Accreditation Newsletters

Briefings on Accreditation and Quality will help you with all of your accreditation and survey preparation needs. Every month, Briefings on Accreditation and Quality takes a look at problematic standards, identifies best practices, and clarifies the latest updates and changes from The Joint Commission, CMS, and other regulatory and accreditation organizations. Briefings on Accreditation and Quality also offers bonus content, tools, sample policies, and more online.

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Issue 12, December 1, 2013 - VIEW THE FULL ISSUE

• Standards year in review (part 1 of 2)

  Every fall, The Joint Commission announces the top 20 most-cited standards among its accredited...

• Promoting a culture of improvement

  Many professionals who end up in a position of advocating for safety and quality improvements in...

• Month one post-survey tips

  The Joint Commission has just left your hospital. First, make sure to celebrate the conclusion of...

• Guilty until proven innocent

  One of the major changes the final omnibus rule places on providers and business associates is the...

Issue 11, November 1, 2013 - VIEW THE FULL ISSUE

• Perfecting infection control on everyday items

  Think back to your last visit to a hospital as a patient or family member. Every patient care area...

• An overview of recent CMS changes

  On August 27, CMS released significant changes impacting several areas of the Conditions of...

• The company you keep

  Overall, BAs have been involved in about 22% of the more than 600 breaches that have been reported...

Issue 10, October 1, 2013 - VIEW THE FULL ISSUE

• Organization works toward improving medication, patient safety

  Everyone in healthcare knows about the struggles of medication reconciliation and its impact on...

• CMS memos every hospital should know, Part 2

  Last month in BOJ, we began our discussion of a number of key memos CMS has released ­impacting...

• Administrative penalties: Defining and avoiding patient safety violations

  The California Department of Public Health (CDPH) has issued 10 penalties to California hospitals...

• CIHQ receives deeming authority

  A new player has entered the field for hospital accreditation: The Center for Improvement in...

• PHI breach bites Walgreens

  We talk often about the cost of Health Insurance Portability and Accountability Act (HIPAA...

Issue 9, September 1, 2013 - VIEW THE FULL ISSUE

• Do red rules work?

  A strong culture of patient safety has been and continues to be a critical component in reducing...

• CMS memos every hospital should know

  Hospitals have seen the publication of many important CMS memos in the past year. Many of these...

• Immediate-use steam sterilization: What is appropriate use?

  Every so often, the topic of steam sterilization comes up when discussing infection control issues...

• Inadequate risk assessments can threaten your meaningful use monies

  In March 2013, the Office of Civil Rights (OCR) began presenting the results of its random audits...

Issue 8, August 1, 2013 - VIEW THE FULL ISSUE

• Joint Commission announces clinical alarms NPSG

  After reading this article, you will be able to:

• White paper: Survey, certification, and ­enforcement procedures

  On April 5, 2013, CMS released a proposed rule to the Survey, Certification and Enforcement...

• FDA issues cybersecurity memo

  In an interesting turn, the FDA has released recommendations for improving cybersecurity for...

• HIPAA and meaningful use

  Welcome to "HIPAA demystified," the first in an ongoing series. Everyone now lives in a world of...

Issue 7, July 1, 2013 - VIEW THE FULL ISSUE

• Behavioral health and the ED

  According to national statistics, anywhere from 25% to 40% of patients in acute care settings have...

• Why become an interim accreditation executive?

  Many hospitals find complying with regulatory and accreditation standards to be a challenge-knowing...

• Alarm fatigue: The Joint Commission's stance on prevention

  Spend a few moments in any hospital and it is likely you'll encounter them-the endless beeps...

• Patient flow techniques: Views from the field

  The Association for Healthcare Accreditation ­Professionals (AHAP), in its most recent poll of...

Issue 6, June 1, 2013 - VIEW THE FULL ISSUE

• Survey experience: Declassified

  In the pages of BOJ, we often explore the results of Joint Commission surveys, looking at RFIs...

• CMS recommends use of AHRQ Common Formats for hospital adverse event reporting

  In a memorandum published to state survey agency directors March 15, CMS resoundingly announced its...

• CMS and accrediting organizations

  Each fiscal year, CMS releases a financial report, and included in this tome-like document is an...

Issue 5, May 1, 2013 - VIEW THE FULL ISSUE

• CMS survey dos and don'ts

  There has been a growing sense of urgency around CMS surveys among accreditation professionals in...

• Where patient rights and patient safety meet

  We hear it time and time again in healthcare: It's all about communication. This is particularly...

• Exploring the hospital hierarchy

  An article by a nurse that appeared recently in The New York Times has brought about a surge of...

• Proposed changes to the CMS hospital CoPs (part 2)

  There are two sections that would affect transplant centers. The first relates to transplant center...

Issue 4, April 1, 2013 - VIEW THE FULL ISSUE

• Drift's role in preventing ­infections

  After reading this article, you will be able to:

• Making the call

  Discharge planning and follow-up phone calls are never easy. It's a perennial challenge for...

• Fire incident highlights need for hand sanitizer safety

  After reading this article, you will be able to:

• Proposed changes to CMS' hospital CoPs coming down the pike

  After reading this article, you will be able to:

Issue 3, March 1, 2013 - VIEW THE FULL ISSUE

• Closing the loop

  After reading this article, you will be able to:

• Cardiac catheter lab challenges

  After reading this article, you will be able to:

• CMS hospital worksheet update

  After reading this article, you will be able to:

• Pursuing new certifications or accreditations

  After reading this article, you will be able to:

• Not enough room at the inn

  Editor's note: Sharon Chaput, RN, CSHA, is the director of regulatory and quality management at...

Issue 2, February 1, 2013 - VIEW THE FULL ISSUE

• Medicine from afar

  Tucked away on the far side of mountain passes in northeast Oregon, the 25-bed critical access...

• Patient bathrooms and locked doors

  Every so often, an incident occurs that brings the topic of locks on patient bathroom doors back to...

• Defining the role

  The expression "many hats" has long been a phrase used to describe survey coordinators...

Issue 1, January 1, 2013 - VIEW THE FULL ISSUE

• Medication reconciliation collaboration

  these patients find themselves in the hospital for a variety of reasons, the process of medication...

• Emergency management and disaster planning

  The question comes up after every disaster: What could we have done differently? This is...

• Joint Commission targets Environment of Care ­improvements

  Given the prevalence of Environment of Care (EC) standards appearing on this year's list of most...

• BOJ 2012 index

  AAAHC announces hospital accreditation program: Respected ambulatory accrediting body enters...