Bureau of Primary Health Care

Health Centers' Most Challenging Standards - 2004

Amb Care Standards Generating Findings
(formerly “Type I Recs”) in 15%+ CHCs Surveyed
[Standard/Element of Performance from 2004 CAMAC]

ORGANIZATION-FOCUSED FUNCTIONS:

Management of Human Resources

  • There is a process for ensuring the competence of all practitioners permitted by law and the organization to practice independently. [HR.4.10/EPs #10, #11, #15]
  • Individuals permitted by law and the organization to practice independently are granted clinical privileges.  [HR.4.20/EPs #2, #3]

Leadership

  • Services provided by consultation, contractual arrangements, or other agreements are provided safely and effectively. [LD. 3.50/EPs #4, #5, #6]
  • The leaders develop and implement policies and procedures for care, treatment, and services. [LD.3.90/EP #2]

Environment of Care

  • The organization addresses emergency management. [EC.4.10/EPs #1 (conducts hazards vulnerability analysis), #21].
  • The organization monitors conditions in the environment. [EC.9.10/EP #3 (annual evaluation of each EC plan)].

Information Management

  • Standardize the abbreviations, acronyms and symbols used throughout the org, including a list of abbreviations, acronyms and symbols not to use. [IM.3.10/EP #2]
  • For patients receiving continuing ambulatory care services, the medical record contains a summary list of all significant diagnoses, procedures, drug allergies, and medications. [IM.6.40/EPs #1, #3]
  • The organization can provide access to all relevant information from a patient’s record when needed for use in patient care, treatment, and services. [IM 6.60/EPs #1, #2]

PATIENT-FOCUSED FUNCTIONS:

Provision of Care

  • Pain is assessed in all patients (“when warranted by the patient’s condition”). [PC.8.10/EPs #1 (conduct or refer for comprehensive pain assessment), #5 (record assessment & measure of pain intensity/quality appropriate to age)]
  • The organization uses at least 2 patient identifiers whenever taking blood samples or administering medication or blood products.  [PC.5.10/EP #4]
  • The patient receives education and training specific to the patient’s needs and as appropriate to the care and services provided. [PC.6.10/EPs#1, #2].
  • Quality control checks, as defined by the organization, are conducted on each procedure. [PC.16.50/EP#3 (2 levels of glucometer control testing per day of patient use → ’05: 2 levels for all instrument-based waived testing…if commercially available)]

Medication Management

  • Medications are properly and safely stored throughout the organization. [MM.2.20/EP #4 (controlled substances stored to prevent diversion), #5 (expired meds are segregated)].

Surveillance, Prevention, and Control of Infection

  • Once the organization has prioritized its goals (for preventing health-care acquired infections), strategies must be implemented to achieve those goals [IC.4.10/EP #2 (hand hygiene program)] [IC.4]