1 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 7 Health Care Regulatory and Certifying Agencies

2 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. The Joint Commission (TJC) The accreditation organization that strives to continuously improve the safety and quality of care provided to the public by monitoring and accrediting health care organizations

3 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Accreditation Determines that a health care organization is in compliance with the required standards of The Joint Commission

4 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Centers for Disease Control and Prevention (CDC)  The U.S. government agency charged with preventing and controlling disease, injury, and disability  It has created multiple infection control standards that are now part of the Joint Commission accreditation  The CDC is a division of the U.S. Department of Health and Human Services

5 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. National Institute for Occupational Safety and Health (NIOSH)  The U.S. government agency responsible for conducting research and making recommendations for the prevention of work- related injury and illness  NIOSH is part of the CDC

6 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Occupational Safety and Health Administration (OSHA)  U.S. Department of Labor agency that ensures the safety and health of America’s workers  They set and enforce standards; provide training, outreach, and education; establish partnerships; and encourage continual improvement in workplace safety and health

7 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Regulatory Agencies  Licensing of health care agencies occurs through state departments of health  Compliance with regulatory standards on both national and state levels is mandatory  Fines can be leveled against organizations for non- compliance  Accreditation agencies evaluate health care organizations against a set of standards that have been validated against best practice. Accreditation is voluntary, though without it, some insurances, including Medicare and Medicaid, will not allow payment for services given to their patients.

8 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. The Joint Commission  Previously known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)  Evaluates and accredits more than 15,000 health care organizations  Independent, not-for-profit organization

9 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. The Joint Commission accredits the following types of organizations:  General, psychiatric, children’s, and rehabilitation hospitals  Critical access hospitals  Health care networks, including managed care plans  Home care organizations  Nursing homes, subacute care, assisted living facilities  Behavioral health care organizations  Ambulatory care and outpatient surgery facilities, rehabilitation centers, infusion centers  Clinical laboratories, blood transfusion and donor centers, and public health laboratories

10 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Benefits of Joint Commission Accreditation  Leads to improved patient care  Demonstrates the organization’s commitment to safety and quality  Offers an educational on-site survey experience  Supports and enhances safety and quality improvement efforts  Strengthens and supports recruitment and retention efforts  May substitute for federal certification surveys for Medicare and Medicaid  Helps secure managed care contracts  Facilitates the organization’s business strategies  Provides a competitive advantage  Enhances the organization’s image to the public, purchasers, and payers  Fulfills licensure requirements in many states  Recognized by insurers and other third parties  Strengthens community confidence

11 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Visits Are Unannounced  This requires that all health care institutions be in a state of “constant readiness.”

12 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

13 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

14 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. How does the Joint Commission Survey affect the staff nurse?  Daily adherence to the standards makes this “business as usual” when the survey is in progress  Expect to participate in interviews or team meeting with Joint Commission representatives  Expect surveyors to interview patients, families and clinical staff  Expect surveyors to review policies & procedures, educational materials and patient records

15 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Regulatory Agencies  OHSA, CDC and the FDA set standards within their own areas.  These standards are incorporated into The Joint Commission’s standards, which are then surveyed

16 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. The Magnet Award  Awarded by the American Nurses Credentialing Center (ANCC)  The Magnet Award is the highest level of recognition that the ANCC can award to organized nursing services  ANCC recognizes nursing-sensitive outcomes as a predictor of quality of patient care  ANCC values the retention and recruitment of highly competent nurses