Offsite (Formally Virtual) Survey and Review Framework: A New Approach for Conducting Surveys and Reviews During the Pandemic
More information on what you can expect:
- Podcast: Take 5: Discussing Offsite Surveys from The Joint Commission
- Video: How Do Surveys Work Virtually?
- Video: What Are the Benefits of an Offsite Survey?
- Video: How Do I Prepare My Tech for an Offsite Survey?
- Video: Your Guide to Offsite Surveys: A message from colleagues and surveyors
- Infographic: Offsite Survey
- Putting COVID-19 Numbers and Vaccinations into Context
- CDC Vaccine Recipient Education
- US Pharmacopeia COVID-19 Vaccine Handling Toolkit
- FDA COVID-19 Vaccines
Educational Videos about Vaccination and the COVID-19 Vaccine
CDC and National Alliance of Healthcare Purchaser Coalitions:
- COVID-19 VACCINE: Get the Facts (No translation)
- COVID-19 VACCINE: Get the Facts (Spanish translation)
- The History of Vaccines (No translation)
- The History of Vaccines (Spanish translation)
- Trusting Vaccines (No translation)
- Trusting Vaccines (Spanish translation)
Resources related to personal protective equipment:
Face Mask Posters and Infographics
- Poster - Wear a Mask (black and white, printer friendly)
- Poster – Wear a Mask (color)
- Infographic – Do’s and Don’ts for Health Care Staff Wearing Face Masks
- Infographic – Aerosol Generating Procedures
Videos - Consistent with CDC recommendations as of March 24, 2020
- The Joint Commission: Removing (Doffing) a Disposable Gown and Gloves with Rationale
- Rush University Medical Center: Step by Step Donning and Doffing: Reusable Gown, N95 Respirator, Goggles or Face Shield
As of March 24, 2020, CDC recommends:
- Contact Plus Droplet plus Eye Protection when providing routine care to known or suspected COVID-19 patients.
- Airborne Plus Droplet plus Eye Protection when performing aerosol generating procedures on known or suspected COVID-19 patients.
These videos provide an example using disposable gowns. It is essential that the instructions to employees take into account the specific PPE the facility is using (e.g., reusable versus disposable gown, N95, PAPR, or surgical mask, goggles, glasses with side shields, or faces mask) being used as well as the physical layout (e.g., ante-room, no ante-room, multiple patient room) and how the organization is utilizing the PPE (e.g., single use, reuse, or extended use).
Combinations of PPE should be considered. For example, if practicing extended use of N95 respirators (recommended by NIOSH) the organization should consider using face shields that will protect the respirator from splashes or splatters and prevent staff from inadvertently touching surfaces of the respirator while in use.
CDC Guidance on Managing Critical Shortages
CDC Guidance on Optimizing the Supply of PPE During Shortages
- Summary Strategies to Optimize the Supply of PPE during Shortages
FDA Guidance on Managing Critical Shortages
- Conservation of Gloves
- FDA Recommends Transition from Use of Decontaminated Disposable Respirators - Letter to Health Care Personnel and Facilities
Note: In reviewing FDA guidance on strategies to conserve gloves, you need to know what type of gloves you use in your facility (e.g., latex, vinyl and nitrile). It is safe to use alcohol-based hand rub on latex and nitrile gloves. But the FDA states that alcohol is not recommended for cleaning vinyl gloves because it may degrade them.
Guidance related to ventilators:
There are intensive efforts underway across the country to try to ensure that the supply of ventilators in the U.S. will be adequate to meet the needs of all COVID-19 patients requiring one. Healthcare leaders and clinical directors should review the FDA’s guidance and the other resources below on mitigation strategies when facing ventilator shortages.
If Shortages Occur Despite Mitigation Strategies
Even with these mitigation strategies, the possibility remains that shortages will occur, and clinicians and healthcare leaders will face the decision of whether to place two patients with COVID-19 on a single ventilator. Experts have differing opinions about whether ventilator sharing can be done safely and effectively. The Joint Commission does not endorse any position because there is not sufficient evidence to guide us. In such situations, we usually remain silent, but we think it is important to provide resources for those who might be facing this difficult decision.
The Society of Critical Care Medicine, in partnership with several other organizations, advises clinicians to not attempt to share mechanical ventilators because it cannot be done safely: “Attempting to ventilate multiple patients with COVID-19…could lead to poor outcomes and high mortality rates for all patients cohorted. …it is better to purpose the ventilator to the patient most likely to benefit than fail to prevent, or even cause, the demise of multiple patients” (March 2020).
However, SCCM’s Mechanical Ventilator Strategies page also included a section labeled “When You’re Out of Options” which provided links to resources for mechanically ventilating two patients with a single ventilator in crisis situations.
Other organizations have drawn different conclusions and have provided advice on how to set up systems to share ventilators in March/April 2020:
- ECRI: Video on setting up mechanical ventilator sharing
- FEMA: Co-Ventilating Patients During a Critical Ventilator Shortage
- Greater New York Hospital Association (GNYHA)/NY Presbyterian: Ventilator Sharing Protocol (version 3)
More recently, the FDA released a letter to Health Care Providers in February 2021, containing the following text and a link to the most current version of the GNYHA/NY Presbyterian Ventilator Sharing Protocol (version 6):
The FDA is informing health care providers and health care facilities about up-to-date information concerning multiplexing ventilator tubing connectors, also known as ventilator splitters, in situations in which no alternatives for invasive ventilatory support are available. Although the FDA has not received any adverse event reports related to the use of ventilator splitters authorized for emergency use during the COVID-19 pandemic, recent literature describes risks that may be associated with using certain ventilator splitters. After considering this recent literature, the FDA is informing health care providers and health care facilities that the literature indicates that certain features are associated with better performance.
High Flow Nasal Oxygen
- Some patients can be effectively managed on nasal oxygen including high flow, but the risk of aerosolization should be considered and managed. The use of high‐flow nasal oxygen in COVID‐19
- An FAQ from the ASA says that if patient oxygenation is not maintained on low-flow oxygen, higher oxygen flows may be unexpectedly needed that might increase aerosolization of COVID-containing respiratory secretions. Each patient will need to be evaluated on a case-by-case basis to consider the balance of aerosolization at the oxygen flow needed to maintain a satisfactory oxygen saturation, and whether to convert to a more closed airway system (LMA or ETT). How should I deliver supplemental O2 to a patient who is wearing a mask and who has or may have COVID-19? (View under Clinical Care section)
FDA Guidance
Other Guidance
- ECRI: Using Anesthesia Units for Patient Ventilators Webinar
- ECRI: Safety of Extended Use and Reuse of N95 Respirators
- ASA: Intubation in Covid-19 Patients
- ASA/APSF: Guidance on Purposing Anesthesia Machines as ICU Ventilators
- ASA: Anesthesia Machines as ICU Ventilators Hotline 1-800-224-1001 — Note: The ASA has set up a staffed hotline to assist providers using anesthesia machines as ventilators.
- ASA: COVID Activated Emergency Scaling of Anesthesiology Responsibilities (CAESAR) ICU
- Anesthesia Patient Safety Foundation: Use of Anesthesia Machines as ICU Ventilators
- Kaiser Permanente: How to Evaluate Medical Air/Oxygen Systems Ability to Support Additional Ventilators
Joint Commission FAQs
- Requirements for Granting Privileges During a Disaster
- Privileging Requirements When Providing Services via Telehealth Links During a Disaster
Joint Commission Quick Safety
Center for Connected Health Policy
- Telehealth & COVID-19: Includes CARE Act Updates & CMS Guidance
- Current State Laws and Reimbursement Policies
- COVID-19 Related State Action
- Full COVID-19 Resources
US Health and Human Services Resources
- Telehealth: Website for Patients and Providers on Using Telehealth
CMS Resources
Note: For resources regarding PPE, please see the PPE section. For resources regarding Telehealth, please see the Staffing and Telehealth section.
Joint Commission Webinars
- Preventing Coronavirus Transmission in Ambulatory Health Care Settings
- Preventing Coronavirus Transmission in Ambulatory Surgery Centers
- Example Infection Control Hazard Assessment Form
Leaders from The Joint Commission answer questions on topics including infection prevention and control, environment of care/life safety and Joint Commission standards.
- COVID-19 Q&A for Ambulatory Health Care with The Joint Commission
- Q&A Presentation Deck
Joint Commission FAQs
- Use of Ambulatory Surgery Centers (ASC) as Alternative Inpatient Care Sites for Hospitals
- Public Health Recommendations to Prevent COVID-19 Spread from Community to Healthcare Facilities
- Locating CMS 1135 Waiver Information
- Ventilation System – COVID-19 Air Handler Maintenance
CDC Resources
Note: CDC Updates infection prevention and control guidance during the COVID pandemic regularly. Please refer to this guidance in addition to the resources listed here.
- Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19
- Prepare to Care for COVID-19 – Practical Tools
- Implementing Safety Practices for Critical Infrastructure Workers who may have had Exposure to a Person with Suspected or Confirmed COVID-19
- Information for Pediatric Healthcare Providers
- Pregnancy and Breastfeeding — Note: Interim guidance on breastfeeding for a mother confirmed or under investigation for COVID- 19 can be found on the CDC website.
- Prison/Correctional Facility Resources
- CDC Updated Guidance for Infection Prevention and Control in Dental Settings During the COVID-19 Response
CMS Resources
- Guidance for Infection Coronavirus Disease in Outpatient Setting: FAQs and Considerations
- CMS Non-Emergent, Elective Medical Services, and Treatment Recommendations
FDA Resources
- Managing drug shortages: FDA search tool for medication Extended Use Dates
Preparing for COVID-19 Vaccination
- CDC Healthcare Professionals: Preparing for COVID-19 Vaccination
- US Pharmacopeia COVID-19 Vaccine Handling Toolkit
Other Resources
- National Institute for Children’s Health Quality (NICHQ): COVID-19 Information for Children’s Health Advocates
- Assistant Secretary for Preparedness and Response (ASPR): Technical Resources, Assistance Center, and Information Exchange (TRACIE) COVID-19 Resources, Updates, Planning
- Ambulatory Surgery Center Association: COVID-19 Resource Center for Ambulatory Surgery Centers
Resources Specific to Re-opening/Continuing of Services
- CMS: Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare: Phase I
- American College of Surgeons, American Society of Anesthesiologist; Association of periOperative Registered Nurses, American Hospital Association — Joint Statement: Roadmap for Maintaining Elective Surgery During COVID-19 Pandemic
- American Medical Association COVID-19: A Physician Practice Guide to Reopening
- American College of Surgeons: Local Resumption of Elective Surgery Guidance
Resources Specific to Secondary Disasters (e.g., Hurricanes)
- Healthcare System Preparedness for Secondary Disasters During COVID-19
Note: For resources regarding PPE, please see the PPE section. For more resources regarding Telehealth, please see the Staffing and Telehealth section.
Leaders from The Joint Commission answer questions on topics including infection prevention and control, 1135 waivers and telehealth.
- COVID-19 Q&A for Home Care with The Joint Commission
- Q&A Presentation Deck
Infographics
Joint Commission FAQs
- Home Ventilator Services – Availability of Non-invasive Ventilators (NIV)
- Managing Patient Care via Telehealth
- Locating CMS 1135 Waiver Information
CDC Resources
Note: CDC Updates infection prevention and control guidance during the COVID pandemic regularly. Please refer to this guidance in addition to the resources listed here.
- Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization
- Discontinuation of Isolation for Persons with COVID-19 Not in Healthcare Settings
Preparing for COVID-19 Vaccination
- CDC Healthcare Professionals: Preparing for COVID-19 Vaccination
- US Pharmacopeia COVID-19 Vaccine Handling Toolkit
Resources Specific to Hospice
- Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 by Hospice Agencies
Resources Specific to Pharmacy Infusion/Specialty/Ambulatory Infusion
Joint Commission FAQs
- Sterile Compounding – Considerations for Sterile Compounding During COVID-19 Pandemic
FDA Resources
- Managing drug shortages: FDA search tool for medication Extended Use Dates
Note: For resources regarding PPE, Ventilators and other relevant topics, please see the appropriate section on this webpage.
Joint Commission Webinars
Leaders from The Joint Commission answer questions on topics including infection prevention and control, life safety and 1135 waivers.
- COVID-19 Q&A for Hospitals with The Joint Commission
- Q&A Presentation Deck
Disease-Specific Care Q&A Webinar
- COVID-19 Q&A for Disease-Specific Care Certification with The Joint Commission
- Additional Q&As
Recommendations on Hospital Surge Capacity
- 5 key steps for finding extra hospital capacity
- Surge Hospitals: Providing Safe Care in Emergencies
- Emergency Management Healthcare Environment Checklist
- Use of Ambulatory Surgery Centers (ASC) as Alternative Care Sites for Hospitals
Infographics
FDA Resources
- Managing drug shortages: FDA search tool for medication Extended Use Dates
Preparing for COVID-19 Vaccination
- CDC Healthcare Professionals: Preparing for COVID-19 Vaccination
- US Pharmacopeia COVID-19 Vaccine Handling Toolkit
Note: CDC Updates infection prevention and control guidance during the COVID pandemic regularly. Please refer to this guidance in addition to the resources listed here.
Note: For resources regarding PPE, please see the PPE section.
Joint Commission FAQs
- Quality Control Testing for COVID-19 Tests
- Validation of COVID-19 Test
Joint Commission Webinars
Leaders from The Joint Commission answer questions on topics including infection prevention and control, environment of care/life safety, CMS 1135 Waivers, and Joint Commission standards.
- COVID-19 Q&A for Laboratories with The Joint Commission
- Additional Q&A Resources
CDC Resources
Note: CDC Updates infection prevention and control guidance during the COVID pandemic regularly. Please refer to this guidance in addition to the resources listed here.
- Division of Laboratory Systems (DLS) – Laboratory Outreach Communication Systems (LOCS)
- Information for Laboratories - Interim guidance and resources for laboratory professionals working with specimens from persons under investigation (PUI) for coronavirus disease 2019 (COVID-19)
- Laboratory Biosafety Guidelines
- CDC Guidance on Specimen Collection and Transport for COVID-19 Testing
- Interim Infection Prevention and Control Recommendations
FDA Resources
CMS Resources
Note: For resources regarding PPE, please see the PPE section.
Joint Commission Webinars
- Preventing Coronavirus Transmission in Nursing Care Centers
- Infection Control Focused Survey Tool for Nursing Homes
- 1135 Waivers for Long Term Care Facilities, Skilled Nursing Facilities, and/or Nursing Facilities
Leaders from The Joint Commission answer questions on topics including infection prevention and control, environment of care/life safety, CMS 1135 Waivers, and Joint Commission standards.
- COVID-19 Q&A for Nursing Care Centers with The Joint Commission
- Additional Q&A Resources
PPE Videos
Consistent with CDC recommendations as of March 24, 2020
- The Joint Commission: Removing (Doffing) a Disposable Gown and Gloves with Rationale
- Rush University Medical Center: Step by Step Donning and Doffing: Reusable Gown, N95 Respirator, Goggles or Face Shield
Joint Commission FAQs
- Locating CMS 1135 Waiver Information
- Public Health Recommendations to Prevent COVID-19 Spread From Community to Healthcare Facilities
CDC Guidance
Note: CDC Updates infection prevention and control guidance during the COVID pandemic regularly. Please refer to this guidance in addition to the resources listed here.
- COVID-19: Long-term Care Facilities and Nursing Homes
- Mitigate Healthcare Personnel Staffing Shortages
- Testing Guidelines for Nursing Homes: Interim SARS-CoV-2 Testing Guidelines for Nursing Home Residents and Healthcare Personnel
CMS Guidance
- COVID-19 Long-Term Care Facility Guidance
- CMS Memo: COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement Activities in Nursing Homes
- NHSN COVID-19 Reporting Requirements for Nursing Homes
- Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes
FDA Resources
- Managing drug shortages: FDA search tool for medication Extended Use Dates
Preparing for COVID-19 Vaccination
- CDC Healthcare Professionals: Preparing for COVID-19 Vaccination
- US Pharmacopeia COVID-19 Vaccine Handling Toolkit
Other Resources
- Leading Age: Coronavirus Resources
- Staffing and Staff Morale
- Respiratory Illness Tracking Tool
- Residents with Dementia
- American Health Care Association: How You Can Help Prevent the Spread of Coronavirus (COVID-19) in Long Term Care Facilities
- OSHA: Respiratory Protection Guidance for the Employers of Those Working in Nursing Homes, Assisted Living, and Other Long-Term Care Facilities During the COVID-19 Pandemic
Infographics
Blog
Resources Specific to Re-opening
FAQ
CDC Healthcare Facilities
CDC Other Facilities
- IHI: A Guide to Promoting Health Care Workforce Well-Being During and After the COVID-19 Pandemic
- Mental Wellbeing for Health Care Workers During the COVID-19 Pandemic
- National Academy of Medicine: Resources to Support the Health and Well-Being of Clinicians During COVID-19
- CDC safety practices for critical infrastructure workers exposed to COVID-19
- Vizient Webinar: Addressing Staff Resilience and PTSD During COVID-19
- Resilience for Second Victims During and After COVID-19
- Quick Safety Issue 54: Promoting Psychosocial Well-being of Health Care Staff During Crisis
- COVID-19 Health Care Staff Trauma and Resilience Oriented Healing
- 1135 Waivers
- Preventing Coronavirus Transmission in Ambulatory Health Care Settings
- Preparing Behavioral Health Organizations for Coronavirus
- Preventing Coronavirus Transmission in the Hospital Setting
- Preventing Coronavirus Transmission in Nursing Care Centers
- Infection Control Focused Survey Tool for Nursing Homes
- COVID-19 Focused Infection Control Survey for Acute & Continuing Care (For Hospitals)
- Preventing Coronavirus Transmission in Ambulatory Surgery Centers
- Example Infection Control Hazard Assessment Form
- 1135 Waivers for Long Term Care Facilities, Skilled Nursing Facilities, and/or Nursing Facilities
- Preparing Behavioral Health Organizations for Coronavirus (oral presentation in Spanish), Preparación de organizaciones de salud mental para el coronavirus (la presentación oral esta en español)
- COVID-19 Health Care Staff Trauma and Resilience Oriented Healing
Hospital Q&A Webinars
Leaders from The Joint Commission answer questions on topics including infection prevention and control, life safety and 1135 waivers.
- COVID-19 Q&A for Hospitals with The Joint Commission
- Q&A Presentation Deck
Home Care Q&A Webinars
Leaders from The Joint Commission answer questions on topics including infection prevention and control, 1135 waivers and telehealth.
- COVID-19 Q&A for Home Care with The Joint Commission
- Q&A Presentation Deck
Laboratory Q&A Webinar
Leaders from The Joint Commission answer questions on topics including infection prevention and control, environment of care/life safety, CMS 1135 Waivers, and Joint Commission standards.
- COVID-19 Q&A for Laboratories with The Joint Commission
- Additional Q&A Resources
Behavioral Health Care Q&A Webinar
Leaders from The Joint Commission answer questions on topics including infection prevention and control, environment of care/life safety, CMS 1135 waivers and Joint Commission standards.
- COVID-19 Q&A Webinar for Behavioral Health Care with The Joint Commission
- Q&A Presentation Deck
Nursing Care Centers Q&A Webinar
Leaders from The Joint Commission answer questions on topics including infection prevention and control, environment of care/life safety, CMS 1135 Waivers, and Joint Commission standards.
- COVID-19 Q&A for Nursing Care Centers with The Joint Commission
- Additional Q&A Resources
Ambulatory Health Care Q&A Webinar
Leaders from The Joint Commission answer questions on topics including infection prevention and control, environment of care/life safety and Joint Commission standards.
- COVID-19 Q&A for Ambulatory Health Care with The Joint Commission
- Q&A Presentation Deck
Disease-Specific Care Q&A Webinar
Leaders from The Joint Commission answer questions on topics including infection prevention and control, 1135 waivers and Joint Commission standards.
- COVID-19 Q&A for Disease-Specific Care Certification with The Joint Commission
- Additional Q&As
- October 26, 2020 – Status of Onsite Survey Activity
- August 14, 2020 – Removal of Position Statement
- May 27, 2020 – Regular Surveys and Reviews to Resume in June — With Some Changes to Protect Safety
- May 12, 2020 – Statement on Removing Barriers to Mental Health Care for Clinicians and Health Care Staff.
- April 23, 2020 – Universal Masking Statement.
- April 6, 2020 – FAQ in Response to The Joint Commission Statement on Use of Face Masks Brought From Home.
- April 1, 2020 – All Joint Commission surveys and reviews will remain on hold until the end of May.
- March 31, 2020 – Joint Commission Statement on Use of Face Masks Brought From Home.
- March 27, 2020 – Public Statement on the Shortages of Critical Medical Equipment.
- March 16, 2020 – The Joint Commission is suspending all regular surveying.
- March 9, 2020 – The Joint Commission continues to actively monitor COVID-19 activity.
- February 25, 2020 – The Joint Commission believes it is time for hospitals to prepare for a possible surge of Coronavirus patients.
- February 14, 2020 – Information and guidance on what your organization needs to know about COVID-19.
- A summary of actions taken by The Joint Commission to advocate for federal resources and responses to aide health care organizations during the COVID-19 emergency
- The Joint Commission Statement on HEROES Act HR 6800
- Joint Statement Supporting Clinician Health in the Post-COVID Pandemic Era
For more information, visit our Federal Relations and Public Policy page.
CDC Resources
- New Guidance Documents webpage that allows users to view and filter through CDC guidance on COVID-19
- Update to COVID-19 training for healthcare professionals webpage, which includes links to webinars and other resources on topics including clinical care and infection control, PPE, nonpharmaceutical interventions, emergency preparedness and response, and others
- Healthcare provider and facility operational considerations for non-U.S. settings
- New weekly surveillance report called COVIDView that will be updated each Friday and will summarize and interpret key indicators, including information related to COVID-19 outpatient visits, emergency department visits, and hospitalizations and deaths, as well as laboratory data
- Updated guidance on strategies for optimizing the supply of N95 respirators
- Information for pediatric healthcare providers regarding children with COVID-19
- Updated interim guidance on the discontinuation of isolation for persons with COVID-19 not in healthcare settings
- Update to interim guidance for implementing safety practices for critical infrastructure workers who may have had exposure to a person with suspected or confirmed COVID-19
- Updated guidance for infection prevention and control in dental settings during the COVID-19 response
- Guidance for the temporary use of certain gas containers for oxygen and nitrogen intended for medical use for the duration of the public health emergency
FDA Resources
- New Emergency Use Authorization (EUA) for non-NIOSH-approved respirators made in China
- Updated FAQs on 3D printing of medical devices, accessories, components and parts during the COVID-19 pandemic
- Effort to develop and implement blood-related therapies for COVID-19
- Enforcement policy for clinical electronic thermometers during the COVID-19 public health emergency
- Enforcement policy for infusion pumps and accessories during the COVID-19 public health emergency
OSHA Resources
New OSHA Program: Policies and Procedures for Implementing a National Emphasis Program (NEP) – NEP ensures that employees with increased potential exposure to SARS-CoV-2 are protected from contracting the virus and are able to reporting issues without retaliation.
- CMS COVID-19 Partner Toolkit
- World Health Organization (WHO)
- ECRI Preparedness Center
- Webinar: Suicide Prevention Resource Center: Treating Suicidal Patients During COVID-19: Best Practices and Telehealth
- American College of Surgeons COVID Resources: COVID-19 and Surgery
Real Voices. Real Stories.
Just like many of you, Joint Commission enterprise staff who are also working on the front lines are facing real challenges. We’d like to share some of their personal experiences.