RSSAll Entries in the "Joint Commission Changes" Category

An Inside Look at Successful RFI Clarification

Just wanted to share this white paper from Lisa Eddy, RN, CPHQ, CSHA, Senior Consultant for The Greeley Company, a division of HCPro, Inc. Those of you who participated in our working group calls on suicide risk assessment should be familiar with Lisa. Hope you find this white paper useful.

Go to http://www.hcpro.com/content/217282.pdf to download a PDF of the white paper.

Brian Driscoll
AHAP Director

Distinguish Between Medical and Behavioral Restraint

From Bud Pate, REHS, Vice President of Content and Development for The Greeley Company:

Surveyors commonly misapply the behavioral health rules to medical restraint. In fairness, the Joint Commission standards and CMS regulations are a more than a little confusing, even when you study them carefully. But the rules for behavioral health restraint are vastly different than those for medical restraint, so your definition should be crystal clear.

Regardless of the location, behavioral health restraint rules should only be applied to address violently aggressive or self disruptive behavior. We recommend that your policy clearly apply the medical restraint rules to the following situations:

– a patient who is in the critical care unit after a suicide attempt and is being restrained to avoind accidental extubation due to twitching or trying to sit up in bed;

– a patient experiencing involuntary thrashing during acute withdrawal syndrome;

– a confused patient who is interfering with nursing care.

“But wait,” you say, “we should use the behavioral health care rules because we are caring for patients with clear emotional disorders.” Or you may say “The confused patient is trying to hurt the nurse, shouldn’t the behavioral health rules apply?”

But remember, all restraint (medical and behavioral) is implemented to address behavior. And if you truly believed the behavioral health care rules applied you would already be staffing these situations with psychiatric nurses. Ask yourself, “would a debriefing be helpful to see how a future episode would be avoided?” I don’t think so.

There will certainly be those who object to this position. If you are one of them, then I encourage you to fully (and I mean fully) implement all the behavioral health care rules to these situations, including: continuous observation, 15 minutes assessments by a staff member with psychiatric training, post-restraint debriefing with the patient, and all the other very restrictive rules. If you don’t feel these measures are clinically necessary, then you agree with me: these are not behavioral health restraint. So define them as medical restraint in your policy.

Remember: we can debate the fine points of a policy with regulators all day long without reaching an adverse conclusion. However, you will definitely be guilty of an infraction if you violate your own policy. In other words: say what you do and do what you say.

Restraint benchmarking survey

Hello, all. I just wanted to share with you some results from our recent benchmarking survey:

Managing the use of restraints and complying with related requirements continue to be major challenges for accreditation professionals throughout the country. And one of the biggest areas of concern is the use of medication restraints, according to AHAP’s most recent benchmarking survey.

According to the members-only survey, conducted in June and July 2008, 46% of accreditation professionals find medication restraints the most troublesome under CMS’ updated restraint Interpretive Guidelines (24% listed soft limb restraints as most troublesome, while 17% listed “other,” 7% listed zippered comforter restraints, and 6% listed low bed restraints).

The number for medication restraints seems high, says Elizabeth Di Giacomo-Geffers, RN, MPH, CNAA, BC, CSHA, member of the AHAP advisory board, healthcare consultant in Trabuco Canyon, CA, and former Joint Commission surveyor. “Perhaps the organizations need to review their definitions of chemical restraint,” she says. “They may, in fact, not be following the CMS/Joint Commission definition—theinappropriateuse of a sedating psychotropic drug to manage or control behavior. To give a medication may in fact be medical management of the patient’s condition and not inappropriate use.”

When asked how they used medication restraints, 51% of survey respondents said they use them to de-escalate aggressive, destructive behavior. Thirty-seven said they use medication restraints to manage behavior, 25% said they use them for other purposes, and 7% said they use them to restrict freedom of movement.

Hope you found this useful. Go to http://www.accreditationprofessional.com/benchmarking_survey.cfm?topic=WS_AHP_QBS to download the full 11-page report, as well as other benchmarking reports from this year.

Latest Sentinel Event Alert: Disruptive behavior

I just wanted to make you aware of some breaking news: The Joint Commission has issued its latest Sentinel Event Alert today addressing bad behavior by healthcare professionals.

Disruptive behavior was considered as a possible National Patient Safety Goal for 2008 but was not selected. The Joint Commission has stated in this most recent alert that rude behavior, unpleasant language, hostile attitudes and other bad behaviors does not only create an unpleasant environment but are detrimental to patient safety and quality of care.

This alert ties into new standards going into effect January 1, 2009, which will require healthcare organizations to create a code of conduct defining acceptable and unacceptable behaviors as well as crafting a process for dealing with poor behavior.

The Sentinel Event Alert provides 11 steps to curbing disruptive behavior. These range from providing education and training for healthcare providers about professional behavior and appropriate interactions with coworkers; creating accountability for maintaining appropriate behavior; establishing a zero tolerance policy for disruptive behaviors and a means for enforcing this policy; and crafting non-confrontational methods for reporting and addressing inappropriate behavior.

The Joint Commission’s Sentinel Event Alert can be found online here: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm

2009 National Patient Safety Goals released

Just wanted to let you know that The Joint Commission released the 2009 National Patient Safety Goals earlier today on its Web site:

http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/

http://www.jointcommission.org/NR/rdonlyres/31666E86-E7F4-423E-9BE8-F05BD1CB0AA8/0/09_NPSG_HAP.pdf

The first link also has a chart identifying which goals have received changes/deletions/additions, and provides a crosswalk to the new numbering system.