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Additional examples will guide surveyors
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has decided not to establish separate employee health standards — for now.
A recent meeting of JCAHO’s committee on healthcare safety resulted in the same verdict handed down by other Joint Commission advisory committees: no new standards now, but officials of the Oakbrook Terrace, IL-based organization will continue to track employee health issues, remaining ready to re-evaluate the need for standards in the future.
JCAHO has been probing the possibility of establishing employee health standards for the past two years, prompted by increasing regulatory focus on health care worker safety issues, such as the Occupational Safety and Health Administration’s (OSHA) proposed tuberculosis standard and the needle safety law recently enacted in California, says Carole Patterson, deputy director of the Joint Commission’s department of standards. (See Hospital Employee Health, December 1998, pp. 146-147.)
"We’ve been tracking the issues and regulations, and we keep asking the question: Do we need more standards? Do we need new standards? All of our advisory committees have said they don’t believe we need standards — at this point, anyway," she states.
Instead, Patterson says plans are to add specific employee health examples to existing standards. For instance, the patient assessment chapter in JCAHO’s manual includes an example of how to question patients about latex sensitivity. That patient-related example will serve as a model for a new example to be added in the manual’s safety management program standards; however, the added example will apply to employee health and safety.
New employee health examples will be added to various chapters and existing standards detailed in JCAHO’s 2000 manual, which will be released this fall.
Leaders of two hospital occupational health organizations had pled the case for stand-alone employee health standards at the committee on healthcare safety meeting. They were disappointed yet hopeful regarding JCAHO’s decision.
"With all the mergers and cost cuttings, employee health departments are getting downsized, staff is getting cut, and our hands are tied," Kathleen VanDoren, RN, BSN, COHN-S, executive president of the Reston, VA-based Association of Occupational Health Professionals in Healthcare (AOHP), told JCAHO committee members.
VanDoren maintains that JCAHO standards would go a long way to help employee health practitioners function more effectively.
"We value OSHA, but having an OSHA inspector come in and levy a fine just doesn’t bother many hospitals," she states. "They figure they’ll just pay the fine and be done with it, but they don’t feel that way about the Joint Commission because their accreditation is at stake. [JCAHO] can help us do our job the way we should do it and protect the health care worker."
In a letter to JCAHO earlier this year, the AOHP had asked for standards specifically related to employee health assessments, hazard control, illness and injury management, infection prevention, occupational health information management, education, and health promotion.
VanDoren says she will continue to advocate employee health standards and has offered to work with JCAHO on developing examples.
Geoff Kelafant, MD, MSPH, FACOEM, vice chairman of the Medical Center Occupational Health section of the American College of Occupational and Environmental Medicine (ACOEM) in Arlington Heights, IL, also outlined areas of concern to JCAHO.
Employees are "internal customers" who "may also be patients," says Kelafant, who is a consultant to JCAHO’s healthcare safety committee. He recommends the addition of examples to the manual’s environment of care section to address responsibility for evaluation, treatment, and care of HCWs incurring occupational injury or illness.
The decision to add examples instead of standards "may seem like a backdoor approach," he tells HEH, but avoiding a lengthy standard-setting process may actually be more advantageous.
"The [committee’s] attitude was positive about the need to look at employee health. The emphasis has not been there in the past, but they are gradually trying to build it into the established framework and immerse surveyors in issues involving employee health. This is a start," he says.