To you advanced degree nurses that like writing all the articles on here, I have a request for an article.
I want to know if accrediting agencies actually help healthcare facilities. For example JACHO: “OurMission: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. “
Do all the JACHO nit picky crazy regulations actually help quality or has it gotten to the point that accreditation organizations gotten over zealous with regulation and box checking that patient care is actually worsening even though charting and other administrative measures are showing high marks
Are we being nit picked apart about measures that have minimal effect while unquantifiable direct care measures, due to the inability to consistently be able to quantify and identify them, being ignored and not valued solely because there is no way to measure for them or just the face that they are not on the ‘list’ of things to monitor?
I feel like healthcare is becoming the ‘wanna be’ field. Where we are more often posers for good care through over charting but actual care and facility staff sanity has gone by the wayside. I don’t like my profession...I don’t respect it because we have lost focus due to reimbursement and over regulation. I don’t feel like I can advocate for the good in my career, because while I know TONS of nurses, CNAs, MDs, NPs, etc that care greatly about patients, all of us are stuck doing a *** job because of over regulation and reimbursement strategies. I am all for hospitals making money, and I like rules, but are we over doing it to the point that we are not obtaining the obvious goal of taking good care of people as the minimum standard?
Not impressed by JACHO. I always fail to see how having my (covered) water bottle placed next to my (freshly cleaned) stethescope is a bigger infection risk than, you know, me being in the room with the patient and breathing the same air...
The other good one was when we had to throw out a freshly opened liter pump bottle of Coffee Mate because the date that it had been opened had been written an inch off from the designated date label. That seriously happened. Over an inch. The date was correct too.
Not impressed by JACHO. I always fail to see how having my (covered) water bottle placed next to my (freshly cleaned) stethescope is a bigger infection risk than, you know, me being in the room with the patient and breathing the same air...
The other good one was when we had to throw out a freshly opened liter pump bottle of Coffee Mate because the date that it had been opened had been written an inch off from the designated date label. That seriously happened. Over an inch. The date was correct too.
And the JC charges your facility quite a bit for that level of quality, well-conceived oversight...
Not impressed by JACHO. I always fail to see how having my (covered) water bottle placed next to my (freshly cleaned) stethescope is a bigger infection risk than, you know, me being in the room with the patient and breathing the same air...
The other good one was when we had to throw out a freshly opened liter pump bottle of Coffee Mate because the date that it had been opened had been written an inch off from the designated date label. That seriously happened. Over an inch. The date was correct too.
Jep. Was on a unit that got cited because one of the multitude of wall mounted hand sanitizer bottles had a tiny bead of gel under the pump. JACHO is a total scam that healthcare mgt bought into at the expense of patient care.
I understand the premise of JAHCO, but I feel like they have come to abuse their so-called “power”. They should ensure a hospital is safe. What they should not do, is make up ridiculous guidelines that are impossible to follow.
If I followed every, single guideline that we would get cited for, my shift would turn into 15 hours regularly. I’m a safe, prudent nurse. I shouldn’t have to chart a pain reassessment for putting ice on someone’s neck or repositioning them. I shouldn’t have to chart their highest level of education every shift. I have to date every, stupid thing. I get a cup out of the cabinet to flush water in my feeding tube? Date and time it. I open sterile water that I’m going to use all of on the shift? Date and time it. For some reason water expires after 24 hours.
Don’t use tape at the nurses station. Don’t drink. Don’t ever eat. No having ketchup in the employee fridge if it’s over 3 days. What? Ketchup expires in 3 days?
Let’s forget you were desperately trying to keep your patient alive all day so family could come and say goodbye. Forget you admitted a terrible trauma while keeping the other one alive. Forget that you are now covered in vomit and GI bleed. You didn’t chart your care plan so we are citing you!!
Jep. Was on a unit that got cited because one of the multitude of wall mounted hand sanitizer bottles had a tiny bead of gel under the pump. JACHO is a total scam that healthcare mgt bought into at the expense of patient care.
Understandable assessment but it is not management who has bought into 3rd party practice assessment companies, the government has. Accredidation by a 3rd company is required by law to participate in many Medicaid programs.
These changes were not done with the intent to increase staffing ratios. They were to cut the over inflated price of hospital stays. Greedy corporate healthcare execs used this as an excuse to cut staffing ratios to get their big bonuses and promotions!
I agree the govt will not voluntarily intervene because they don't want to spend the money. I believe the answer is to get the National Nurses United across the country and get staffing ratios like CA was able to achieve with their help!
If you read the published justifications and rationales, some going back to the late 70's the specifically call out controlling the nurse to patient ratio. Nursing has been cited as a major controllable expense in healthcare for decades now.
This is not my opinion nor do I support it but Google the rational for the MS-DRG, there are whole papers and articles written about increasing the nurse to patient ratio through the MS-DRG base rate.
I understand the premise of JAHCO, but I feel like they have come to abuse their so-called “power”. They should ensure a hospital is safe. What they should not do, is make up ridiculous guidelines that are impossible to follow.
If I followed every, single guideline that we would get cited for, my shift would turn into 15 hours regularly. I’m a safe, prudent nurse. I shouldn’t have to chart a pain reassessment for putting ice on someone’s neck or repositioning them. I shouldn’t have to chart their highest level of education every shift. I have to date every, stupid thing. I get a cup out of the cabinet to flush water in my feeding tube? Date and time it. I open sterile water that I’m going to use all of on the shift? Date and time it. For some reason water expires after 24 hours.
Don’t use tape at the nurses station. Don’t drink. Don’t ever eat. No having ketchup in the employee fridge if it’s over 3 days. What? Ketchup expires in 3 days?
Let’s forget you were desperately trying to keep your patient alive all day so family could come and say goodbye. Forget you admitted a terrible trauma while keeping the other one alive. Forget that you are now covered in vomit and GI bleed. You didn’t chart your care plan so we are citing you!!
It’s absolutely ridiculous.
I understand your frustration but many of those items are not inventions of the Joint Commission but rather items from various regulatory bodies such as the whole eating thing and maintaining food items in employee refrigerators.
I can tell many people never worked in food service or the lab. Many of the things nurses complain about are standard regulated items in other areas.
Imagine a restaurant and everyone who audits that restaurant, you have the fire marshal, you have the department of health or your equivalent in your state to assess the safety of their food, and you might even have code enforcement people.
Now imagine a laboratory and everyone who audits them including.
Now imagine a hotel and everyone who audits them with special emphasis on safety since it is a multi-story building.
Now imagine a government managed emergency center/shelter and the regulations something like that might have.
Now imagine a pharmacy and those who audit them with special attention from the DEA and others.
It goes on and on.... A hospital is a city in a box.
The Joint Commission and other accrediting bodies, that are many times required by law, attempt to condense all of those auditing agencies into one massive audit which is why you have so many annoying and silly items you are dinged on.
I understand your frustration but many of those items are not inventions of the Joint Commission but rather items from various regulatory bodies such as the whole eating thing and maintaining food items in employee refrigerators.
I can tell many people never worked in food service or the lab. Many of the things nurses complain about are standard regulated items in other areas.
I worked in food device many years ago. Like I said, I think the premise is good, but their focus is wrong. I should not get dinged on my charting for missing a plan of care or did I educate the pt on hand hygiene. And yes, they do cite you for that.
Everytime my pt bucks the vent and I bolus them, I have to document it in 5 different places. And yes, if you miss it, they cite you.
Water does not expire in 24 hours, I’m sure that the surveyors keep ketchup in their own personal fridge for longer than 3 days. Tape at the nurses station is not an infection risk. That is what I’m talking about with ridiculous things.
They should be checking the temps on the fridge, they should ensure that we aren’t using expired equipment, that we are safely administering meds, that the hospital is clean. Those things are important. Citing us because I missed a goal or education? Especially when my pt is vented? Crazy. I had to chart education last night on a pt we decided to terminally wean. But the terminal wean was to occur after shift change. On my shift, it had to be documented. That’s total absurdity if you ask me.
I worked in food device many years ago. Like I said, I think the premise is good, but their focus is wrong. I should not get dinged on my charting for missing a plan of care or did I educate the pt on hand hygiene. And yes, they do cite you for that.
Out of curiosity, are you expected by policy at your facility to have a plan of care of patient education on hand hygiene? If Joint Commission was not there and you never ever did those things, would it be a problem?
I have found that usually for small hyper-specific things like that the Joint Commission is dinging someone on non-compliance to a self-developed policy, not something the Joint Commission is inventing/requiring.
18 minutes ago, LovingLife123 said:
Everytime my pt bucks the vent and I bolus them, I have to document it in 5 different places. And yes, if you miss it, they cite you.
Water does not expire in 24 hours, I’m sure that the surveyors keep ketchup in their own personal fridge for longer than 3 days. Tape at the nurses station is not an infection risk. That is what I’m talking about with ridiculous things.
Redundant documentation again sounds like a facility process/policy issue to me unless the Joint Commission is inventing/requiring a new process for your facility? Did they invent a new process or ding you for non-compliance to your own internally developed process?
As far as food and beverage goes, that is generally a Department of Health thing or a laboratory certification/standards thing should you handle or process lab materials in the area. Again, not something the Joint Commission necessarily invents, they are enforcing stupid rules likely invented by your state's regulating bodies.
18 minutes ago, LovingLife123 said:
They should be checking the temps on the fridge, they should ensure that we aren’t using expired equipment, that we are safely administering meds, that the hospital is clean. Those things are important. Citing us because I missed a goal or education? Especially when my pt is vented? Crazy. I had to chart education last night on a pt we decided to terminally wean. But the terminal wean was to occur after shift change. On my shift, it had to be documented. That’s total absurdity if you ask me.
You can't think of accrediting bodies like the Joint Commission as a singular entity focused on patient care. Think of them as the sum of all of the regulatory bodies within your state, everything from food service to fire, combined with the ultimate facility policy/process policemen.
Many of the stupid things we are cited for are self-created issues. If we do not like being held to our policy or procedure because it is stupid then it is literally in our power to change it.
I will give you an example. We had a documented procedure for maintaining charting on a particular procedure in two places, our unit would keep paper charting and then it would be documented in the computer. Often times the paper charting was not maintained well and only kept for our own tracking/records. To keep from being dinged for not keeping pristine paper records we simply changed the documented procedure to only call for a single entry into the computer. We still maintained our paper charts but since it was not called for officially we were not held to keeping the charts pristine by the Joint Commission.
Out of curiosity, are you expected by policy at your facility to have a plan of care of patient education on hand hygiene? If Joint Commission was not there and you never ever did those things, would it be a problem?
I have found that usually for small hyper-specific things like that the Joint Commission is dinging someone on non-compliance to a self-developed policy, not something the Joint Commission is inventing/requiring.
Redundant documentation again sounds like a facility process/policy issue to me unless the Joint Commission is inventing/requiring a new process for your facility? Did they invent a new process or ding you for non-compliance to your own internally developed process?
As far as food and beverage goes, that is generally a Department of Health thing or a laboratory certification/standards thing should you handle or process lab materials in the area. Again, not something the Joint Commission necessarily invents, they are enforcing stupid rules likely invented by your state's regulating bodies.
You can't think of accrediting bodies like the Joint Commission as a singular entity focused on patient care. Think of them as the sum of all of the regulatory bodies within your state, everything from food service to fire, combined with the ultimate facility policy/process policemen.
Many of the stupid things we are cited for are self-created issues. If we do not like being held to our policy or procedure because it is stupid then it is literally in our power to change it.
I will give you an example. We had a documented procedure for maintaining charting on a particular procedure in two places, our unit would keep paper charting and then it would be documented in the computer. Often times the paper charting was not maintained well and only kept for our own tracking/records. To keep from being dinged for not keeping pristine paper records we simply changed the documented procedure to only call for a single entry into the computer. We still maintained our paper charts but since it was not called for officially we were not held to keeping the charts pristine by the Joint Commission.
We got our accreditation to be a Comprehensive Stroke Center a whole back. We were certified by JHACO so yes, many of these things are coming from them.
You are missing my point. You can be a JHACO advocate all you want, and as I stated, they do serve a purpose. But they don’t focus on the big things. It’s the small, minute things. They don’t at all see we just cracked a chest open at bedside, or I was involved in a bedside laparotomy. That my whole day was simply keeping my patient alive and the other happy at the same time with ice and pain meds. So then I get to stay until 2100 charting things 3 times so I’m compliant. I’m late getting home to my family and frankly, it’s burning nurses out. The focus should be on the safety of the hospital and not our charting. And my charting is pretty darn good. I’m pretty quick and accurate. But I was at work until 2030 last night finishing up plans of care on a new admit and my dying terminal wean because she was a stroke and the chart will “fail” if I don’t chart my plan of care and education. Should I have charted I educated my GCS of 6 on the importance of physical therapy while she was in V-Tach, or while I was placing an OG for vomiting? Or while we discussed terminally weaning or trach and pegging?
We got our accreditation to be a Comprehensive Stroke Center a whole back. We were certified by JHACO so yes, many of these things are coming from them.
You are missing my point. You can be a JHACO advocate all you want, and as I stated, they do serve a purpose. But they don’t focus on the big things. It’s the small, minute things. They don’t at all see we just cracked a chest open at bedside, or I was involved in a bedside laparotomy. That my whole day was simply keeping my patient alive and the other happy at the same time with ice and pain meds. So then I get to stay until 2100 charting things 3 times so I’m compliant. I’m late getting home to my family and frankly, it’s burning nurses out. The focus should be on the safety of the hospital and not our charting. And my charting is pretty darn good. I’m pretty quick and accurate. But I was at work until 2030 last night finishing up plans of care on a new admit and my dying terminal wean because she was a stroke and the chart will “fail” if I don’t chart my plan of care and education. Should I have charted I educated my GCS of 6 on the importance of physical therapy while she was in V-Tach, or while I was placing an OG for vomiting? Or while we discussed terminally weaning or trach and pegging?
I agree with your sentiment 100%. It is a simple mathematical fact: If my time is completely full, and a task is added, a task of equal size will need to be subtracted. My tasks fall into two categories; patient care and charting. If a charting task is added, that time has to come from somewhere. If I don't want to get dinged, that time comes from PT care.
No PT has ever benefited from me asking a bizarre selection of inane questions, or me charting response to an icepack. They have suffered if I have to use my limited time doing that, rather than help them download Goodrx on their phone so they can afford the medication and actually be compliant.
But- much of what you cited is not from regulatory agencies, but straight from hospital policy as hospital staff misinterpret those regulations. These are unusually mid-level admin who walk around with clipboards, none of whom do bedside care.
Take for example water at the nursing station- This is neither a threat to PTs or staff. And, I challenge anybody to find a regulation anywhere that prohibits it.
BlueShoes12, BSN, RN
131 Posts
Not impressed by JACHO. I always fail to see how having my (covered) water bottle placed next to my (freshly cleaned) stethescope is a bigger infection risk than, you know, me being in the room with the patient and breathing the same air...
The other good one was when we had to throw out a freshly opened liter pump bottle of Coffee Mate because the date that it had been opened had been written an inch off from the designated date label. That seriously happened. Over an inch. The date was correct too.