21 MARCH 2007
More JCAHO fun
All physicians hate JCAHO. Truly, it is an awful organization and they do awful things to the practice of medicine*. It seems like every year there is some new fad, some new measure that they are pushing down the throats of the people trying to practice medicine in a challenging environment.
I am sure there is some good that comes of JCAHO regulations. Their intentions may be good. But when you are the practicing doc (or nurse, God help them, the burden of the regs falls much harder on the nurses), trying to deal with a sick population, half of whom are uninsured, in an overcrowded ED with too few nurses and no inpatient beds and no specialists will to take call, the miniscule, petty, trivial, small-minded rules promulgated by this unelected bunch of bureaucrats can make you crazy.
For example, a couple of years ago, it was decreed that nothing could be stored under the sink in the ED. I have no idea why -- under the sink is a perfectly good storage place for non-medical supplies. They had to turn the ER upside down finding new legal storage places for the displaced stuff. And last year it was abbreviations. I agree that some abbreviations probably are confusing and should be clarified -- that's good common sense. But they came out with a list of dozens of abbreviations which are banned, many of which are perfectly clear (such as the use of L for Left and R for right). There is no appeal for their decisions, they are passed down from on high as infallible law, and woe betide the nursing manager if the department is singled out as deficient on a JCAHO survey.
The new rule, designed, it seems, to increase patient treatment times and decrease patient satisfaction and quality of care, is this:All non-emergent medications must be reviewed by a pharmacist and mixed (if necessary) by a pharmacist.
Which sounds reasonable on the face of it until it collides with the hard reality:
We don't have a pharmacist in the ED. There aren't enough pharmacists to go around as it is, and now, instead of keeping the drugs in the ER and mixing them at the point of service (which isn't that hard), we need to send up to the inpatient pharmacy, wait for the PharmD to get around to it in their workflow, and send it back down. And we are not even talking about the dangerous stuff, but routine meds like certain antibiotics. Another interruption to our workflow, another delay in patient care, just one more in the death of a thousand cuts that is making health care that much more of an unpleasant profession.
And the scary thing is that this is an improvement from the original draft regulation, which said that all meds had to be reviewed in advance by a pharmacist.
Maybe that MBA might be a good idea after all...
* yes, this is hyperbole. get over it.
I am sure there is some good that comes of JCAHO regulations. Their intentions may be good. But when you are the practicing doc (or nurse, God help them, the burden of the regs falls much harder on the nurses), trying to deal with a sick population, half of whom are uninsured, in an overcrowded ED with too few nurses and no inpatient beds and no specialists will to take call, the miniscule, petty, trivial, small-minded rules promulgated by this unelected bunch of bureaucrats can make you crazy.
For example, a couple of years ago, it was decreed that nothing could be stored under the sink in the ED. I have no idea why -- under the sink is a perfectly good storage place for non-medical supplies. They had to turn the ER upside down finding new legal storage places for the displaced stuff. And last year it was abbreviations. I agree that some abbreviations probably are confusing and should be clarified -- that's good common sense. But they came out with a list of dozens of abbreviations which are banned, many of which are perfectly clear (such as the use of L for Left and R for right). There is no appeal for their decisions, they are passed down from on high as infallible law, and woe betide the nursing manager if the department is singled out as deficient on a JCAHO survey.
The new rule, designed, it seems, to increase patient treatment times and decrease patient satisfaction and quality of care, is this:All non-emergent medications must be reviewed by a pharmacist and mixed (if necessary) by a pharmacist.
Which sounds reasonable on the face of it until it collides with the hard reality:
We don't have a pharmacist in the ED. There aren't enough pharmacists to go around as it is, and now, instead of keeping the drugs in the ER and mixing them at the point of service (which isn't that hard), we need to send up to the inpatient pharmacy, wait for the PharmD to get around to it in their workflow, and send it back down. And we are not even talking about the dangerous stuff, but routine meds like certain antibiotics. Another interruption to our workflow, another delay in patient care, just one more in the death of a thousand cuts that is making health care that much more of an unpleasant profession.
And the scary thing is that this is an improvement from the original draft regulation, which said that all meds had to be reviewed in advance by a pharmacist.
Maybe that MBA might be a good idea after all...
* yes, this is hyperbole. get over it.
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