After three years of working through the PPR process for its Joint Commission accreditation, Adirondack Medical Center in Saranac Lake, NY, found methods of combining staff education with innovative uses of the PPR tool to improve its overall experience. "Our first experience with PPR was in spring of 2005, when they first rolled it out," says Adele Hodlin, RN, MS, CPHQ, director of quality management at Adirondack Medical Center.

Editor's note: Patton is the former Joint Commission executive director of accreditation services and principal of Patton Healthcare Consulting, LLC, in Glendale, AZ. To ask him a question, e-mail Matt Phillion at mphillion@hcpro.com and look for the answer in an upcoming issue.

Telepsychiatry, or assessing the mental health of patients via an electronic connection, sounds more futuristic than it is. In fact, the practice is growing more common in hospitals across the country. Some states prohibit telepsychiatry, whereas others make use of telepsychiatric links for various reasons, such as rural or isolated facilities that need full-time, 24-hour psychiatrists for assessments and massive campuses with separate behavioral health buildings.

Editor's note: This feature explores problematic Joint Commission standards with expert advice from BOJ advisors. This month, Elizabeth Di Giacomo-Geffers, RN, MPH, CNAA, BC, a healthcare consultant in Trabuco Canyon, CA, discusses PI.3.20. PI.3.20 requires an ongoing and proactive process for seeking out the causes of-and identifying methods for the prevention of-adverse effects to increase patient safety. PI.3.20 applies preventive, proactive patient safety tactics rather than reactive actions taken only after an error or adverse event has occurred.

Being in constant compliance with regulatory standards is one goal for hospitals everywhere. But promoting constant preparation remains a difficult task for most facilities. Teresa Dillingham, RM, CPHQ, an accreditation manager at Trover Health System, a 101-bed hospital in Madisonville, KY, relies on constant momentum and staff preparation to make her survey run smoothly.

Editor's note: Sue Dill Calloway, RN, MSN, JD, director of hospital risk management for OHIC Insurance Company, The Doctor's Company, in Columbus, OH, is the CMS corner lead contributor. Submit a topic idea to her by contacting BOJ Editor Matt Phillion at mphillion@hcpro.com. I recently had the privilege of working with a hospital that had a visit from its state department of health regarding the CMS restraint and seclusion regulations. New regulations on restraint and seclusion took effect on January 8, 2007.