Safety culture, rapid response considered; standards changes announced

The JCAHO proposed the safety-culture goal for the 2006 set, but the commission wanted more time to evaluate the requirements, including how to use assessment tools and address patient harm, Croteau said.

Putting forth the proposal helps draw more attention to the issue of patient safety, Croteau said.

"This is a risky business," Croteau said. "A culture of safety is a culture where risk is acknowledged and we work to reduce harm."

Hospitals can start to involve patients in their care now, Croteau said. A benchmark is the Dana-Farber Cancer Institute in Boston, which has former patients sit on numerous committees to provide a different perspective on certain issues, he said.

The JCAHO also proposed improving the safety of using anticoagulants, insulin, and narcotics for 2006 but withdrew it after a lack of support from the field, the commission said earlier this year.

Bar coding back on the table
Using technology to identify patients is something the JCAHO has eyed in the past. Bar coding was a proposed 2005 goal, but the commission tabled it after receiving more than 1,000 comments from the field.

The goal this time around would not necessarily require hospitals to develop bar-code systems within a certain period, Croteau said. The proposed requirement may allow hospitals time to think about how they would use the technology and start planning for a system without setting an implementation deadline, he said.

The goal may also consider other track-and-trace technologies, such as radio frequency identification, to identify patients, Croteau said.

If hospitals currently use bar coding, surveyors will want to learn about the system and will ask questions about how staff use it to ensure patients get the correct medications and treatments, said Patricia Adamski, RN, MS, MBA, senior associate director for standards interpretation.

Rapid response may become mandatory
The Institute for Healthcare Improvement in Cambridge, MA, made rapid response teams part of its 100,000 Lives campaign to save that many patients by June 14, 2006. The teams may include a respiratory therapist, intensive care nurse, and physician assistant, and they respond to certain triggers that show a patient is headed for a code situation.

The JCAHO will consider making the concept that began in Australia in the late 1980s a requirement for U.S. hospitals.

"There is a lot of evidence that it improves outcomes," Croteau said. "Sometimes it's just an experienced nurse that says, 'The patient doesn't look right.'"

Ceiling placed on goals
The JCAHO will attempt to limit to two the number of new goals each year, Croteau said. The limit will help hospitals manage priorities, including existing goals.

"We believe you will accomplish more if you focus on a relatively small group instead of focusing on everything at once," Croteau said.

The commission also wants to keep the number of goals stable each year, meaning certain goals would retire into the standards to make room for new requirements, he said.

Other news addressed
The JCAHO also addressed during Executive Briefings a few standards changes that will occur in 2006, including primary source verification of credentials. Standard HR.1.20, element of performance #4, requires hospitals to verify staff licenses upon employment and when the license expires.

That verification would mean contacting the agency issuing the license or looking up the certification on a registry Web site, Adamski said. Obtaining a photocopy of the license would not meet the standard.

The commission also announced that it will send standards updates to hospitals in January and July. The two updates replace the quarterly updates to the Comprehensive Accreditation Manual for Hospitals, said Kurt Patton, MS, RPh, executive director for accreditation services.

Receiving four updates each year overwhelmed some hospitals, Patton said. Semiannual updates will also help alleviate some technical problems with the online periodic performance review tool, meaning the commission would have to make fewer changes to the program throughout the year, he said.

"Hopefully this is something the industry will respond positively to," Patton said.

Editor's note: To learn more about the Hospital Executive Briefings conference and what organizations can expect from the JCAHO in 2006, including unannounced surveys and standards changes, check out the October Briefings on JCAHO. For more information or to order, call customer service at 800/650-6787.