JCAHO and Time out

[Dixielee, BSN, RN]

We recently went thru our joint commission audit and dinged on some really stupid stuff....like having too many O2 cylinders and having a portable computer (on wheels) in front of a fire extinguisher. Anyway, we have now completely gone off the deep end and instituted some of the most time intensive endevors ever. Is anyone doing the "Time out" dance now?

With any invasive procedure including I&D's, LP's and sutures for lac repair, yes sutures, we must get informed consent (already did this for LP's), have the nurse or tech and MD in the room. Stop before getting started, verify the patient name 2 ways, asking patient if they agree and all in room must say they agree. State type of procedure reiterating site 3 separate times, all saying they agree. If this time out is interrupted at any point, phone call, family walking in room, patient screaming, etc....we must start over. If anyone turns their back to work on a tray or pull up a sheet, we must start over. It has to be silent and no movement during the timeout.

The doc had 2 forms to fill out and bring into the room, and H&P, and form stating their intent...i.e. lac closure left wrist using 4-0 ethelon...etc.

It is adding so much time and paperwork to what we already do.

Everyone is ticked, but we are told tough, this is what JCAHO wants and what they want is what they get. Is this what it is all coming to?

With this stuff and mandatory computerized charting (another thorn in myside), there is scant time for patient care. They have become incidental in this whole picture.

If this is the way of the future, then I want out, and I want out soon.

BTW, this is a 50+ bed trauma, referral center with over 100K visits per year.

I have done this 32 years now, maybe it is time to work at Lowes. Don't laugh, I can learn to drive a forklift!

[dazedandconfused]

We havebeen doing the time out for about a year and a half. Each doc does it in their own special way- ugh. The biggest problem is getting them to complete the paperwork before starting the procedure and sedation. Drives me nuts. But we have learned to live with it.

[Noryn]

I have only been a nurse for 8 years and you know I was burned out of the acute care hospital setting after 5 years. I have been lucky and have been able to find jobs at an insurance company and other nursing office jobs. I really feel that there isnt that large of a shortage of nursing, more like an abundance of bs and shortage of nurses willing to put up with it day in and out.

The paperwork and regulations of the state, and/or JCAHO just get ridiculous. The state of ERs around the country is not very good right now and adding more paperwork or repetition to this will not help. It gets to the point where these regulatory agencies and administrations could care less if the patient dies, but you better not leave out the important stuff like knowing what their hobbies are, their food likes and dislikes, their reading level, etc.

I am not saying some of these concepts are not important, especially verifying patient consent and identification but you know the process you describe is just ridiculous.

[Dixielee, BSN, RN]

The paperwork and regulations of the state, and/or JCAHO just get ridiculous. The state of ERs around the country is not very good right now and adding more paperwork or repetition to this will not help. It gets to the point where these regulatory agencies and administrations could care less if the patient dies, but you better not leave out the important stuff like knowing what their hobbies are, their food likes and dislikes, their reading level, etc.

AMEN!!! It seems as though these regulators have nothing to do but make sure they ensure themselves a job. I am near the end of my hospital nursing career, and it makes me sad, but I am just sick and tired of the BS. I still have to work, but I don't have to be miserable.

It is one thing to have to put up with drunks and abusive patients, that I can handle, but this is pushing me over the edge.

[Daytonite, BSN, RN]

If you are able to get involved in the JCAHO committee in your hospital, do it. You'll learn tons of information about how the process works and maybe it won't seem as horrible to you. Hospitals maintain JCAHO accreditation because Medicare says they won't pay for any Medicare beneficiary claims from them if they don't. And, whenever Medicare says something all the other insurance companies fall in line behind Medicare. This is merely how our free capitalistic society disguises and runs a form of socialized healthcare on us. It's going to get more and more regulated. The way I see it is we play along with the game or just get out altogether. The government is just too big to fight against.

[TazziRN, RN]

We've done time outs for several years now, but only for procedures requiring sedation. I agree, sounds like your facility is carrying things a bit too far.

[jmgrn65, RN]

Time Out just needs to be before the procedure begins someone says this is Jane Doe and we are doing blank of the blank, of course if there is a particular site like left foot then that is mentioned, it doesn't have to be done 3 times. It has to be documented somewhere that it was done. There should not be additional paperwork, just make an additional line on your charting that it was done. Also who is present during the TIme out. YES JCAHO is getting ridicolus (sp) :angryfire Do they actually work in a hospital?

[Dixielee, BSN, RN]

I do think our hospital has gone berzerk over this thing. It has generated 4 additional pieces of paper. 2 for the doc, a consent, and the time out sheet for the nurse that verifies all this stuff was done. We have to document the docs did their work, and that we did ours. Sigh.....I don't think this does anything more than create more "time out" from patient care and plenty of fluff and buff for the chart.

Initially they said it had to be done for anything that crossed a mucous membrane or skin, which would include dental blocks and venipunctures. Fortunately, reason got that stopped.

[MajorDomo]

I don't know if it is JCAHO or the managements fear of them. A time out for sutures... oops sorry doc, you sewed the wrong lac. Time outs are great for OR and Pre-Ops, other invasive procedures are covered by consents. My biggest annoyance right now is the medication reconciliation. Our NM wants us to complete it in triage, so little old man with 10 meds, who doesn't remember their names (except one starts with "C") comes in for a stubbed toe. So I am suppose to call up his Primary Doc for a med list, verify all the meds, dosages and times while I have 6 more people who showed up on the short bus that need to be triaged. Gee I wonder why time before being triaged is increaseing.

AHHHH good vent

MajorDomo

[Dixielee, BSN, RN]

I don't know if it is JCAHO or the managements fear of them. A time out for sutures... oops sorry doc, you sewed the wrong lac. Time outs are great for OR and Pre-Ops, other invasive procedures are covered by consents. My biggest annoyance right now is the medication reconciliation. Our NM wants us to complete it in triage, so little old man with 10 meds, who doesn't remember their names (except one starts with "C") comes in for a stubbed toe. So I am suppose to call up his Primary Doc for a med list, verify all the meds, dosages and times while I have 6 more people who showed up on the short bus that need to be triaged. Gee I wonder why time before being triaged is increaseing.

AHHHH good vent

MajorDomo

They did do something smart with the med reconciliation at our place, maybe as a trade off for the time out stuff. In triage we ask the usual med stuff and get what we can. There is a spot to check that says, meds complete, needs further investigation, no home meds, or resources exhausted.

In triage or even in the back if we can't get the info, maybe pharmacy is closed, no one home at present etc, but the info can be gotten later, we check "needs further investigation". We don't have to reconcile eveything right there but just have to address that we tried and need more work.

Once they are admitted, if they can't get the info for some reason, they check "all resources exhausted".

That seems to satisfy the paperwork demons at our place.

It seems like patient care is a secondary concern to the JCAHO folks.

[tvccrn, ASN, RN]

Wow, our Time Out is simply done in front of the patient with the doctor and staff before the procedure begins. In the cath lab this involves something like this...

"Dr. Jones, you are doing a cath and right heart cath on Mrs. Smith."

We then document it in the WITT system (compterized monitoring and documentation system).

This was good enough for the JCAHO in theory, but you better watch them. They dinged us on not doing this when everyone in the room including the doctor testified that it was done. The examiner was simply not paying attention.

tvccrn

[Pedi-ER-RN, RN]

We currently don't have to do time outs for lac repairs, but for every other invasive procedure. Also, we haven't started the med reconsilliation yet, but I expect it to be a nightmare when it starts. From what I've been told, you have to include OTC meds also, is this true? Most of our Pedi's aren't on much(unless they are chronics), but some of our GYN'S are on numerous meds and they don't have a clue the strenght, dosage, etc...