Joint Commission Basics
During the JC survey, the surveyors will talk primarily to: A. The Hospital Administrators B. The doctors, nurses and staff C. The patients D. The Daily News
B. Doctors, nurses and staff
How do you handle blood or a spill on the floor?
Answer: Warn others nearby, place a sign near spill, and call environmental services.
Nothing is to be left in the hallways for more than: a) 2 hours; b) 8 hours; c) 30 minutes; d) 10 minutes
Answer: c) 30 Minutes
How many years does the VA's strategic plan cover?
Answer: five to seven years
What government agency controls Arlington Cemetery?
Answer: The United States Department of the Army
What does TJC stand for?
Answer: The Joint Commission
Name one way you reduce the risk of health-care associated infections in your department.
Answer: Hand Hygiene: Handwashing with soap and water before and after each patient contact. Alcohol-based hand sanitizer may also be used.
Answer: R=Rescue, A=Alarm, C=Contain/confine, E=extinguish/evacuate
What are the four sections of QSV?
Answer: HRO/Process Improvement, Education/CPPD, Quality & Safety, and Infection Prevention and Control
What is a reasonable accommodation?
Answer: Facilities are accessible, modified work schedules, special assistance/equipment, and or reassignment.
What is HIPPA?
Health Insurance Portability and Accountability Act. States the PHI may only be used for purposes of treatment, payment, and healthcare operations.
Using HRO principles; How does clinical staff improve the accuracy of patient identification in their area?
Answer: Use TWO patient identifiers when providing care, treatment or services.
What does PASS stand for?
Answer: P=Pull the pin, A=Aim the nozzle at the base of the fire, S=Squeeze the handle, S=Sweep the nozzle from side to side
What is VA's Vision Statement?
Answer: “to provide veterans the world-class benefits and services they have earned – and to do so by adhering to the highest standards of compassion, commitment, excellence, professionalism, integrity, accountability, and stewardship.”
Name two patient rights.
Answer: Right to be treated with respect; Right to receive information in a manner they understand; Right to privacy; Right to religious/spiritual services; Right to participate in their medical decision making
What is "tracer methodology"?
Answer: Surveyors analyze a hospital's systems by selecting a specific patient to "trace" patient care areas that have participated in their care through the institution.
What are examples of 2 standard precautions that are used in clinic areas?
Answer: Use of safety needles; wearing gloves or other PPE; disposing of sharps appropriately; cleaning any spills correctly.
Can clinic personnel wear artificial nails, extenders, acrylic wraps, overlays or shellac?
Answer: NO!!
What is VA's Mission Statement?
Answer: To fulfill President Lincoln's promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.
Name three of the five VA facilities not located on the continental U.S.?
Answer:
American Samoa
Guam
Philippines
Puerto Rico
Virgin Islands
The Joint Commission survey is conducted a) Annually; b) Every 3 Years; c) Every 5 Years
Answer: b) Every 3 Years
What is a sentinel event?
Answer: An unexpected occurrence involving death or serious physical or psychological injury (i.e. patient suicide; discharge of infant to wrong family; administration of blood with patient's wrong blood type).
What is a PDP and do you have one?
Answer: Professional Development Plan.
What are VA's core values?
Answer: Integrity, Commitment, Advocacy, Respect, and Excellence. The core values define “who we are,” our culture, and how we care for Veterans and eligible beneficiaries. I CARE
Where do you report near misses, close calls, and incidents?
Answer: Joint Patient Safety Reporting system or JPSR