Joint Commission

lkwashington · Nov 12, 2010

In my opinion, the only stress that is put on the workplace by JCAHO is making sure all policy and procedures are in place for the safety of the employees and patients. I think the stress comes from getting everything in order for JCAHO, which should be kept in order before and after the inspection is done. If everything is in order and kept no one should only have minimum worries.

silentRN · Nov 12, 2010

I agree. It's just that time of year when JCAHO is making their rounds at the hospital. I hate when they come.

CathyLew · Nov 12, 2010

Oh, but they do get super picky on some things.... I love it when they ding us and tell us--you are doing everything the correct way, its just that you aren't following some obscure policy that happens to be in our policy books. Half the time we get dinged, its because someone who only sits behind a desk, made so many policies that are impossible to follow....

Esme12, ASN, BSN, RN · Nov 12, 2010

Joint Commision just wants a standard to be followed to minimize errors! A common book of instructions so everybody is on the same page. What they want is if you make a policy you must follow it........if you make the policy difficult to follow that's your fault....it must be followed. They don't want policys to be elaborate just followed. That is where a lot of facilities get dinged. They think JC wants theses elaborate "impressive" policies....they don't, they just want every one on the same page. If the facilities followed the new guidelines of "constant rediness" it really should not be a big deal.........like I said SHOULD not be a big deal..........but we all know the last min crunch is a real pain..........hint If you get stopped and don't know the answer always say I am not sure but I know where to find the answer! They like that :)

tyvin, BSN, RN · Nov 12, 2010

Love em; to a certain degree. They keep the places on their toes. Same with the state examiners. Could you just imagine if there was nothing to ensure regulations were being adhered to? Disaster........

merlee · Nov 12, 2010

Inspectors don't bother me - - it's the administrators that do. They make everyone crazy. I wish there was more of a surprise to it, but then there would be total chaos.

LTC facilities get surprise visits, so do Home Health care agencies. And I've been lucky enough to see them all!

diane227, LPN, RN · Nov 13, 2010

Joint Commission is hired by the hospital for the survey process. Most hospitals obtain the survey as a way of demonstrating they have met a certain standard of care. Those visits are scheduled and the hospital knows when they are coming. The Joint Commission has no power to fine or close a facility. However, if they find infractions they can report them. When your state surveyors come in, that is a different story. They come to your facility in two ways: to address a complaint that they have received or to perform a routine survey. They come unannounced and they can look at anything they want to during the survey. They have both state and federal regulations upon which they survey you and they have the power to levy a fine, pull your medicare/ medicaid funding, or close you down. Depending on the nature of the problem your facility will be given a period of time to correct the problem and that period of time depends on the severity of the issue at hand.

You can find out more by going to the JCAHO web site and to the department of health web site for your state. All regulations can be found there. You can also go to the Center for Medicare Services (CMS) web site and find out all about the federal rules and regs.

I urge nurses to be at least somewhat familiar with these standards so that you are aware of hot topic items. Also, if you need to make a complaint, these sites can instruct you as to how to do this.

elkpark · Nov 13, 2010

Joint Commission is hired by the hospital for the survey process. Most hospitals obtain the survey as a way of demonstrating they have met a certain standard of care. Those visits are scheduled and the hospital knows when they are coming.

(That's no longer true -- JCAHO began doing unannounced visits several years ago (finally, after years of criticism that the surveys were pretty meaningless when scheduled in advance.)

steelydanfan · Nov 15, 2010

Joint Commission is hired by the hospital for the survey process. Most hospitals obtain the survey as a way of demonstrating they have met a certain standard of care. Those visits are scheduled and the hospital knows when they are coming. The Joint Commission has no power to fine or close a facility. However, if they find infractions they can report them. When your state surveyors come in, that is a different story. They come to your facility in two ways: to address a complaint that they have received or to perform a routine survey. They come unannounced and they can look at anything they want to during the survey. They have both state and federal regulations upon which they survey you and they have the power to levy a fine, pull your medicare/ medicaid funding, or close you down. Depending on the nature of the problem your facility will be given a period of time to correct the problem and that period of time depends on the severity of the issue at hand.
You can find out more by going to the JCAHO web site and to the department of health web site for your state. All regulations can be found there. You can also go to the Center for Medicare Services (CMS) web site and find out all about the federal rules and regs.
I urge nurses to be at least somewhat familiar with these standards so that you are aware of hot topic items. Also, if you need to make a complaint, these sites can instruct you as to how to do this.

It is true that JCAHO is paid by the hospital to do the survey, but unless the hospital is JCAHO certified, they are not eligible to treat Medicare pts. Therein lies the rub. JCAHO was originally intended to, and still does in some ways, pinpoint failures in and improve upon hospital policies and procedures. However, they have become a self-fufilling organization. Unless they they find fault, they will cease to exist; therefore, they will ALWAYS find fault. Hence, some of the most ludicrous and shortsighted rules imaginable that hospitals MUST follow.

Just think of the INSANE amount of duplicate charting that you must do. Thank JCAHO.

The rules of JCAHO mean less time at the bedside for us all. But those paper trails look great!

grannyrn65 · Nov 15, 2010

It is true that JCAHO is paid by the hospital to do the survey, but unless the hospital is JCAHO certified, they are not eligible to treat Medicare pts. Therein lies the rub. JCAHO was originally intended to, and still does in some ways, pinpoint failures in and improve upon hospital policies and procedures. However, they have become a self-fufilling organization. Unless they they find fault, they will cease to exist; therefore, they will ALWAYS find fault. Hence, some of the most ludicrous and shortsighted rules imaginable that hospitals MUST follow.
Just think of the INSANE amount of duplicate charting that you must do. Thank JCAHO.
The rules of JCAHO mean less time at the bedside for us all. But those paper trails look great!

It isn't the JCAHO fault that nurses spend less time at the patient's bedside. But it is because of their standards and their accreditation that your facility gets Medicaid and Medicare, as well as some insurance companies, funds. And without them or their mountains of paper work, you would not be employed. Everyone complaints about their paperwork. Without paperwork, a facility would not have the proof something was done. No paper work, no proof of medication, no care plan, no proof, so on.

GrannyRN5`

steelydanfan · Nov 15, 2010

It isn't the JCAHO fault that nurses spend less time at the patient's bedside. But it is because of their standards and their accreditation that your facility gets Medicaid and Medicare, as well as some insurance companies, funds. And without them or their mountains of paper work, you would not be employed. Everyone complaints about their paperwork. Without paperwork, a facility would not have the proof something was done. No paper work, no proof of medication, no care plan, no proof, so on.
GrannyRN5`

So, I'm supposed to be happy to be employed to do "mountains of paperwork"? As opposed to having the time to think and plan and teach and actually make a difference in my patient's lives? The paperwork" existed 30 years ago, albeit handwritten and all in one easy to find place. Now it is scattered across 15-20 computer pages. Go figure. The "proof" of my actions and outcomes was solidified the day I graduated from nursing school 30 years ago, and it lives on in every pt. I discharge safely home. I do enough charting to satisfy the most rabid lawyer, never mind my managers. I haven't seen anything good from JCAHO before or since the Medication Reconciliation Form. Somehow, I can't think that's worth the billions they rake in every year.