by Lisa McNerney, BSJ, MA, RN

NH AWHONN Newsletter Editor

Although “network” and “networking” may be among those words you’d like to see retired, at least for awhile, because of their overuse, there’s much to be said for being able to share information through an “interconnected system of people” trying to achieve a common goal. 

It’s likely that the vast majority of this newsletter’s readers are working for facilities that seek accreditation from The Joint Commission.  We’d like to think that we’re always prepared for a visit from TJC surveyors, that we perform up to that organization’s standards each and every day with each and every patient or client.  And while that may be true, it never hurts to have an idea what they’ll be focusing on. 

Here are some key points that came out of a recent visit to one New Hampshire hospital:

• If you use moderate sedation in your facility, ensure that an “immediate re-evaluation” happens for the patient prior to induction.

• Patients who are discharged after receiving moderate sedation need to be given instructions about “do’s and don’ts,” and these need to be age-appropriate.  (A 2-year-old should not receive discharge instructions warning him not to drive; rather, his guardian should be counseled not to leave him in the tub alone.)

• TJC also wants to see an “age-appropriate” skin risk assessment on pediatric patients.  The pedi patient should not be being assessed using the adult Braden scale.

• Life support equipment and supplies need to be “tested” and checked the same way in every area in which “code carts” are located.

• “Unacceptable” abbreviations, deemed so because using them may undermine safe care, must be eliminated.

• If a patient reports “10 out of 10” pain, a comprehensive pain assessment should be done in order to determine the best course of action.

• Pain reassessment within an appropriate amount of time is essential.  How else can we know if what we did for the patient was effective?

• PRN orders should come with an indication—“acetaminophen for fever greater than x,” for instance.

• All orders must be dated and timed, as must acknowledgment of those orders.

• Verbal orders, whether delivered in person, which should be rare, or over the telephone, must be “authenticated” by the licensed independent practitioner or the covering LIP within 48 hours (so you can see why “dated and timed” is so important here!)

• Staff competencies must be well-documented, up-to-date, and readily available in the individual’s file. 

• Time-outs must be documented on all appropriate invasive procedures.  This includes, for example, a circumcision, where the time-out verifies that this is the correct baby having the correct procedure to which his guardian has appropriately consented, and that the correct equipment and the proper staff for the process are on site and ready to perform.

Although staff are often counseled to be polite to surveyors but “not to say too much,” surveyors say that they are appreciative when staff are welcoming and are willing to speak to the work that they do, especially if they can point to “best practices” in their areas. 

It’s not enough, therefore, to be able to point to The Joint Commission’s National Patient Safety Goals poster on the wall, but rather to be able to show how the goals are incorporated into patient care each and every day—whether TJC is in the house or not.

And isn’t it great that we have a network like NH AWHONN through which to share this information?  If a survey—by The Joint Commission or any other governing body--is in your facility’s future, best wishes for a successful performance.  If patient safety, satisfaction, and support is “Job One,” you’ll do great. 

Page Updated 2/2/10