Joint Commission On The Accreditation Of Healthcare Organizations Research Articles

Preventable deaths in a French regional trauma system: A six-year analysis of severe trauma mortality

Analyzing mortality in a mature trauma system is useful to improve quality of care of severe trauma patients. Standardization of error reporting can be done using the classification of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). The aim of our study was to describe preventable deaths in our trauma system and to classify errors according to the JCAHO taxonomy. We performed a six-year retrospective study using the registry of the Northern French Alps trauma network (TRENAU). Consecutive patients who died in the prehospital field or within their stay at hospital were included. An adjudication committee analyzed deaths to identify preventable or potentially preventable deaths from 2009 to 2014. All errors were classified using the JCAHO taxonomy. Within the study period, 503 deaths were reported among 7484 consecutive severe trauma patients (overall mortality equal to 6.7%). Seventy-two (14%) deaths were judged as potentially preventable and 36 (7%) deaths as preventable. Using the JACHO taxonomy, 170 errors were reported. These errors were detected both in the prehospital setting and in the hospital phase. Most were related to clinical performance of physicians and consisted of rule-based or knowledge based failures. Prevention or mitigation of errors required an improvement of communication among caregivers. Standardization of error reporting is the first step to improve the efficiency of trauma systems. Preventable deaths are frequently related to clinical performance in the early phase of trauma management. Universal strategies are necessary to prevent or mitigate these errors.

Opioid Epidemic in the United States

Over the past two decades, as the prevalence of chronic pain and health care costs have exploded, an opioid epidemic with adverse consequences has escalated. Efforts to increase opioid use and a campaign touting the alleged undertreatment of pain continue to be significant factors in the escalation. Many arguments in favor of opioids are based solely on traditions, expert opinion, practical experience and uncontrolled anecdotal observations. Over the past 20 years, the liberalization of laws governing the prescribing of opioids for the treatment of chronic non-cancer pain by the state medical boards has led to dramatic increases in opioid use. This has evolved into the present stage, with the introduction of new pain management standards by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) in 2000, an increased awareness of the right to pain relief, the support of various organizations supporting the use of opioids in large doses, and finally, aggressive marketing by the pharmaceutical industry. These positions are based on unsound science and blatant misinformation, and accompanied by the dangerous assumptions that opioids are highly effective and safe, and devoid of adverse events when prescribed by physicians. Results of the 2010 National Survey on Drug Use and Health (NSDUH) showed that an estimated 22.6 million, or 8.9% of Americans, aged 12 or older, were current or past month illicit drug users, The survey showed that just behind the 7 million people who had used marijuana, 5.1 million had used pain relievers. It has also been shown that only one in 6 or 17.3% of users of non-therapeutic opioids indicated that they received the drugs through a prescription from one doctor. The escalating use of therapeutic opioids shows hydrocodone topping all prescriptions with 136.7 million prescriptions in 2011, with all narcotic analgesics exceeding 238 million prescriptions. It has also been illustrated that opioid analgesics are now responsible for more deaths than the number of deaths from both suicide and motor vehicle crashes, or deaths from cocaine and heroin combined. A significant relationship exists between sales of opioid pain relievers and deaths. The majority of deaths (60%) occur in patients when they are given prescriptions based on prescribing guidelines by medical boards, with 20% of deaths in low dose opioid therapy of 100 mg of morphine equivalent dose or less per day and 40% in those receiving morphine of over 100 mg per day. In comparison, 40% of deaths occur in individuals abusing the drugs obtained through multiple prescriptions, doctor shopping, and drug diversion. The purpose of this comprehensive review is to describe various aspects of crisis of opioid use in the United States. The obstacles that must be surmounted are primarily inappropriate prescribing patterns, which are largely based on a lack of knowledge, perceived safety, and inaccurate belief of undertreatment of pain. Key words: Opioid abuse, opioid misuse, nonmedical use of psychotherapeutic drugs, nonmedical use of opioids, National Survey on Drug Use and Health, opioid guidelines.

Abstract P145: Implementation of a Simple Computerized Heart Failure Discharge Instruction Tool Lead to Increased Adherence to JCAHO Heart Failure Core Measures and Reduced Heart Failure Readmission Rate

Background: Suboptimal adherence to JCAHO (Joint Commission on the Accreditation of Healthcare Organizations) heart failure (HF) core measures have been reported in various hospital settings. Non- adherence to JCAHO HF core measures have been associated with decreased survival. The purpose of this study was to evaluate the impact of implementation of a discharge instruction tool on the adherence to JCAHO HF measures and analyze HF outcomes. Methods: A simple computerized discharge instruction tool (DIT) included an electronic check list of four JCAHO HF core measures to be completed and verified by all physicians who discharged acute HF patients; and got implemented at Catholic Medical Center (CMC), New Hampshire from January 2008. We compared the patient data before (January to December 2007; n=219)) and after (January 2008 to June 2009; n=326) implementation of DIT for adherence to four JCAHO HF core measures. All patients were followed for six months to analyze HF readmission rate and cardiac related death. Results: Total eligible patients (n=545) with their adherence to the HF core measures and improvement in the adherence to discharge instructions are shown in Table 1 and Figure 1-a/b. Reduction of six-month readmission rate (36.2 vs 27.8%; p=0.03) recognized an approximate saving of $6500.00 per case accounting to a total annual savings of approximately $176,000; with no significant change in the hospital length of stay and cardiac related death. Conclusions: A simple DIT achieved an improved adherence to JCAHO HF core measures and CMC acquired a local and regional recognition. Similar DIT could be shared in other hospitals across the nation to achieve improved HF outcomes.

The Impact of Hospital Quality-Related Practices on Health Outcomes

In this paper we analyze the cross-sectional relationship between hospital quality scores calculated by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and risk-adjusted indicators of outcomes and quality-mortality, rates of surgical/medical misadventures, adverse drug reactions, and length of stay-calculated from Nationwide Inpatient Sample discharge records. The results suggest that greater adherence to JCAHO accreditation standards is not associated with reduced mortality or lower probability of avoidable hospital or physician-caused adverse outcomes. Other hospital characteristics, such as teaching/non-teaching and urban/rural status, also exhibit little or no correlation with risk-adjusted survival and adverse-event probabilities.

An Intervention to Maximize Research Sample Collection for Pregnant Subjects at Delivery

regnant women enrolled in clinical researchstudies requiring samples to be collected atdelivery aiord the researcheronly one opportunityto collect those samples, which if not collected re-sult in incomplete data sets. We hypothesized thatthe inclusion of a‘‘time out’’ review forall Cesareanand vaginal births would increase research samplecollection.We sought to evaluate the eiectivenessof implementinga time-out intervention whenpreg-nant study participants deliver in order to enhancethe collectionof biological research samples.Literature ReviewPerinatal research literature is mostly void in de-scribing speci¢c methods for identifying pregnantstudy subjects in labor and delivery and how re-search samples are collected at the time ofdelivery. Recent obstetric studies describe speci¢cbiological samples being collected at delivery;however most studies do not describe how themedicalandnursingstaiknowstocollect thedata.In 2006, aspartofthe national patient safety goals,the Joint Commission on the Accreditation ofHealthcare Organizations (JCAHO) recommendeda perioperative veri¢cation process, or ‘‘time out,’’to include identi¢cation of correct patient, correctsite, correct side, correct procedure, correct posi-tion for the procedure, and the availability ofspecial equipment ifneeded (2007).MethodologyStudy subjects included pregnant women deliver-ing at Duke University Medical Center (DUMC) whopreviously consented to IRB approved studies re-quiring research samples at delivery.Obstetric staiwere educated on the implementation of a vaginaldelivery time out that included research participa-tion.Collection rates of research samples obtainedat delivery were collected retrospectively from wo-men delivering by Cesarean and prospectivelyafterimplementationofresearchinthetimeoutpro-cedurefor those subjects delivering vaginally.Data Analysis & InterpretationPrior to study implementation, 105 subjects deliv-ered vaginally and were on one or more studies.Ofthose, 65.7% (69/105) had research samples col-lected forall studies. After study implementation, 83of 97 (85.6%) subjects who delivered vaginallyhadsamples collected for all studies (p5.001). Eighty-fourofthe 97 subjects (86.6%) had documentationof the time out procedure; of these 89.3% (75/84)had all samples collected. Of the 13 without timeout documentation, only 8 had all samples col-lected (61.5%, p5.008). Implementation anddocumentation of time out in vaginal deliveriesimproved research sample collection.Implications for Nursing PracticeByimplementingasuccessfulinterventiontocollectblood and tissue samples at delivery, the re-searcher is able to obtain those data that arecrucial to answering important perinatal researchhypotheses. Including research in all obstetric timeout procedures provides additional assurance thatcompliance with the JCAHO patient safety goals isbeing met. The inclusion of research participationinobstetrictimeoutproceduresisaneiectiveinter-vention maximizing research sample collection atdelivery that maybe implementedbyothers.

Emergency department over-crowding: a global perspective

Emergency department over-crowding: a global perspective

Introduction of new safety technologies into central venous access

The American Society of Anesthesiologists, the Anesthesia Patient Safety Foundation, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), and the Patient Safety and Quality Improvement Act of 2005 encourage anesthesiology departments to institute systematic improvements in patient safety, including but not limited to integration of new safety technologies. The evaluation and method of use of the reciprocating procedure device in central venous access is presented.

Identification and prioritization of quality indicators in clinical genetics: An international survey

The range and demand for clinical genetic services will continue to grow, and now is an ideal time to assess current service quality. Based on the previous work of quality professional organizations such as the Institute of Medicine (IOM) and The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) which is now known as The Joint Commission (TJC), an independent group of genetic and healthcare quality professionals (InheritQual) drafted and defined a list of potential quality indicators for clinical genetics. Perspectives on the appropriateness and the practicality of each indicator were surveyed and analyzed. The Quality Special Interest Group of the American College of Medical Genetics (ACMG) chartered the survey results. After measuring the degree of consensus, an expert panel was selected to review the quality indicators based on practicality and applicability. This expert panel comprised of members of the ACMG Quality Sig workgroup met for final consensus and developed a methodology to pilot these indicators.

The egocentric surgeon or the roots of wrong side surgery

> “Oh wad some power the giftie gie us > > To see the world as our patient sees it! > > It wad frae monie a blunder free us,...

2007 National Patient Safety Goals

THE PURPOSE OF the Joint Commission’s National Patient Safety Goals (NPSGs) is to promote specific improvements in patient safety. The Goals highlight problematic areas in health care and describe evidence and expert-based solutions to these problems. 1 The Joint Commission2007 National Patient Safety Goals. 2006 Google Scholar The NPSGs focus on system-wide solutions, whenever possible, in an effort to promote the delivery of safe, high-quality health care. Accredited health care organizations are evaluated for continuous compliance with the specific requirements associated with the National Patient Safety Goals, and organizations are permitted to design alternative approaches to meeting goal requirements and to request Joint Commission consideration and approval of such alternatives. The Joint Commission also provides guidance on how to achieve effective compliance with each of the goal’s requirements. 1 The Joint Commission2007 National Patient Safety Goals. 2006 Google Scholar NOTE: JCAHO is now The Joint Commission. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has shortened its name to The Joint Commission. The change was made official in January when The Joint Commission launched a redesigned website. Check out the new website at: http://jointcommission.org and see the new Joint Commission logo as well. NOTE: JCAHO is now The Joint Commission. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has shortened its name to The Joint Commission. The change was made official in January when The Joint Commission launched a redesigned website. Check out the new website at: http://jointcommission.org and see the new Joint Commission logo as well. Nancy M. Saufl, MS, RN, CPAN, CAPA, is a past President of the American Society of PeriAnesthesia Nurses, and the Coordinator of the Preadmission Testing Center at Florida Hospital-Memorial Division, Ormond Beach, FL, USA.

Organizational and Unit Factors Contributing to Reduction in the Use of Seclusion and Restraint Procedures on an Acute Psychiatric Inpatient Unit

The use of seclusion or restraint (S/R) as an emergency medical intervention to assist patients in regaining behavioral control continues to be an area of interest and concern for the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), consistent with the ongoing concerns in the medical, patient advocate, legislative and legal communities. This study examined unit characteristics and the use of S/R in a VA facility with a secured, acute mental health unit before and after the promulgation of the JCAHO 2000 standards for utilization of S/R for behavioral health reasons. Variables examined include patient acuity, patient census, number of admits, number of discharges, length of stay, number of nursing staff on duty, critical incidents and S/R hours per month. Results indicated S/R use began showing a notable decrease corresponding to the time that senior unit management began discussions of the new JCAHO standards. These reductions maintained statistical significance even after controlling for changes in unit environmental variables.

Guidance on Public Reporting of Healthcare-Associated Infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee

Consumer demand for healthcare information, including data about the performance of healthcare providers, has increased steadily during the past decade. Many state and national initiatives are under way to mandate or induce healthcare organizations to publicly disclose information regarding institutional and physician performance. Mandatory public reporting of healthcare performance is intended to enable stakeholders, including consumers, to make more informed choices on healthcare issues.Public reporting of healthcare performance information has taken several forms. Healthcare performance reports (report cards and honor rolls) typically describe the outcomes of medical care in terms of mortality, selected complications, or medical errors and, to a lesser extent, economic outcomes. Increasingly, process measures (ie, measurement of adherence to recommended healthcare practices, such as hand hygiene) are being used as an indicator of how well an organization adheres to established standards of practice with the implicit assumption that good processes lead to good healthcare outcomes. National healthcare quality improvement initiatives, notably those of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the Centers for Medicare & Medicaid Services (CMS), and the Hospital Quality Alliance, use process measures in their public reporting initiatives.

Impact of a Negative Evaluation for Underlying Coronary Artery Disease on One-year Resource Utilization for Patients Admitted with Potential Acute Coronary Syndromes

Reduction in emergency department (ED) overcrowding is a major Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) initiative. One major source of ED overcrowding is patients waiting for telemetry beds. Objective: To determine whether, in patients admitted with a potential acute coronary syndrome, a negative evaluation for underlying coronary artery disease would reduce ED and hospital revisits over the subsequent year compared with patients who did not receive an evaluation for underlying coronary artery disease. Methods: Nine hundred ninety-nine consecutive patients admitted for potential acute coronary syndromes through the ED during a one-year period were screened for inclusion. Patients who had a negative evaluation for underlying coronary disease were compared with patients who were not evaluated for underlying coronary artery disease for subsequent ED visits, hospital admissions, and cardiac resource utilization over the year following the index visit via a health system–wide computerized record review. Patients with positive tests or biomarkers at the index visit were excluded. Each repeat visit was rated as “potentially cardiac” or “noncardiac.” Results of echocardiograms, stress tests, and catheterizations and information about in-hospital deaths were obtained. Results: Six hundred ninety-two patients met the inclusion criteria: 556 patients received no evaluation for underlying coronary artery disease, 116 had a negative stress test, and 20 had a negative cardiac catheterization during the index visit. Patients with no evaluation for underlying coronary artery disease and patients with a negative evaluation had similar likelihoods of a repeat ED visit (negative test 39.0% vs. no test 40.3%; p = 0.85) and repeat hospital admission (28.7% vs. 31.5%; p = 0.61). The rates of a potentially cardiac-related ED visit (21.3 vs. 23.4%; p = 0.65) and hospital admission (17.7% vs. 20.7%; p = 0.48) were not significantly different. The two populations had similar utilization rates of echocardiograms, stress tests, and catheterizations (p > 0.70 for all). Conclusions: For patients admitted to the authors' institution with a potential acute coronary syndrome, there was no association between a negative evaluation for underlying coronary artery disease and overall or potentially cardiac ED visits, admissions, or cardiac resource test utilization over the year following the index visit.

Impact of a Negative Evaluation for Underlying Coronary Artery Disease on One‐year Resource Utilization for Patients Admitted with Potential Acute Coronary Syndromes

Reduction in emergency department (ED) overcrowding is a major Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) initiative. One major source of ED overcrowding is patients waiting for telemetry beds. To determine whether, in patients admitted with a potential acute coronary syndrome, a negative evaluation for underlying coronary artery disease would reduce ED and hospital revisits over the subsequent year compared with patients who did not receive an evaluation for underlying coronary artery disease. Nine hundred ninety-nine consecutive patients admitted for potential acute coronary syndromes through the ED during a one-year period were screened for inclusion. Patients who had a negative evaluation for underlying coronary disease were compared with patients who were not evaluated for underlying coronary artery disease for subsequent ED visits, hospital admissions, and cardiac resource utilization over the year following the index visit via a health system-wide computerized record review. Patients with positive tests or biomarkers at the index visit were excluded. Each repeat visit was rated as "potentially cardiac" or "noncardiac." Results of echocardiograms, stress tests, and catheterizations and information about in-hospital deaths were obtained. Six hundred ninety-two patients met the inclusion criteria: 556 patients received no evaluation for underlying coronary artery disease, 116 had a negative stress test, and 20 had a negative cardiac catheterization during the index visit. Patients with no evaluation for underlying coronary artery disease and patients with a negative evaluation had similar likelihoods of a repeat ED visit (negative test 39.0% vs. no test 40.3%; p = 0.85) and repeat hospital admission (28.7% vs. 31.5%; p = 0.61). The rates of a potentially cardiac-related ED visit (21.3 vs. 23.4%; p = 0.65) and hospital admission (17.7% vs. 20.7%; p = 0.48) were not significantly different. The two populations had similar utilization rates of echocardiograms, stress tests, and catheterizations (p > 0.70 for all). For patients admitted to the authors' institution with a potential acute coronary syndrome, there was no association between a negative evaluation for underlying coronary artery disease and overall or potentially cardiac ED visits, admissions, or cardiac resource test utilization over the year following the index visit.

Medicare funding for nursing education: Proposal for a coherent policy agenda

Medicare Graduate Medical Education (GME) funding for nursing education, established in 1965, no longer represents a coherent policy agenda, which must support educating the nursing workforce from classroom to practice. Three key concepts must be addressed: nursing education costs for both service and educational institutions, defining nursing education in federal rules and regulations, and the community's role in supporting nursing education. Responsibility for educating a nursing workforce must be shared by the community of academic, health care, professional, and government institutions and organizations, a policy supported by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Knowledge about costs, funding streams, and policies for nursing education is essential for nursing educators to advocate for funding of nursing education and practice. Nursing programs and academic institutions need to initiate discussions with policy makers and potential community partners about service/education partnerships. Finally, community investment in nursing education pays dividends by providing essential health services of a highly skilled professional workforce.

An introduction to the ASPAN pain and comfort clinical guideline

THE JOINT COMMISSION on the Accreditation of Healthcare Organizations (JCAHO) mandates that all individuals have the right to effective pain/symptom management, and this mandate should be a part of basic clinical nursing care.1,2 The Agency for Healthcare Research and Quality (AHRQ; formerly the Agency for Health Care Policy and Research [AHCPR]) also states that institutions have the responsibility for pain management and that this responsibility begins with the affirmation that patients should have access to the best level of pain relief that may be provided safely.3 Despite the availability of effective analgesics and new technologies for drug administration, studies continue to find suboptimal pain management.4 Health care professionals underestimate pain when performing clinical assessments, and this pain assessment is difficult because of the complex interactions between patient and practitioner.5 A lack of understanding about basic pain management concepts continues despite more recent efforts to improve nurses’ knowledge of pain management.6 Inadequate education of nurses in the area of pain concepts fails to prepare them to assess and control postoperative pain effectively.7

Cardiovascular News

Cardiovascular News

Govt. Names Organizations That Can Accredit Methadone Programs

Back to table of contents Previous article Next article Professional NewsFull AccessGovt. Names Organizations That Can Accredit Methadone ProgramsJim RosackJim RosackSearch for more papers by this authorPublished Online:1 Feb 2002https://doi.org/10.1176/pn.37.3.0005bFour organizations were chosen last month by the Substance Abuse and Mental Health Services Administration (SAMHSA) to accredit programs that use methadone to treat individuals with opiate abuse and dependency.Along with the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Council on Accreditation for Children and Family Services (COA), and the State of Washington Department of Social and Health Services Division of Alcohol and Substance Abuse will accredit methadone treatment programs for SAMHSA’s Center for Substance Abuse Treatment (CSAT).CSAT hopes that the move to accreditation, announced last year (Psychiatric News, March 2, 2001), will lead to improvements in the quality and oversight of opioid treatment programs that use either methadone or levo-alpha-acetyl-methadol (LAAM) to prevent relapse in addiction to heroin and other opiates.“As a benchmark of quality,” CSAT Director H. Westley Clark, M.D., J.D., M.P.H., said in a prepared statement released by the center, “accreditation indicates that an organization meets certain critical performance standards. This should enhance community confidence in opioid treatment and enhance the ability of treatment programs to access managed care contracts.”SAMHSA Administrator Charles G. Curie added that “accreditation of methadone treatment programs is a fundamental shift in the way we approach drug abuse treatment in our nation. Accreditation can help to reduce stigma and discrimination by moving drug abuse treatment into the mainstream of medicine. Just like treatment for other diseases, physicians and other health care professionals will make decisions based on standards that emphasize best-care practices for patients.”The final approval of the four accrediting agencies follows recommendations made in 1997 by a National Institutes of Health consensus panel, which concluded that the existing federal and state regulations limited the ability of physicians to provide methadone treatment to patients and recommended the move away from regulatory oversight to accreditation in an effort to improve the quality of care. The change is also consistent with a report by the Institute of Medicine in 1995, which stressed the need to readjust the balance among regulations, clinical practice guidelines, and quality assurance systems.Under the regulations authorizing the new accreditation process, treatment programs must apply for certification to one of the four approved accrediting agencies no later than March 4, so that accreditation is achieved no later than May 19, 2003.CSAT, Clark said, is providing technical assistance to help treatment programs meet the new federal regulations and the accreditation standards. Each of the four accrediting agencies will provide technical assistance to programs seeking certification through their agency.Questions regarding technical assistance with meeting the new accreditation standards can be directed to a toll-free CSAT helpline at (800) 839-6120. Other information about the new federal regulations is available toll free from CSAT at (866) 463-6687. ▪ ISSUES NewArchived

APA Makes Presence Felt At Recent AMA Meeting

APA Makes Presence Felt At Recent AMA Meeting

Evidence-based practice part 3: Acute pain management of the perianesthesia patient

Evidence exists that pain is inadequately controlled in most patients. This is caused, in part, by the fact that doctors and nurses have based clinical practice on myths and misconceptions about pain medications, rather than by using evidence-based research. Evidence also exists that when pain is adequately controlled, there is greater patient satisfaction with care. The purpose of Part 3 in this series on pain is to review the literature on inadequate pain management, to review Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) guidelines for correcting the inadequacy of pain control, and to review evidence-based medications used for pain management. © 2001 by American Society of PeriAnesthesia Nurses.