Joint Commission Citing & Employee Files

[brockclan3, LVN]

Joint commission has been at our facility this week and watched me do a blood glucose check on a patient. I failed to wipe the first drop of blood before obtaining the sample for the stick so our department was cited. My supervisor told me about the citing and that Joint Commission would be reviewing my personnel file. I am a newer nurse (a year and a half) and while working in the department I started in I received several write ups for errors I have made. My question is, given my previous write ups, what does this mean for me and the facility I work at given this error?

[klone, MSN, RN]

They don't care about write-ups. They're looking for proof of completed competencies (such as a competency on how to do use the glucometer).

[klone, MSN, RN]

My question is, why have you been written up so many times?

[ruby_jane, BSN, RN]

OK so...in a non-acute care setting none of the diabetics I've ever seen wipe that first drop. What were you trained to do? I assume if you were trained to do it the way you did it, everyone gets retrained.

[JKL33]

On 5/16/2019 at 6:40 PM, brockclan3 said:

My supervisor told me about the citing and that Joint Commission would be reviewing my personnel file.

As klone said, the truth is that they want to see whether your employer has taken appropriate steps to ensure the competency of employees to perform the procedure in question.

Not sure why your supervisor phrased it the way s/he did; I guess given the background it's possible that what s/he wanted to say was that the employer will be reviewing your employment situation. Or maybe just convey displeasure/concern with the overall situation. Who knows.

How have things been going, otherwise?

[brockclan3, LVN]

4 hours ago, ruby_jane said:

OK so...in a non-acute care setting none of the diabetics I've ever seen wipe that first drop. What were you trained to do? I assume if you were trained to do it the way you did it, everyone gets retrained.

Well, in all actuality, when I was trained and in clinicals I was just handed a glucometer and asked to go check the blood sugar. I don't know of any co-workers that check blood sugars like joint commission says we need to. But now we will be wiser.

[brockclan3, LVN]

1 hour ago, JKL33 said:

As klone said, the truth is that they want to see whether your employer has taken appropriate steps to ensure the competency of employees to perform the procedure in question.

Not sure why your supervisor phrased it the way s/he did; I guess given the background it's possible that what s/he wanted to say was that the employer will be reviewing your employment situation. Or maybe just convey displeasure/concern with the overall situation. Who knows.

How have things been going, otherwise?

My supervisor told me that JC would be reviewing my file and she had concerns in regards of my past mistakes/write-ups. I asked her if there was a possibility that I would lose my job and she said she didn't think so. But I know that might be a possibility. Since I changed departments everything has been REALLY good. I haven't made any errors and everyone says I am doing great.

[LovingLife123]

I always wipe the first drop. I’m surprised so many do not. It’s how I was trained from day one. All my coworkers do it as well.

[Swellz]

13 hours ago, LovingLife123 said:

I always wipe the first drop. I’m surprised so many do not. It’s how I was trained from day one. All my coworkers do it as well.

I was trained this way as well, but I have run in to a lot of people who were never taught that way.

[MunoRN, RN]

Best practice is actually to use the first drop from a clean finger, the extra squeezing require to milk that second drop is more likely to skew the result than using the first drop: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041180/

Separate from that, the JC has no role in determining how you practice or taking any actions against your license or job. That doesn't mean JC surveyors frequent overstep their bounds and convey opinions on practice issues, but all they have the authority to do is survey facilities for CMS accreditation and there is no CMS requirement regarding using the first or second drop. CMS does require that hospitals take reasonable steps to ensure their policies reflect correct practice and that those policies are followed where appropriate which may be what the JC is looking at here if there is a policy where you work to use the second drop.

[StrwbryblndRN]

What is your current policy?

At my previous employer we used second drop of blood. My current employer is to use first drop.

Each had their own policy and was clear on what was expected. I follow policy.

[Kyrshamarks, BSN, RN]

Remember TIC IS NOT A GOVERNMENTAL AGENCY!!! They are a private company that gives a "certification" thtvsays you meet their standards. Legally insurance companies and Medicare cannot even ask if you are TJC certified and cannot deny payment based on lack of certification.