This is a vent. I got cornered by a surveyor yesterday. Patient was 98, post op ortho, lost a liter of blood in the OR, got transfused but needed a dose of a pressor after he dumped his pressure upon arrival to the PACU. White as the sheet. Anesthesia encourages me to start small with any pain meds I give. Did I mention the history of kidney disease?
Here comes the JC to question me about my care. ALL they cared about was if I was following the 1-10 pain scale, and if the pain meds were ordered according to that pain scale. (They were) They didn't like my mention of nursing judgement regarding the low BP upon arrival and my choice to start at the lower dose (which was within ordered parameters.) they demanded to see the orders for the parameters for the low BP r/t the pain meds. A co-worker jumped in to intervene at that point; she was quicker at pulling up the info they wanted.
I transferred the patient to the ICU then went to lunch. I was then told that the JC had demanded to see my file to assess my competencies. Director sent them to HR, as I am on orientation, and she didn't have anything to show them. I was pretty upset at that, even though everyone told me not to worry. Anesthesia MD said to me that if we are ONLY going to medicate according to the 1-10 pain scale without looking at the whole picture of what's going on with the patient we would kill a lot of patients. A robot could medicate that way. Do you think the JC will be there to have our backs after that kind of fallout? I doubt it. For the record, I did medicate the patient for pain twice, and he was comfortable and safe when he left my care.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Can a facility opt out of JC evaluations? I thought this was required by law to be an accredited healthcare facility. If you aren't accredited, then a lot of insurance plans won't reimburse for your care, including Medicare/Medicaid. Or am I mistaken about that?
NOt all facilities are accredited by the Joint Commission although they have the majority. Accreditation is for CMS/Medicare/Medicaid as a requirement.
I see, and thanks for clearing that up. I have never worked for a facility that didn't have JC come in, and it's always a huge ordeal that everyone dreads.
Do you think the JC will be there to have our backs after that kind of fallout? I doubt it.
You used your nursing judgement to keep the patient safe, in a situation that is not black or white. When there is a fallout you will be questioned about your lack of nursing judgement. Wish JC could understand this and the complexity of nursing.
Can a facility opt out of JC evaluations? I thought this was required by law to be an accredited healthcare facility. If you aren't accredited, then a lot of insurance plans won't reimburse for your care, including Medicare/Medicaid. Or am I mistaken about that?
Yep. My facility is accredited by HFAP. They make rounds just like JC. HFAP
I've said for years, the only health care reform we need in this country(USA) is abolish The Joint Commission and focus on letting the health care professionals practice health care. I would love to see a study of patient outcomes in a hospital that followed JC requirements, and one that managed patient care priorities based on the assessment of the health care providers. I would bet the non-JC facillity would do the care better, cheaper, and with higher patient satisfaction and lower complication rates every time.
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
We were surveyed recently at my facility. I was so stressed I killed my immune system and got horribly sick. Now I'm laid up in bed with diarrhea and vertigo. So glad it's over!!!
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Esme12, ASN, BSN, RN
20,908 Posts
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