JCAHO:  Big Brother is Watching Us!

PLEASE NOTE: this page is NOT endorsed by the JCAHO, or any healthcare
facilities.  It is strictly my opinions & ventilation page.  Any offense is entirely up to you!
Thank you -                  you may now proceed with caution...

If you are a health care worker, then you know exactly what I am talking about!  If you are not, well, I am sure that whatever it is that you do has a system of checks & balances which govern how you will proceed in your daily work.

JCAHO, or the Joint Commission on Administration of Hospitals & Organizations, is the body politic which can make or break an insitution which provides healthcare.  Every year, sometimes biannually, this committee is 'invited' to a facility in order to see that standards are met, policies are upheld, and protocol is adhered to. Inspection time!

OK, here I go on the ol' soapbox.  Although I am well aware that any institution requires some sort of administrative 'leash', I am also faced with the changes that are endured due to policy & protocol mandated by such administration.  On the one hand, yes it's good that someone is watching out for how business is done. On the other hand, those who create & enforce these mandates are rarely the ones who are out on "the floor" or in "the unit" having to deal with the often unrealistic and sometimes downright ridiculous effects these have.

FOR instance:
  - Locking of refrigerators which hold medicines & culture
   media - I can only speak for the one on my unit, which holds
    such meds as bicitrate (an antacid), maalox (also an antacid),
    hemabate (a medication given to stop hemorrhage), methergine
    (another blood-loss controlling med.), various suppositories which
    contain NO controlled drugs, and stuff to do cultures from assorted
    body orifices with. 
        In my unit, which is a very busy labor & delivery floor, we may
    perform up to 10 deliveries in 24 hrs. (on a reallllllly busy day!).  We
    might also see up to 48 outpatients in that same 24 hr. period.  Our staff
    usually consists of 2 docs, a midwife, 3-4 RN's, and 1-2 LPN's.  There is
    one set of keys for anything that is locked up.  We have 6 labor/delivery/
    recovery rooms - 2 of which are rather far away from our one meds fridge.
    This poses a big problem on those manic days, especially as we cannot keep
     any medications/syringes/needles in our LDR's (thank you again, JCHAO)
     and ANY woman giving birth is at risk for hemorrhage.  The bicitrate is
     the antacid given to a mother before going to cesarean section, also, so it
     is another thing that's now difficult to get to in a hurry.  So, my problem
     with this lock-up issue is that there are no controlled substances in our
     fridge, there is but one set of keys & it is in the hands of someone who is
     also caring for 1-2 patients, and the fridge is a good distance from at least
     2 of the LDR's & our OR.  As you can see, this is definitely a risk when
     a nurse needs these meds in a hurry.

  - Locking of the "Medicine Cart" - Pretty much the same problem as above, but
    there are fewer "critical" things loaded into our meds cart.  We are not one of those
    units where ALL our drugs are stored on this cart, meaning we don't make the
    "med rounds" as is traditional on medicine/surgery floors.  So, we don't keep any
    drugs of abuse/narcotics on our cart.  It is just VERY annoying to have to find the
    person with the keys to unlock said cart to retreive a motrin, or a vistaril tablet,
    or perhaps a lowly tylenol.  It just always makes me believe that the folks who
    come up with these rules have just been out of the loop of working with patients
    for quite some time.  Otherwise, they might have a clue how things like this are
    more vexatious to have these areas locked than it is productive or meaningful.

  - Christmas Decorations - OK, maybe I am heading into the realm of the petty here...
    BUT - our unit did a fantastic job of putting up decorations for the Christian Holiday!
    Even I assisted with these, being the only Pagan in their midst.  Hey, I am all for any-
    thing which promotes esprit de corps.  At any rate, we made a HUGE felt banner which
    held the pictures of all the folks who work in our area, and it was beautiful!  We hung it
    on the door to our unit which has a tiny window in it.  It wasn't in the way of much of
    anything, it wasn't dangerous, it wasn't anything but a lovely piece of group-effort
    motif for a holiday.  But we were made to move it to an out-of-the way location where
    most of our patients & their families & visitors to the unit would probably not ever see it.
    However, we had decorative lights up all over the place, and extension cords running in
    odd places which didn't seem to bother the "inspectors" one bit.  Kinda odd, don't you think?!

  - Inspection Time - In all my years of nursing, which will soon number 18,
    I have worked in 10 hospitals.  In every single one of them, I have seen
    this dubious event occur.  And, in every single one of them, I have been
    witness to a mad scurry to "make things right" for "those JCAHO folks".
    New policies & protocols are instituted, chart audits are performed at a
    furious pace, and in all of it, those who are on the floor working their butts
    off doing the real labor of the unit are subject to major & minor changes
    which often affect the way in which they are able to do their job. 
    Unfortunately, these changes do not always enhance how work is done;
    rather, they cause upset among the staff, a lot of "relearning", moving
    around & locking up of equipment/supplies/meds, etc. 
      Once this big inspection is "over", the lauds are passed around, the
    various boss-people smile & wipe their brows, and things pretty much go
    back to 'how it was'.  So, I ask you, WHY WHY WHY is there the mad rush
    to start with?!  It is upsetting in myriad ways, and seems only to be a dog &
    pony show with no lasting results except for that 'trophy' score.  Sometimes,
    I will admit, there are changes which are productive & permanent, but that's
    not in the greater percentage of 'outcome'. [See above for example of the changes]

-  Come back soon for more of my caustic remarks & opinionated view, 
     if you can stand it!        Thanks for reading...



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