On September 25, The Joint Commission hosted a one-day Summit on Medication Reconciliation with the goal to discuss the challenges associated with reconciling medications in various health care settings, to identify best practices, and to bring forth potential refinements to medication reconciliation practices. The Joint Commission co-convened the Summit in collaboration with the American Academy of Family Physicians, the American College of Physicians, the American Medical Association, the American Society of Health-System Pharmacists, the Institute for Healthcare Improvement, the Institute for Safe Medication Practices, the Society of Hospital Medicine, and the United States Pharmacopeia. Approximately 50 professional societies and associations, as well as selected interest groups, participated in the Summit.
The Joint Commission instituted medication reconciliation requirements as part of its 2005 National Patient Safety Goals. Compliance rates for 2006 reveal that Goals 8a (comparing the patient’s current medications to those ordered while under the care of the health care organization) and 8b (communicating the patient’s medications to the next provider of service and giving the medications list to the patient at discharge) have proven to be difficult for many health care organizations to meet. Non-compliance rates for these requirements—18.9 percent for Goal 8a and 14.2 percent for Goal 8b for 2006—remain much higher than desired.
The consensus of the Summit was that the process of medication reconciliation, obtaining an accurate medication list from the patient, and assuring its accuracy throughout the care continuum, improves patient safety. However, more guidance on implementation is required. Additionally, NPSG 8a needs clarification, particularly in regards to the information that should be included on a medication list, the appropriate times and settings for taking medication information (as well as information about allergies, etc.), and how to handle temporary changes to a medication list. Discussion included the process of medication reconciliation, the role of the patient in improving the process, and the barriers to implementation. A document outlining the suggestions of the Summit attendees and next steps is being developed. The Joint Commission will communicate new developments from the Summit in future issues of This Month, Joint Commission Online, and Perspectives. (Contact: Peter Angood, pangood@jointcommission.org)
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The Joint Commission is engaged in the following activities as part of its Standards Improvement Initiative:
- The review and revision of the Infection Prevention and Control, Management of Information, and Improving Organization Performance chapters have been completed. The revised chapters were approved by the Standards and Survey Procedures Committee at its August and October meetings. At its November meeting, the SSP Committee will review proposed changes to the Medication Management, Environment of Care, and Management of Human Resources chapters.
- New improvements to the manuals will include color-coded tabs, graphic icons, an enhanced index, and hard-copy manuals for specific services. Electronic versions of the manuals continue to be developed and would include links as well as capabilities to copy-and-paste and search by key word.
- Refinements continue to be made to the redesign of the manuals. The redesign will result in the renumbering of the standards. The new numbering system will allow organizations to accurately sort standards in the electronic manual and will accommodate the addition of new requirements while preserving a logical flow and minimizing the need for frequent renumbering.
- “Virtual” pilot testing with selected surveyors and Central Office staff helped identify refinements for EPs and areas for surveyor education.
- The scoring and decision model continues to be refined based on the input received from the following groups: the Surveyor Advisory Committee, the Hospital Advisory Council, the Physicians Engagement Group, the Hospital Corporate Liaisons, the Standards Improvement Initiative Accredited Customers Work Group, the Business Advisory Group, the Workgroup on Accreditation Issues for Small and Rural Hospitals. In addition, feedback was solicited from the Centers for Medicare and Medicaid Services, six State Hospital Associations and two State Licensure Agencies.
SII is part of a continuous effort to eliminate non-essential standards and to ensure that the remaining standards are understandable and relevant to the care setting to which they apply. The initiative is limited to changes of current standards; it is not designed to introduce new requirements. Questions and suggestions can be sent to standardsimprovement@jointcommission.org.
SII Timeline
October 2006: The Standards Improvement Initiative was launched. The Joint Commission began seeking feedback through an on-line opinion survey and public comment on standards for the ambulatory, hospital, critical access hospital, home care and office-based surgery accreditation programs.
June 2007: “Virtual” pilot testing with selected surveyors and Central Office staff.
August and October 2007: The Surveillance, Prevention and Control of Infection, Improving Organization Performance, and Management of Information chapters were approved by the Standards and Survey Procedures Committee.
Early 2008: The Joint Commission will begin conducting mock surveys using the improved standards and manuals.
Mid 2008: Target date for completing improvements to the ambulatory, hospital, critical access hospital, home care and office-based surgery accreditation manuals. Final revised standards will be provided to accredited organizations in the affected programs.
January 2009: Improvements to the standards are targeted to go into effect January 2009 for the ambulatory, critical access hospital, home care, hospital, and office-based surgery programs.
(Contact: Carol Gilhooley, cgilhooley@jointcommission.org)
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The Joint Commission officially announced its new Disease-Specific Care Program for chronic obstructive pulmonary disease management. The Joint Commission is accepting applications from organizations interested in achieving this advanced certification. The fourth leading cause of death in America, COPD typically refers to two lung diseases, chronic bronchitis and emphysema, that interfere with normal breathing. Developed in collaboration with the American Lung Association, The Joint Commission’s new certification program requires meeting standards and performance measurement requirements. Advanced certification in COPD care recognizes exceptional clinical programs that utilize performance improvement to optimize the quality of care provided to these patients. The American Lung Association reports that more than 11 million U.S. adults are estimated to have COPD, which is a major cause of hospitalization in the older population. The Joint Commission’s and the American Lung Association have focused this certification program on promoting successful efforts in COPD management which include:
- A standard method of delivering or coordinating care.
- Implementation of evidence-based clinical practice guidelines.
- Encouraging sharing information across settings and providers, while safeguarding patient rights and privacy.
- A comprehensive performance improvement program which uses outcomes data to continually enhance existing treatment plans and clinical practices.
- Clinical practices which support patient’s self-management activities.
(Contact: Jean Range, jrange@jointcommission.org)
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The Joint Commission Board of Commissioners announced the addition of an initial set of seven hospital outpatient measures to its current complement of core measure sets that may be used to satisfy ORYX performance measurement requirements. The hospital outpatient measures are listed in the Centers for Medicare and Medicaid Services (CMS) Outpatient Prospective Payment System (OPPS) Calendar Year 2008 Proposed Rule, and are to be used by hospitals in meeting the requirements set forth in the Tax Relief and Health Care Act of 2006 (Section 109). The new federal reporting requirement for hospital outpatient measures is intended to be complementary to, and modeled after, the current Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU). See the complete news release. (Contact: Jerod Loeb, jloeb@jointcommission.org)
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The Joint Commission announced this year’s organization and individual recipients of the 11th Annual Ernest Amory Codman Award to recognize excellence in the use of outcomes measurement to achieve improvements in the quality and safety of health care. The Codman Award, established in 1996, is the first national health care award that recognizes excellence in performance measurement. The award recipients in the following categories are:
- Behavioral Health Care: Addiction Treatment Services of Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
- Hospital: Broward General Medical Center, Fort Lauderdale, Florida; Christiana Care Health Services, Wilmington, Delaware; and Saint Joseph Healthcare, Lexington, Kentucky.
- Long Term Care: Sea View Hospital Rehabilitation Center and Home, Staten Island, New York.
- Multiple Organization: Seton Family of Hospitals, Austin, Texas.
- Individual: John E. Wennberg, M.D., M.P.H., director of the Center for Evaluative Clinical Services at Dartmouth Medical School in Lebanon, New Hampshire.
See the news release. (Contact: Teena Wilson, twilson@jointcommission.org)
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In a unique display of international patient safety collaboration, the top health leaders from Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States met on November 1 in Washington, D.C. to sign a letter of intent to support efforts to advance the global patient safety agenda through engagement in a special World Health Organization (WHO) Action on Patient Safety Initiative. The collaborative initiative, known familiarly as the High 5s Project, seeks to improve the safety of patients around the world. The Project is being coordinated by the WHO Collaborating Centre, which is led by The Joint Commission and Joint Commission International, in partnership with the WHO World Alliance for Patient Safety and the Commonwealth Fund. The centerpiece of the High 5s Project involves the development and implementation of standardized operating protocols (SOPs) to address five widespread patient safety problems in the participating countries and elsewhere. The SOPs will seek to:
- Promote effective management of concentrated injectable medicines.
- Assure medication accuracy at transitions in care.
- Improve communications during patient care handovers.
- Assure performance of the correct procedure at the correct body site.
- Promote improved hand hygiene to prevent healthcare-associated infections.
Four of the five SOPs have been finalized and approved by the participating countries. The fifth will be finalized within the next month. Once in place, the SOPs are expected to have broad impacts in preventing avoidable deaths and serious injuries in hospitals. The Project also involves the elaboration of a sophisticated impact evaluation strategy that will assess not only the degree to which patient safety vulnerabilities have been eliminated but also the economic and cultural impacts of the SOPs at the hospital level. Project implementation is targeted for late summer of 2008, with the expectation that its impacts will be assessed over a five-year period. Volunteer hospitals will be invited to share their experiences and lessons learned with each other over time through an electronic learning community. It is anticipated that the learning experience will lead to continuing refinements to the SOPs over the project period. More information about the High 5s project is at http://www.jcipatientsafety.org/. See the complete news release. (Contact: Karen Timmons, ktimmons@jcrinc.com)
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The Joint Commission announced that its Division of Quality Measurement and Research will study how rapid tests for influenza are implemented in outpatient medical settings including solo and group practice physician offices, community health centers, and acute care hospital emergency departments throughout the United States. The study is funded by a cooperative agreement from the U.S. Centers for Disease Control and Prevention. Nancy Kupka D.N.Sc., M.P.H., R.N. is the Principal Investigator. Influenza kills approximately 36,000 people in the United States each year. Rapid diagnostic tests have been developed to test for influenza outside of the clinical laboratory. However, the current extent and quality of testing for influenza outside the clinical laboratory is unknown, especially in places such as physicians’ offices, emergency departments and community health centers. This project will examine outpatient settings that have adopted the use of rapid tests for influenza, including the types of rapid tests in use and how they are selected; the training and competency of individuals performing testing; the extent to which good laboratory practices and testing guidelines are being followed; the impact of use of the rapid tests on antiviral and antibiotic prescribing practices; and the perceived advantages and disadvantages of using rapid influenza testing. This study is completely independent from The Joint Commission accreditation process.
The Joint Commission will convene a technical advisory panel to assist with the study, composed of public health officials and representatives from the following professional associations: The American Public Health Association, American Medical Association, National Association of Community Health Centers, American College of Physicians, American College of Emergency Physicians, American Academy of Pediatrics, American Academy of Family Physicians and the Association of Public Health Laboratories. The Joint Commission requires accredited organizations to meet both federal Clinical Laboratory Improvement Amendment of 1988 (CLIA) requirements and Joint Commission standards regarding the use of waived tests such as rapid influenza tests. See the complete news release. (Contact: Stacey Champagne, schampagne@jointcommission.org)
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The Joint Commission expanded pilot testing of its WikiHealthCare™ application to include a collaborative approach to the development of accreditation and certification standards. Publicly launched in June, this free, Internet-based collaborative forum can be accessed at http://wikihealthcare.jointcommission.org, and there are now more than 2,800 registered users. Patient care providers, health care administrators, researchers and other health care professionals are able to collaborate with each other to provide input at the beginning stages of standards development. Participants can engage in discussions about emerging issues pertaining to different types of service settings, help determine how standards might be applied to address those issues, and suggest the performance requirements that should be used to measure compliance with those standards. The Joint Commission will use this collective input when developing accreditation or certification standards. The first issues to be considered on the site are:
- The transfer of health information.
- Pharmacist review of protocols for contrast agents in radiology.
- How health care services can be provided using the concepts of clinical microsystems and client-centered care.
(Contact: Scott Williams, swilliams@jointcommission.org)
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The Joint Commission’s CEO opinion survey of accredited organizations and programs includes questions about the benefits of Joint Commission accreditation and the accreditation process. The survey is conducted quarterly by telephone with CEOs and by mail with other representatives of organizations following their on-site survey. For the second quarter of 2007, survey questions revealed the following ratings as excellent, very good and good:
Overall survey experience—95 percent
Overall value of accreditation to the organization—93 percent
Likelihood of re-applying for accreditation—97 percent
Likelihood of recommending Joint Commission accreditation—93 percent
Engaging physicians in the survey process—86 percent
Fostering a culture of continuous operational improvement—96 percent
Providing a meaningful assessment of an organization’s strengths and weaknesses—93 percent
Reducing costs associated with survey preparation and consulting—73 percent
Relevancy of standards to providing safe, high-quality care—92 percent
Enhancing the educational benefits of an on-site survey—91 percent
Customer service—93 percent
(Contact: Chuck Mowll, cmowll@jointcommission.org)
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