THUMBS UP IF YOU CITE! :D Status of Quality Tools and Standards: In this section
ID: 430497 • Letter: T
Question
THUMBS UP IF YOU CITE! :D
Status of Quality Tools and Standards: In this section, you will review the status of the information management system and accreditation.
A. Describe the current status of accreditation based on recent accreditation survey reports.
B. Analyze the current information management systems and patient care technologies for their ability to collect data used to report quality measures and accreditation requirements. Are these systems and technologies adhering to the appropriate policies and regulations to meet the needs for accreditation and compliance?
C. Explain the impact of meaningful-use implementation at the organization as it pertains to patient safety and quality.
Explanation / Answer
A. The Joint Commission’s accreditation process seeks to help organizations identify risks to quality and patient safety — including risk previously unknown to the organization — by conducting a meaningful assessment, and to inspire them to improve their care, treatment and services.
Joint Commission standards are the basis of this objective evaluation process that can help health care organizations assess, measure and improve performance. The standards focus on important care and organization functions that are essential to providing safe, high-quality care. The Joint Commission’s standards set expectations for organization performance that are reasonable, achievable and survey able.
Joint Commission surveys are unannounced, with some exceptions, such as initial surveys. A survey is designed to be individualized to each organization, to be consistent, and to support the organization’s efforts to improve performance. During the on-site survey, Joint Commission surveyors evaluate an organization’s performance of functions and processes aimed at continuously improving patient outcomes. They do this by:
The scoring and decision process is based on an evaluation of compliance with Joint Commission standards and other requirements. Compliance with the standards is scored according to specific performance expectations called elements of performance. While a preliminary Summary of Survey Findings Report is provided at the conclusion of the on-site survey, this report does not include an accreditation decision. The final accreditation decision is made at a later date, after the report is reviewed by Joint Commission Central Office staff. The accreditation decisions that can be awarded are: Preliminary Accreditation, Accreditation, and Accreditation with Follow-up Survey, Preliminary Denial of Accreditation, and Denial of Accreditation.
Expectations of accreditation
An organization’s accreditation cycle is continuous, as long as the organization has a full, unannounced survey within 36 months of its last survey, and continues to meet all accreditation-related requirements, including, but not limited to, submission of an annual Intracycle Monitoring (ICM) profile and the Focused Standards Assessment (FSA). The ICM process facilitates a continuous accreditation process by incorporating an additional form of evaluation that is conducted in between full accreditation surveys.
Accreditation decisions
At the organization exit conference, the survey team presents a preliminary Summary of Survey Findings Report. In this report, organizations will not receive an accreditation decision or any scores. The final accreditation decision will be made subsequently. The following is an overview of the accreditation decisions. Specific information about accreditation decisions, policies and procedures can be found in The Joint Commission’s accreditation manuals. The accreditation decisions are:
Accreditation is awarded to a health care organization that is in compliance with all applicable standards at the time of the on-site survey or has successfully addressed all Requirements for Improvement (RFIs) in an Evidence of Standards Compliance (ESC) submission within 60 days following the posting of the Accreditation Survey Findings Report and does not meet any other rules for other accreditation decisions.
Accreditation with Follow-up Survey results when a health care organization is in compliance with all standards, as determined by an acceptable ESC submission. A follow-up survey is required within six months to assess sustained compliance.
Limited Accreditation results when a health care organization is in satisfactory compliance with the limited set of standards and elements of performance (EPs) assessed in the first of the two surveys conducted under the Early Survey Policy.
Preliminary Denial of Accreditation is recommended when there is justification to deny accreditation to a health care organization as evidenced by one or more of the following: an immediate threat to health or safety to patients or the public; submission of falsified documents or misrepresented information; lack of a required license or similar issue at the time of survey; failure to resolve the requirements of an Accreditation with Follow-up Survey status; or significant noncompliance with Joint Commission standards. This decision is subject to review and appeal by the organization before the determination to deny accreditation.
Denial of Accreditation results when a health care organization has been denied accreditation. All review and appeal opportunities have been exhausted. For an organization undergoing an initial survey, the organization has failed to demonstrate compliance with all applicable Joint Commission standards.
B. Patient care technology has become increasingly complex; transforming the way nursing care is conceptualized and delivered. Before extensive application of technology, nurses relied heavily on their senses of sight, touch, smell, and hearing to monitor patient status and to detect changes. Over time, the nurses’ unaided senses were replaced with technology designed to detect physical changes in patient conditions. Consider the case of pulse asymmetry. Before its widespread use, nurses relied on subtle changes in mental status and skin colour to detect early changes in oxygen saturation, and they used arterial blood gasses to confirm their suspicions. Now pulse asymmetry allows nurses to identify decreased oxygenation before clinical symptoms appear, and thus more promptly diagnose and treat underlying causes.
While technology has the potential to improve care, it is not without risks. Technology has been described as both part of the problem and part of the solution for safer health care, and some observers warned of the introduction of yet-to-be errors after the adoption of new technologies. For example, nurses and other health care providers can be so focused on data from monitors that they fail to detect potentially important subtle changes in clinical status. Problems may emerge based on the sheer volume of new devices, the complexity of the devices, the poor interface between multiple technologies at the bedside, and the haphazard introduction of new devices at the bedside. Despite the billions of dollars spent each year on an ever-increasing array of medical devices and equipment, the nursing profession has paid little attention to the implementation of technology and its integration with other aspects of the health care environment.
Patient care technologies of interest to nurses range from relatively simple devices, such as catheters and syringes, to highly complex devices, such as barcode medication administration systems and electronic health records. Technology can be broadly defined to include clinical protocols and other “paper” based tools, but for the purpose of this chapter, we will focus more on equipment and devices that nurses are likely to encounter in delivering direct care to patients. The purpose of this chapter is to provide a conceptual model for technologies that nurses are likely to encounter and to delineate strategies for promoting their effective and safe use.
C. More and more health care providers are adopting and using health information technology tools like electronic health records (EHRs) since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009. HITECH provided incentives for use of EHRs with functions (‘meaningful use functionalities’) known to enable better care, improved health and lower costs. There is growing anecdotal evidence of the benefits of health IT, but reviews of the evidence base are dated and none have focused on meaningful use functionalities.
That’s why we asked RAND to update previous reviews and examine recent evidence on the effects of meaningful use functionalities on quality, safety, and efficiency outcomes. The study was the largest and most comprehensive assessment of the health IT literature to date.
Meaningful use functionalities have predominantly positive effects on quality, safety, and efficiency outcomes.
Figure 1
Figure 1: Updated Systematic Review of Effects of Meaningful Use Functionalities on Quality, Safety and Efficiency, By Study Outcome Result (% of Studies)
Health IT evaluation studies, 2007-2013 (n=493). Positive defined as health IT improved key aspects of care but none worse off; Mixed-positive defined as positive effects of health IT outweighed the negative effects; Neutral defined as health IT not associated with change in outcome; Negative defined as negative effects of health IT on outcome.
Figure 2
Figure 2: Updated Systematic Review of Effects of Meaningful Use Functionalities on Quality, Safety and Efficiency, By Study Outcome Result (% of Studies)
Health IT evaluation studies, 2007-2013 (n=493). Number of studies by meaningful use functionality in parentheses. Positive defined as health IT improved key aspects of care but none worse off; Mixed-positive defined as positive effects of health IT outweighed the negative effects; Neutral defined as health IT not associated with change in outcome; Negative defined as negative effects of health IT on outcome.
Health IT effects varied by type of outcome but were mostly positive overall.
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