triggered by information technology related problems emerge in an endless stream, attracting international attention. In 2020, the Joint Commission of Taiwan (JCT) collaborated with the Emergency Care Research Institute (ECRI) to establish Taiwan’s first Information Technology related Patient Safety (ITPS). ITPS aims to collect information technology related patient safety incidents of healthcare organizations via reporting. In 2021, ITPS received a total of 50 incident cases, with the highest number of incidents in categories of inspection/examination/pathology (40%) and medication (38%). In terms of cause classification, the information system (48%) and system interface (26%) problems were the most common. In order to ensure the accuracy and integrity of the reported incident, a dedicated specialist will communicate with the hospital and clarify specific details of the incident. Then, an expert team will conduct in-depth analysis to identify potential patient safety risks in the hospital’s information system and provide immediate feedback and recommendations with final reports. The expert team will also invite hospitals to share their improvement benchmark experience, jointly explore this emerging field, and create a safe e-healthcare system within the country.</p> <p> </p>

Clinicopathological Features, Staging Classification, and Clinical Outcomes of Esophageal Melanoma: Evaluation of a Pooled Case Series.

Studies that have attempted to validate the staging systems and the predictors of survival for patients with primary malignant melanoma of the esophagus (PMME) have been underpowered given their scarcity and small scale. We aimed to review a large number of PMME cases to know more about its clinicopathological features, TNM staging systems, and survival predictors of PMME. Case reports on PMME were extracted from PubMed/Medline through bibliography search and our center. A total of 287 PMME cases were identified. The majority of the patient population was male (72.08%). The most common location of PMME was the lower esophagus (50.62%) and middle esophagus (35.39%). Among the patients, 82.28% received surgical intervention. The median overall survival (OS) duration was 15 months (0.5–244). The American Joint Commission on Cancer staging classification (AJCC) for the mucosal melanoma of the upper aerodigestive tract with stage IVB and IVC integrated in stage IVA showed better distribution of OS than that for esophageal carcinoma. T stage, N stage, and surgery had significant impacts on OS duration in univariate analysis. However, only T stage and N stage were identified as independent factors for OS duration in the multivariate Cox models. PMME is an aggressive tumor with poor prognosis. The AJCC staging system for mucosal melanoma with stage IVB and IVC integrated in stage IVA may be a better option for staging PMME patients. T stage and N stage are independent factors for OS.

Anaplastic testicular seminoma presenting as a hydrocele, in a 36-year-old patient with a family history of anaplastic seminoma.

Testicular cancer is the solid tumor with the greatest incidence in men between 15 and 44 years old. Its main histological type is germ cell tumor, that is divided into seminomatous and non-seminomatous tumors. Seminoma, consisting 55% of testicular cancer, manifests in the fourth decade of men's life and a rare type of it is the anaplastic seminoma (5% to 15% of testicular seminoma). Diagnosis is based on clinical examination, testicular ultrasound, magnetic resonance imaging, tumor markers measurement and pathological examination, while treatment of choice is radical orchiectomy, with or without retroperitoneal lymphadenectomy, potentially followed by radiotherapy or chemotherapy. We present the case of a 36-year-old male patient, whose father suffered from anaplastic seminoma and visited the hospital due to a painless hydrocele. The testicle was swollen and hard on palpation, while cytological examination of the drained fluid detected neoplasm, potentially seminoma. Tumor markers measurement, as well as abdominal and pelvic computerized tomography scans, were evaluated and the patient was staged as IIA, according to the American Joint Commission on Cancer. Radical orchiectomy with high ligation of the seminal vesicle was performed and the pathological examination showed anaplastic testicular seminoma. Postoperatively, four cycles of chemotherapy with bleomycin, etoposide and platinum (BEP) were performed and no signs of recurrence were present after 1 year. In conclusion, anaplastic seminoma has a good prognosis and is suggested to be treated with radical orchiectomy, with or without retroperitoneal lymphadenectomy, potentially followed by radiotherapy or chemotherapy.

Predictors of patient safety activities among registered nurses and nurse aides in long-term care facilities: cross-sectional study

BackgroundIn Korea, nurse aides (NAs) are legally permitted as substitutes for registered nurses (RNs) in long-term care (LTC) facilities, even though they have very different levels of education and qualification standards. Many studies in hospitals have shown better hospital nurse staffing, more educated nurses, and improved nurse work environments have been associated with lower hospital mortality and length of stay. There is research showing that a higher percentage of RNs with a bachelor’s degree corresponded to lower incidence rates of pressure ulcers in Korean LTC facilities. This study aimed to explore the factors that influence patient safety activities of the RNs and NAs working in LTC facilities and to identify the relationship between patient safety culture (PSC) and patient safety activities.MethodsThis study is a descriptive cross-sectional survey. The study participants were conveniently collected from 88 RNs and 71 NAs who worked at 33 LTC facilities for more than three months. The patient safety activities tool was developed by the researchers for residents of LTC facilities based on the tools developed by Park et al. (2012) for hospital nurses and the patient safety goals of the Joint Commission. The questionnaires were collected by email or mobile application and kept confidential. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficients, and multiple regression analysis.ResultsThe mean scores of PSC and patient safety activities were 4.03 ± 0.51 points and 4.29 ± 0.49 points out of 5, respectively. There was significant correlation between PSC and patient safety activities (r = .23, p = .004). Factors influencing patient safety activities among RNs and NAs in LTC facilities were RNs (β = .377, p < .001), organizational system of PSC (β = .314, p < .010), and work shift type (fixed night shift, on-call, 24-h shift) (β = -.264, p = .004), which explained about 36.0% of total variance (F = 5.69, p < .001).ConclusionThe findings indicate that it is necessary to mandate RNs instead of NAs to enhance residents’ safety in LTC facilities. Additionally, the importance of an organizational safety system and effective working shift types to prevent residents’ safety accidents in LTC facilities is indicated.

Technical Report: Breastfeeding and the Use of Human Milk.

Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding or the provision of human milk a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention and The Joint Commission monitor breastfeeding practices in United States hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding. Efforts to improve breastfeeding rates must acknowledge existing disparities and the impact of racism in promoting equity in breastfeeding education, support, and services.

Policy Statement: Breastfeeding and the Use of Human Milk.

Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding, or the provision of human milk, a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention (CDC) and The Joint Commission monitor breastfeeding practices in US hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding.

Transition to an interactive virtual skills-fair for a pediatric ambulatory care center

Competency assessment in healthcare organizations is an ongoing effort “focused on (assessing) the specific knowledge, technical skills, and abilities required (of nurses) to deliver safe, quality care” (The Joint Commission [TJC], 2022, para. 9). The TJC does not specify what competencies to assess or the time between assessments. It is up to each healthcare organization to create a plan based on the skill level of its nursing staff, “the needs of its patient population, conditions or diseases treated, and the equipment it uses” (TJC, 2022, para.12).

The evidence base for US joint commission hospital accreditation standards: cross sectional study

ObjectiveTo evaluate the evidence upon which standards for hospital accreditation by The Joint Commission on Accreditation of Healthcare Organizations (the Joint Commission) are based.DesignCross sectional study.SettingUnited States.ParticipantsFour Joint Commission R3...

Patient dose and dose monitoring in Interventional Radiology

Synopsis:Throughout the past decades, diagnostic and interventional radiology have been known as major sources of radiation dose exposed to the world population. The International Basic Safety Standard (BSS) issued by the International Atomic Energy Agency (IAEA) clearly outlines key activities in radiation protection from medical exposure. Those activities include justification, optimization, and limitation of dose. The BSS requires optimization of protection and safety for each medical exposure. Key components of optimization include patient dosimetry and Dose Reference Levels (DRLs). Patient dose monitoring and audit have been used as tools for optimization and required by either regulation or accreditation such as the Joint Commission (JCI). The speaker aims to provide information regarding the concept of dosimetric parameters in fluoroscopic guided procedures in interventional radiology and cardiology, and the use of dose management software in radiological practice. How to start up the dose monitoring and audit in interventional cardiology, JCI compliance issues, DRLs and audit systems. Benefits of the dose management software in a purpose of national dose index registry will also be discussed. Synopsis: Throughout the past decades, diagnostic and interventional radiology have been known as major sources of radiation dose exposed to the world population. The International Basic Safety Standard (BSS) issued by the International Atomic Energy Agency (IAEA) clearly outlines key activities in radiation protection from medical exposure. Those activities include justification, optimization, and limitation of dose. The BSS requires optimization of protection and safety for each medical exposure. Key components of optimization include patient dosimetry and Dose Reference Levels (DRLs). Patient dose monitoring and audit have been used as tools for optimization and required by either regulation or accreditation such as the Joint Commission (JCI). The speaker aims to provide information regarding the concept of dosimetric parameters in fluoroscopic guided procedures in interventional radiology and cardiology, and the use of dose management software in radiological practice. How to start up the dose monitoring and audit in interventional cardiology, JCI compliance issues, DRLs and audit systems. Benefits of the dose management software in a purpose of national dose index registry will also be discussed.

The Road to Excellence: Paving the Way to Construct a Successful Infection Prevention Program in a Complex Healthcare Network

BackgroundOur healthcare system is a level I trauma center with 25 clinics and over 1 million patient encounters per year. The Infection Prevention team of 9 has oversight of all infection prevention activities. A mock survey was completed to prepare the system for a Joint Commission survey. Results from the mock survey identified gaps within the infection prevention program and called attention to the need to implement best practices. During this time, the infection prevention team was experiencing challenges related to the COVID-19 pandemic and high staff turnover.MethodsMock survey findings were categorized into 8 buckets: Infection prevention program, dust and environmental cleaning, expiration dates, manufacturer's instructions for use, low level disinfection, probes, scopes, and storage of supplies. Infection Preventionists were assigned to service lines and buckets to facilitate interdepartmental collaboration and create solutions to address findings. Routine tracers completed by the infection prevention team provided a means to measure compliance over time.ResultsThe mock survey was conducted in November 2020 and the Joint Commission survey was completed in November 2021. In just 12 months, there was a 98% reduction in the number of findings attributed to the Infection Control chapter - 168 mock survey findings in 2020 was reduced to 2 survey findings in 2021. In 2020, 127 findings were considered high risk and 33 were considered an immediate threat to health and safety. There were 0 findings in 2021 that were considered high risk or an immediate threat to health and safety.ConclusionsImplementation of a robust infection prevention program is essential to the success of the healthcare system. Key elements that contribute to a high-quality program include standardization of best practices, designating team members to become consultants for service lines, increasing interaction and visibility with staff members, and implementing committees to discuss opportunities for improvement and monitor initiatives.

Mediating Role of Burnout in the Effect of Nurses' Workload on Turnover Intention during COVID-19 Pandemic

Objectives of this study are to investigate the effect of workload on turnover intention and burnout and the mediating role of burnout in the effect of workload on leaving.COVID-19 pandemic leads to highly challenging work conditions for healthcare workers including nurses who mostly work at the front-line accompanying patients. This research was conducted in a private hospital with a Joint Commission International (JCI) certificate in Istanbul of Turkey between January and March 2021. 247 nurses comprising 91% of the nurse population in the hospital have been included. Workload had positive effect on burnout (β=0.51, 95% CI [0.287, 0.441]) and turnover intention of nurses (β=0.31, 95% CI [0.322, 0.603]). Burnout had a positive effect on turnover intention (β=0.54, 95% CI [0.932, 1.32]) and a mediating role in the effect of workload on turnover intention (β=0.41, 95% CI [0.302, 0.530]).Our finding indicated that increased workload is associated with increased levels of burnout and turnover intention of nurses. Furthermore, burnout has a positive effect on mediating the turnover intention.

HIPAA and Access to Medical Information by Medical Examiner and Coroner Offices.

Often, medical staff and sometimes their attorneys mistakenly believe that HIPAA prevents disclosure of medical records to medical examiner and coroner offices. Medical examiner and coroner government offices are not covered entities. Moreover, HIPAA specifically allows disclosure to law enforcement, public health, and medical examiner and coroners. However, state and Joint Commission requirements may further impact disclosures.

The Expansion of Turkey’s Medical Tourism Industry

The Expansion of Turkey’s Medical Tourism Industry

A Hospital's Roadmap for Improving Nursing Excellence Using AACN's Healthy Work Environment Standards.

A Hospital's Roadmap for Improving Nursing Excellence Using AACN's Healthy Work Environment Standards.