Just-surveyed EDs report on new JCAHO process

Have you pictured accreditation surveyors interviewing your newest, least well-spoken nurse about your restraint policy, as part of the new Shared Visions, New Pathways survey process that began in January 2004? Or have you envisioned patient tracers being done for an ED patient where everything that could go wrong, did?

If so, you have plenty of company. "We were anxious about the new process, even though we’ve done a lot of preparation," acknowledges Barb Baughman, RN, director of emergency services at Harford Memorial Hospital in Havre de Grace, MD, which was surveyed in January 2004 by the Joint Commission on Accreditation of Healthcare Organizations. "We didn’t know what to expect."

To improve the way you prepare, consider the following reports from just-surveyed EDs:

• Make sure every staff member is ready to talk about the 2004 National Patient Safety Goals.

"They touched on every single one of the goals, time and time again," reports Karol Edwards, RN, nursing director of the ED at Upper Chesapeake Medical Center in Bel Air, MD. "One way or another, surveyors constantly found a way to bring them up in the conversation."

This should be a top priority as you prepare nurses for survey, emphasizes Edwards. The safety goals were posted on bulletin boards throughout the ED and printed on pocket-sized guides for all nurses, she says. "We talked about them in all of our staff meetings, they were highlighted in mock surveys, and we drilled the nurses on an individual basis," says Edwards.

When you post the safety goals, include an explanation for each about its specific application in the ED, recommends Baughman.

• Surveyors will want to talk to staff nurses.

You won’t have a lot of control over whom surveyors talk to, since surveyors will ask to speak with nurses who cared for specific patients, as opposed to formally scheduled appointments with managers, emphasizes Baughman. "In the past, the staff would sort of disappear when the surveyors arrived," she says.

Although Baughman acknowledges supplementing her nursing staff during the survey, she knows that won’t be an option when unannounced surveys begin in 2006. "I did put on more experienced nurses instead of new grads for that week, but we won’t be able to do that soon," she says. "The moral is, you need continuous education so everyone is always prepared."

However, surveyors are taking a more educational role and often made suggestions to improve compliance, says Baughman. "I felt very relaxed with them," she says. "You didn’t feel they were there to try and make you fail."

To prepare nurses for possible questions about core measures, Baughman posted bulletin boards to show the ED’s core measure data, including aspirin-on-arrival and door-to-drug times for myocardial infarction, and diuretic administration and brain natriuretic peptide levels for congestive heart failure. "The board was in the unit staff area where nurses could have referred to it for specifics if questions had been asked," she says.

• Give surveyors consistent responses.

During a patient tracer of an orthopedic patient admitted with a hip fracture, the surveyor discovered the woman had come to the ED the previous day with a knee injury and returned the following day with hip pain. "The surveyors wanted to know how we decided whether a physician assistant or physician saw a patient," says Baughman. "They also asked if the patient would be upgraded in their priority level if they came back for a return visit."

After Baughman explained that higher acuity patients are seen by physicians and lower acuity patients are seen by physician’s assistants, and that patients with additional or unresolved complaints usually would be bumped up to a higher acuity, the surveyor asked to speak to a triage nurse, gave the scenario, and asked the same questions.

"Thankfully, she gave the same response," says Baughman. "The surveyors were looking for consistent answers. No matter what unit they go to, they want everybody to be saying the same thing."

• Surveyors may ask patients about their ED stay.

The surveyor asked a dialysis patient about his time in the ED, including how quickly he was triaged, how quickly a physician saw him, and how he was treated, says Edwards.

• Be ready to discuss all the details of a patient’s care.

While tracing an intensive care unit patient with chest pain who came to the ED by ambulance, the surveyor specifically asked to talk to a less experienced nurse. "They wanted a new nurse who was only there for a year or two, but I didn’t have any on that day," says Edwards. "They didn’t want to talk to me at all."

The surveyor wound up talking to an experienced ED nurse and fired away detailed questions for more than an hour, says Edwards. "It was one question after another to that staff nurse," she says. "She went through the entire process, right up to getting the patient admitted."

The surveyor asked questions such as, "When the patient arrived by ambulance, what did you do? Was the electrocardiogram done within 10 minutes? How did you know it was the correct patient when the medications were given? If you heard the monitor go off, what did you do?"

"When the nurse said that vital signs were taken, the surveyor showed her the patient’s chart and asked where they were listed," adds Edwards.

Although detailed questions do give surveyors ample leeway to branch off into other areas, this makes the survey process more focused on patient care, says Edwards. "It was not intimidating to the nurse or clinical coordinators involved," she says. "It was an opportunity to brag about the great care that we give."


For more information on the Joint Commission’s new survey process, contact:

  • Barb Baughman, RN, Director of Emergency Services, Harford Memorial Hospital, 501 S. Union Ave., Havre de Grace, MD 21078. Telephone: (443) 843-5544. Fax: (443) 843-7954. E-mail: blb.01@ex.uchs.org.
  • Karol Edwards, RN, Nursing Director, Emergency Department, Upper Chesapeake Medical Center. 500 Upper Chesapeake Drive, Bel Air, MD 21014. Telephone: (443) 643-2120. E-mail: kle.01@ex.uchs.org.