The Joint Commission plans to issue five new standards initiatives affecting ambulatory facilities in 2012. Virginia McCollum, RN, associate director of the department of standards interpretation at the accreditation agency, says the planned initiatives are discussed in the Oct. 2011 issue of Joint Commission Perspectives, which was just released. The planned standards will be reviewed and finalized by the Joint Commission board. Facilities then have six months to prepare before they are surveyed and scored on them.
1. Alarm fatigue. The Joint Commission is developing a new standard to deal with "alarm fatigue," Ms. McCollum says. Staff at hospital and outpatient facilities have to contend with a wide variety of patient monitors with built-in alarms that go off frequently. For example, the Boston Globe reported that one 15-bed unit at Johns Hopkins Hospital in Baltimore had an average of 942 alarms per day, or about one every 90 seconds. "There can be so many alarms that they may drown each other out," Ms. McCollum says. "You hear so many going off that you may develop alarm fatigue and not respond to a patient emergency."
In a 2004 national patient safety goal, the Joint Commission cautioned hospitals not to become too dependent on alarms, advising them to routinely test alarms and improve staff training on how to use them. But the problem does not seem to have been resolved. The Globe said biomedical engineers advised a Joint Commission official last year that hospital staff had been disconnecting monitor speakers, taping over them and turning down volume to "escape the constant noise."
2. Overuse of treatments. Minimizing potential overuse of healthcare treatments and procedures is "a very interesting area," Ms. McCollum says. "There has been an ongoing concern in healthcare about this for several years now." For example, although X-rays and CT scans save lives, they also pose radiation risks. On Aug. 24, the Joint Commission issued an alert on the dangers of medical radiation, noting that Americans' exposure to ionizing radiation has nearly doubled in the past two decades. The Joint Commission observed that "any physician can order tests involving exposure to radiation at any frequency, with no knowledge of when the patient was last irradiated or how much radiation the patient received."
3. Updating sentinel event policy. Hospitals and outpatient facilities are expected to closely monitor each sentinel event, which is any unexpected occurrence "involving death or serious physical or psychological injury, or the risk thereof," according to one definition. The Joint Commission began to require reporting of sentinel events in 1998 and then updated its definition of a sentinel event in 2007.
4. Influenza vaccinations for healthcare workers. The Joint Commission is developing proposed new and revised standards for influenza vaccination of health care workers in all accreditation programs. While hospitals and nursing homes have a specific standard on influenza vaccines for healthcare workers, other healthcare settings do not. However, under standards IC.01.03.01 and IC.02.01.01, these organizations have already been required to assess their risks and take actions to protect patients and healthcare workers as part of their infection prevention and control activities.
5. Reporting natural disasters. The unusual number of natural disasters this year has required last-minute rescheduling of on-site surveys several times, Ms. McCollum says. The Joint Commission wants to be better informed on disaster warnings so it can plan inspections accordingly. "If there is a natural disaster, we are asking organizations to tell their account executive at the Joint Commission, so that we can reschedule any activities," she says. Since site surveys are unannounced, the specific surveyed facility would not be aware of the need to contact inspectors in advance.
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