Stephen A. LaTour, Ph.D., has been named Chair of the MS.1.20 Implementation Task Force. LaTour is president of Calder LaTour Inc., a firm specializing in strategy and research with a focus on health care. Two new members have joined the task force, bringing the membership to 19: Paul A. Gitman, M.D., from New York, and Jay A. Gregory, M.D., from Oklahoma. A subcommittee has been assigned to identify options for resolving the main issues concerning the implementation of revised standard MS.1.20. Implementation issues have been raised by the member hospitals of the American Hospital Association and the Federation of American Hospitals, among others. The subcommittee will present options for discussion by the task force at its next meeting on May 7. (Contact: Lynn Berry, lberry@jointcommission.org)
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Hospitals, critical access hospitals and long term care facilities have expressed to The Joint Commission that it is taking a longer time to implement some of the new requirements of the Emergency Management standards that were effective in January 2008. These requirements call for the involvement of the community in organization plans and response efforts during disasters.
In order to allow more time for organizations to implement these standards, The Joint Commission will allow the following through 2008: the new requirements will be surveyed, non-compliance will be cited in an organization’s survey report, and the organization will need to address the non-compliant standards in its Evidence of Standards Compliance. However, non-compliance will not be included in the count of non-compliant standards contributing to either a Preliminary Denial of Accreditation or Conditional Accreditation decision. The following Elements of Performance in the Environment of Care chapter would not count toward the accreditation decision:
EC.4.11 EP 9, 10 EC.4.12 EP 6
EC.4.13 EP 7 EC 4.14 EP 8, 10
EC.4.15 EP 2, 3, 5 EC.4.16 EP 2, 3
EC.4.17 EP 4 EC.4.18 EP 4, 5, 6
(Contact: Gail Weinberger, gweinberger@jointcommission.org)
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On January 1, 2009, several positive changes will take effect for accredited organizations. Some changes are a result of the Standards Improvement Initiative (SII) and others are due to ongoing improvements to the accreditation process. This section highlights these changes, why they are being made, and how they will impact accredited organizations.
The 2009 program manuals will be available electronically as “E-ditions” beginning in November 2008. Along with the customary free copy of the comprehensive print manual, organizations will receive a free E-dition (i.e., single user license). The free single-user license E-dition can be upgraded to a site license (unlimited concurrent users per site) for a fee. E-ditions will be accessible via the Internet with login and password. More information about the E-ditions, including how organizations will receive them, will be available in September. In response to field demand, key E-dition features include:
- Easy navigation to the standards. Three ‘clicks’ to reach any standard with its full description, rationale, and elements of performance with scoring criteria.
- Easy navigation to historical crosswalks. Links between the 2008 and 2009 standards to ease the transition to reorganization and renumbering of the standards.*
- Keyword search capability across one or more manuals.
- Applicability filters to show only those standards that apply to a particular health care setting (e.g., ambulatory care organizations offering diagnostic/therapeutic imaging).*
* For Phase 2 programs (behavioral health, laboratory, long term care) these features will be available in the 2010 E-ditions.
In July, prior to the launch of the E-ditions, The Joint Commission website will provide the 2009 standards in PDF (portable document format) for the ambulatory, critical access hospital, home care, hospital, and office-based surgery programs. An extensive, historical crosswalk in PDF will also be posted with the standards to help with the transition to the new numbering system. These PDFs will be available on the website until the print manuals are published in September 2008. As a reminder, SII is limited to changes of current standards; it is not designed to introduce new requirements. The changes include clarifications to the language, deletions of duplicative information, reorganization and renumbering. (Contact: Carol Gilhooley, cgilhooley@jointcommission.org or Sara Randall, srandall@jcrinc.com)
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Medications specifically made for adults and administered to children in health care facilities are putting young patients at greater risk for drug errors, according to a Joint Commission alert issued to improve pediatric safety. The Joint Commission’s latest Sentinel Event Alert addresses pediatric medication errors, and urges greater attention to precautions such as medication standardization, improved medication identification and communication techniques, as well as the use of kilograms as the standard weight measurement to calculate proper dosages. Most of the harmful pediatric medication errors tracked during the past two years by U.S. Pharmacopeia involved either an improper dose or quantity, according to the Alert. Problems typically arise when hospitals and clinics are forced to prepare special volumes or concentrations because the drugs are formulated and packaged primarily for adults. The need to alter the original medication dosage requires a series of calculations and tasks that increase the chance for error.
To reduce the risk of pediatric medication errors, The Joint Commission’s Sentinel Event Alert suggests that health care organizations take a series of specific actions, including:
- Use the Joint Commission’s National Patient Safety Goals and Medication Management Standards to guide safe medication practices for pediatric patients.
- Weigh all pediatric patients in kilograms, which then becomes the standardized weight used for prescriptions, medical records and staff communication.
- Do not dispense or administer drugs classified as high risk until the patient has been weighed, unless it is an emergency situation.
- Require prescribers to write out how they arrived at the proper dosage, as dose per weight, so that the calculation can be double checked by a pharmacist, nurse or both.
- Use pediatric-specific medication formulations and concentrations when possible.
The Alert also encourages organizations to be open and transparent if an error occurs in order to facilitate learning so that future errors can be prevented; drug manufacturers to develop pediatric-specific formulations and to standardize labeling and packaging of all medications; and parents to seek out information and ask questions about their child’s medications and to repeat back instructions to health care professionals in order to avoid mix-ups. The Alert is available online. (Contact: Peter Angood, pangood@jointcommission.org)
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Understanding the often complex medical information your doctor or other caregivers give to you can be difficult, and the consequences of misunderstanding this information can be life threatening. The Joint Commission launched a national campaign to help Americans prevent health care errors by promoting “health literacy” – the ability of patients to obtain, process and understand the basic information and services needed to make appropriate decisions regarding their health. The new education campaign is part of The Joint Commission’s award-winning national Speak Up™ program that helps patients become more informed and involved in their health care. For patients who may have difficulty comprehending the information needed to make important decisions about their care, navigating the health system can be daunting. Complex forms, conversations with doctors, medication instructions, and coping with a real or perceived lack of attention from hospital personnel all place high demands on patients. Factor in the growing number of people who must manage one or more chronic health conditions, such as hypertension, coronary artery disease or diabetes, and the impacts of health literacy are profound. “Understanding Your Caregivers” offers patients questions and answers that will help them to better understand the care they receive. The brochure is available online. (Contact: Cathy Barry-Ipema, cbarry-ipema@jointcommission.org)
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As the face of America continues to change, a research report released today by The Joint Commission, entitled “One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations,” urges health care organizations to assess their capacity to meet patients’ unique cultural and language needs. In its 2001 report “Crossing the Quality Chasm,” the Institute of Medicine identified patient-centered and equitable care as important elements of quality. The “One Size Does Not Fit All” report is based on successful practices now being used in hospitals, and underscores the need to move away from a “one size fits all” approach that negatively affects the quality and safety of care for diverse patients. The report includes a self-assessment tool that can help health care organizations tailor their initiatives to meet the needs of diverse populations. The tool addresses the main issues found in the report and provides a framework for discussing needs, resources and goals for providing the highest quality care to every patient served. The report is the result of an ongoing multi-year research study, “Hospitals, Language, and Culture: A Snapshot of the Nation,” supported by funding from The California Endowment. This study provides the first comprehensive examination of how hospitals across the United States respond to the diverse cultural and language needs of their patients. The complete text of “One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations,” is available online.(Contact: Amy Wilson-Stronks, awilson-stronks@jointcommission.org)
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New compliance data for the National Patient Safety Goals through the third quarter of 2007 is available online. The data was derived from surveys conducted at 5,447 health care organizations from January 1 to September 30, 2007. (Contact: Pat Adamski, padamski@jointcommission.org)
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Quality Reports® for Joint Commission certified disease-specific care programs and for certified health care staffing firms are now available on the Quality Check™ website, www.qualitycheck.org. For disease-specific care programs, Quality Reports feature a user-friendly format to help individuals compare programs in a number of key areas and include:
- Certification decision and effective date
- Requirements for Improvement in the event of an adverse certification decision
- Last full review and last on-site review dates
- Demographic information
- Certified locations of care
- National Patient Safety Goal compliance (as applicable)
- Commentary (optional)
Information for health care staffing firms includes all of the above except NPSG compliance. Searches can be conducted by name, zip code or state. (Contact: Dawn Allbee, dallbee@jointcommission.org)
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The National Quality Improvement Goal (NQIG) data for hospitals has been updated on Quality Check™, www.qualitycheck.org. New data is included on Pneumonia Care measure 5c/14454 (Initial Antibiotic Received Within 6 Hours of Hospital Arrival). Updates are included for Children’s Asthma Care (CAC) measures and for CMS (Centers for Medicare & Medicaid Services) 30-Day Mortality measures. The mortality measure data reported is for heart attack and heart failure discharges from July 2005 through June 2006. (The data file was last updated by CMS on December 11, 2007. The Joint Commission will continue to update its NQIG data quarterly and will include the most recently available CMS mortality data file.) (Contact: Dawn Allbee, dallbee@jointcommission.org)
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