Joint Commission
The Joint Commission is due to come and audit NWTHS at any time and when they come they won’t want to know what I know, they will want to know what you know. Please learn these details and be ready to speak on them. Charge nurses: huddle these / review these with staff.
The auditor should arrive at the main campus first; they would at some point in the survey be brought over to the FED(s) at a scheduled time. HOWEVER, if they mistakenly arrive at the FEDs first follow these steps:
Ask for their ID
Do NOT bring them behind the doors of the FED, they should go to the main hospital so have them take a seat in the waiting room and..
Tell the FED director and they will come talk with the auditor; if after hours or the director is unavailable - call the operator at the main hospital (ext 1000), tell them a JC auditor is at the site and you need instructions, they will call the quality manager, AOC, or house sup to give you instructions.
CT – will check to see if cabinet doors are locked that have contrast and the cleaning log for the Trophon.
They will randomly pick employee files to audit to make sure orientation, certification, competencies, and other requirements are in them. Please get your information to Tiffany Powers asap in order to keep your file up to date.
Fire – we have monthly (both shifts) fire drills, the safety officer, security officer AND fire officer is Kyle Hawley. KNOW WHERE the nearest fire extinguisher is regardless of where you are standing in the building, the Fire pulls/alerts are always by the doors so a person could always alert of a fire while exiting, know PASS, know RACE (should be on badge), call 911 for fire (not 8999…that’s for main).
No corrugated cardboard is allowed as storage in the building, please remove any and all that you see. This is a know source of roach and other small bug infestation / breeding.
There should not be any storage of any kind within 18” of the ceiling anywhere in the FEDs, this poses a fire sprinkler block
All curtains should be dated with an expiration date – they are good for 6 months or should be replaced when an infectious patient is in the room.
NO fake nail, gel, or any overlay except for ordinary polish and they shall be cut short, ¼”
There should only be patient food items, unopened, in date in the patient refrigerator and freezer; remove all staff items. Should the staff fridge be full, you may place items in the EMS fridge until we are stocking that regularly.
There should be a wheelchair by triage as chest pain and stroke complaints are not supposed to walk back to the rooms but be wheeled.
Code strokes are called overhead and go straight to CT and should be met there by all services represented at the FEDs; Dr. Hearts are called overhead and all resources should be in the room to facilitate landing them. Perform a FAST at triage to determine initial status and need for code stroke (go find out what this is if you don’t know)
We should now have a nurse at triage at all times when there are 3 RNs on duty
Regardless of nurse or tech at triage, if there is a line formed or more than one person at triage at a time what would you do ? call another staff member up front to ascertain chief complaints and assist with triage
Patients often want to discuss insurance and money at triage… how do you handle this ???? Once the patient has arrived, you can no longer discuss these issues until they have received an MSE from the physician. HOWEVER…WHAT CAN YOU SAY ???? “YOU ARE WELCOME TO HAVE A SEAT AND CALL YOUR INSURANCE FOR AN EXPLANATION OF EMERGENCY ROOM BENEFITS”
Not everyone will want to do that so be prepared with some other phrases like “we do not want to delay the process of providing you care with your condition at this Emergency Department”, or “Regulations don’t allow for us to delay care for emergencies by talking about payment and insurance until after you have seen the physician so we can start on your plan of care asap”.
If they call ahead, these items can be discussed on the phone; this part of EMTALA only applies to anyone on the grounds (on our facility property in any way…car, ambulance, etc).
Discharge instructions are very important. If you are unaware that you can add education to discharge instructions in Cerner, find out about this process. An auditor might follow you into a room and watch you give discharge instructions. IF THERE IS A SEDATION…. The patient must go home with education / information about the procedure AND sedation care information
SI / HI patient. There is a binder at each site with the policy and forms for this…know every bit of it ! This is a JC hot topic and more importantly, there are an increasing number of patients needing this help and we want to keep them safe. Every patient entering the ED gets a Suicidal Risk Assessment: The question is in the advanced triage (yellow plus) under “General / Screenings”-à “Suicidal Risk Assessment”. If you the patient indicates “yes” to this question, Cerner will bring up the “C-SSRS” which is the Columbia Suicide Severity Rating Scale. If the patient is on papers or deemed high risk by this scale, they must have a constant sitter without exception. Call the house sup, FED management, use lab,rad,techs…any means necessary to have a constant sitter. Documentation is key ! Should the patient who is a risk to themselves or others attempt to leave, we do not physically detain them but attempt to de-escalate, ask them to stay, call 911 and then our security, know which way they headed etc. and CHART CHART CHART all of this.
I’ll continue this thread as I think of other information you should know. Thanks for all you do !
Andrea
