Home Health & Hospice Week

JCAHO focuses on medication management, patient falls.

Starting next year you may have to know more than ever about your patients'medications or face sanctions from the Joint Commission on Accreditation of Healthcare Organizations.

JCAHO will require two new National Patient Safety Goals of home care organizations on medication management and patient falls (see "New 2005 National Patient Safety Goals for Home Care Providers'") The Oakbrook Terrace, IL-based accrediting organization has dumped one safety goal from 2004, on system alarms, and has retained the other five goals.

The new goal on medication reconciliation will prove "quite a challenge" to home health agencies, predicts consultant Betty Gordon with Simione Consultants in Westborough, MA. HHAs can have a hard time securing a complete list of patients'medica-tions when they have multiple physicians giving prescriptions and multiple pharmacies filling them, Gordon notes.

"No one source knows what the patient is taking," Gordon tells Eli. And the patient is often a poor source of reliable information.

For home medical equipment suppliers, only organizations that offer clinical respiratory services will be responsible for the medication reconciliation patient safety goal, says Robert Thornburg of Seal Beach, CA-based Home Medical Equipment Industry Consultation. "These organizations, however, have always been required to possess policy and procedure addressing cardiopulmonary medication profiles from admission to discharge or transfer, with appropriate forwarding of patient records at that point," Thornburg points out.

Some states have inter-agency transfer forms for communicating information between providers when patients move, Gordon says. In those states, HHAs will have an easier time obtaining medication information from hospitals. But in other states, "it will be a matter of what they can get the hospital to share," she expects.

Agencies will often have to fall back on the tried-and-true method of having the home care nurse physically look over all the medications in the patient's home during a visit, Gordon says.

Prepare now: In anticipation of this goal, HHAs should draft policies and procedures on what they will do to obtain and validate medication information, Gordon advises. But how JCAHO will monitor whether agencies successfully gather all medication information is unclear, she says.

HHAs and suppliers already may be more familiar with the second new goal: reducing the risk of patient harm from falls. This triggers an adverse event in Home Health Compare, requiring emergent care for the patient, Gordon notes. "Agencies should already be very focused on it."

Suppliers address fall risks at admission, Thornburg points out. They assess the patient's ability to use the equipment after instructions and demonstration by staff, and assess the residence for hazards that may compromise safe use of the equipment.

If HME staff deem the delivery unsafe, they "may be required to notify the referral source of the situation so that alternate arrangements can be made," Thornburg says.

Respiratory staff may make recommendations to the physician based on their review of patient medications and "clinical impressions of the patient," Thornburg adds.

"Appropriate policy and procedure for all of the above is already in place in the well run HME organization," Thornburg contends. "This is good home care practice," Gordon agrees.

Editor's Note: A list of all the 2005 goals is at www.jcaho.org/accredited+organizations/patient+safety/npsg.htm.