JCAHO Jeopardy Kelly D. Young, MD, MS Harbor-UCLA Medical Center JCAHO BASICS PATIENT SAFETY $100 $100 $200 WORKPLACE DOCUMENTATION POTPOURRI $100 $100 $100 $200 $200 $200 $200 $300 $300 $300 $300 $300 $400 $400 $400 $400 $400 $500 $500 $500 $500 $500 JCAHO Basics $100 What does JCAHO stand for? Answer Hint: It’s not “Julie Comes And Hangs Out” Answer JCAHO Basics $100 Return to Jeopardy Joint Commission on Accreditation of Healthcare Organizations AKA “Yes, we can close your hospital and make you seek new residencies” JCAHO 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 JCAHO Basics $200 B) YOU! That’s why you’re playing this game, right? Return to Jeopardy JCAHO Basics $300 What is “tracer methodology”? Answer Answer JCAHO Basics $300 Return to Jeopardy Surveyors analyze a hospital’s systems by following individual patients through their hospitalization, evaluating multiple care units, departments, and services rendered to the patient. JCAHO Basics $400 What is HIPAA? Name one way protected health information is kept Answer private in your department. NOT HIPPO! Answer JCAHO Basics $400 Return to Jeopardy HIPAA: Health Insurance Portability and Accountability Act States that PHI may only be used for purposes of treatment, payment, healthcare operations Shredder or blue HIPAA trashcan for HIPAA sensitive documents Codes for patient chief complaints DON’T use “5150” or “OD” on the board Don’t discuss patients in hallways or elevators Keep curtains closed and don’t let patients stare at the board JCAHO Basics $500 What is ORYX? Bonus $100: name one core measure of ORYX Answer Answer JCAHO Basics $500 ORYX is an initiative that requires hospitals to collect and submit electronically data each quarter Heart failure – Discharge instructions: activity, diet, follow-up, medications, symptoms worsening, weight monitoring – LV function assessment – ACE inhibitor for LV systolic dysfunction – Adult smoking cessation advice / counseling More next slide Answer continued Return to Jeopardy Pneumonia – Adult initial antibiotic within 4 hrs – Median time to first antibiotic dose (goal 240 minutes) – Adult blood culture before first antibiotic IF blood culture performed at all – Pneumococcal vaccination – Adult smoking cessation advice/counseling – Adult oxygenation assessment Pregnancy and related conditions – VBAC, inpatient neonatal mortality, 3rd & 4th lacs Patient Safety $100 Name one of the 2009 National Patient Safety Goals Answer Answer Patient Safety $100 Return to Jeopardy Improve accuracy of patient identification Improve effectiveness of communication among caregivers Improve safety of using medications Reduce risk of health-care associated infections Accurately & completely reconcile medications across continuum of care – Medicine reconciliation form Identify safety risks inherent to population (e.g. suicide Med Reconciliation Form Check whether to stop old meds Patient gets yellow copy List new long-term meds here and write in layperson lingo Fill out your name, number, date, time, etc. Patient Safety $200 Name one way you reduce the risk of health-care associated infections in your department Answer Answer Patient Safety $200 Return to Jeopardy Handwashing with soap and water before AND after each patient contact – Even if you used gloves – Wash vigorously for 15 seconds Alcohol-based hand rubs may be used if there is no visible soiling and C. diff is not suspected Use of artificial or long fingernails is prohibited LATHER UP! Patient Safety $300 How do you improve the accuracy of patient identification in your department? Answer Answer Patient 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) Return to Jeopardy Patient Safety $400 How are you improving the effectiveness of communication between caregivers? Answer Answer Patient Safety $400 Return to Jeopardy Telephone orders are read back Verbal orders are repeated back Critical lab values and other test results are read back We use standardized abbreviations and avoid certain unapproved dangerous abbreviations Preliminary radiology reads in Notes feature of Synapse – Overread by radiologist and we are notified of any disagreements Patient Safety $500 Name 3 of the unapproved abbreviations Answer Answer Patient Safety $500 U or u (unit) IU (international unit) Ug (microgram) 1.0 (no terminal zeros) .5 (always use a leading zero – “always lead, never follow”)) Return to Jeopardy X3d (for 3 days or for 3 doses) TIW (three times weekly) qD or qoD (every day, daily, or every other day) MS, MSO4, MgSO4 (morphine sulfate or magnesium sulfate) Workplace $100 Where are the fire extinguishers in the PED? BONUS: Where’s the oxygen shutoff valves in case of a fire? Answer Answer Workplace $100 Return to Jeopardy 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 Workplace $200 What color “code” would you call if you had a violent patient? Who would come? Answer Answer Workplace $200 Code Green Crisis Response Team responds Does NOT include police officer ED staff are still responsible for the patient, and should assist in restraint if necessary Return to Jeopardy Workplace $300 What do the RACE and PASS mnemonics stand for when there is a fire? Answer Answer Workplace $300 Remove patients and others Alarm Contain the fire (close doors) Extinguish the fire when it is safe to do so Return to Jeopardy Pull the pin Aim the nozzle at the base of the fire Squeeze the handle Sweep the nozzle from side to side Workplace $400 What should you do in the event of a hazardous material spill?* Answer * Material more hazardous than cafeteria food, but less hazardous than anthrax Answer Workplace $400 Return to Jeopardy Rinse exposure with water Post warning signs Cordon off area Consult Material Safety Data Sheet (MSDS) or call Hazardous Material Safety Office Workplace $500 What are code pink, code white, code orange, code gray, and code triage? ($100 per correct answer) Answer Answer Workplace $500 Return to Jeopardy Code pink: infant / child abduction – The number afterwards refers to the age of the child, e.g. Code pink 3 Code white: pediatric code blue Code gray: bomb threat Code orange: hazardous material or radiation spill / exposure Code triage: disaster Documentation $100 How do you document in your procedure note that you confirmed the correct identity of the patient, and the correct site of the Answer procedure? Answer Documentation $100 Return to Jeopardy Document that a “time out” was done (check box on procedure note area of 253 form) Documentation $200 How would you write the order for 100 mg of Motrin to be given to a 10 kg child PO?* Answer * Answer is NOT “with a pen” Answer Documentation $200 Return to Jeopardy Motrin 100 mg = 10 mg/kg PO now Must put mg/kg (Date and time order, of course) Documentation $300 What’s wrong with this order? Motrin 600 mg PO q 6-8 hours prn pain (standard adult dose) Answer Answer Documentation $300 Return to Jeopardy No range orders allowed (No range in doses, no range in time intervals) Documentation $400 Which is acceptable? Answer Answer Documentation $400 C Signature Last name legibly spelled out Degree (MD, RN, PNP, etc.) Identification number Return to Jeopardy Documentation $500 What’s the “fifth vital sign” that we document on ALL patients, and where do we document it? Answer Answer Documentation $500 PAIN score PAIN score PAIN score (am I getting through?) Pre-printed pain scales on 1st AND 3rd page of 253s Return to Jeopardy 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 $100 True of False: Answer 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 Return to Jeopardy Answer Potpourri $100 So VERY VERY False! Parent “El bebe tiene mucho fiebre, hasta ciento siete, y no come nada, nunca, en todo su vida, (esos Cheetos son la primera comida de todo su vida), y tiene fiebre por dos o tres meses, y le duele todo su cuerpo, y tiene ronchas y grippe y tos y nausea y diarrea…” Sibling Interpreter “Tiene fiebre?” “Yes” Potpourri $200 Does Harbor have a mission? Answer It’s not “To get our residents more sleep and more money.” Answer Potpourri $200 Return to Jeopardy Mission: to provide high quality, cost-effective, patient-centered care through leadership in medical practice, education and research. Potpourri $300 What quality performance data are collected in your area, and how are you involved? Answer Answer Potpourri $300 Return to Jeopardy 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. Potpourri $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 Potpourri $400 Return to Jeopardy Only special fire doors may remain open. Doors may not be propped open (including the 2 doors on either side of the PED board). Potpourri $500 A two-parter: Answer 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 Potpourri $500 Return to Jeopardy Check on the equipment for a dated sticker that it has been serviced by mechanical. Pink signifies a “combination cart” which has supplies for both pediatric and adult codes.