In light of feedback we received about Home Care Bulletin (see article on survey results), I’d like to use my column to clarify the applicability of National Patient Safety Goal 3E, Reduce the likelihood of patient harm associated with the use of anticoagulation therapy.
Under the home care program, NPSG 3E is applicable to home health, hospice (inpatient or patient residence), pharmacy dispensing services, freestanding ambulatory infusion services and long term care pharmacy services. NPSG 3E is not applicable to personal care services, clinical consultant pharmacy services or home care medical equipment (including clinical respiratory services and rehabilitation technology).
In the 2008 NPSG Chapter posted on the website, under the NPSG 3E requirement, there is a note: This requirement applies only to organizations that provide anticoagulant therapy. This is relevant only if the organization is dispensing and/or administering anticoagulant therapy. This does not include monitoring, drawing labs, or education of the patient regarding anticoagulant therapy.
For more information about the 2008 NPSGs, contact the Standards Interpretation Group at
(630) 792-5900, or use the online form. If you have questions about anything else, I’d love to hear from you! You can reach me at (630) 792-5742, or dzak@jointcommission.org.
Debra Zak, Ph.D., R.N.
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The Department of Health and Human Services’ Center for Medicare & Medicaid Services has announced its continued approval of The Joint Commission’s deeming authority for home health agencies seeking to participate in the Medicare or Medicaid programs. The federal government published official notice of a six-year extension of this deeming authority in the Federal Register on March 28. Under this notice, CMS officially recognizes that The Joint Commission’s accreditation requirements meet or exceed the Medicare conditions for participation for home health agencies. The federal deemed status option for Joint Commission-accredited home health agencies first became effective in June 1993.
“Our accreditation process focuses on stimulating safe, quality patient care,” says Debra Zak, executive director. “We are pleased to once again receive CMS’ approval of our high standards.”
Qualified home health agencies should notify The Joint Commission of their interest in using accreditation for Medicare certification purposes prior to applying for a survey. For more information about the deemed status option, call (630) 792-5251. Deemed status options are also available for Joint Commission-accredited hospices.
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As part of the transition to a more continuous accreditation process, The Joint Commission has expanded the window for unannounced surveys to within 18-39 months (was 24-39 months) after an organization’s previous survey, effective mid-2008. The Joint Commission’s Accreditation Committee recently approved the methodology for conducting these surveys.
The approved methodology takes into account Priority Focus Process data across multiple quarters as well as trends in the performance of these data. Based on performance over time and trends in performance, some home care organizations will be identified and scheduled for an earlier survey. These outliers represent circumstances where data suggest that patient safety and quality are potentially at risk. It is expected that the majority of organizations will still be surveyed in the year that their triennial survey would be due, and a minority of organizations will be surveyed earlier. For more information, see the April 2008 issue of The Joint Commission Perspectives or contact your account representative.
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Simplified scoring and decision processes are effective January 1, 2009 for all accreditation programs. The new processes:
- Are based on the “criticality” of survey findings. This means that accreditation decisions and the timing of follow-up requirements are judged in relation to the immediacy of the threat to health care quality and patient safety.
- Reflect an organization’s performance respecting compliance with Joint Commission standards and elements of performance.
The proposed changes to the scoring and decision processes are still under review by The Joint Commission. Final changes to the scoring and decision processes will be posted to The Joint Commission website by July 1.
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Joint Commission accredited home care organizations want more information about complying with specific standards according to the recent readership survey. In addition, readers would like more articles about survey preparation and National Patient Safety Goals. Of the 478 survey respondents, 96 percent always or sometimes read Home Care Bulletin.
Open-ended comments include:
- “I like that it is succinct. I would have difficulty finding the time to read a lengthy, detailed document.”
- “I would love to see examples of problems and how they were corrected.”
- “Include surveyor tips with feedback on current trends seen in the field.”
- “I would like to see the section on how to comply with the standards to state the standard, tell how to comply, and then show examples of how organizations have complied.”
“I appreciate the constructive feedback that we received about Home Care Bulletin,” says Debra Zak, executive director. “Look for improvements based on your comments and keep reading!”
If you do not currently receive Home Care Bulletin via list serve, you can subscribe today.
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Current and archived issues of The Joint Commission Perspectives are available for accredited home care organizations. Perspectives is the official Joint Commission newsletter—and the primary source for changes to standards and accreditation requirements. In 10 steps that will take five minutes or less, you can register as an individual subscriber:
- Go to www.ingentaconnect.com.
- On the right side of the screen, under “Need to register?” click “Sign up here.”
- On the “Personal Registration” page, complete the required fields. Create your own user name and password and click “Register.”
- On the next screen, click “Activating Personal Subscriptions” and click the “Add” tab.
- Using the “Publisher Name” section, click “J” to find “Joint Commission Resouces” and find the entry for Joint Commission Perspectives.
- Check the small box to the left of Joint Commission Perspectives.
- In the larger box to the right of the title, enter your Subscription Number. Note: Your subscription number is your last name and zip code (example: Smith12345).
- Click “add,” which appears above and below the subscription number boxes.
- Your subscription activation will be processed; initial activation should take less than one hour.
- When your subscription is activated, it will appear in your “Personal Subscriptions” list.
For technical support of the online version of The Joint Commission Perspectives, e-mail perspectives@jcrinc.com.
In addition, all Joint Commission-accredited home care organizations receive two hard copies of The Joint Commission Perspectives—one to the CEO and one to the medical staff director. Those names are derived from the electronic application for accreditation. Any changes to those names will need to be made to the e-App.
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Q: Please clarify the National Patient Safety Goal requirement for read-back of verbal orders or critical test results.
A: With respect to NPSG 2A, read-back expectations are:
- The receiver writes down the complete order/test result or enters it into a computer.
- The receiver reads back the order/test result. (Just repeating back the order/test result is not acceptable. The receiver must write down the order/test result first and then read it back.)
- The individual who gave the order/test result confirms the read-back is correct.
Please note: When orders/test results are not received directly—for example, if they are left on a nurse’s voice mail—then the nurse must call the prescriber or his or her agent back to get the order/test result directly. When orders/test results are received by the patient or family members and there is no evidence of a written order, new prescription, or written test results, the nurse must call the prescriber or his or her agent back to get the order/test result directly. In cases where there is evidence of a new prescription, test result or signed order, there is no need to call the prescriber or physician. The new prescription, order or test result would be appropriately documented in the patient’s medical record.
NPSG 2C will be the subject of the next Ask the expert.
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Margherita Labson, R.N., is the new associate director in the Department of Business Development. Labson is an experienced lecturer and educator, a published author, and is functionally fluent in Spanish. She has been a Joint Commission home care surveyor since 1995. She can be reached at
(630) 792-5284.
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The Joint Commission is hiring home care surveyors. For more information, go to Career Opportunities.
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Home Care: Executive Briefings
September 30, Oakbrook Terrace, Ill.
November 11, Phoenix, Ariz.
Home Care Accreditation Essentials
October 1-2, Oakbrook Terrace, Ill.
November 12-13, Phoenix, Ariz.
To register, call JCR Customer Service at (877) 223-6866, or visit http://www.jcrinc.com/.
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The Joint Commission’s home care team will exhibit at the following conferences:
- Visiting Nurse Association of America, May 1-2, Nashville, Tenn., booth 400
- Medtrade, May 7-8, Long Beach, Calif., booth 2135
- Pennsylvania Association of Medical Equipment Suppliers, May 19-20, Hershey, Penn.
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Debra Zak, Ph.D., R.N., executive director
(630) 792-5742 or dzak@jointcommission.org
Bob Floro, director
(630) 792-5741 or rfloro@jointcommission.org
Margherita Labson, R.N., associate director
(630) 792-5284 or mlabson@jointcommission.org
Richard Cornwell, account executive
(630) 792-5294 or rcornwell@jointcommission.org
Account representative
(630) 792-3007
Standards Interpretation Group
(630) 792-5900
JCR Customer Service
(877) 223-6866
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