What do you think of JCAHO?

[GardenDove]

I keep hearing more absurd edicts from the joint commission. They've banned certain commonly worn shoes called crocs. They've banned pens that go around your neck. They also seem to have many other annoying and time consuming requirements. I think they are ruining bedside nursing. They seem to think that the more forms filled out, the better.

Yesterday I had a vent pt with restraints. We have a stupid restraint form that needs a million boxes filled every hour. It totally loses it's meaning and does nothing to improve care, but my manager has to worry more about this form than a million more important things. She's always reminding us to fill in the million boxes. I just check them off ahead of time. The pt had many other more important things going on, being on several drips, Q 1 hour blood sugars, and I was taking off orders all day long.

Anyways, I think the regulators have become a self-perpetuating bureaucratic entity in my opinion.

[RNperdiem, RN]

Where will JCHAO be when my patient self extubates and has a bad outcome? Will JCHAO be there to back me up for going restraint free? How about my hospital? What about the patient?

[imenid37]

We had a very competent, reasona

ble nurse-surveyor. I didn't think much of the physician surveyor to put it mildly. In principle, it's a good idea to have someone watching over facilites BUT there are a lot of silly rules and in essence, it has become a game of sorts. I think the surprise visits are better than when we knew when they were coming. A facility, for the patients' sake shold always try to be at its best. I'd love to see the joint and NPSG's address the whole pulling thing. I think it's very unsafe, more so than some of the not filling out of forms. We have created tons more paperwork than we had twenty years ago and expect fewer nurses to do it while caring for a higher number and complexity of patients. That is more of a problem than if staff are wearing shoes not in accordance w/ the facilty's policy.

[canoehead, BSN, RN]

i also think that hospital administrations hide behind the jcaho banner when they post certain rules. for example, requiring us to sign a form saying why we didn't get a flu shot, or stating it to be a jcaho requirement that we tell them the nature of an illness when we call in sick.

we are jcaho certified and don't have to do either of these. admin has just found an easy excuse.

[jrbl77, RN]

have you heard of jumping through hoops?

[meandragonbrett]

JCAHO needs to be flushed down the toilet.

[Chaya, ASN, RN]

It could be a good thing. Just like Magnet Status. But both things instead of really improving things like they claim to do, instead just take away from patient care (and thus safety) to fill out paperwork to "prove" that we're safe. But when have logic and bureaucracy ever crossed paths?

The concept of JCAHO is basically good but they took a wrong turn in implementing it. They can't seem to get the long view-ie: can't see the forest for the trees-of extra documentation, extra signatures, etc, etc, etc

[Bluehair]

I think they could potentially do a lot of good but they get caught up in all this nit-picky crap instead, so much so that it often violates safety, confidentiality, etc.. For instance, if they wanted to do something useful, I would love to see them standardize the colors for codes or the colors for precaution bracelets; it would be nice if the color for DNR or even fall precautions were the same from one institution to the next.

Actually I just heard that standardization of colored bracelets is already on the way. I don't think it is JCAHO that is doing it, but our state governing agencies instead. Joining in with other states. Can't remember all the colors (we haven't started making the swap yet) but it's something like red will be allergies, etc.

[Bluehair]

Nope, not the jacho nazis. They'er to concerned about crocks with holes in them and making sure you use black ink.

Our infection control guru gave credit to OSHA for the no-Croc's/no neck pen ruling, not JCAHO.

[CseMgr1, ASN, RN]

I delt with JACHO for the 18 years I was in home health, and watched their elements go from the ridiculous to the absurd.

As far as I am concerned, they have become just another pathetic, money-making bureaucracy.

[Bluehair]

We had a very competent, reasona

ble nurse-surveyor. I didn't think much of the physician surveyor to put it mildly. In principle, it's a good idea to have someone watching over facilites BUT there are a lot of silly rules and in essence, it has become a game of sorts. I think the surprise visits are better than when we knew when they were coming. A facility, for the patients' sake shold always try to be at its best. I'd love to see the joint and NPSG's address the whole pulling thing. I think it's very unsafe, more so than some of the not filling out of forms. We have created tons more paperwork than we had twenty years ago and expect fewer nurses to do it while caring for a higher number and complexity of patients. That is more of a problem than if staff are wearing shoes not in accordance w/ the facilty's policy.

Same at our last inspection - the nurse was friendly and reasonable, worked at putting people at ease and made sure we had everything down but didn't work at tripping you up so she could nit pick. The MD, however, had a serious napoleon complex and a pathologic fixation on med reconciliation to the exclusion of other topics at times!

I think part of why they end up getting to be such Nazi's about things is because there ARE some people out there who don't exercise decent judgement about things. You must have heard of them - the non-IV irrigation tubing that got hooked up to a patient's IV and they died, the patient who hung in their posey vest and died, po liquid meds given IV, 8 Gm of IV Dilantin given in a single dose, on and on and on. It's sort of how life works in our society in general. The rest of us with some amount of common sense have to do a bunch of silly things, goofy rules get made to try to keep stupid people in line and the rest of us have to suffer with the consequences. Enter JCAHO, the medical rule makers and gate keepers. The actual national patient safety goals themselves seem innocent enough, it's what you have to do to achieve them that is such a pain in the butt. Some of that does go back to individual hospital's policies. Our restraint policy is q 2 hour documentation, not q 1. It's been thru JCAHO a number of times with no trouble.

I agree, Imenid, it's a lot more reasonal (and presumably productive) to be keeping up with the JCAHO stuff all the time, not just at survey time. I think the places that do it ONLY at survey time do end up getting more dings.

[JRapha'sRN]

saying "JCAHO" is similar to saying any naughty swear word

I think it's not jcaho that is the problem, it is the paranoid administration that try to read into all of jcaho's guidelines and then enforce not only their interpretation of the rule, but 7 extra things , just to make sure that we are "ok" when jcaho comes.

I think some of jcaho's goals are great, it's just hospital admin that we need to string up by their toenails

[jmtndl]

I have always thought that JCAHO would be much more useful if they spent their time counting horse droppings at the Kentucky Derby. And I have dealt with them for 35 years.