Smallpox vaccinations imminent for hospitals

Know the consequences for your facility

The Atlanta-based Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) recently approved a plan that calls for smallpox immunization of 510,000 health care workers.

The plan suggests that all hospitals should designate a "smallpox care team" that will be immunized prior to any release of the virus. The committee recommends that the team include a minimum of 40 health care workers per hospital, with some hospitals vaccinating 100 or more, including emergency department physicians and nurses, infection control professionals, intensive care unit nurses, infectious disease consultants, radiology technicians, respiratory therapists, engineers, security, and housekeeping staff.

To help you prepare for sweeping procedural changes, American Health Consultants offers Imminent Smallpox Vaccinations in Hospitals: Consequences for You and Your Facility, a 90-minute audio conference Wednesday, Dec. 11, from 2-3:30 p.m., EST. This session is designed to help you and your staff answer serious questions and prepare your facility for the inevitable. How will being vaccinated affect you? How do you protect yourself, patients, and family? What are the logistics of implementing a smallpox care team? How do you deal with vulnerable populations? How do you minimize side effects?

This panel discussion will be led by William Schaffner, MD, chairman of the department of preventive medicine at Vanderbilt University Medical Center in Nashville, TN. A veteran, award-winning epidemiologist who has seen actual cases of smallpox and currently oversees a volunteer smallpox vaccine study at Vanderbilt, Schaffner began his distinguished medical career as a medical detective in the CDC's Epidemic Intelligence Service. He also is a liaison member of ACIP. Schaffner and an expert panel of emergency and infection control professionals will help you prepare for this critical task.

The second speaker, Jane Siegel, MD, is a professor of pediatrics at the University of Texas Southwestern Medical Center in Dallas. The author of several books on infection control issues, Siegel has emerged in recent years as a key CDC advisor. As a member of the CDC Healthcare Infection Control Practices Advisory Committee, she is on a bioterrorism working group that reviewed the critical issues regarding smallpox vaccine. Showing a clear knowledge of the pros and cons of the various options, Siegel presented the working group's research to ACIP.

The cost of the program is $299, which includes 1.5 hours of free CE, CME, and Critical Care credits. ACEP Category I credit approval for the conference is pending. You can educate your entire facility for one low fee. The facility fee also includes handout material, additional reading and references, as well as a compact disc recording of the program for continued reference and staff education. For more information, or to register, call customer service at (800) 688-2421. When ordering, please refer to the effort code: 65341. nJoint Commission unveils changes to survey process

Changes include mid-term self-assessments

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is significantly revamping its accreditation process to answer its critics and sharpen the focus of its accreditation process. The new initiative, "Shared Visions - New Pathways," will allow hospitals to conduct self-assessments and let surveyors focus on actual patient care experiences.

According to the Joint Commission, based in Oakbrook Terrace, IL, Shared Visions represents agreements among JCAHO and health care organizations about what a modern accreditation process should be able to achieve, while New Pathways represents a new set of approaches or pathways to the accreditation process that will support fulfillment of the shared visions. The initiative will be implemented in January 2004.

The new initiatives include the following:

  • streamlined standards and a reduced documentation burden to focus more on critical patient-care issues;
  • a self-assessment process to support organizations’ continuous standards compliance while freeing up survey time to focus on the most critical patient-care issues;
  • a priority focus process that integrates organization-specific data and recommends areas for the surveyor to focus on during survey;
  • a new survey agenda with six basic components: an opening conference, a leadership interview, the validation of the self-assessment results, the focus on actual patients as the framework for assessing compliance with selected standards, discussion and education on key issues, and a closing conference;
  • an enhanced role for surveyors in the new process, facilitated by extensive surveyor training;
  • revised decision and performance reports providing more meaningful and relevant information;
  • the use of ORYX core measure data to identify critical processes and help organizations improve throughout the accreditation cycle;
  • better engagement of physicians in the new accreditation process;
  • a new approach to surveying complex organizations.

New process should eliminate ramp-up

The new survey process will be more continuous and will eliminate much of the ramp-up that often takes place before a scheduled survey, says Dennis O’Leary, MD, president of the Joint Commission. "We’re consolidating, saying things in a lot fewer words, and moving standards to the most appropriate sections," he explains. "We have reduced the number of scorable elements, and that has a significant impact in terms of the burden on accredited organizations."

Accredited organizations will complete the self-assessment at the 18-month point in their three-year accreditation cycle, rating the level of compliance with all standards applicable to that organization. There will be no on-site surveyor visit at the 18-month point.

In the self-assessment, if an organization finds itself not compliant in any standards area, it must detail the corrective actions that it has taken or will take to comply. These actions will be entered into the self-assessment and submitted to JCAHO for review. This activity will not result in any change in accreditation status for the organization.

A JCAHO staff member will follow up with the organization to review its findings, approve the corrective actions, and provide advice or assistance on those actions. At the 36-month point, or the triennial survey, surveyors will go on-site to verify that the organization has implemented the corrective actions as laid out in its self-assessment.

JCAHO reports that, during pilot testing, organizations strongly approved of the self-assessment process to help maintain continuous standards compliance. Organizations reportedly required no new resources to complete the assessment, and most already were completing self-assessments using other tools. All the organizations that took part in the pilot completed the self-assessment in the eight weeks allowed. The majority of the organizations indicated that they would prefer three to six months to complete the assessment.

JCAHO says it will contact organizations three to six months in advance of their accreditation midpoint with information on the self-assessment tool, so organizations have adequate time to complete the assessment.

At the triennial survey, surveyors will validate an organization’s compliance over a minimum 12-month track record with all standards involved in its corrective actions. The corrective actions will also drive appropriate on-site education with surveyors.

A special 16-page edition of Perspectives, the Joint Commission’s official newsletter, takes an in-depth look at the new accreditation process and is available at Joint Commission Resources’ web site at Questions may be e-mailed to