ALL: Everybody, CHP: Chaplain, C&P: Credentialing & Privileging, E&M: Engineering & Maint, EOC: Environment of Care, FB: Finance/Business, FdDt: Food services/Dietary, GB: Gov Body, HR: Human Resources/Personnel, HST: Human Service Tech/Aid, IC: Infection Control, IM: Info Mgt/Med Records, IT: Info Technology, JCSC: Jt Com Survey Coordinator, LDR: Leadership/Mgt, MEC: Med Exec Committee, MD: Medical Staff, ofco: Officer and/or Committee, PI: Performance/Quality Improvement com/dept, PPR: PPR team mbrs/ldrs, P&T: Phrm & Therapeutics Com, Phrm: Pharmacy, PSY: Psychology, PtAd: Patient Advocate, PtEd: Patient Education, RHB: Rehab/Activity Therapy, RN: Nursing, SFT: Safety, StEd: staff ed & training dept, SW: Social Work, TxTm: Treatment Team, x: Exec, Dir or Chief (e.g., MDx = Medical Director)

Pg01- Approved: Revisions to Emergency Management Standards for Critical Access Hospitals, Hospitals and long Term Care: New revisions to EC4.10 and EC.4.20 emphasize the 'all-hazards' and 'scalable' approach and the importance of planning and testing response plans especially when there may be no support from the local community. Although not effective until Jan 1, 2008, EC leaders and Safety Off/Com should review these revisions and the six 'critical areas' the article identifies.

Pg10- The Joint Commission Awarded Grant to Study Smoke-Free Hospital Campuses: TJC is touting this as a 'first-of-its-kind evaluation of the challenges of implementing or transitioning to a smoke-free campus. JCSC's* should be on the lookout for an electronic survey. Apparently, the new trend is toward no smoking anywhere on hospital grounds.

Pg12- Update: The Joint Commission Launches Strategic Surveillance System and Redesigned Extranet: Finally, the frequently announced S3 along with a redesigned Joint Commission Connect is scheduled to be available in 'early July 2007'. New features in Connect include section dedicated to 'What's Due' and 'New Reports', that could be useful. The S3 reports are supposed to help hospitals prioritize their improvement efforts by providing reports on risk assessment and comparative performance. PI Dept. and Hosp. Leaders should explore the possibilities.

Pg14- Approved: Revisions to Standard LD.3.110, Element of Performance 12, for Critical Access Hospitals and Hospitals: Effective 1/1/08 there must be mutual agreement (or a documented attempt) with your OPO about the hospitals approach to asystolic recovery. Med Staff should review the details of this.

Pg15- Approved: Revisions to Standard PC.2.120 for Critical Access Hospitals and Hospitals: Hallelujah #1. TJC has revised its standards to 'align' with CMS final ruling on histories and physicals published in Nov 2006. Med Staff, JCSC

Pg16- Approved: Revisions to Standard PC.12.90, Element of Performance 4 for Hospitals: Hallelujah #2. TJC has revised its standards to 'align' with CMS final ruling on 1-hour evaluations by nurses or physician assistants issued in Dec 2006. Med Staff, RN, JCSC

Pg18- Frequently Asked Questions on the Environment of Care: This section provides clarification on the issues of combining generator tests and how to handle inaccessible fire and smoke dampers. Worth a read by Eng/Maint and the authors of related EC plans. .

Pg01- Documentation Needs Prior to Survey: Are your presurvey documents ready? Read about what your organization should have ready prior to the surveyors’arrival: Although this info is also available in your standards manual and Surveyor Activity Guide, this article is a decent summary for your JCSC* and others who plan for survey preparation/readiness.

Pg04- Reducing Errors for High-Risk Medications: Yes, State Hospitals have such meds (e.g., Insulin, anticoagulants, narcotics). Fair summary of what to do with high-risk and LA/SA medications. Worthwhile reading for Pharm and P&T. Get more details and a fuller listing of the meds at sLIB.130 Med Mgt

Pg09- Pella Regional Health Center Uses Lean Methodology to Design Innovative Shift-Change Tool: If SBAR is not your cup of hand-off communication tea, RN leaders may want to try INFORM. Approach is reasonably relevant for Psych hospitals. Sample form included in article.

Pg01- The Narrative Medicine Examining a patient’s story through literary analysis: As the title suggests, narrative medicine approaches the understanding of a patient's story in much the same way one would approach literature. As mental health professionals we are already attuned to this. However, any clinician involved in assessment might benefit from this refresher. [Abstract]

Pg09- Communicating Through a Daily Goals Form (Ensuring that physicians, nurses, and pharmacists are on the same page): This Johns Hopkins case study focuses on the standardization and improvement of communication for an ICU. (Think hand-off communication plus). With psych hospital stays decreasing in length, the points about the rounding process and a supportive form could be useful for any TxTm that wants to be more efficient/effective. The idea of having daily goals for a patient is also worth considering! [Abstract].

Pg01- Life Safety Code ®Specialists’ Scope Expanding (All Hospitals and Critical Access Hospitals to Be Included as of January 1, 2008): As announced in the Jan and March Perspectives, ALL HOSPITALS will have an LSC specialist starting in 2008. The article explains why, how the survey will change (e.g., 2 days for specialist if you have 750,000 sq ft) and gives some preparation tips. This is a must read for JCSC* and EC leaders. [Abstract]

Pg04- Decreasing Slips, Trips, and Falls (NIOSH Study Helps Health Care Organizations Improve Worker Safety): Workers in health care have relatively more slips, trips and falls. Article identifies risk factors and responsive best practices. Safety Off/Com. [Abstract]

Pg06- Safe Oxygen Cylinder Storage (Following Cohesive Guidelines): This is a popular survey issue (for surveyors) that is worth mastering. Good article about the proper storage, handling, volume (up to 300 cubic feet of nonflammable gas in an unprotected environment provided that the cylinders are properly secured/racked), and trans-filling of cylinders. Safety Off/Com and EC. [Abstract]

Pg08- Ensuring the Use of Sterilized and Disinfected Equipment (Improving Infection Control While Reducing Turnaround Time and Costs): Medical equipment and devices that contact patients must be properly sterilized or disinfected after use. This article offers five suggestions for sterilizing and disinfecting 3 categories of equipment. IC, EC, RN, Dentist [Guidelines] [Abstract]

Pg10- Q&A - Reminder About Program-Specific Tracers Survey Process May Include Tracers for Industry-Specific Issues: Nothing really new in this mini-rehash. Best description is still 2007 March Source and 2006 Nov Perspectives, [see also sLib.040.80 - Tracer Methodology]