Joint Commission standard

[icunurse1955]

We recently had our unannounced Joint Commission survey. A standard that we were not in compliance on was PC.01.02.03 that states " For a medical history and physical examination that was completed within 30 days prior to registration or inpatient admission, an update documenting any change in patient condition is completed within 24 hours after registration or inpatient admission, but prior to surgery or a procedure requiring anesthesia services."

In order to correct this, we developed a sticker to be placed on the chart that states that the H&P has been reviewed and no changes are noted. If there are changes, then there is place for those.

We place those on there and the surgeons are to fill them out and sign them prior to surgery since the attending that dictated the H&P are not there in time to sign them.

We are getting a lot of resistance from the surgeons because they feel that they are making an addendum to someones elses H&P and that makes them liable for any unknown or unforeseen conditions that may have developed since the H&P.

I would like to know how everyone else is meeting this standard.

Thank you.

[Argo]

We meet it and make it plain and simple. Either the surgeon doeswhat he Hastings do as a requirement or we don't roll to the OR. Consent signed. H&p updated/done/signed. They all fell in line after a couple of weeks.

[HamsterRN, ADN, RN]

That's the point, they are responsible for knowing if there have been any significant changes since the current H&P was dictated and to document these changes if they exist. We use the same system and got some resistance at first, but it turned out the resistance was mainly due to the fact that the surgeons weren't reading the H&P's of patients they were about to operate on, they've since quieted down after it was pointed out that they should probably know the basic story of patients they are about to operate on and therefore should be capable of updating or amending an H&P.

[icunurse1955]

We have one surgeon who is the problem. His argument is that the patient may have developed something unforeseen such as a breast tumor prior to the surgery and then he would not know that and would be held accountable. (This is an orthopedic surgeon and very hard to deal with).

[Lucky0220]

Does your hospital have a Chief Medical Office? This is usually an MD that deals with non compliance issues, rudeness to staff, etc., of the physicians with privledges at the hospital. If your hospital has one, let him deal with this arrogant surgeon!

[canoehead, BSN, RN]

I vote that it is a physician issue, and the physicians should handle it. Nursing time is valuable, and they've already flagged the charts.

Besides- the surgeon admits he does not know the complete and current health status of a patient he's bringing to the OR? Unacceptable. He shouldn't be able to have OR time until he takes a moment to examine his patients.