JACHO absurdities

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Anyone have any new ridiculous JACHO or hospital guidelines?

We can no longer test our laryngoscopes blades because the pouch must remain closed until the patient is in the room.

Also, we cannot leave medications in the room unattended, even emergency prefilled sticks that are sealed.
 
Anyone have any new ridiculous JACHO or hospital guidelines?

We can no longer test our laryngoscopes blades because the pouch must remain closed until the patient is in the room.

Also, we cannot leave medications in the room unattended, even emergency prefilled sticks that are sealed.

Just pass off the sterile handle and blade to the scrub with all the other stuff she has open, have her test it then hand it to you when you're ready. Problem solved.
 
Anyone have any new ridiculous JACHO or hospital guidelines?

We can no longer test our laryngoscopes blades because the pouch must remain closed until the patient is in the room.

Also, we cannot leave medications in the room unattended, even emergency prefilled sticks that are sealed.
As much as I dislike the Joint Commission, I have to agree there is no reason for opening disposable laryngoscopes if there is no patient in the room about to be intubated. All it does is create waste (MAC cases with no plan to intubate, yet people still open laryngoscopes, cases cancelled, cases moved to another room...) and open the window to cross contamination. I have yet to find one that doesn’t work, and if it doesn’t just open another one. The days of broken reusable bulbs are long gone and so must the practice of checking the bulb.
 
That blade issue is a big problem for a bunch of my partners that believe it is malpractice to not have a tested and immediately available blade at all times. There’s more than one handle and blade in the drawer, and you can check the light without opening the handle bag anyway. We will all end up using disposables before long. Blades, handles, fibers, everything.
 
As much as I dislike the Joint Commission, I have to agree there is no reason for opening disposable laryngoscopes if there is no patient in the room about to be intubated. All it does is create waste (MAC cases with no plan to intubate, yet people still open laryngoscopes, cases cancelled, cases moved to another room...) and open the window to cross contamination. I have yet to find one that doesn’t work, and if it doesn’t just open another one. The days of broken reusable bulbs are long gone and so must the practice of checking the bulb.

But the mouth isn't exactly sterile, so why would "blade contamination" matter as long as the tube is kept as clean as it can be?
 
Ricky Gervais=My Hospital
Woman=Jacho




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Anyone have any new ridiculous JACHO or hospital guidelines?

We can no longer test our laryngoscopes blades because the pouch must remain closed until the patient is in the room.

Also, we cannot leave medications in the room unattended, even emergency prefilled sticks that are sealed.

Your first complaint is old. They have been doing that for years.

The complaint about meds is silly to me. Not bc they say you can’t do it but because I haven’t needed emergency drugs in this manner ever. Just go with it and fight the real absurdities. I wish I had a good example but I missed the Last joint visit we had which was 3 weeks ago. We did very well ( read: we are good BS artist).
 
Rules include, cannot wear an undershirt beneath scrub top (chest hair sticking out ok I guess), IV cannot be started in pre-op per nursing protocol without doc signing an order sheet (great for when private docs roll in from office and pt not ready to go back), no beard hair exposed, no drawn up drugs even if in pyxis between cases, drugs have to be drawn as the pt in the room, any syringe used with left over med has to be discarded within 1hr of drawn (somehow doesn't apply to infusions...), Saline flush syringes have to be secured\locked. These are just a few that one of the hospitals I work at instituted to meet requirements since they got dinged in the past...
 
Again.....go through the motions while the idiots are there then return to your slovenly ways.

Problem is the they are continuing to enforce it because they are afraid of surprise visits and the risk of getting shut down
 
This stuff makes absolutely no sense. We all must wear masks and cover every hair follicle to prevent infection. Here comes the patient by the sterile field, a$$ exposed, with no mask laying on their hospital bed they've been $hitting in and gown they've been dragging all over the hospital floor/bathroom. It's all very logical.

Don't forget MRSA contact precautions! Gove and gown everyone! But as soon as they're discharged, they can cough, touch and sneeze on everything in the hospital.

I am yet to see evidence any of this works. I recently saw a statement from the American College of Surgeons saying surgical caps are not inferior (and maybe better) than boufants. AORN straight up makes things up and JACHO jumps on it...
 
These guys only exist to perpetuate their own existence. They keep making up rules to label facilities as "in violation" of these made up rules, justifying their return visit. Rinse and repeat and you end up with all of these made up rules with scant evidence, created by clipboard warriors who never touch patients. It will only stop when hospitals have the guts to say that they don't need their arbitrary approval to continue operating.

They embody the administrative creep that is often ignored during discussions of why healthcare is so expensive.
 
Here is one:

You need to keep your anesthesia omnicell locked while you are in the room in the middle of a case.

I still need to confirm this, but it’s absolutely ridiculous if found to be true.

Surgeon: “oops... hole in the PA... we are loosing blood fast”
Aneathesia: “hold pressure while I log into the omnicell and pull out some pressors... it will only be a few minutes”. :wow:
 
Perhaps the dumbest thing is that we pay JC to come to this to us.

I have been shaving my head bald for the past 20 years; the good Lord has made that job much faster and easier over those two decades. That is covered in the mandatory cap while in OR. I am clean shaven. But my eyebrows could be mistaken for an entire family of caterpillars that have taken supraocular residence on my face; these brows roam unrestrained. It’s so f@ucking stupid.

Meanwhile, 80% of our orthopedic surgeons jump out of their Porsches (literally) in scrubs, and I can’t wear a personalized cloth cap on my bald head...
 
Here is one:

You need to keep your anesthesia omnicell locked while you are in the room in the middle of a case.

I still need to confirm this, but it’s absolutely ridiculous if found to be true.

Surgeon: “oops... hole in the PA... we are loosing blood fast”
Aneathesia: “hold pressure while I log into the omnicell and pull out some pressors... it will only be a few minutes”. :wow:

Maybe, like me, they are wondering why you would need to treat hypovolemia with a pressor? (j/k) :laugh:
 
Far less issues with DNV in my experience but still a parasitic mess.

We have DNV but still literally get weekly emails about the nurses (and us lets be honest here) opening and testing laryngoscopes in the trauma room and GI. It’s the mock surveyor everytime and its apparently unlikely to make a difference in the actual inspection but man, it’s obnoxious.
 
But the mouth isn't exactly sterile, so why would "blade contamination" matter as long as the tube is kept as clean as it can be?
Contamination from one patient to another.

Let's say you routinely open the disposable for a MAC case but don't use it and then put it back in the dtawer because it is clean.

If people then use an open laryngoscope because "they know people put them back because they are clean" eventually someone is bound to use a dirty one that was placed back in the drawer by whomever.

Just don't open them. There is no reason to unless you are about to intubate.
 
We've got beard covers, so why no chest hair covers? Surely they can create a mesh man bra for us hairy dudes to wear underneath the scrubs
What about eyebrow covers and ear hair covers?
 
I've come to understand that it's as much the idiots in your own hospital as it is the idiots from JC. JC is an unthinking machine, so as long as you're pointing to a hospital policy that you're complying with, they generally won't get in a twist.

If some hospital good idea fairy decides that 70s style polyester leisure suits are the required attire in the OR, then JC will enforce that rule. They come to check boxes, not think.
 
I think it’s silly to knock checking your blades and handles before the patient is in the room. About 1% of our disposable blades are defective. Nice time to find out in the middle of an RSI or a neonatal intubation that your blade doesn’t work. Sterility concerns are overblown. Intubation is a contaminated procedure, keeping your blades sealed isn’t going to make it more sterile. If you are allowing blades you put into someone’s mouth back into the drawer the problem isn’t that you open blades ahead of time, the problem is that you’re an idiot.
 
Chlorhexidine prep can't go into any trash container that is in the OR because of...explosion?

Our hospital recently did this. We also can't use chlorhexidine prep to reprep once the patient is draped or being draped due to possible explosion.

Today, the nurse couldn't get across the sterile field to the outside door.. So she rolled the kick bucket across the room to get rid of the explosives!

One of our techs took a prep home, put a blow torch to it, and couldn't get it to do anything.

These nurses/admins have to find new projects to justify their existence. We have an article posted in the surgeon lounge about how elimation of surgeon caps did nothing but increase costs significantly.
 
Our hospital recently did this. We also can't use chlorhexidine prep to reprep once the patient is draped or being draped due to possible explosion.

Today, the nurse couldn't get across the sterile field to the outside door.. So she rolled the kick bucket across the room to get rid of the explosives!

One of our techs took a prep home, put a blow torch to it, and couldn't get it to do anything.

These nurses/admins have to find new projects to justify their existence. We have an article posted in the surgeon lounge about how elimation of surgeon caps did nothing but increase costs significantly.

I heard cloth caps are ok to wear as long as they're laundered by the hospital, because supposedly the hospital spends top dollar on laundry services that totally don't leave remnants of tape or previous patient's body hair on "fresh" sheets and blankets.
 
I heard cloth caps are ok to wear as long as they're laundered by the hospital, because supposedly the hospital spends top dollar on laundry services that totally don't leave remnants of tape or previous patient's body hair on "fresh" sheets and blankets.

My favorite thing is how the laundry slowly gives us more and more laundry with other hospital's names on it...must be a real unique cleaning process.
 
We now have “single patient use” rolls of tape in our top drawer because of a JCHAO visit. They have barely enough on them to tape in an IV.
 
We now have “single patient use” rolls of tape in our top drawer because of a JCHAO visit. They have barely enough on them to tape in an IV.

Ha we have those too. I am reminded daily some nurse in an office a hundred miles away from the hospital who hasn't touched a patient in 10 years gets to throw this "quality improvement intervention" onto a CV in hopes of a promotion further up the chain of useless persons who leech precious dollars off the healthcare system for their 'service' to our hospital.

I think a strong case could be made against JCAHO for racketeering. We are forced to pay them to come solve nonexistent problems, because when actual problems don't exist they create some to justify their existence. If not met it could result in loss of accreditation and ruin of the hospitals services. Sounds like a racket to me. My guess is the original intentions were good, what it has devolved into is pathetic.
 
Ha we have those too. I am reminded daily some nurse in an office a hundred miles away from the hospital who hasn't touched a patient in 10 years gets to throw this "quality improvement intervention" onto a CV in hopes of a promotion further up the chain of useless persons who leech precious dollars off the healthcare system for their 'service' to our hospital.

I think a strong case could be made against JCAHO for racketeering. We are forced to pay them to come solve nonexistent problems, because when actual problems don't exist they create some to justify their existence. If not met it could result in loss of accreditation and ruin of the hospitals services. Sounds like a racket to me. My guess is the original intentions were good, what it has devolved into is pathetic.
There's a lot of racketeering in healthcare.

ABMS MOC is another example.
 
Ha we have those too. I am reminded daily some nurse in an office a hundred miles away from the hospital who hasn't touched a patient in 10 years gets to throw this "quality improvement intervention" onto a CV in hopes of a promotion further up the chain of useless persons who leech precious dollars off the healthcare system for their 'service' to our hospital.

I think a strong case could be made against JCAHO for racketeering. We are forced to pay them to come solve nonexistent problems, because when actual problems don't exist they create some to justify their existence. If not met it could result in loss of accreditation and ruin of the hospitals services. Sounds like a racket to me. My guess is the original intentions were good, what it has devolved into is pathetic.


This.

I have been saying this for forty years.

People making up crap problems, then starting a ‘quality improvement project’ that ties physicians’ hands, then pointing to it and saying, “Oh, look what we accomplished this year,” when their annual review comes around.

Getting promoted on the backs of people who actually make a difference to patient care.
 
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