A practical guide to achieving AAAASF accreditation.

As time goes on, more professional societies and individual states are mandating stricter standards for office surgical facilities to ensure quality of care. As the nurse is often the person who coordinates accreditation efforts within the facility, he or she needs to be "savvy" regarding the implementation and maintenance of these standards. The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) criteria are discussed with strategies and rationale for implementation.     

Accreditation of ambulatory surgery centers

Ambulatory surgery centers are flourishing in the United States. Accreditation of these unique facilities by the Accreditation Association for Ambulatory Health Care reflects a commitment to quality, patient-centered care and to excellence in this specialty area. The accreditation process is complex and lengthy; the benefits, however, outweigh the disadvantages. By successfully completing the accreditation process, a facility demonstrates to the public, its patients, and other health care professionals that it provides exemplary ambulatory surgical care. Successfully accredited facilities also have competitive advantages over nonaccredited surgical centers.     

Joint Commission on International Accreditation workshop: Planning,development and provision of laboratory services

Throughout the world, the oversight of health care quality is accomplished through professionally based accrediting bodies and state regulatory agencies. These organizations set standards or define regulations that address important organizational functions. The Joint Commission, a private sector United States-based non-profit organization, is the forerunner and best known among healthcare accreditation groups. One of the functions assessed by the standards of the JCI Clinical Laboratory Accreditation Program is the planning, development and provision of laboratory services. The standards related to this issue adress the necessary processes that should be in place prior to performing patient testing.     

Development of outcome standards in critical care

The forces influencing the development of outcome standards are gaining momentum. These forces are professional nursing issues, accreditation standards, and reimbursement issues. Traditionally, structure and process measures provided the means for evaluating the quality of nursing care. But nurses also play an important role in achieving positive patient outcomes. Outcome standards provide a mechanism for measuring patient outcomes. In 1990 the American Association of Critical-Care Nurses (AACN) published Outcome Standards for Nursing Care of the Critically Ill. The book serves as a model for developing and using outcome standards in critical care units. This chapter describes these outcome standards and recommends ways to use them. The Joint Commission on the Accreditation of Healthcare Organizations' (JCAHO) ten-step model outlines development of unit-specific outcome standards. Methods focus throughout on a quality assurance framework.     

Ethics committees in long-term care facilities

Biomedical ethical dilemmas occur in long-term care facilities (LTCFs), particularly in the absence of residents' advance directives. Ethics committees are required in hospitals and long-term care facilities accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), but many LTCFs do not have JCAHO accreditation. A survey of LTCFs in one county in a Southwestern state found that only 29% of those LTCFs responding had an organized ethics committee. This article discusses the purpose, membership, and meetings of an ethics committee in LTCFs. A sample process for resolving a biomedical ethical dilemma is presented. Nurses can initiate the development of an ethics committee using available resources or combining resources with other local LTCFs. The ethics committee should consider the education of all persons involved to facilitate resolution of clinical ethical dilemmas.     

The new JCAHO pain standards: implications for pain management nurses.

The newly approved Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pain management standards present an important opportunity for widespread and sustainable improvement in pain assessment and management. Unrelieved pain is a major, yet avoidable, public health problem. Despite 20 years of work by educators, clinicians, and professional organizations and the publication of clinical practice guidelines, there have been, at best, modest improvements in pain management practices. Multiple barriers found in the health care system, and among health care professionals, patients, and families, continue to impede progress. In August 1997 a collaborative project was initiated to integrate pain assessment and management into the standards, intent statements, and examples of implementation of JCAHO--a rare opportunity to improve pain management in health care facilities throughout the country. After review by multiple JCAHO committees and advisory groups and critique by an expert panel, the JCAHO Board of Commissioners approved the revisions in May 1999. The revisions are published in the 2000-2001 standards manuals and will be effective January 1, 2001, for all patient care organizations accredited by JCAHO--ambulatory care, behavioral health, health care networks, home care, hospitals, long-term care, and long-term care pharmacies. An evaluation of the impact of the revisions is currently being completed, and education of the JCAHO surveyors and health care professionals is underway. Nurses, especially those with expertise in pain management, are valuable resources as health care organizations change their pain assessment and management processes to meet the new standards.     

Implementation of structure and process standards

A dilemma in critical care nursing practice is how to develop and implement a practical quality assurance program that incorporates high-quality standards of nursing care for critically ill patients and addresses those aspects of care considered important by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Standards for Nursing Care of the Critically Ill defines and describes structure and process standards and provides a comprehensive guide for the development of a program for the delivery of quality care to critically ill patients. The purpose of this chapter is to discuss practical application of the standards described by the American Association of Critical-Care Nurses (AACN) through the use of policies and procedures that support structure and process standards.     

The quality assurance process in critical care education

The American Association of Critical-Care Nurses (AACN) has developed education standards for critical care nursing. These structure and process standards can be used as part of the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) ten-step process for monitoring and evaluating critical care education programs. This chapter discusses the application of the monitoring and evaluation process, based on education standards, for critical care education programs.     

Clinical laboratory accreditation in India

Test results from clinical laboratories must ensure accuracy, as these are crucial in several areas of health care. It is necessary that the laboratory implements quality assurance to achieve this goal. The implementation of quality should be audited by independent bodies,referred to as accreditation bodies. Accreditation is a third-party attestation by an authoritative body, which certifies that the applicant laboratory meets quality requirements of accreditation body and has demonstrated its competence to carry out specific tasks. Although in most of the countries,accreditation is mandatory, in India it is voluntary. The quality requirements are described in standards developed by many accreditation organizations. The internationally acceptable standard for clinical laboratories is ISO15189, which is based on ISO/IEC standard 17025. The accreditation body in India is the National Accreditation Board for Testing and Calibration Laboratories, which has signed Mutual Recognition Agreement with the regional cooperation the Asia Pacific Laboratory Accreditation Cooperation and with the apex cooperation the International Laboratory Accreditation Cooperation.     

The evolution of standards. From capability of performance to demonstrated performance

Standardization of performance expectations and accountability for nursing care have been an integral part of nursing departments for many years. The Joint Commission on Accreditation of Hospitals (JCAHO) has used the nursing standards manual to evaluate a nursing division's capability to provide quality care. In this article, the way in which a meaningful quality assurance system is developed is discussed. The aspects discussed in depth are (1) development of standards that define performance; and (2) quality assurance measures that audit performance. By following the steps outlined, a nursing department will have progressed from describing the nurse's capability to provide optimum care to demonstrating optimum performance.     

Quality assurance to quality improvement: the impact of the agenda for changes

Health care professionals are committed to the continual improvement of the quality of patient care. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has launched a major research and development project intended to improve its ability to evaluate health care organizations and encourage greater attention to the quality of daily patient care. This chapter describes JCAHO's challenge to evaluate capability and performance of health care organizations and practitioners. The intent of JCAHO's agenda for change is to focus on patient outcomes and quality improvement through a more precise and objective evaluation of both clinical and managerial performance. Through the agenda for change, JCAHO and the health care organization will participate in a continuous-flow monitoring system in which clinical and organizational data are transmitted from the field to JCAHO, analyzed, and fed back to the health care organization.     

Home care accreditation through Joint Commission on Accreditation of Healthcare Organizations

As home care has become an increasingly viable alternative to inpatient care, the need for industrywide standards has become a major concern for consumers and payors of health care. The Joint Commission on Accreditation of Healthcare Organizations has developed standards which measure the quality of care and services provided by a home care organization. This article outlines the basic standards that a home infusion therapy service must meet in order to earn accreditation.     

Responses of baccalaureate and graduate programs to the emergence of choice in nursing accreditation

Specialized accreditation in nursing is a widely recognized and respected hallmark of program quality. The advent of a second specialized accrediting agency for baccalaureate and higher degree programs in nursing prompted a survey of these programs to determine their choice of nursing accreditation agency, factors influencing their choice, their perceptions of the value added by nursing accreditation, and the difficulties encountered with the accreditation process. These study variables and the relationships between choice of accrediting agency and types of degree-granting nursing education programs offered by the institution, agency membership in the National League of Nursing (NLN) or the American Association of Colleges of Nursing (AACN), expected date of next accreditation visit, geographic region, public versus private status, and type of institution (Carnegie classification) were analyzed. Findings revealed that nearly a quarter (24%) of respondents intend to continue with the NLN Accrediting Commission (NLNAC), whereas 30% indicated they have already switched to the Commission on Collegiate Nursing Education (CCNE) or intend to do so prior to their next accreditation cycle. However, nearly a quarter (24%) of respondents said they plan to be accredited by both agencies for the immediate future, and 21% indicated they are still undecided. Study findings suggest an end to single-source accreditation, and the beginning of a new market-oriented approach.     

Revitalizing a documentation system.

The nursing department of a 154-bed acute rehabilitation facility, cognizant of the changing trends in health care and responding to feedback from staff, developed and implemented a comprehensive documentation system. The previous system had been fragmented, inconsistent, and inefficient. The development of the new system focused on the complex needs of the rehabilitation client and the equally complex standards required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), and insurance carriers. The final product, which was based on the nursing process and functional health patterns, encompassed the following areas from admission to discharge: providing feedback on clients' functional abilities and progress toward goals, satisfying requirements of the 1990 JCAHO standards, and, finally, using a flow sheet that saves nursing time and increases objectivity. This article describes the system from conceptualization to successful implementation.     

Standards of care: integrating nursing care plans and quality assurance activities

Traditionally, standards are used to define the level of care that a patient can expect to receive in a given institution or on a given nursing unit. These standards are the foundation of quality assurance programs. Unfortunately, with the increased emphasis on monitoring care, many standards are being written after the quality assurance activities have been developed and are in place. Often, standards are placed neatly in a book that is dusted off and brought out when the Joint Commission for Accreditation of Healthcare Organizations representative (JCAHO) visits. The nursing staff at the unit level has no real knowledge or understanding of the standards. This may result in a nonfunctioning quality assurance program.     

From quality assurance to quality improvement. The Joint Commission on Accreditation of Healthcare Organizations and Emergency Care.

The transition from quality assurance to quality improvement is at an early stage, but it clearly has begun. The progressive anticipated changes in the tone and content of JCAHO standards will place the JCAHO in a different posture in relation to accredited hospitals. Standards are of course a set of requirements that must be met as a condition of accreditation. But the JCAHO's bottom line expectation will be a meaningful and demonstrated improvement in hospital performance. How hospitals reach this objective is their business. This shifts the onus of responsibility to where it belongs and suggests a more facilitative role for the JCAHO. Although the JCAHO is introducing standards requirements that are minimally essential to the achievement of improved performance, full-fledged adoption of CQI concepts will not be mandated. Management structures and styles in health care organizations vary considerably, and CQI is but one means to the desired end of improved performance. We believe, however, that it is the best means and that most organizations will discover this for themselves. Notwithstanding the magnitude of needed internal behavioral change, excellence in performance is what most health care organizations want for themselves and their patients. CQI offers them the opportunity to reach this lofty goal.     

Standards of care and practice: a vital link in quality assurance

In the critical care unit setting, a quality assurance program is based on the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) ten-step model for monitoring and evaluation. The addition of nursing standards of patient care and standards of nursing practice to that ten-step model provides the vital link between patient expectations, staff performance, and quality assurance in that unit.     

An overview of nursing ethics for nurse educators.

Nursing ethics is a topic included in most health care institutions as a requirement for accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This article provides an overview of nursing ethics in a format that allows the reader to understand the basic principles while applying the information to daily work situations in a format for use in a classroom environment. The issue of dilemma recognition is addressed as well as mechanisms that may be used to facilitate dilemma resolution. Information is also provided for use in the development of skills in ethical decision-making.