2.10 Hospital Accreditation Standards Overview
| Environment of careEmergency managementHuman resourcesInfection prevention and controlInformation managementLeadership | Life safetyMedication managementMedical staffNational patient safety goalsNursingProvision of care, treatment, and services | Performance improvementRecord of care, treatment, and servicesRights and responsibilities of the individualTransplant safetyWaived testing |
Source: © Joint Commission: CAMH: 2010 Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, IL: Joint Commission, 2011, available at www.jcrinc.com/Joint-Commission-Requirements/Hospitals
Critical Thinking 2.3
Review the case studies on reducing harm to patients at, www.commonwealthfund.org/Innovations/Case-Studies.aspx
What can each staff member do to improve the quality of care, especially the safety of patient care?
How can we work toward a culture of continual improvement for those issues and situations that cause errors and almost lead to errors?
How much control do nurses have in identifying errors and reporting them?
What can you do to improve the quality of care afforded in your organization?
Improving Quality Through Health Professions Education
There is a need to focus on retooling the health care workforce with new knowledge and requisite skills to function in better, redesigned health care systems. To begin to realize the quality agenda set forth by the IOM (2001), a subsequent report, Health Professions Education: A Bridge to Quality (IOM, 2003c), delineates a needed overhaul of the curriculum of health professionals' education to transform current skills and knowledge (IOM, 2003c, p. 1). This curriculum includes training clinicians to develop:
1 Ability to provide patient‐centered care: Patient‐centered care emphasizes recognition of the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient's preferences, values, and needs. It builds knowledge of effective communication approaches that allows patient access to information and achieves patient understanding. Patient‐centered care respects patients' individuality, values, and needs, and uses related population‐based strategies to improve appropriate utilization of health care services. Patient‐centered care is important, because research continues to find that involving patients in decision making about their care results in higher functional status, better outcomes, and lower costs.
2 Ability to effectively work in interprofessional teams: This competency calls for functioning effectively within nursing and interprofessional teams and fostering open communication, mutual respect, and shared decision making to achieve quality patient care. Interprofessional teams have been shown to enhance quality and lower costs, even though this training is challenged by differences in communication norms across disciplines and power and turf controversies among disciplines.
3 Understanding of evidence‐based practices: Evidence‐based practice integrates the best current research evidence with clinical expertise and patient and family preferences and values for delivery of optimal health care. To actively provide EBC, clinicians need the following knowledge and skills: how to locate the best sources of evidence, how to formulate clear clinically‐based questions, and how to determine when and how to translate new knowledge into practice.
4 Ability to measure the quality of care: Clinicians need to be able to use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Clinicians must use comparison benchmarks to identify opportunities for improvement; design, test, and assess quality improvement interventions; identify current and potential errors in care; and implement safety design principles such as recognizing human factors and the need for standardization.
5 Ability to use health information technology: Health care informatics applications use information and technology to communicate, manage knowledge, mitigate errors, and support decision making. They enhance patient safety by driving standardization, as well as by facilitating knowledge management and communication. As more technology becomes available, database systems are linked within and across health care settings. As our evidence‐based measures and decision‐making tools improve, clinicians will need to be able to fully utilize health information technology to improve the quality of health care delivery.
Quality and Safety Education for Nurses (QSEN)
The IOM's 2004 Report on Patient Safety was the first in a series of three reports published since the year 2000 to emphasize the connections among nursing, patient safety, and quality of care. Keeping Patients Safe sets forth the structures and processes that health care workers use in the delivery of care and emphasizes the need to design the nurses' environments to promote the practice of safe nursing care (IOM, 2004b). The importance of organizational management practices, strong nursing leadership, and adequate nurse staffing for providing a safe care environment is critical (Laschinger & Leiter, 2006). The IOM Report (2010) The Future of Nursing Leading Change Advancing Health suggest that nurses should practice to the full extent of their education and training, achieve higher levels of education and training through an improved education system that promotes seamless academic progression, and be full partners with physicians and other health care professionals.
In 2008, the American Association of Colleges of Nursing (AACN) and the National League for Nursing (NLN) embraced the inclusion of quality improvement systems thinking, change strategies, and patient safety, etc., into undergraduate and graduate nursing education curricula. In 2005, the RWJF funded the University of North Carolina at Chapel Hill School of Nursing on a long‐term project aimed at increasing the inclusion of quality in nursing education and the development of well‐prepared faculty to teach the quality and safety competencies recommended by the IOM to make health care safe, effective, patient centered, timely, efficient, and equitable (IOM, 2001). In 2009, the AACN lent its support to this Quality and Safety Education for Nurses (QSEN) project (www.qsen.org) (Kovner et al., 2010).
The QSEN website is now a comprehensive resource for teaching strategies, etc., for the development of quality and safety competency in nursing.
Critical Thinking 2.4
Think about the competencies needed to improve health care education:
1 Patient‐centered care delivery
2 Interdisciplinary teamwork
3 Evidence‐based practice
4 Measurement of the quality of care
5 Health information technology skill
6 Culture of safety
How can you improve your education and experience in each of the competencies now and throughout your career?
Never Conditions
In 2008, the CMS identified hospital‐acquired conditions (never conditions) for which they will not reimburse hospitals
