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8/17/2000

Treatment Standard Challenges Care Providers

Cheryl A. Thompson

Providing care in accordance with a prescriber’s order turned out to be last year’s most challenging standard to home health and hospice services during surveys by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

The standard, also known as "TX.2," was scored by surveyors as partial, minimal, or no compliance at more than 20 percent of home care and hospice providers visited, reports Darryl Rich, Pharm.D., M.B.A., FASHP, associate director of accreditation operations at JCAHO. For the "top 10" list of home care standards with the greatest percentage of low scores, see the tables below.

 JCAHO’s "Top 10" Listsa

 Home Health Services

Standard

Description

% of Surveyed Organizations with Score of 3-5

TX.2

Care provided in accordance with a prescriber’s order

35.3

IM.9.20

Home care record includes documentation of medication use and medication allergies or sensitivities

32.9

HR.4

Competence assessment program in place

25.3

HR.6.2

Performance appraisals are conducted per job description

15.8

PE.2.5

Nutritional risk is assessed

14.8

TX.1.4

Actions identified in care plan are implemented

14.1

IM.9.15

Prescriber’s orders are authenticated according to law

13.2

IM.9.25

Home care record contains a discharge summary

12.3

HR.4.1

Competence data are aggregated and analyzed

12.0

IC.2

Infection-control policies are implemented

10.0

 

Home Pharmaceutical Services

Standard

Description

% of Surveyed Organizations with Score of 3-5

IM.9.20

Home care record includes documentation of medication use and medication allergies or sensitivities

26.7

HR.4

Competence assessment program in place

15.9

TX.5.2.1

Medications are accurately labeled according to law

12.8

IM.9.13

Home care record contains an appropriate care plan

12.8

PE.2.5

Nutritional risk is assessed

10.1

IM.9.22

Home care record contains documented response to care

9.5

IM.9.4

Home care record contains an initial assessment

9.4

RI.1.1.4

Patient has a right to formulate advance directives

9.2

HR.6.2

Performance appraisals are conducted per job description

9.1

HR.5/TX.1.1

Staff undergo orientation/Patient’s problems and needs are addressed in care plan

7.9

 

Equipment Management Services

Standard

Description

% of Surveyed Organizations with Score of 3-5

TX.2

Care provided in accordance with a prescriber’s order

35.9

EC.12

Equipment maintenance (patient’s equipment)

30.6

HR.4

Competence assessment program in place

20.6

EC.11

Equipment is received and stored appropriately

14.7

IC.1.1

Infection-control program includes surveillance, prevention, control, and reporting

12.8

EC.13

Equipment maintenance (facility-based equipment)

11.6

HR.6.2

Performance appraisals are conducted per job description

10.9

HR.4.1

Competence data are aggregated and analyzed

10.6

TX.2.2.1

Physicians are informed of their responsibilities

10.1

PF.4.8/IC.2

Patient education provided on medical equipment/Infection-control policies are implemented

9.7

 

Hospice Services

Standard

Description

% of Surveyed Organizations with Score of 3-5

TX.2

Care provided in accordance with a prescriber’s order

21.8

IM.9.20

Home care record includes documentation of medication use and medication allergies or sensitivies

21.2

HR.4

Competence assessment program in place

20.4

HR.6.2

Performance appraisals are conducted per job description

16.2

PE.2.5

Nutritional risk is assessed

10.9

HR.5

Staff undergo orientation

9.2

IM.9.15

Prescriber’s orders are authenticated according to law

9.2

RI.1.1.4

Patient has a right to formulate advance directives

9.2

PI.4.1

Statistical control techniques are applied to performance-improvement data

7.1

IM.9.25

Home care record contains a discharge summary

7.0

a Home care standards with the highest percentage of scores of 3 (partial compliance), 4 (minimal compliance), or 5 (no compliance) for JCAHO surveys conducted Jan-Dec 1999.