JCAHO and Time out

June55Baby · Jun 26, 2006

We conduct a time out for every invasive procedure performed in our hospital including PICC Lines, radiological procedures, and certain ER procedures. We use a bright green sticker to document that the entire team paused, confirmed (as appropriate) correct patient, side/site, procedure, patient position, and any implants or special equipment or requirements.

Generally this takes only a few seconds. It goes like this. The nurse would say, "We are taking the time out to confirm that this is Mr. Jones and we are suturing the laceration on his right forearm. There were no special equipment, requirements, or implants. Does everyone agree?" And everyone in the room verbally says "yes". This is documented on the green sticker and placed in the medical record.

Recently, this time out (and site marking) saved a podiatrist from doing a procedure on the wrong foot of one of our patients.

azhiker96, BSN, RN · Jun 26, 2006

We had to post a sign outside our clean equipment storage room that says no smoking within 50 feet. This room is in PACU. Smoking has not been a problem so far. Also, all O2 cylinders must be either in use or in the storage location. The explanation is an unattended cylinder could leak oxygen and cause a fire. Once again, this is in PACU where we could easily have half a dozen or more pts on 10-15 lpm of house O2 at the same time. :lol2:

Sugah Britches · Jun 30, 2006

JACHO last week.. only ding was that on the initial triage assessment, we do not inquire if the pt is being abused/do you feel threatened or unsafe at home?????

Question about 1%.. do you have the small single dose or the larger multi dose? We currently use the multi, but are "not allowed" to keep on suture tray.. so we are suppose to charge each new pt with a new bottle and then discard the remaining. It seems like such a waste and expense to the pt.

Home Health Columnist / Guide · Jun 30, 2006

why this "nonsense" : patient safety

[banana] the number of times surgeons operated on the wrong person, wrong location or performed the wrong surgery increased from 42 in 1995 to 58 in 2001.

jcaho identified a number of factors contributing to the increased risk for wrong site, wrong person or wrong procedure surgery, including: emergency cases; unusual physical characteristics, including morbid obesity or physical deformity; unusual time pressures to start or complete the procedure; unusual equipment or set-up in the operating room; multiple surgeons involved in the case and multiple procedures being performed during a single surgical visit.

in florida, the board of medicine heard 20 cases of wrong-site surgery in 2000, compared with eight cases in 1999.

in may, a surgeon at h. lee moffitt cancer center & research institute was disciplined for removing the breast of a woman scheduled for a lumpectomy.

http://www.bizjournals.com/tampabay/stories/2001/12/31/newscolumn5.html

[/banana]

as manager of a homecare central intake department receiving 1,800 to 2,000 referrals monthly, i can't tell you how many times we are not informed adequately of patients care needs. only 10 of our referrals have med list sent by facility. 40% pts are missing discharge instructions in the home. 50% have at least one med not filled cause of issues.

past month's referrals snafu's included:

1. rn assessed pt, found "tube coming out of his back at waist level." patient clueless. discharge summary checked: no mention of tube, tube care nor diagnosis involving a tube. followup call to doctor: had nephrostomy tube placed for ureter blockage, was to be irrigated bid. no rx, no wound care supplies, no syringes--2 days to obtain.

2. diabetic patient thought the nurse was bringing out her insulin and syringes: that's what her doctor told her. no glucometer in the home. no rx. orders were to teach glucometer use. easting breakfast donut.

3. pt with pe and dvt getting lovenox bid in hospital, calls on call frantically 9pm day of discharge "where's my nurse and med" no orders for lovenox given at time of referral. pharmacy closed. follow-up in am:

lovenox bid on discharge sheet, no rx, call to pharmacy, dose unavailable till 48 hours and insurance does not cover med.....forget outcome.

4. new gestational diabetic, orders for tight insulin coverage given and stat pm visit requested by referral source at 3pm. (1 hr pp blood sugar almost 400). inquired did pt have rx, med, syringes or glucometer "no, i'm waiting for her to call me back with name of pharmacy". 5pm phone call by mom baby manager to patient: hadn't checked answering machine, just got in from work, unaware of any of this info and would not be available in daytime for teaching as has to work---might call doc back in day or 2.

sentinel alerts available here:

http://www.jointcommission.org/sentinelevents/sentineleventalert/

signup to receive alerts:

http://www.jointcommission.org/library/newsletters/list_serve.htm

2006 alerts:

issue 36 - april 3, 2006: tubing misconnections—a persistent and potentially deadly occurrence

issue 35 - january 25, 2006: using medication reconciliation to prevent errors

ern91 · Jul 6, 2006

Oh My God!! Time Out Forms In An Er Is Ridiculous!! Seems This Is More For An Inpatient Setting Rather Than The Er Which Is Really An Outpatient Setting. We Don't Amputate Limbs! The Requirement Is That A Time Out Be Done For Any Invasive Procedure. Wellllll...does That Mean An Iv? Foley? Ngt? See What I Mean? I Find It Quite Insulting That Jchao Requires This For Sutures, Lp's I&d's. It's Pretty Obvious To All Involved Where The Sites Are In These Cases. There Is The Real World...and Then There Is Jchao

**canoehead, BSN, RN** · Jul 6, 2006

JCAHO recently visited our hospital and missed nonworking alarms on moniters, stretchers that have nonworking brakes, wheelchairs without footrests, inabilty to get code cart or stretchers in half the rooms in the ER, battery lasting 5 minutes on code cart, lack of barrier between nursing and patient care area (patients can hear everything at the desk), no PI reviews that I'm aware of besides the dam med reconciliation, syringes and needles in all the rooms, patients admitted after 4-5 hours in the ER with no nursing notes except initial triage, or received treatment in the ER for the same time without any repeat vital signs, missing consent forms on sedation and transfusions, standing med orders for outpatients that are 6 months old or worse.... I could go on for a long, long time.

But we passed with no deficiencies. Someone said to me that they don't have definite standards that every hospital has to meet. He said they just look for continuous improvement. So if you were a slow learning hospital you could ignore a lot of the standards? I know that among hospitals in this area JCAHO seems to have different rules for different hospitals. Is that the administration blaming JCAHO for things they want done, or are the national standards not consistent. For myself I would assume as a consumer that if a facility is accredited they have met a minimum standard.

I have worked in a facility that is not JCAHO accredited and their main income was from Medicare/Medicaid payments. They said they were fine as long as the state inspections were OK, and the state came more often for facilities that didn't have JCAHO coming.

JCAHO stinks.