Can accreditation watch’ be avoided after errors?
Question: I’ve heard a lot about the "accreditation watch" program recently implemented by the Joint Commission on the Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, but how can it be avoided? Once we’ve experienced a serious error at the hospital, do we just wait for the Joint Commission to show up and place us on accreditation watch, or is there something we can do?
Answer: You can’t avoid being placed on accreditation watch if the Joint Commission determines that the adverse event merits it. But that doesn’t mean you shouldn’t take decisive action before the Joint Commission knocks on your door.
The new program from the Joint Commission involves putting facilities on "accreditation watch" status after a particularly egregious error that suggests there may be a systemic problem threatening the health and safety of patients. Once placed on accreditation watch, the facility must present a report on the error within 30 days, including an explanation of why it happened and how it will be corrected. (For more on the Joint Commission’s accreditation watch program, see HRM, January 1997, pp. 5-6.)
If your facility has an event that might get the Joint Commission’s attention, it’s best to begin a full-scale investigation of the problem, says Karen Struck, RN, MS, a risk manager with Risk Management Concepts, a division of Schifrin, Gagnon & Dickey in Van Nuys, CA, a health care consulting firm. The investigation will serve the best interests of your patients and facility, regardless of whether the Joint Commission hears about your event and comes to investigate.
"This won’t prevent being put on accreditation watch, because that will happen if they find that the event qualifies," Struck explains. "But there always is a benefit in being able to show the Joint Commission that you’ve already investigated the problem and started to address the problem. They will be friendlier, more collaborative, and you can take a lot of stress out of the situation."
An early investigation also can take some of the sting out of the negative publicity that will accompany being placed on accreditation watch. If your local newspaper reports the Joint Commission’s action, it will look better if you can say that the hospital conducted a thorough investigation and implemented solutions before the investigators made you do so.
Struck points out that the investigation necessary in such a scenario may go beyond what the risk managers typically would do after an adverse event. The investigation should be thorough enough to trace the problem to the system weakness that made it possible.
"Risk managers usually look at serious medication errors, for instance, but sometimes they only go back far enough to assess liability and look for obvious causes," Struck explains. "When the problem is serious enough to make accreditation watch possible, you have to go further."
[For more information, contact Karen Struck, Risk Manager, Risk Management Concepts, 14530 Delano St., Van Nuys, CA 91411. Telephone: (805) 494-6596.]
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