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Pilot site offers sneak peek’ at new process
A new survey process by the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations holds nurses more accountable for care delivered, according to one pilot test site. "They not only looked at the chart for pain, restraints, and vital signs, but went a little deeper and looked at the end result, what happened to the patient," says April Dukes, RN, BSN, head nurse of the emergency department (ED) at Tift Regional Medical Center in Tifton, GA. "It was more in-depth and pinpointed areas that needed attention."
Dukes obtained a "sneak peek" at the new survey process when her facility participated in a pilot study this past June. The surveyors reviewed charts of patients who were being treated, says Dukes. "They focused a great deal on continuity of care and looked at the care provided by EMS, then the ED, then the medical floor," she reports.
Another difference predicted from the changes to the accreditation process is an end to the frantic preparations before every survey. The Joint Commission Initiative for Accreditation Process Improvement is described as a paradigm shift to change the focus from survey preparation to continuous operational improvement. It will be effective as of January 2004. However, organizations will need to start preparing now by scheduling a self-assessment 15-18 months after their most recent survey, according to the Joint Commission.
Joint Commission officials say that it will improve the consistency of surveys, distribute best practices to educate facilities, and use more technology in the survey process. Here is how surveys will change: Standards will be streamlined, with a reduced documentation burden to focus more on critical patient care issues. There will be a self-assessment process for compliance, to free up survey time for the most critical patient care issues. The new survey process will have six basic components: an opening conference, a leadership interview, validation of self-assessment results, a focus on actual patients as the framework for assessing compliance with selected standards, discussion and education on key issues, and a closing conference.
Focus on care instead of standards
The best way to prepare for the new survey process is to pay less attention to individual standards and more attention to how overall systems impact patient care, according to Michelle H. Pelling, MBA, RN, president of The ProPell Group, a Newberg, OR-based health care consulting group specializing in survey preparation and performance improvement. "Examine the accuracy, timeliness, and safety of your patient care processes and how well they coordinate with other processes in the hospital," she advises. "This will be a more beneficial use of resources when it comes to survey preparation."
It’s most important for you to consider the main processes critical to the provision of care and smooth operations of the ED, Pelling says. These include patient assessment, medication use, communication, and information management, she says. For each of these systems, she says you should assess the degree of vulnerability for noncompliance with standards. The goal is to move toward continual operational improvement, she says. "In the end, the true test is whether the ED department has been able to effect better, safer care for their patients," she says. Your ED will be meeting the individual Joint Commission standards as a "by-product" of doing the right things for your patients, she says.
Overall, Pelling says the new survey approach is much more pragmatic and useful approach to improving critical processes and addressing patient safety challenges. The proof will be in how well the Joint Commission executes it, she says. "Survey prep" will continue to be labor-intensive for your ED, she adds. "The good news is that preparing for the new accreditation process may be labor that results in improving the way we provide care and keep patients safe," she says.
For more information about the new survey process, contact:
• April Dukes, RN, BSN, Emergency Department, Tift Regional Medical Center, 901 E. 18th St., Tifton, GA 31794. Telephone: (229) 382-7120. Fax: (229) 382-7120. E-mail: email@example.com.