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Hint: Restroom breaks need not waste time
The Center of Living, Home Health and Hospice in Asheboro, NC, found a novel way to keep staff thinking about an upcoming accreditation survey at all times: The agency started a "toilet-training" program in which questions were posted on restroom stall doors.
The agency was preparing for a survey by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), based in Oakbrook Terrace, IL, and managers wanted the material to become second nature to staff.
The agency turned the survey preparation process into a humorous game, says Anneal Lamb, social worker and director of hospice division and networking for humanity. "We called it toilet-training,’ and it included any kind of Joint Commission question," she says. The questions were posted on bright-colored papers of purple, pink, orange, and yellow. "This was to catch their attention," Lamb says.
Every few days, managers would rotate the questions on the stalls, and a couple weeks later, they’d post new questions. In the men’s rest rooms, the questions were placed on the mirrors at eye level. The game continued for about four months. "The answers we put in a different location so staff would have to find them," Lamb says. "We might put the answers at the bottom of the stall or the bottom of the door."
Then, at each staff meeting, Lamb would quiz the staff on the answers to the posted questions.
Here are the agency’s questions:
Question: Does Center of Living assess hospice patients for pain and other symptoms, spiritual needs, or support networks?
Answer: Staff consistently use assessment tools and document this use in the medical records. Interdisciplinary notes consistently indicate that the spiritual and bereavement needs of patients and their families are met.
Question: Does Center of Living continually measure its important processes and outcomes?
Answer: Yes, on a monthly basis.
Question: Does Center of Living have bylaws or articles of incorporation that define the governing body’s responsibilities?
Answer: Yes, these can be reviewed in the administrative assistant’s office.
Question: Does Center of Living identify the time frames within which it is able to provide ordered services?
Answer: Yes, policies are in place.
Question: Does hospice provide the same quality of care and services for all patients?
Answer: Regardless of payer source, hospice patients are offered the same professional services.
Question: Do Center of Living leaders and staff receive information about patient/family satisfaction, then act on the feedback appropriately?
Answer: All satisfaction forms are reviewed by CEO, directors, supervisors, and clinical staff.
Question: Do Center of Living staff offer patients written materials that describe advance directives?
Answer: Yes, written information is given to patients on admission.
Question: Does Center of Living inform patients of their right to participate in investigational studies?
Question: How does Center of Living respect each patient’s right to privacy and security?
Answer: All staff are taught to ring the doorbell or knock and identify themselves before entering a patient’s home or bath area. Staff are taught to wear their identification name tags.
Question: Do staff respect patients’ property?
Answer: Yes. For example, a staff nurse who damages the finish on a patient’s table from an alcohol wipe informs both the patient and her supervisor and completes an incident report to have the agency pay to have the table repaired.
Question: Does Center of Living teach staff how to identify and handle ethical dilemmas, issues, or conflicts?
Answer: Center of Living educates its staff to discuss any issue with the team and revise the plan of care accordingly. If that solution does not work, staff will talk with upper management and the ethics committee if necessary.