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Tuesday 2:46 CST, September 26, 2017

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Ambulatory Buzz

RSS Feed RSS By: Michael Kulczycki, Executive Director, Ambulatory Health Care

Information on all things ambulatory from The Joint Commission

Let’s Make Dialysis Safer – Together!

Sep 20, 2017 | Comments (0) | 264 Views

17.AHC_KristenBy Kristen Witalka
Senior Business Development Specialist
Ambulatory Care Services 

The Joint Commission as an organization makes a special effort to partner with like-minded organizations to improve disease care. At the ambulatory care level, we work with state and national associations on specific disease interventions. One of the most rewarding partnerships has been the “Making Dialysis Safer for Patients Coalition” with The Centers for Disease Control and Prevention (CDC). Part of the magic of this campaign is visible in the raw numbers. According to CDC data: 

  • approximately 37,000 bloodstream infections occurring each year among dialysis patients with central lines

  • estimated individual cost per hospitalization = $23,000 

  • currently, there are 400,000+ people undergoing hemodialysis care and at risk of serious infection 



The Joint Commission is positioned to hasten the interventions that can bring these numbers down. The good news is, you too can help bring about this change by joining with us on the “Making Dialysis Safer for Patients Coalition.”

We chose this particular coalition because of its set of core interventions that have been proven to reduce the number of dialysis bloodstream infections by half and be sustainable. Our executive director of ambulatory care, Michael Kulczycki, spoke in a recent podcast about the value this joint venture brings to ambulatory care organizations.

Membership Benefits
The CDC has also developed a set of audit tools, checklists, and other resources to help facilitate adoption of these critical core interventions. The “Making Dialysis Safer for Patients Coalition,” a collaboration of diverse organizations, aims to facilitate dialysis-specific core intervention implementation and adoption, increase awareness and share experiences and findings. These core interventions relate to a broad range of topics under the kidney care and infection prevention umbrella, including:

  • hand hygiene observations

  • catheter care toolkit

  • injection safety tools

  • AV fistula and graft cannulation

Patient education resources are available in English and Spanish on a wide variety of topics, including:

  • environmental surface disinfection for clinical managers of dialysis facilities

  • hemodialysis central venous catheter scrub-the-hub protocol

  • complete set of prevention tools including checklists and audit tools for catheter connection and disconnection, arteriovenous fistula and graft cannulation and decannulation, dialysis station routine disinfection and more

Kidney Care / Dialysis Applicability Grid
To further simplify matters from an ambulatory care point of view, the ambulatory care program has created an applicability grid specific to kidney care/dialysis providers that displays the standards relevant to the Kidney Care /Dialysis setting (locate ‘Kidney Care/Dialysis’ on the list and scroll down to that setting type). 

We encourage you to consider adopting the interventions of the “Making Dialysis Safer for Patients Coalition." We welcome the opportunity to collaborate with you! 

I’d like to hear your thoughts regarding our new collaborative effort with the CDC. Please contact me at

Get “The E Factor” at the Annual Ambulatory Care Conference: Oct. 18-19, 2017

Sep 06, 2017 | Comments (0) | 444 Views

17.AHC_Craig_DeaoBy Craig E. Deao, MHA
Senior Leader & National Speaker
The Studer Group

Today, engagement isn’t optional for those who work in healthcare or for the patients who seek their care. Unprecedented change is disrupting the health care industry; the only way we can hope to successfully navigate it and achieve our clinical quality goals is through 100 percent commitment among stakeholders.

That’s precisely what I’ll be discussing October 18 at The Joint Commission’s 2017 Annual Ambulatory Care Conference in Rosemont, IL. The title of my talk is borrowed from the name of my recent book: “The E Factor: How Engaged Patients, Clinicians, Leaders, and Employees Will Transform Healthcare”.



Why Satisfaction Is Necessary, But Insufficient
How is engagement different from satisfaction? And from patient experience, for that matter? While all three are valid measures of how patients rate care, they measure different things. It turns out that engagement is the least measured of the three, but the most important. Why? Because it correlates most closely with the clinical outcomes that matter most, both for patient health and, increasingly, your ambulatory care organization’s bottom line.

I’ll be sharing examples of how leading organizations are measuring engagement and how those findings are shaping the future of healthcare by creating more value, through hardwiring a “Culture of Always” where people are committed to doing the job right. Every time.

Living the Standards
Talking about Standard X.XX doesn’t inspire or motivate. What people in your organization care about is their ability to deliver safe, quality care to every patient every time. That’s why the words and body language you choose are mission-critical to engaging individuals in the limited time you have with them. 

Engagement is also about connecting to both the heart and the head… whether you’re a surveyor or an ambulatory care leader trying to motivate people to consistently live the standards. Ultimately, engagement is about building trust by connecting during every interaction. 

The #1 Most Powerful Way to Build Patient Engagement (and It’s Easy!)
The best way to build patient engagement is by demonstrating expertise and empathy. Remember the old adage, “Nobody cares how much you know until they know how much you care?” It’s true.

Capture33I’ll share a number of ways to build engagement, but the most effective is also the simplest and one you can implement in your organization right now. Here it is: When clinicians sit next to a patient during a visit rather than stand, patients perceive that the clinician has spent more time with them. Researchers in a study (see chart below) found that the average patient with a sitting provider perceived the visit lasted three and one-half minutes longer than it actually did. But not just that. The patients in the study reported: 

  • Higher satisfaction

  • Stronger adherence to medical advice

  • Lower costs

  • Better clinical outcomes 

It’s a simple way to engage patients effectively for no extra cost.

Additional Conference Highlights
My talk on patient engagement is just one part of a robust clinical topic line-up at The Joint Commission’s 2017 Annual Ambulatory Care Conference:

  • Update and insights on Project REFRESH

  • Changes impacting Environment of Care (EC) and Emergency Management (EM) and Infection Control

  • The critical role of human factors in patient safety

  • Specific tracks focused on medical, dental, episodic, surgical, diagnostic or therapeutic settings

I recommend you hear what previous conference attendees have to say about this important conference! 

Click here to visit our website and register for the 2017 Annual Ambulatory Care Conference today. 


New Medication Management Standards Effective Jan. 1, 2018

Aug 23, 2017 | Comments (0) | 1119 Views

17.AHC_PodgornyBy Kelly Podgorny, DNP, RN
Project Director
Department of Standards and Survey Methods

The Joint Commission’s updated medication management (MM) standards are effective January 1, 2018, for all accredited ambulatory care organizations and office-based surgery practices. The intent of the update is to assure the standards continue to reflect evidence-based practices and quality and patient safety issues that emerged from the healthcare field in recent years. During the review by staff from our Department of Standards and Survey Methods (DSSM) it was determined some additions and revisions were also needed for the Environment of Care [EC] and Record of Care, Treatment, and Services [RC] standards. 

The Joint Commission conducted a field review of all proposed revisions pertaining to medication management during September and October 2016. These final standards changes require organizations to take the following actions:

  • Implement a policy to provide emergency backup for essential medication dispensing equipment identified by the organization
  • Implement a policy to provide emergency backup for essential refrigeration for medications as identified by the organization
  • Add “wasting” of medications to the required written policy addressing the control of medications between when they are received by an individual health care provider and when they are administered
  • Implement a policy that describes the types of medication overrides that will be reviewed for appropriateness and the frequency of the reviews when automatic dispensing cabinets are used
  • Record, in the patient’s clinical record, the date and time of any medication administered.

Emergency Back-Up Policies
Essential back-up power is highly relevant for ambulatory settings and is addressed in two separate EPs (see the first two bullets above). Both requirements are found in the EC chapter and mandate that organizations establish a policy to provide emergency back-up for medication dispensing equipment and refrigeration of essential medications. There is no specific direction on the content of the policy, but organizations must document how they will provide emergency back-up for essential medication dispensing equipment and essential refrigeration for medication identified by the organization.

Appropriate Medication Overrides
Ambulatory care organizations also must be aware of MM.08.01.01, regarding the review of overrides. Per the new EP 16 for Standard MM.08.01, the organization must have a policy regarding the type of medication overrides that will be reviewed for appropriateness and frequency of reviews when using automatic dispensing cabinets. Note - a one hundred percent review of overrides is not required. 


Defining “Signed and Held” Orders
Lastly, ambulatory care providers should be familiar with the new type of medication order that was added to the examples in Standard MM.04.01.01, “signed and held orders.” A "signed and held order" is a medication order with specific instructions from a licensed independent practitioner to administer the medication to the patient in a clearly defined circumstance that becomes active upon the release of the order on a specific date(s) and time(s). In the ambulatory care setting, this may apply to patients transferred from ambulatory care to a different setting, who have an order for a medication to be administered upon arrival at the new setting. 

According to Joyce Webb, RN, Ambulatory Care program project lead at the Joint Commission, “These revised and updated medication management standards support the provision of safe and effective medication management in ambulatory care organizations.” 

While these are the most pertinent updates for ambulatory care organizations that reflect the latest evidence based research, more medication management standards are available for all settings. The pre-published version of the revisions and updates to the medication management chapters can be found on The Joint Commission’s website.

For more information regarding the new medication management revisions, please contact Kelly Podgorny, DNP, RN, project director, at

Making Ambulatory Surgery Safer

Aug 09, 2017 | Comments (0) | 1922 Views

Castro_PhotoBy Gerard M. Castro, PhD, MPH
Project Director, Patient Safety Initiatives
The Joint Commission 


17.AHC_Melissa_MillerMelissa Miller, MD, MS
Medical Officer, Division of Healthcare-Associated Infections, Center for Quality Improvement and Patient Safety
Agency for Healthcare Research and Quality

More than 23 million surgeries are performed annually in U.S. ambulatory surgery centers (ASCs). It is likely that this number will continue to increase as more and more procedures are being performed in ASCs rather than hospital settings. 

While the overwhelming majority of ASC procedures are done safely and without incident—as with surgeries in any health care setting—complications can result. These include healthcare-associated infections (HAIs), such as surgical site infections (SSIs) and other safety problems.

The Joint Commission and the Agency for Healthcare Research and Quality (AHRQ), the nation’s patient safety agency, have long been committed to keeping patients safe from harm by helping ASCs and other types of providers address these risks. That’s why The Joint Commission has developed goals that focus on common problem areas and why AHRQ has developed a new toolkit specifically designed to help ASCs reduce patient harm that can result from those problems.

The more than 2,100 freestanding ambulatory care organizations accredited by The Joint Commission are required to comply with rigorous standards and National Patient Safety Goals (NPSGs) that focus on problems in the ambulatory setting and how to solve them, including those related to: 

  • identifying patients correctly
  • using medicines safely
  • preventing infection
  • preventing mistakes in surgery

New Toolkit Offers Guidance
AHRQ’s new “Toolkit to Improve Safety in Ambulatory Surgery Centers” can help Joint Commission-accredited ambulatory care organizations adhere to these NPSGs. The toolkit, developed as part of a national implementation project, is based on the core concepts of AHRQ’s Comprehensive Unit-based Safety Program (CUSP) — a multifaceted approach combining improved teamwork, communication and patient safety culture that speeds frontline clinicians’ adoption of evidence-based practices to reduce harm. CUSP has been used in hospitals and long term care facilities to significantly reduce infections and other patient harms.


The toolkit combines proven practices with insights from staff experiences at more than 650 ASCs across the country. Through a step-by-step implementation guide, ASC staff learn how to use an ASC-specific safe surgery checklist and other interventions to improve care. Topics in the toolkit cover:

  • teamwork and communication
  • coaching clinical teams
  • patient and family engagement
  • sustainability

Unique Resources Available 
Several resources are available in the toolkit, including PowerPoint presentations, videos, facilitator notes and checklists. These materials are uniquely fashioned for the ASC setting, but are customizable to ensure they reflect facility-specific needs. A patient brochure “Getting Ready for Your Ambulatory Surgery” also is available to help patients know what to expect before, during and after surgery.  

All patients deserve to receive the safest and highest quality care whether in the ambulatory or another health care setting. We hope your ASC will join The Joint Commission and AHRQ in working toward this goal by making the more than 23 million surgeries performed in ASCs safer. 

We’d love to know your thoughts on this toolkit. Please feel free to email and let us know how we can further help to reduce harm. 

Keys to Better Environment of Care Compliance with EC.02.06.01 – Part 2

Jul 26, 2017 | Comments (0) | 2601 Views

By Kathy Tolomeo
Engineer, Standards Interpretation Group
The Joint Commission

Our previous posting of AmBuzz  addressed many challenges of EP.02.06.01 and provided insights to increase both your awareness and compliance efforts with the wide-ranging EPs associated with EC.02.06.01. Let’s take a look at this important EC standard from the point-of-view of our surveyors.

Surveyor Scrutiny

As noted previously, EC.02.06.01 and its accompanying EPs are receiving increased attention from ambulatory care surveyors. Since 2016, Life Safety Code (LSC) surveyors have been added to most ASC surveys for one day. These LSC surveyors have focused on EP 1 of this standard, due to the wide array of issues it addresses, for example:

  • stained ceiling tiles
  • damage to furniture or equipment that would prevent proper cleaning
  • nurse call pull cords in patient bathrooms that are not properly installed

The good news is that compliance with EC.02.06.01 is now easier, thanks to Project REFRESH, an ongoing Joint Commission initiative that aims to improve consistency in standards interpretation, as well as enhancing and streamlining the post-survey process. In this more streamlined format, EC.02.06.01, EP 13 has been moved and reworded to fit within EC.02.05.01 as the new EP 16.

Many observations that were scored in the past at EP 1 today have their own unique standards that went into effect earlier this year. Because frequently cited items from EP 1 are now part of their own standard, we’re looking forward to easier compliance. It will also allow ambulatory care organizations to identify problematic items and proactively address them.

Five Strategies for Improved Compliance

The following measures can help your ambulatory care organization create a safer environment and, in turn, better adhere to EC.02.06.01 and its associated EPs. Here are five steps you can take to pave the road to EC standards compliance:

1. Conduct risk assessments. Examples of hazards to assess include:

  • appropriate handwashing facilities
  • unsecured equipment and supplies
  • poor room design and maintenance

2. Improve rounding and environmental tours. Constant self-assessment is the key here. The American Society for Healthcare Engineering (ASHE) has published a tool offering concrete “how-to’s” on environment of care rounding.

3. Refer to important codes and guidelines. Examples include NFPA 99—The Health Care Facilities Code (2012 edition), the Facility Guidelines Institute’s Guidelines for Hospitals and Outpatient Facilities, 2014 edition, and recommendations provided by ASHE.

4. Take advantage of Joint Commission’s EC tools. The Joint Commission has created extensive multimedia resources focused on this standard, including these two videos – take a look:

EC.02.06.01 Leadership 

EC.02.06.01 Clinical Impact

The Standards Interpretation Group has also created a Physical Environment Portal  which provides an array of insights regarding Life Safety Code and other crucial areas in your organization.

5. Remember our intent. We understand it can be frustrating that specific safety hazards aren’t identified in the standard, but we assure you The Joint Commission isn’t out to confuse you. We simply aim to prevent deficiencies that compromise patient and staff safety in your ambulatory organization’s physical environment.

For questions regarding this or any other ambulatory care standards, we encourage you to check the Standards Interpretation Group (SIG) FAQs or reach out to SIG staff directly at 630.792.5900, x3.