Other survey tips from the horse's mouth
Other survey tips from the horse’s mouth
The Joint Commission surveyor of Lufkin, TX-based Memorial HomeCare passed on a few tidbits for agencies preparing to meet the 1997-1998 Joint Commission standards:
• Expand your definition of "adverse drug reaction."
Make sure it spells out the signs and symptoms of an adverse drug reaction as part of the actual definition, says Kay McRae, RN, CQI coordinator. Examples: rash, difficulty breathing.
• Expand your discharge summaries for physicians.
While the 1995-1996 standards may have left the Joint Commission’s intent a little fuzzy, the new standards are much clearer, says Patricia R. Jones, RN, administrative director of home health. Discharge summaries should summarize the entire course of care since admission to home care, not just the patient’s condition at discharge.
• Make sure your glucometer records and machines are in tip-top shape.
Both McRae and Jones were surprised by the amount of attention the surveyor paid to their glucometer logs. "She went through them with a fine-toothed comb, making sure there was one for each month for each nurse," says McRae.
McRae had earlier in the year addressed the problem of getting these logs in from nurses with a simple log for tracking when the nurses turned them in. She sends a "late notice" if a nurse does not turn in the log for one month by the 10th of the next month.
"I tell them, It’s just like your water bill. It’s due on the 10th of every month,’" McRae says.
The surveyor also was pleased to find that the agency participated in a service provided by the College of American Pathologists (CAP) that allows the agency to check the accuracy of the glucometer machines used in the homes. Three times a year, the college sends two unknown blood samples to the agency to be tested by its home glucometers used in the home. The agency records the results on the CAP form and sends it back to be compared to other test results. In a few weeks the agency receives a report showing if the glucometer has deviated significantly from the mean scores of the others and needs to be adjusted. The Whole Blood Glucose Waived Survey costs $120 for the year.
Quick JCAHO tip for Texas: Two-step TB test, or no two-step TB test? That was the question when the surveyor came, say Kay McRae, RN, CQI coordinator, and Patricia R. Jones, RN, administrative director of home health at Lufkin, TX-based Memorial Home Care. Apparently, there is some confusion between the Texas Occupational Safety and Health Administration office and the current Centers for Disease Control and Prevention guidelines regarding two-step TB tests for staff. It is unclear whether they are required or just recommended. To avoid getting a supplemental recommendation from JCAHO, agencies in Texas "may want to look at their policy regarding a two-step TB test and seek a written opinion from OSHA and the CDC to make sure you are meeting their guidelines," says Jones.
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