The Failure of the Joint Commission

[abbaking]

I want honest opinions here. I consider myself one of the many that think the Joint Commission has outlived its usefullness. Every year more National Patient Safety Goals, Sentinel Event alerts and more Do Not Use abbreviations. While the Joint Commission does have some very important safety goals and patient safety recomendations, To me its seems that it is an organization that turns a blind eye and a deaf ear to the obvious and focuses on the irrelevant.

For example, A few year back a Sentinel Event alert was issued abour MRI safety. Although MRI incidents may occur, the number is relatively low - However Patient care in hospital up and down the country continues to suffer due to short staffing or over-burdened nurses.

In every Sentinel Event alert or National Patient Safety Goal, workplace recomendations are issued by the Joint Comission - In nearly every instance, Better nurse staffing is recomended.

How come with each new Patient safety goal or Sentinel event alert - nursing paperwork/charting increases and time for actual patient care is diminished?

If the Joint Commision was serious about patient safety, NATIONWIDE NURSE TP PATIENT STAFFING RATIO'S would be implemented.

What is the hold up?

[dcarriv]

i think that jacho has the best people money can buy.

[llg, PhD, RN]

I generally agree with the OP sentiments. TJC is not the answer to today's problems. It's time for a major overhaul -- and not just a name change.

[nursinger]

I generally agree with the OP sentiments. TJC is not the answer to today's problems. It's time for a major overhaul -- and not just a name change.

I wholeheartedly agree with everyone's sentiments. Oh this is gong to be good. :yeah:

[casper1]

If we didn't have to spend so much time documeting everything we do, so the facility can prove to JAHCO that it's been done Nurses would have more time at the bedside and maybe less staff would be needed.

[RNsharkinaj]

Also definitely agree, the charting is outrageous. Just a few days agree I was joking to a few other nurses that if we wanted to we could sit down and chart for several days.....literally!!! and still have things that could be filled out. Less charting and more patient care, I am a huge fan of that!!!

[buransic]

Although I'm new to nursing, I'm not new to business. TJC has an important role to play in the standardization of care. However, the point that they're nibbling around the edges on important issues such as nurse-to-patient ratios, and since nursing is the key to patient safety, thus the TJC is less than adequately addressing patient safety warrants further investigation. I'll guess that the reason TJC won't take on N:P ratio is because it's a deal breaker for hospital compliance. Lately, all the hospital company annual reports show adverse impact of payroll costs (read nursing) on profitability. For TJC to take this on is just too big a deal and they wouldn't have resource for anything else. Whether that's reasonable or not; well, it's hard to tell. If the probability of success for mandating N:P ratios is low, then the outcome is the same whether they take it on or not.

[tgilk]

Interesting timing for your post. Bob Wachter just posted a piece about how he felt that TJC was becoming significantly more relevant with some contemporary changes...

The Health Care Blog: The New Joint Commission

And while I don't dispute your underlying point (quality and safety both being intimately tied to nursing care), I think the MRI sentinel event alert is a poor target.

Yes, MRI deaths are less than those caused by people tipping vending machines over themselves to get that stuck bag of chips... but the MRI environment is one where the fundamental laws of physics change imperceptibly and normally-harmless objects can become lethal just by moving them a foot one way or the other. These sorts of risks are wholly unknown by the non-MR public, so there is a unique duty of the provider to make sure that they have protections that conform to industry best practices.

John Q. Public knows the risks of tipping that big machine towards him to get an extra Snickers bar (even if he misjudges what the risks are). The same person is largely 100% unaware that failing to disclose the aneurysm clip or relinquish the 'lucky pocketknife' could result in someone getting killed in the MRI suite.

We're not talking raw-denominator numbers here, we're talking about a duty to manage unknown (to patients and visitors) risks that they have no awareness of / control over.

Tobias Gilk

[abbaking]

Interesting timing for your post. Bob Wachter just posted a piece about how he felt that TJC was becoming significantly more relevant with some contemporary changes...

The Health Care Blog: The New Joint Commission

And while I don't dispute your underlying point (quality and safety both being intimately tied to nursing care), I think the MRI sentinel event alert is a poor target.

Yes, MRI deaths are less than those caused by people tipping vending machines over themselves to get that stuck bag of chips... but the MRI environment is one where the fundamental laws of physics change imperceptibly and normally-harmless objects can become lethal just by moving them a foot one way or the other. These sorts of risks are wholly unknown by the non-MR public, so there is a unique duty of the provider to make sure that they have protections that conform to industry best practices.

John Q. Public knows the risks of tipping that big machine towards him to get an extra Snickers bar (even if he misjudges what the risks are). The same person is largely 100% unaware that failing to disclose the aneurysm clip or relinquish the 'lucky pocketknife' could result in someone getting killed in the MRI suite.

We're not talking raw-denominator numbers here, we're talking about a duty to manage unknown (to patients and visitors) risks that they have no awareness of / control over.

Tobias Gilk

I believe that the MRI safety Sentinel Event Alert, for example was bogus to begin with. Joint Commission with a task force and recomendation all about MRI safety? Come on - What about safety instructions from the machines manufacturer. Personally, I think Jont Commision should focus more on the realities of healthcare and not the isolated RARE incidents that the news media (and JCAHO) sensationalize.

[elkpark]

Part of Joint Commission's problem is that they have to keep inventing new standards, "problems" to solve, etc., as time goes on to continue to justify their existence (and their charging hospitals obscene amounts to be surveyed). Once all the hospitals are in compliance with all the sensible, reasonable standards, what is the reason to continue to pay big bucks for a Joint Commission survey q three years??? They have to keep coming up with new things to look for in hospitals, and they ran out of realistic, meaningful rules/standards a long time ago and are now heading into "la la land" territory.

I always thought, from my experiences with surveys as a staff nurse and advanced practice nurse, that Joint Commission was a joke. I was pleasantly surprised to find, when I took a position as a hospital surveyor for my state and CMS, that most of the state surveyors (in all the states) also consider Joint Commission to be a joke. My state licensing agency surveyed hospitals at no charge, and did much more thorough, meaningful surveys than Joint Commission did -- hospitals in my state used to tell us that they were always happy to see us show up (always unannounced, unlike JCAHO at the time!) because they knew that if they passed our survey (or corrected whatever we found deficient), they had nothing to worry about with Joint Commission, because we were much tougher on them than Joint Commission. They were v. impressed with how much more thorough and complete our surveys were, and that they weren't charged for them.

Part of what state surveyors (who are all also contract surveyors for CMS) do is go into hospitals (a limited number, selected randomly by CMS) after they've had their Joint Commission survey and do another complete survey (what is called a "validation" survey) -- the purpose of the validation survey is to doublecheck and see what Joint Commission missed and how well they're doing their job of enforcing the CMS rules/regulations (which they are supposed to be doing, in addition to enforcing their own standards/requirements). CMS is always unhappy with the job Joint Commission is doing, but not unhappy enough, so far, to sever their relationship with them. I wish they would -- Joint Commission is such a racket. They charge you a fortune for the "privilege" of being surveyed by them, they strong-arm the hospitals to buy all kinds of "We passed Joint Commission" banners, mugs, pens, etc., and they pressure hospitals to hire "consulting firms" run by former Joint Commission surveyors to help them get ready for Joint Commission surveys -- oy veh!!! I don't know why everyone puts up with this and why they're still in business.

[Zookeeper3]

My fear is that with all the documentation standards, facilities are becoming more concerned that everything is DOCUMENTED as a priority...... instead of actually done:eek:

[forrester]

Having the Joint Commission regulate healthcare is like having Exxon/Mobil regulate the oil industry.

Even after being spanked by Medicare.

We need a new system.

The facts are plain. The system has basically not responded to the IOM report.