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Medications and pain management also key issues
Compliance with the National Patient Safety Goals top the list of items that Joint Commission on the Accreditation of Healthcare Organizations’ surveyors examine, according to home health managers who recently have undergone accreditation surveys. "Our surveyor focused upon safety and looked at specific items such as how we ensured the safety of patients on oxygen," says Sharon Darnall, RN, director of Crittendon Health System’s Marion (KY) Home Health. The surveyor examined the agency’s process for teaching oxygen safety to both patients and staff members, she explains. "The surveyor did make one site visit that was for a patient on oxygen," Darnall adds.
During the site visit, the surveyor talked with the staff member as well as the patient, she says. "She stayed during the entire visit with the RN, then went on another personal care visit with one of our aides." The surveyor also questioned staff members and observed infection control practices, especially the use of hand gels and hand washing, she adds.
Infection control also was at the top of the list for the surveyor who visited Home Care Providers in Burlington, NC. "The surveyor was very interested in our hand-washing policy, especially for nurses providing wound care," says Dottie Moseley, RN, BS, MPH, director of the home health agency. During one of the surveyor’s site visits, the nurse had to change dressings on three wounds. "The nurse washed her hands prior to beginning wound care and changed gloves for each wound, but she didn’t wash her hands between caring for each wound," she says.
Because the surveyor did not see this as a trend throughout the agency, she merely suggested to Moseley that hand-washing and wound-care techniques be reviewed with all staff members. Moseley’s agency did receive a Type 1 recommendation when the surveyor discovered that in three of the 40 patient records examined, the staff used a pulse oximeter but did not have a physician order for its use. "We consider a pulse oximeter a normal method of obtaining a vital sign for our patients, but it is a device that requires a physician order so we are making sure we get the order ahead of time," says Moseley. The agency now has changed physician orders to include pulse oximetry as standard protocol included in all new patient admissions, she adds.
During the home visits, Moseley’s surveyor questioned patients about their understanding of medications and pain management. "She was very focused on pain management and wanted to make sure the patient and nurse talked about pain and explored options for managing it," Moseley says. The surveyor also talked with staff members, but the interviews differed from survey interviews in the past, she adds. "The surveyor was interested in communications between different disciplines, so she interviewed groups of staff members from different disciplines at the same time," Moseley explains.
Questions posed to the group addressed topics such as continuing education, orientation, handling difficult patients, and communicating with each other about a particular patient’s care, she explains. "The interviews were very relaxed, non-threatening, and informative, she adds.
Unique emergency plan impresses surveyors
While all home health agencies have some sort of emergency plan, even if it is a part of the hospital’s plan, the surveyor at Marion Home Health was impressed with Darnall’s plan. "She told me that she was glad to see that we didn’t just rely upon the hospital plan," notes Darnall. "We took the hospital’s emergency plans and expanded them to reflect our own unique situation that has our employees working independently in patient homes and traveling between patient homes," she says. The surveyor complimented Darnall on taking the extra step to ensure that the plan addressed her employees’ and patients’ needs specifically.
[For more on home care survey tips, contact:
• Sharon Darnall, RN, Director, Marion Home Health Services, Crittendon Health Systems, P.O. Box 386, Marion, KY 42064. Phone: (270) 965-2550. E-mail: sdarnall@crittendon_health.org.
• Dottie Moseley, RN, BS, MPH, Director, Home Care Providers, Alamance Regional Medical Center, 2732 Anne Elizabeth Drive, Burlington, NC 27216. Phone: (336) 538-8500. Fax: (336) 538-8598.]