ED nurses check off tasks when JCAHO comes
Surveyors scrutinized medication practices
The minute you learn that accreditation surveyors are on site, you probably have a "wish list" of tasks that should be done immediately. At Providence St. Vincent Medical Center in Portland, OR, ED nurses created checklists for technicians, nurses, physicians, and health unit coordinators to use.
When the "Dr. J" page is heard overhead, indicating that a mock or actual survey is taking place, ED staff refer to the checklist as a reminder to perform tasks such as pulling curtains closed or disposing of food containers. (See the checklist used by ED nurses.)
During drills, leadership walks through the ED, talking with staff, reviewing the National Patient Safety Goals from the Joint Commission, and reviewing patient charts. During these mock surveys, staff use "prompt cards" with questions and answers on various topics that surveyors are likely to ask about, says Eileen Wheaton, RN, the ED charge nurse who helped to develop the cards. "I pretend to be a surveyor and ask questions about medication administration, patient safety, environment of care, infection control, or patient rights."
The cards have the answers on the back, if staff need prompting. "However, after using them for many months, there is less prompting needed for the answers," says Wheaton. "The question-and-answer drills helped desensitize staff to the fear around talking to a surveyor." Nurses may know the answers, but under pressure may have a difficult time articulating them, so the repetitive drills help staff feel comfortable and "think quick on their feet," says Wheaton.
During the actual survey, the prompt cards and checklists paid off, says Julie Briggs, RN, BSN, manager of the ED. "We helped each other out in answering their questions and bragging about our accomplishments," she says.
Medications under scrutiny
At one point during the survey, three surveyors appeared at once in the ED, all asking different questions. The physician surveyor asked for a tour of the ED. "He was very complimentary of the ED and our processes," says Briggs. "We shared with him all the great things we have been doing — our shared governance, our [quality assurance] projects, our door-to-balloon times."
The surveyor asked to see a closed chart and reviewed it with an ED nurse. "While the documentation was very good, he found an unapproved abbreviation — 'U' rather than units — when a nurse documented she had administered insulin," says Briggs.
Meanwhile, the nurse surveyor asked about ED processes, and an administrative surveyor focused on medications. "That is where we took our biggest hit," she says.
The surveyor didn't like that nurses mixed their own antibiotic bags. He also asked to see the ED's conscious sedation forms, the form used to document correct-site verification, and reviewed a closed chart from a conscious sedation patient seen earlier that day.
Upon reviewing a medication reconciliation form, the surveyor didn't like that the nurse had written "unknown" under medications. "They seemed to feel if he was alert and oriented, then we should have been able to obtain the name of medications he was taking," says Briggs. The hospital is moving to a computerized charting system, which will have all the patient's meds listed. "The system will be integrated into pharmacy, so they will have all the records we have," Briggs says.
The minute you learn that accreditation surveyors are on site, you probably have a "wish list" of tasks that should be done immediately. At Providence St. Vincent Medical Center in Portland, OR, ED nurses created checklists for technicians, nurses, physicians, and health unit coordinators to use.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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