jcaho jeopardy kelly d. young, md, ms harbor-ucla medical center
TRANSCRIPT
JCAHO JeopardyJCAHO Jeopardy
Kelly D. Young, MD, MSKelly D. Young, MD, MS
Harbor-UCLA Medical CenterHarbor-UCLA Medical Center
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JCAHO BASICS
PATIENT SAFETY
WORK- PLACE
DOCUMEN-TATION
POT-POURRI
JCAHO Basics $100JCAHO Basics $100
What does JCAHO stand for?
Hint: It’s not “Julie Comes And Hangs Out”
Answer
Answer Answer JCAHO Basics $100JCAHO Basics $100
Joint Commission on Accreditation of Healthcare Organizations
AKA “Yes, we can close your hospital and make you seek new residencies”
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JCAHO Basics $200JCAHO Basics $200
During the JCAHO survey, the surveyors will talk primarily to:
A) The hospital administrators
B) The doctors and nurses
C) The patients
D) The LA Times
Answer
Answer Answer JCAHO Basics $200JCAHO Basics $200
B) YOU!
That’s why you’re playing this game, right?
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JCAHO Basics $300JCAHO Basics $300
What is “tracer methodology”?
Answer
Answer Answer JCAHO Basics $300JCAHO Basics $300
Surveyors analyze a hospital’s systems by following individual patients through their hospitalization, evaluating multiple care units, departments, and services rendered to the patient.
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JCAHO Basics $400JCAHO Basics $400
What is HIPAA? Name one way protected health information is kept private in your department.
Answer
NOT HIPPO!
Answer Answer JCAHO Basics $400JCAHO Basics $400
HIPAA: Health Insurance Portability and HIPAA: Health Insurance Portability and Accountability ActAccountability Act
States that PHI may only be used for purposes States that PHI may only be used for purposes of treatment, payment, healthcare operationsof treatment, payment, healthcare operations
Shredder or blue HIPAA trashcan for HIPAA Shredder or blue HIPAA trashcan for HIPAA sensitive documentssensitive documents
Codes for patient chief complaintsCodes for patient chief complaints DON’T use “5150” or “OD” on the boardDON’T use “5150” or “OD” on the board Don’t discuss patients in hallways or elevatorsDon’t discuss patients in hallways or elevators Keep curtains closed and don’t let patientsKeep curtains closed and don’t let patients
stare at the boardstare at the board
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JCAHO Basics $500JCAHO Basics $500
What is ORYX?
Bonus $100: name one core measure of ORYX
Answer
Answer Answer JCAHO Basics $500JCAHO Basics $500
ORYX is an initiative that requires ORYX is an initiative that requires hospitals to collect and submit hospitals to collect and submit electronically data each quarterelectronically data each quarter
Heart failureHeart failure– Discharge instructions: activity, diet, follow-Discharge instructions: activity, diet, follow-
up, medications, symptoms worsening, up, medications, symptoms worsening, weight monitoringweight monitoring
– LV function assessmentLV function assessment– ACE inhibitor for LV systolic dysfunctionACE inhibitor for LV systolic dysfunction– Adult smoking cessation advice / counselingAdult smoking cessation advice / counseling
More next slide
Answer continuedAnswer continued
PneumoniaPneumonia– Adult initial antibiotic within 4 hrsAdult initial antibiotic within 4 hrs– Median time to first antibiotic dose (goal Median time to first antibiotic dose (goal
240 minutes)240 minutes)– Adult blood culture before first antibiotic IF Adult blood culture before first antibiotic IF
blood culture performed at allblood culture performed at all– Pneumococcal vaccinationPneumococcal vaccination– Adult smoking cessation advice/counselingAdult smoking cessation advice/counseling– Adult oxygenation assessmentAdult oxygenation assessment
Pregnancy and related conditionsPregnancy and related conditions– VBAC, inpatient neonatal mortality, 3VBAC, inpatient neonatal mortality, 3rdrd & 4 & 4thth
lacslacs
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Patient Safety $100Patient Safety $100
Name one of the 2009 National Patient Safety Goals
Answer
Answer Answer Patient Safety $100Patient Safety $100
Improve accuracy of patient identificationImprove accuracy of patient identification Improve effectiveness of communication Improve effectiveness of communication
among caregiversamong caregivers Improve safety of using medicationsImprove safety of using medications Reduce risk of health-care associated Reduce risk of health-care associated
infectionsinfections Accurately & completely reconcile Accurately & completely reconcile
medications across continuum of caremedications across continuum of care– Medicine reconciliation formMedicine reconciliation form
Identify safety risks inherent to population Identify safety risks inherent to population (e.g. suicide(e.g. suicide
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Med Reconciliation Med Reconciliation FormForm
Check whether to stop old meds
List new long-term meds here and write in layperson lingo
Fill out your name, number, date, time, etc.
Patient gets yellow copy
Patient Safety $200Patient Safety $200
Name one way you reduce the risk of health-care associated infections in your department
Answer
Answer Answer Patient Safety $200Patient Safety $200
Handwashing with soap and water Handwashing with soap and water before AND after each patient contactbefore AND after each patient contact– Even if you used glovesEven if you used gloves– Wash vigorously for 15 secondsWash vigorously for 15 seconds
Alcohol-based hand rubs may be used Alcohol-based hand rubs may be used if there is no visible soiling and C. diff if there is no visible soiling and C. diff is not suspectedis not suspected
Use of artificial or long fingernails is Use of artificial or long fingernails is prohibitedprohibited
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LATHER UP!
Patient Safety $300Patient Safety $300
How do you improve the accuracy of patient identification in your department?
Answer
Answer Answer Patient safety $300Patient safety $300
• I use TWO (2) (dos) identifiers when providing treatment, administering medications, collecting specimens, discharging the patient
• Patient’s name
• Patient’s MRUN
• NOT patient’s room number or chief complaint (e.g. the lac in room 6)
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Patient Safety $400Patient Safety $400
How are you improving the effectiveness of communication between caregivers?Answer
Answer Answer Patient Safety $400Patient Safety $400
Telephone orders are read backTelephone orders are read back Verbal orders are repeated backVerbal orders are repeated back Critical lab values and other test results are Critical lab values and other test results are
read backread back We use standardized abbreviations and avoid We use standardized abbreviations and avoid
certain unapproved dangerous abbreviationscertain unapproved dangerous abbreviations Preliminary radiology reads inPreliminary radiology reads in
Notes feature of Synapse – Notes feature of Synapse – Overread by radiologist and we Overread by radiologist and we are notified of any disagreementsare notified of any disagreements
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Patient Safety $500Patient Safety $500
Name 3 of the unapproved abbreviations
Answer
Answer Answer Patient Safety $500Patient Safety $500
U or u (unit)U or u (unit) IU (international IU (international
unit)unit) Ug (microgram)Ug (microgram) 1.0 (no terminal 1.0 (no terminal
zeros)zeros) .5 (always use a .5 (always use a
leading zero – leading zero – “always lead, “always lead, never follow”))never follow”))
X3d (for 3 days or X3d (for 3 days or for 3 doses)for 3 doses)
TIW (three times TIW (three times weekly)weekly)
qD or qoD (every qD or qoD (every day, daily, or day, daily, or every other day)every other day)
MS, MSO4, MgSO4 MS, MSO4, MgSO4 (morphine sulfate (morphine sulfate or magnesium or magnesium sulfate)sulfate)
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Workplace $100Workplace $100
Where are the fire extinguishers in the PED?
Answer
BONUS:
Where’s the oxygen shutoff valves in case of a fire?
Answer Answer Workplace $100Workplace $100
1) Next to the nurses’ lounge as you go back toward the IR rooms
2) Opposite the white board with patient names
3) Oxygen shutoff valves
Between rooms 3 & 4 for Rooms 3-8
In hallway on the way to AED waiting room for back I-R rooms
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Workplace $200Workplace $200
What color “code” would you call if you had a violent patient? Who would come?
Answer
Answer Answer Workplace $200Workplace $200
Code GreenCode Green Crisis Response Team Crisis Response Team
respondsresponds Does NOT include police Does NOT include police
officerofficer ED staff are still ED staff are still
responsible for the responsible for the patient, and should assist patient, and should assist in restraint if necessaryin restraint if necessary
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Workplace $300Workplace $300
What do the RACE and PASS mnemonics stand for when there is a fire?
Answer
Answer Answer Workplace $300Workplace $300
Remove patients Remove patients and othersand others
AlarmAlarm Contain the fire Contain the fire
(close doors)(close doors) Extinguish the Extinguish the
fire when it is fire when it is safe to do sosafe to do so
Pull the pinPull the pin Aim the nozzle at Aim the nozzle at
the base of the the base of the firefire
Squeeze the Squeeze the handlehandle
Sweep the nozzle Sweep the nozzle from side to sidefrom side to side
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Workplace $400Workplace $400
What should you do in the event of a hazardous material spill?*
* Material more hazardous than cafeteria food, but less hazardous than anthrax
Answer
Answer Answer Workplace $400Workplace $400
Rinse exposure with waterRinse exposure with water Post warning signsPost warning signs Cordon off areaCordon off area Consult Material Safety Data Consult Material Safety Data
Sheet (MSDS) or call Hazardous Sheet (MSDS) or call Hazardous Material Safety OfficeMaterial Safety Office
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Workplace $500Workplace $500
What are code pink, code white, code orange, code gray, and code triage?
($100 per correct answer)
Answer
Answer Answer Workplace $500Workplace $500
Code pink: infant / child abductionCode pink: infant / child abduction– The number afterwards refers to the The number afterwards refers to the
age of the child, e.g. Code pink 3age of the child, e.g. Code pink 3 Code white: pediatric code blueCode white: pediatric code blue Code gray: bomb threatCode gray: bomb threat Code orange: hazardous material Code orange: hazardous material
or radiation spill / exposureor radiation spill / exposure Code triage: disasterCode triage: disaster
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Documentation $100Documentation $100
How do you document in your procedure note that you confirmed the correct identity of the patient, and the correct site of the procedure?Answer
Answer Answer Documentation $100Documentation $100
Document that a “time out” was done (check box on procedure note area of 253 form)
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Documentation $200Documentation $200
How would you write the order for 100 mg of Motrin to be given to a 10 kg child PO?*
* Answer is NOT “with a pen”
Answer
Answer Answer Documentation $200Documentation $200
Motrin 100 mg = 10 mg/kg PO now
Must put mg/kg
(Date and time order, of course)
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Documentation $300Documentation $300
What’s wrong with this order?
Motrin 600 mg PO q 6-8 hours prn pain (standard adult dose) Answer
Answer Answer Documentation $300Documentation $300
No range orders allowed
(No range in doses, no range in time intervals)
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Documentation $400Documentation $400
Which is acceptable?
Answer
Answer Answer Documentation $400Documentation $400
CC
SignatureSignature Last name legibly spelled outLast name legibly spelled out Degree (MD, RN, PNP, etc.)Degree (MD, RN, PNP, etc.) Identification numberIdentification number
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Documentation $500Documentation $500
What’s the “fifth vital sign” that we document on ALL patients, and where do we document it?
Answer
Answer Answer Documentation $500Documentation $500
PAIN scorePAIN score PAIN scorePAIN score PAIN score (am I PAIN score (am I
getting getting through?)through?)
Pre-printed pain Pre-printed pain scales on 1scales on 1stst AND 3AND 3rdrd page of page of 253s253s
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GOALS
Pain med w/in 30min
Reassess w/in 30min of IV/IM pain med, w/in 60min of PO
Pain score < 4 at d/c or pain med for home
Potpourri $100Potpourri $100
True of False:
A minor sibling may translate for the parent if the minor is 13 years old or older, clearly fluent in both languages, and the parent and minor consent to using the minor as an interpreter
Answer
Answer Answer Potpourri $100Potpourri $100
ParentParent ““El bebe tiene mucho fiebre, El bebe tiene mucho fiebre,
hasta ciento siete, y no come hasta ciento siete, y no come nada, nunca, en todo su vida, nada, nunca, en todo su vida, (esos Cheetos son la primera (esos Cheetos son la primera comida de todo su vida), y tiene comida de todo su vida), y tiene fiebre por dos o tres meses, y le fiebre por dos o tres meses, y le duele todo su cuerpo, y tiene duele todo su cuerpo, y tiene ronchas y grippe y tos y nausea ronchas y grippe y tos y nausea y diarrea…”y diarrea…”
Sibling InterpreterSibling Interpreter ““Tiene fiebre?”Tiene fiebre?”
““Yes”Yes”
So VERY VERY False!
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Potpourri $200Potpourri $200
Does Harbor have a mission?
It’s not “To get our residents more sleep and more money.”
Answer
Answer Answer Potpourri $200Potpourri $200
Mission: to provide high quality, cost-effective, patient-centered care through leadership in medical practice, education and research.
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Potpourri $300Potpourri $300
What quality performance data are collected in your area, and how are you involved?
Answer
Answer Answer Potpourri $300Potpourri $300
Residents perform peer review of AED and PED charts for pain assessment and management. The data are collated and shared on a quarterly basis, and individual residents also receive a report of how they performed. Also, chart review 8am in the PED.
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Potpourri $400Potpourri $400
Dr. X is starting his shift in the PED. He walks down the hall, Starbucks in hand, and waves “hi” to the nurses and clerk. He rounds the corner, going through the propped open door to stand in front of the board. He notes that there are 2 patients with the same initials on the board. He dumps his empty coffee cup in the trash, sets down his trusty Harriet Lane Handbook on the counter, and picks up a chart. Where’s the JCAHO violation?Answer
Answer Answer Potpourri $400Potpourri $400
Only special fire doors may remain open. Doors may not be propped open (including the 2 doors on either side of the PED board).
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Potpourri $500Potpourri $500
A two-parter:
1) How do you know a piece of equipment (e.g. defibrillator, ultrasound) is okay to use?
2) What does the pink tubing around the IV pole on the code cart mean?
Answer
Answer Answer Potpourri $500Potpourri $500
Check on the equipment for a Check on the equipment for a dated sticker that it has been dated sticker that it has been serviced by mechanical.serviced by mechanical.
Pink signifies a “combination Pink signifies a “combination cart” which has supplies for both cart” which has supplies for both pediatric and adult codes.pediatric and adult codes.
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