New Requirements on the Horizon: Resuscitative Services

On December 21, 2020, The Joint Commission published a new, updated version of their proposed Resuscitation Standards. Redesign of these standards began in early 2020 with the first opportunity to submit comments being concluded mid-year. While some of the revisions appear to be simple word-smithing opportunities, there are several changes, if adopted as written, that organizations will want to be aware of.

A significant change will occur related to staff education and training. This element of performance will remove the requirement of using an evidence-based training program and shift the design of the education and training to be based upon what the hospital defines in policy as their requirements. Note that each organization will need to determine which roles within their organization will be required to have education and training along with determining the format and frequency for this education and training. This appears to give organizations more flexibility in designing their programs. For instance, perhaps in the Emergency Department where resuscitative skills are performed regularly, organizations may elect to offer education and training at a lesser frequency than in other departments where these skills are not honed on a regular basis. This element of performance goes further to state that completion of BLS certification does not meet this requirement. We interpret this to mean that BLS certification can be a component of your education and training program but cannot be used to fulfill your entire program. Staff completing BLS certification still need education and training on the specific equipment and protocols that your organization has in place in order to safely and effectively deliver these services.

There are new requirements that will require organizations to develop and implement post-cardiac arrest care policies and protocols based upon current scientific literature, a field that developed several years ago and focuses on the pathophysiological changes inclusive of body temperature management that occur post cardiac arrest. Post cardiac arrest care is further supported by the requirements noted at proposed PC 02.01.20 EP 2 which focuses organizations on care of the whole patient across the continuum, or various stages of care, needed by obligating organizations to address post cardiac arrest care needs as a component of the discharge plan.

The 2010 American Heart Association Guidelines related to Post-Cardiac Arrest Care identify the following key components for post cardiac arrest care:

• Body temperature management
• Organ specific assessments and support
• Vasoactive Medication considerations
• Central Nervous System concerns
• Organ donation post cardiac arrest

Their focused article on post care appears in the November 2010 issue of Circulation which can be accessed through the American Heart Association website: https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.110.971002

New standards would not be complete without the soft push or soft reminder to use data to improve the processes of providing care and patient outcomes. Here we see at PI 01.01.01 and 03.01.01 new elements that will require the collection of data, and analysis of collected data to identify opportunities for early recognition or prevention of cardiac arrest.

The Joint Commission feedback process closed on February 22, 2021. Updated standards will be made available once TJC has reviewed and considered all the feedback provided to them.