Joint Commission

Latest Issue of OR Manager
October 2017

Joint Commission: Top five most challenging requirements for 2017

Editor's Note The Joint Commission on September 20 announced the top five most challenging requirements for the first half of 2017. The top five requirements identified most frequently as “not compliant” during surveys and reviews for hospital accreditation were: 86%--LS.02.01.35: The hospital provides and maintains systems for extinguishing fires. 74%--LS.02.01.30:…

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By: Judy Mathias
September 21, 2017
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Joint Commission issues Sentinel Event Alert on inadequate hand-offs

Editor's Note The Joint Commission on September 13 announced a new Sentinel Event Alert that focuses on inadequate hand-offs and tips to improve them. A common problem with hand-offs is communication, which is the focus of “Sentinel Event Alert, Issue 58: Inadequate hand-off communication.” The alert includes an infographic of…

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By: Judy Mathias
September 14, 2017
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Joint Commission temporarily suspends accreditation surveys in Houston

Editor's Note The Joint Commission announced on August 30 that because of flooding in Houston and surrounding areas, it is temporarily suspending accreditation survey activity for organizations severely affected by Hurricane Harvey. Joint Commission Online Weekly Newsletter

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By: Judy Mathias
September 1, 2017
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Joint Commission issues R3 Report on pain assessment and management standards for hospitals

Editor's Note The Joint Commission has issued a new R3 Report to help accredited hospitals better understand and comply with its new and revised pain management standards, which are effective January 1, 2018. This R3 Report provides in-depth rationale, references, and evidence used in the development of the new and…

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By: Judy Mathias
August 30, 2017
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Joint Commission deletes standard related to performance on ORYX measures

Editor's Note The Joint Commission announced August 21 that Standard PI.02.01.03: “The hospital improves its performance on ORYX accountability measures” and the Standard's one Element of Performance: “The hospital achieves a composite performance rate of at least 85% on the ORYX accountability measures transmitted to the Joint Commission” will be…

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By: Judy Mathias
August 22, 2017
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Bulletproof Solutions for Finding-Free Joint Commission and CMS Surveys

After this session you’ll be able to: 1. Summarize 2017 Joint Commission standards and Centers for Medicare & Medicaid Services (CMS) regulations. 2. Develop strategies to ensure ongoing compliance and survey readiness. 3. Understand methodologies surveyors utilize to assess compliance. Why this is important: As anyone who has undergone a…

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Few outcome measures meet criteria for accuracy, validity assessment

Editor's Note This study from the Joint Commission finds that criteria for assessing whether outcome measures are accurate and valid enough to use for public reporting, payment, and accreditation are not well-defined. The authors propose four criteria to assess outcome measures: Strong evidence should exist that good medical care leads…

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By: Judy Mathias
August 17, 2017
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Joint Commission: Quick Safety on noises, distractions in ORs

Editor's Note The Joint Commission on August 16 announced a new Quick Safety that focuses on noise and distractions in the OR and how they can make it difficult to hear and discern information or communicate effectively. ORs are prone to high levels of noise, which can be distracting and…

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By: Judy Mathias
August 17, 2017
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Joint Commission announces first recipient of Comprehensive Cardiac Center Certification

Editor's Note The Joint Commission on July 19 announced that the University of Kansas Health System, Kansas City, is the first hospital in the nation to achieve its Comprehensive Cardiac Center (CCC) Certification. To achieve certification, hospitals must demonstrate compliance with consensus-based standards, evidence-based clinical practice guidelines for cardiac care,…

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By: Judy Mathias
July 19, 2017
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Joint Commission revises 2018 Medication Management standards

Editor's Note The Joint Commission on July 12 announced revisions to its Medication Management standards that will become effective January 1, 2018. Among the revisions: Implementing a policy to provide emergency backup of medication dispensing equipment. Adding “wasting” of medication to required written policies. Implementing a policy for medication overrides…

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By: Judy Mathias
July 13, 2017
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Joint Commission: Four new performance measures for total joint certification

Editor's Note Four new performance measures are available for the Joint Commission’s Total Hip and Total Knee Replacement (THKR) advanced certification program, the Joint Commission announced on July 5. They are: THKR-1 Regional anesthesia THKR-2 Postoperative ambulation on the day of surgery THKR-3 Discharged to home THKR-4 Preoperative functional/health status…

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By: Judy Mathias
July 6, 2017
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Friend or Foe? Preparing for Your Joint Commission Survey

As anyone who has undergone a Joint Commission Survey knows, preparation is key to a positive survey outcome. To ensure you are equipped with up-to-date Joint Commission standards and Centers for Medicare & Medicaid Services (CMS) requirements affecting surgical services and areas that perform invasive procedures, Rosing returns to lead…

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