Communication among caregivers is a key focus
Questions surveyors asked in one recent survey
What were you told about this patient by the previous caregiver during reports? What are you doing for this patient? What are you going to tell the next caregiver about this patient?
These were three questions JCAHO surveyors asked staff again and again at Eunice (LA) Community Medical Center during a March 2005 survey.
"As one of our priority focus areas, communication among caregivers was a key focus during our JCAHO survey," says Denel LaFleur, the organization’s JCAHO coordinator.
"The purpose of these questions was to evaluate the continuity of care and caregiver knowledge of the patient."
Surveyors wanted to know how staff members ensured they had all of the information they needed to take care of the patient, since information management was another priority focus area. The surveyor repeatedly asked, "What do you need to know so you can properly care for this patient?" to evaluate the caregiver’s knowledge of pertinent aspects of care, such as laboratory and X-ray results.
"He wanted to know how results were reviewed and communicated, especially critical values," LaFleur explains. "They asked this information of every discipline, including the different nursing units, respiratory therapy, and dietary."
The surveyors also wanted to know how new information would affect a patient’s care, asking, "What information is important for you to review today for this patient?"
"They wanted to hear about getting lab work or test results back, and how that would modify what they were doing," LaFleur adds. For example, one staff member answered that due to the radiology test results, the patient’s treatment plan was altered, and in another instance, due to a patient’s lab results, the dietitian was consulted.
The surveyor wanted to see that the patient’s chart was available to all caregivers, verified that staff were familiar with what was documented in the physician’s admission history and physical, and asked to be told about the patient’s comorbidities. "One nurse answered that the reason the patient was admitted was due to noncompliance with her previous medicines, which he had read in the physician’s notes," she says. "The nurse added that it was the patient’s second readmission for noncompliance."
Surveyors were very interested in the plan of care, how it was implemented, and how different disciplines communicated and kept an eye on the big picture, to ensure that by the time of discharge, all of the patient’s needs were met.
"They wanted to see, for instance, that nursing staff knew what the dietitian had been working to accomplish during the patient’s stay and what had been achieved, " LaFleur explains. "They basically wanted to be assured that the left hand knew what the right hand was doing."
This is increasingly important as patients are being pushed through the system quicker, she adds. "As a small hospital, we can’t afford an extra day in the patient’s stay because the respiratory therapist didn’t communicate with the nurse — we don’t have the resources to absorb wasted time or supplies."
Staffing was another key focus, with surveyors asking managers, "How do you plan for patient needs in your staffing mix and level? How do you measure quality for this unit? How do you know if your staffing is effective?"
Overall, the new process was much more educational and a better measure of true compliance, LaFleur says.
"Everywhere the surveyor went, he said, I’m not here to try to catch you on anything, just to measure your compliance against established standards. If you don’t understand something, please ask me for clarification,’" she notes. "It was a nonthreatening type of atmosphere from start to finish."
The focus was on real-time delivery of patient care, LaFleur adds. "There weren’t any closed charts reviewed during the survey. The surveyor was interested in where you’re at now, not 12 months ago."
[For more information on the organization’s JCAHO survey, contact:
- Denel LaFleur, Eunice Community Hospital, 400 Moosa Blvd., Eunice, LA 70535. Phone: (337) 457-5244, ext. 250. E-mail: [email protected].]
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