JCAHO Mock Survey Problems

  1. Our Med/Surg unit went through a Mock Survey last week in preparation for JCAHO's visit in the Fall. I wasn't at work when this happened, but apparently we didn't do too well. Some areas cited included having IV antibiotics (piggybacks) lying on the med carts (*GASP*), and having vials of saline (for IV flushes) sitting out on the med carts(*HORRORS*), and other petty (to ~ME~ anyway) demerits, or whatever they call them. Have you ever heard of the two things I mentioned being a problem? Why not keep making the jobs even MORE difficult and inconvenient for the nurses.

    There were some problems that I can understand like leaving unmarked syringes (saline or heparin flushes) on the top of med carts, but again, much is done for our convenience to keep up with the demands of our unit. JCAHO wants everything locked up tight (again, I can understand the rationale), but it's starting to feel more and more like the straws are beginning to break the camel's back on our units. We just received our manager's resignation email yesterday, our ratios were recently raised and PCT's cut back, the hospital's facing financial troubles, yada yada yada... but that's another story and thread. (Is there a smilie tearing its hair out?)
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    About RN-PA

    Joined: Jan '02; Posts: 1,178; Likes: 21
    Staff Nurse; from US
    Specialty: Med-Surg, Long Term Care

    10 Comments

  3. by   P_RN
    Bottles of saline are easy. Use once and throw away. No way I'm using a bottle that's been opened.

    Minibags....I usually kept mine in a box with an ice pack when the med carts were used. After we went to teams it was easier to keep them in the fridge. We'd have boxes in there lined up by team number and room number. The JCAHO just don't want them to be exposed to heat or pilferage. Or to curious eyes either I guess.
  4. by   RN-PA
    Originally posted by P_RN
    Bottles of saline are easy. Use once and throw away. No way I'm using a bottle that's been opened.

    Minibags....I usually kept mine in a box with an ice pack when the med carts were used. After we went to teams it was easier to keep them in the fridge. We'd have boxes in there lined up by team number and room number. The JCAHO just don't want them to be exposed to heat or pilferage. Or to curious eyes either I guess.
    These are 30 ml multidose vials of saline. I still don't understand why they can't be where we can have easy access.

    As far as the refrigerated IV antibiotic piggybacks, I like to get them a little closer to room temperature before infusing them. Having all my IV piggybacks in front of me on the med cart has helped with my organization, too. JCAHO means too many regulations and not enough common sense, IMHO. :stone
  5. by   altomga
    Having IV piggybacks out of the fridge breaks them down (supposedly decreases the effectiveness) It also violates HIPAA regulations. These meds have patients names on them that Passer-bys could see. Saline...it is considered a med and is supposed to be locked up.
    I agree that the rules and regulations are getting to be something of a aggravation.
    We recently had our official survey from JCAHO and did well (94% total "grade")
    Our floor got a Type 1 for the med fridge not having the proper info on the temp required
    Another for unapproved abbreviations being used ie) U instead of Units....QD instead of Qday....we just switched this policy so we expected this though.

    Good luck!!
  6. by   renerian
    We always used multidose saline more than once. Date it as it is opened and disgard every week. The cost of pitching a vial that is mostly full is a waste of money. Of course you and I pay for that in the form of higher bills and insurance premiums.

    renerian
  7. by   P_RN
    I stand by my statement. I will not use a multiuse bottle that has been opened by someone else. I have seen a nurse who stole demerol by putting it into a saline bottle. If someone "flushed" with 2-3 cc of 100mg/cc meperidine....well......
  8. by   NRSKarenRN
    In this day and age of liability + contamination concerns, I'd toss opened 30CC vials too.

    Golden rule: Prevent harm at all costs.

    We need to rethink how we do things " We always did it this way"----just like using multi-dose KCL vials and sharpening our needles for use with glass syringes.
    Last edit by NRSKarenRN on Apr 24, '03
  9. by   RN-PA
    I guess I've been a little naive about the multi-dose vials and will have to re-think. If they're to be single dose vials, then we need to stock smaller than 30 cc vials-- very wasteful if you're only drawing up 2 cc flushes at a time.

    On another note, we are being told that *EVERY* time we give a patient a med, or do wound care or the like, we have to ask them:

    *Their name
    *Their birthday

    Every single time (and check their name-band). So, I meet my patient at the beginning of my 8 hour shift and ask name and birthday. Then in subsequent interactions, I'm asking the same thing. I'm sorry, but this is NUTZ! If I had a nurse asking me this numerous times in a shift, I'd doubt their memory AND their competency. The two identifiers are even included in our computerized careplans. Anyone else having this same emphasis? (And please don't tell me how important identifying a patient is-- I know it's important, but this kind of "Stepford wife" nursing is creeping me out!)
  10. by   canoehead
    Most of my pts (at night) are lucky to know their name- no way they'd even know what a birthday was!
  11. by   RN-PA
    Originally posted by canoehead
    Most of my pts (at night) are lucky to know their name- no way they'd even know what a birthday was!


    The night shift nurses will certainly be popular on our units when they're having to wake the patients every time they need to interact with them to ask the patients' names and birthdays.
  12. by   Kimburly
    My personal fave when JCHACO comes is locking ALL of the cabinets. Who needs IV tubing for there personal pleasure?

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