N108: Transition to the Registered Professional Nurse

N108: Transition to the Registered Professional Nurse Role Study Guide • Regulatory agencies: These have an increasing role in maintaining quality practice and care. The Joint Commission surveys most hospitals and other healthcare organizations for quality of care. During the survey, the entire organization is evaluated and receives a grade in all areas noting deficiencies and required improvements. A satisfactory Joint Commission survey qualifies the institution as “deemed satisfactory” to receive funding from Medicaid and Medicare. • State health department : The Joint Commission accreditation could also serve as an interim survey for the state health department’s quality control. State agency standards and criteria are applied to meet a minimum level of quality. • Community Health Accreditation Program (CHAP): This is an independent evaluating body for community health organizations. If CHAP has accredited something, it has “deemed” status with the government’s HCFA, meaning it qualifies for Medicare funding. Sentinel Events The Joint Commission adopted the Sentinel Event Policy in 1996 to help hospitals that experience serious adverse events improve safety and learn from those sentinel events. Careful investigation and analysis of Patient Safety Events (events not primarily related to the natural course of the patient’s illness or underlying condition), as well as evaluation of corrective actions, is essential to reduce risk and prevent harm. A sentinel event is a Patient Safety Event that results in any of the following: death, permanent harm, or severe temporary harm. Such events are called "sentinel" because they signal the need for immediate investigation and response. The Commission points out that not all sentinel events stem from an error, and not all errors lead to sentinel events. Most sentinel events result from systemic problems rather than the mistake or failure of a single individual. Inadequate communication among healthcare providers is the number one root cause of sentinel events. In 2006, the second leading root cause was incorrect assessment of a patient’s condition, the third leading cause was inadequate leadership, orientation, or training. The Joint Commission requires that organizations conduct a root cause analysis to identify contributing factors within 45 days of a sentinel event or becoming aware of the event. This analysis focuses on systems and processes, not individual performance. All persons involved with the event in any way should participate in the analysis. Root cause analysis seeks to answer three questions: what happened, why did it happen, and what can be done to prevent it from happening again. National Patient Safety Goals (NPSG) This is a critical method by which to promote and enforce major changes in patient safety. It came about as the result of thousands of participating healthcare organizations. The Joint Commission established the NPSG. There is a separate set of safety goals for each type of agency providing care, and the goals are structured in the same way for each type of agency and use a consistent numbering system. Each year, The Joint Commission reexamines the sentinel event data and safety goals and revises them by deleting those that have been largely achieved while adding new safety goals. When a goal appears to be no longer an area of concern or is not appropriate to that type of agency, the goal is omitted and moved to standards. In 2002, in efforts to reduce sentinel events and adverse outcomes, accredited

©2017

Achieve Test Prep

Page 136

of 171