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Growing consensus exists regarding the importance of spiritual assessment. For instance, the largest health care accrediting body in the United States, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), now requires the administration of a spiritual assessment. Although most practitioners endorse the concept of spiritual assessment, studies suggest that social workers have received little training in spiritual assessment. To address this gap, the current article reviews the JCAHO requirements for conducting a spiritual assessment and provides practitioners with guidelines for its proper implementation. In addition to helping equip practitioners in JCAHO-accredited settings who may be required to perform such an assessment, the spiritual assessment template profiled in this article may also be of use to practitioners in other settings.

Admission handoff is a high-risk component of patient care. Previous studies have shown that a standardized physician electronic signout (“eSignout”) may improve ED-to-inpatient handoff safety and efficiency in teaching hospitals. This model has not yet been studied in non-teaching hospitals. The objectives of the study were to determine the efficiency of an eSignout platform at a community affiliate hospital by comparing ED length of stay (LOS) for a 5-month period before and after implementation and to compare the quality assurance (QA) events among admitted patients for the same time period. A retrospective, interventional study was conducted with the main outcome measures including ED LOS with calculation of 95% CI, mean comparison (t test), and number of QA events before and after implementation of the eSignout model. Prior to eSignout implementation, 1045 patients were admitted [mean ED LOS 330.0 min (95% CI 318.6–341.4)]. Following implementation, 1106 patients were admitted [mean ED LOS 338.9 min (95% CI 327.4–350.4, p = 0.2853)]. Nine pre-implementation QA events and six post-implementation events were identified. Use of a physician eSignout in a non-teaching hospital had no statistically significant effect on ED LOS for the admitted patients. The effect of an electronic interdepartmental handoff tool for patient safety and clinical operations in the non-teaching setting is unclear.

This performance improvement (PI) project was conducted to recommend improvements for pain reassessment workflow and policies at a large military primary care clinic. The Joint Commission survey identified inconsistent pain reassessment practices at the facility in 2012. A review of the literature reveals that pain reassessment procedures can be affected by unclear organizational policies, poorly designed documentation procedures, and redundant or inefficient workflow practices. This PI project was designed to assess pain reassessment compliance rates, associated documentation, and clinic workflow, and to identify opportunities for improvement. Pain reassessment compliance was evaluated using an Electronic Medical Record (EMR) query for patients treated between February 1 and May 30, 2013, who received Toradol at a large military outpatient clinic (n = 151). In addition, observations of clinic workflow were conducted using tracer methodology as recommended by The Joint Commission to track a convenience sample of 12 patients moving through clinic care processes. Pain reassessment documentation and workflow procedures were then evaluated using the Situation Awareness (SA) framework, which is an approach used to evaluate operational implications of factors affecting staff decisions and performance (e.g., stress and workload, interface design, automation, complexity of workflow, staff abilities and training, goals and expectations). The EMR review revealed compliance rates greater than 90% for all pain reassessment requirements with the exception of the maximum 30-minute interval between initial and follow-up pain assessment required by clinic policy, which had a compliance rate of 38%. Pain reassessments were documented to occur at a mean time of 48.25 minutes after initial assessment. During the tracer, none of the 12 patient encounters was fully compliant with clinic policies. An analysis of clinic workflow using the SA framework revealed that the SA of clinic staff was impacted by a lack of standardized procedures and heavy reliance on staff memory. Recommendations for improvement included possible extension of the 30-minute time requirement, development of a template for pain reassessment documentation in the EMR, standardizing hand off and admission/discharge processes, and designing an electronic or manual dashboard to indicate pain reassessment times. Future PI projects in other military clinics would benefit from use of the SA perspective to review clinic policies, EMR documentation, and workflow analysis. Further analysis will be needed to evaluate the impact of these improvements.

Several questions on alternative equipment maintenance (AEM) plan are answered. If your risk assessment results in placing certain equipment in an AEM, you may change either the manufacturer's scheduled maintenance activities or frequencies (or both) as long as your risk assessment indicates that these changes do not reduce the safety of equipment and that the changes are based on accepted standards of practice. Changes like this should only be made with corresponding changes in hospital policy. Hospitals should also have (and follow) robust policies that address how to capture equipment that was unavailable (\"in use\" or \"non-locatable\") during its scheduled maintenance window. The Joint Commission and Centers for Medicare & Medicaid Services allow hospitals to consider documented service histories from sources other than the hospital when conducting the risk assessment to determine what equipment to be included in an AEM.

Franko discusses the importance of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). JCAHO is an organization committed to improving safety and quality of care by providing standards, survey evaluations, sentinel event alerts, and professional consulting services to health care organizations.

Questions about those subjects that matter most to you are answered. People have always said that if you go to a unit to work on that equipment, and it's on a patient, they have never, ever advocated taking it off a patient to see if it's working. They would expect you to have some sort of policy to guide you on the next steps. But if you were there and your intent was to work on it but it was in use, then you're good to go. While The Joint Commission does not survey against specific HIPAA regulations, the standards do require compliance with applicable law and regulation.

The Joint Commission's new requirements related to antimicrobial stewardship are a national priority to decrease antimicrobial resistance and improve the correct use of antimicrobials. The Centers for Disease Control and Prevention estimates that at least 2 million illnesses and 23,000 deaths are caused by antibiotic-resistant bacteria in the US alone each year. Current scientific literature emphasizes the need to reduce the use of antimicrobials (e.g., antibiotic, antifungal, antiprotozoal, and antiviral medications) in all healthcare settings. The Centers for Medicare & Medicaid Services recently adopted the 2012 editions of NFPA 101: Life Safety Code and NFPA 99: Health Care Facilities Code. The effective use of data enables hospitals to identify problems, prioritize issues, develop solutions, and track to determine success.

Objective. To describe the components of the new Joint Commission International (JCI) accreditation program for hospitals, and compare this program with the four quality evaluation models described under the ExPeRT project (visitatie, ISO, EFQM, organizational accreditation). Results. All the models have in common with the JCI program the use of explicit criteria or standards, and the use of external reviewers. The JCI program is clearly an organizational accreditation approach with evaluation of all the «systems» of a health care organization. The JCI model evaluates the ability of an organization to assess and monitor its professional staff through internal mechanisms, in contrast with the external peer assessment used by the visitatie model. The JCI program provides a comprehensive framework for quality management in an organization, expanding the boundaries of the quality leadership and management found in the EFQM model, and beyond the quality control of the ISO model. The JCI organizational accreditation program was designed to permit international comparisons, difficult under the other models due to country specific variation. Conclusion. We believe that the organizational accreditation model, such as the international accreditation program, provides a framework for the convergence and integration of the strengths of all the models into a common health care quality evaluation model.