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Feigin:
JCAHO compliance is mandatory |
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Impending JCAHO review serves as
a reminder
of the importance of quality patient care
By Ralph D. Feigin, M.D.
In mid-February the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) will visit Texas Children’s
Hospital to evaluate our institution and hopefully confer
reaccreditation for the next three years. This is our
opportunity to once again show, with great pride, the breadth,
depth and quality of the entire hospital, focusing most
importantly on the quality of patient care and the superior
outcomes that we believe our patients enjoy.
Although the Joint Commission regulations are extensive in their
number and scope, they actually define, according to their own
definition, minimal acceptable standards of care. At Texas
Children’s Hospital we strive to exceed all minimal acceptable
standards and hope to demonstrate that our institution not only
is as good as, but better than, any other hospital of its kind
in the nation.
During each of its triannual visits, the Joint Commission
particularly focuses on areas it believes are of greatest
concern nationwide and may have achieved high visibility during
the preceding three years. For example: As a result of the
report from the Institute of Medicine National Academy of
Sciences on patient safety, which highlighted the large number
of deaths that occur annually in the United States as a result
of safety issues in hospitals nationwide, national patient
safety goals have been established by the Joint Commission.
I know that I can speak for all of the physicians in the
hospital when I state that patient safety has always been of
paramount importance; nevertheless, physicians and other health
care providers occasionally lapse, usually as a result of time
constraints, into habits that may compromise patient safety in
one way or the other. This is a good time for us to reiterate
those issues where 100 percent compliance is absolutely required
by the Joint Commission. These include:
Discontinuing the use of
non-approved abbreviations. Habits inculcated in another era,
including those taught in medical school many years ago, such as
writing prescriptions using symbols like Q.D. or Q.O.D. are no
longer acceptable.
Dosages should be specified
precisely and if the dose is less than one unit, it should be
preceded by a leading 0 such 0.12, or if a whole number of 1 or
greater should not be followed by a decimal point and a trailing
zero.
Always check the patient’s armband
to match the name and medical record number or orders.
Clinic patient identifiers should
include the name of the patient and their date of birth.
Mark the surgical site when
laterality, multiple digits and/or spine levels are involved.
Perform a timeout before invasive procedures or surgery. This
process must include the entire team taking time to identify
that the procedure is being performed on the correct patient, it
is the correct procedure, the patient is in the correct
position, the correct site is being operated upon and the
correct type of implant or other equipment is being utilized.
Post-operative procedure notes must include a pre-operative and
post-operative diagnosis, a description of the findings, the
procedure performed, the name of the surgeon and specimens
removed.
Perform personal hand hygiene. This
involves use of soap and water for visibly soiled hands and an
alcohol-based rub for hands soiled in a manner not visible. Hand
hygiene should be conducted before and after every patient
contact.
Remember to write down and read back
when receiving or giving verbal or telephone orders or receiving
critical laboratory values.
Please remember that documentation,
such as signing and dating all entries in the medical record is
imperative. Limit verbal orders; if used be sure to sign
immediately or as soon as possible. Document all indications for
medications prescribed as needed. Do not write a blanket
reinstatement of previous orders or write an order that states:
“Resume previous orders.” All restraint orders must be rewritten
daily.
A summary list for patients
receiving three or more visits in the same clinic must be
provided.
The sedation form, when sedation is
utilized, must be complete with all boxes checked, signed, dated
and timed.
Patient privacy is also an area that
has been highlighted. Log out of the floor roster on Oacis or
other computer applications when you are finished. Avoid
discussions about patient care in public places, such as
elevators and hallways. Place patient charts inside the drawer
when you have completed reading them or writing any notes.
I know these are values the medical
staff generally accepts because it is the right thing to do on
behalf of the care of every patient. I also recognize there are
some occasions – such as during the course of an emergency or
when someone is distracted by the needs of another patient –
where there is the potential for lapses.
Please accept this friendly reminder
to do your best in all of these areas all of the time.
Thank you for all that you do for patients at Texas Children’s
Hospital and in the Houston and national communities in which
you serve.
Ralph D. Feigin, M.D., is physician-in-chief at Texas
Children’s Hospital and professor and chairman of the Department
of Pediatrics at Baylor College of Medicine.
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