Spotlight on standards: What’s important for 2001
Spotlight on standards: What’s important for 2001
If you want to know what standards the Joint Commission on Accreditation of Healthcare Organizations is likely to focus on in the coming months, pay attention to which ones are references in multiple functional chapters, says Kathryn Wharton Ross, MS, RN, CNAA, a health care consultant in Durango, CO.
"[The Joint Commission is] thinking in terms of systems now," she says. "And [it’s] looking at the various functions and where a certain standard would be placed in a system."
Here are some of the standards Ross suggests Joint Commission surveyors will pay particular attention to in 2001:
• Staffing and human resource standards. "I think these are going to get a lot of focus in the coming year," she says. "The Joint Commission is proposing to look at some systems in order to survey staffing. So I think all the human resource standards are going to be a major focus, but primarily staffing and competency."
• Medical staff standards. The areas of credentialing and peer review are also likely to draw a lot of attention, Ross says, as are any other standards that concern patient safety issues. "There’s still going to be significant emphasis on peer review and the use of aggregate data, particularly on reappointment," she adds. "That’s reaffirmed with one of the new changes for 2001, where we’re looking at a practitioner-specific date and comparing it to the aggregate, either by department or for the hospital. I think that’s moving one step beyond what some organizations have been doing."
She adds that the telemedicine standards "certainly open up a new arena for us in medical staff," but they aren’t likely to prove very problematic for hospitals.
• Pain management. Pain management is a theme that runs through several functional chapters in the standards manual, and even has implications for leadership planning, human resources competency, and medical record documentation. "There are education and orientation issues in terms of making staff familiar with new practices in pain management and using some of the guidelines," Ross says. "It’s also important to know that people are competent when it comes to pieces of equipment that may be involved. In information management, it’s important to make sure that we have documentation of how we’re doing and the results of our pain management processes."
• Anesthesia and sedation. In the past, some hospitals have had difficulty understanding how to apply the Joint Commission’s anesthesia standards, Ross notes. "It seems to me the Joint Commission was a little concerned," she says. "There have been some sentinel events that have occurred with conscious sedation, and I think there was a feeling that it had to tighten up those standards a little bit. For a while, hospitals were in a kind of never-never land, where the anesthesia standards were not being surveyed in the area of conscious sedation. But after January 2001, they will be, and they’ll be enforced."
Also, in the preface to standard TX.2, the Joint Commission "basically told hospitals that they had to do protocols that addressed things like staffing, competencies, equipment, and monitoring the patient. They’ve actually incorporated that into the TX.2 standard now. So there are probably going to be some rewrites and rethinking of how we’re doing conscious sedation and what that’s going to mean in terms of our practitioners and what we’re looking at. It’s certainly going to require organizations to clearly define what kinds of outcomes they’re going to monitor in those areas."
• Restraints. In January, the Joint Commission will shift its focus regarding the survey of restraint standards to conform to the Health Care Financing Administration’s (HCFA) Condition of Participation on restraints. "HCFA looks at the standards in terms of the behavior of the patient, instead of the site of care," Ross says. "In January, the Joint Commission will be surveying the standards based on the behavior of the patient as well, not necessarily the site where the patient is. That’s going to be a major change for hospitals."
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