The Joint Commission is Returning to Pre-Pandemic Survey Procedures
As of March 15, 2021, The Joint Commission will be reverting back to pre-pandemic survey procedures in light of reduced cases of COVID-19 across the U.S. according to a message that was sent by Mark Pelletier, Chief Operating Officer and Chief Nurse Executive of The Joint Commission today. This return to pre-pandemic survey procedures means […]
How to Maintain a Compliant Hospital Code Cart
Being ready for situations where your patient requires resuscitation is critical. Staff complete training in basic/advanced life support, and some staff complete more advanced skills in pediatric and neonatal resuscitation, as appropriate. There has been increased focus on drills and simulation to better prepare the team in these life-saving measures. However, has anyone looked at […]
PROPOSED REVISIONS FOR RESUSCITATION STANDARDS
The Joint Commission has proposed changes to the Resuscitation Standards for Hospital and Critical Access Hospitals. These changes were most recently released December 21, 2020. Since then TJC has opened the opportunity to provide feedback on these proposed standard changes. The window to submit your feedback will close on February 22, 2021. To provide feedback, […]
Time Sensitive New Survey Guidance from CMS- Survey Suspensions
Get Ready for Your Next Survey
In preparing for your Joint Commission survey, it is always helpful to review the Survey Activity Guides published by the Joint Commission annually. These guides will not only assist you in preparing for survey but will also provide you with an abstract of each survey activity that includes logistical needs, session objectives, an overview of […]
Cybercrime – Is Your IT System Secure?
Recently there has been a lot of news about cybercrime related to hospital IT systems. The American Hospital Association published a Special Bulletin recently updating hospitals of these attacks and the need to make sure that their IT systems are secure. This information comes from the Cybersecurity and Infrastructure Security Agency, the FBI and the […]
Are additional waivers available for ACLS, BLS and CPR certifications?
New Definition for Fall Events Under TJC’s Sentinel Event Policy
The Joint Commission will be defining fall events in their Sentinel Event Policy starting January 1, 2021 to help address the need for more preventive fall measures. This new definition will be more closely aligned with established guidelines from the National Database of Nursing Quality Indicators™ and the National Quality Forum. The new definition will […]
History & Physical Requirement Changes – Ambulatory Surgery Centers
CMS’s recently announced adoption of the final rule that will make changes to several regulatory requirements that affect hospitals, critical access hospitals and/or Ambulatory Surgery Centers. These changes will be phased in over the next two years. The first change removes the current requirements found at 416.52(a) for a H&P within 30 days of the […]
EXPANSION OF SURVEY- HOSPITAL OWNED AMBULATORY CARE LOCATIONS
UPDATE: USP 795, 797 and 825
On March 12, the United States Pharmacopeia announced the results of the last minute appeal that was filed earlier this year- just before the anticipated implementation deadline for the updated USP Chapter 795, USP Chapter 797 and brand new USP Chapter 825. To summarize the actions taken, the USP has accepted the appeal for USP […]
Monsters Under the Bed – The Hidden Danger of Mold
As children, many of us were keenly aware of the dangers of monsters lurking under our beds and in our closets at night. Age and wisdom (and sometimes a flashlight wielding parent) soon dismissed these creatures as figments of our own imagination. However, as leaders in healthcare, we should realize that there are indeed monsters […]