Joint Commission InternationalVirginia Maripolsky,Assistant CEONursing Affairs

Joint Commission International AccreditationJoint Commission International (JCI ) is a division of the Joint Commission in Oak Brook, IllinoisCreated in 1998 (2541)

Philosophy of Accreditation

Evaluates the entire health care organization as a complex interaction of many clinical and management processesUses published consensus standard in conducting an evaluation

Formal on-site evaluation every 3 years to assess compliance with the standardsSurveyors include a team of health care professionals such as physicians, nurses, pharmacists, and health care executives

JCI Reputation

Accredits over 17,000 organizations worldwideAbout 130 of those are acute care hospitals in 23 countries

Joint Commission International StandardsFocus on the patientDesigned to be interpreted/surveyed within the local culture and legal framework

Joint Commission International Accreditation Standards for Hospitals360 Standards1240 Measurable ElementsSection I : Patient Centered StandardsSection II : Health Care Organization Management Standards

Standards ContentEach JCI Standards contains 3 components :The Standard Description of the intent of the standardMeasurable element(s) to be scored

Measurable ElementsEach standard has one or more measurable elements that incorporate the major principles addressed in the intent statementEach applicable measurable elements is scoredMet (10)Partially Met (5)Not Met (0)

To improve the safety and quality of care in the international community through the provision of education, publications, consultation, evaluation, and accreditation services

Mission of Joint Commission International

JCI DefinitionsBest practice:Clinical, scientific, or professional technique, method, or process that is recognized by a majority of professionals in a particular field as more effective at delivering a particular outcome than any other practice.These practices, also sometimes referred to as good practice or better practice, are typically evidence based and consensus driven.

JCI DefinitionsPalliative services:Treatments and support services intended to alleviate pain and suffering rather than to cureillness. Palliative therapy may include surgery or radiotherapy undertaken to reduce or shrink tumors compressing vital structures and thereby improve the quality of life. Palliative services include attending to the patients psychological and spiritual needs and supporting the dying patient and his or her family.

Pain Management and End-of-Life Care

Patients who are in pain or approaching the end of life and their families require care focused on their unique needs. Patients may experience pain associated with treatments or procedures such as postoperative pain or pain during a physical therapy session, or pain associated with chronic disease or acute illness. Dying patients may also experience other symptoms related to the disease process or curative treatments or may need help in dealing with psychosocial, spiritual, and cultural issues associated with death and dying. Families and caregivers may require respite from caring for a terminally ill family member or help in coping with grief and loss.

Pain Management and End-of-Life CareThe organizations goal for managing pain or providing care at the end of life considers the settings in which care or service is provided (such as a hospice or palliative care unit), the type of services provided, and the patient population served. The organization develops processes to manage pain and end-of-life care. These processes - assure patients that pain and symptoms will be assessed and appropriately managed;- ensure that patients in pain or terminally ill will be treated with dignity and respect;- assess patients as frequently as necessary to identify pain and other symptoms;- plan preventive and therapeutic approaches to manage pain and other symptoms; - educate patients and staff about managing pain and other symptoms.

COP.6 Patients are supported in managing pain effectively.

Intent of COP.6Pain can be a common part of the patient experience; unrelieved pain has adverse physical and psychological effects. The patients right to appropriate assessment and management of pain is respected and supported. Based on the scope of services provided, the organization has processes to assess and manage pain appropriately, includinga) identifying patients with pain during initial assessment and reassessments;b) providing management of pain according to guidelines or protocolsc) communicating with and educating patients and families about pain and symptom management in the context of their personal, cultural, and religious beliefs d) educating health care providers about pain assessment and management.

Measurable Elements of COP.6

1. Based on the scope of services provided, the organization has processes to identify patients in pain. 2. Patients in pain receive care according to pain management guidelines. 3. Based on the scope of services provided, the organization has processes to communicate with and educate patients and families about pain. 4. Based on the scope of services provided, the organization has processes to educate staff about pain.

COP.7 The organization addresses end-of-life care.Intent of COP.7Patients who are in pain or dying have unique needs for respectful, compassionate care. To accomplish this, all staff are made aware of the unique needs of patients in pain or at the end of life. Concern for the patients comfort and dignity should guide all aspects of care during the final stages of life. End-of-life care provided by the organization includesa) providing appropriate treatment for any symptoms according to the wishes of the patient and family;b) sensitively addressing issues such as autopsy and organ donation;c) respecting the patients values, religion, and cultural preferences d) involving the patient and family in all aspects of care; ande) responding to the psychological, emotional, spiritual, and cultural concerns of the patient and family.To accomplish these goals, all staff are made aware of patients unique needs at the end of life.

Measurable Elements of COP.7

1. Staff are made aware of patients unique needs at the end of life. 2. End-of-life care provided by the organization addresses dying patients needs at least including elementsa) through e) in the intent statement as appropriate to the patient and family.

Standard COP.7.1 As appropriate to the care and services provided, assessments and reassessments of the dying patient and their family are designed to meet individualized needs.

Intent of COP.7.1

Assessments and reassessments need to be individualized to meet patients and families needs when a patient is at the end of life. Assessments and reassessments should evaluate, as appropriatea) symptoms such as nausea and respiratory distress;b) factors that alleviate or exacerbate physical symptoms;c) current symptom management and the patients response;d) patient and family spiritual orientation and, as appropriate, any involvement in a religious group;e) patient and family spiritual concerns or needs such as despair, suffering, guilt, or forgiveness;f ) patient and family psychosocial status such as family relationships, the adequacy of the home environment if care is provided there, coping mechanisms, and the patients and familys reactions to illness;g) the need for support or respite services for the patient, family, or other caregivers;h) the need for an alternative setting or level of care; andi) survivor risk factors such as family coping mechanisms and the potential for pathological grief reactions.

Measurable Elements of COP.7.1 1. Patients and families are assessed and reassessed at least for those elements identified in a) through i) in the intent statement, as appropriate. 2. Assessment findings guide the care and services provided.

StandardCOP.7.2 Care of the dying patient optimizes his or her comfort and dignity.Intent of COP.7.2The organization ensures appropriate care of those in pain or dying by: taking interventions to manage pain and primary or secondary symptoms; preventing symptoms to the extent reasonably possible; taking interventions that address patient and family psychosocial, emotional, and spiritual needs regarding dying and grieving; taking interventions that address patient and family religious and cultural concerns; and involving the patient and family in care decisions.

Intent of COP.7.2

The organization ensures appropriate care of those in pain or dying by: taking interventions to manage pain and primary or secondary symptoms; preventing symptoms to the extent reasonably possible; taking interventions that address patient and family psychosocial, emotional, and spiritual needs regarding dying and grieving; taking interventions that address patient and family religious and cultural concerns; and involving the patient and family in care decisions.

Measurable Elements of COP.7.2 1. Interventions are taken to manage pain and primary or secondary symptoms. 2. Symptoms are prevented to the extent reasonably possible. 3. Interventions address patient and family psychosocial, emotional, and spiritual needs regarding dying and grieving. 4. Interventions address patient and family religious and cultural concerns. 5. The patient and family are involved in care decisions.

StandardAOP.1.8 The initial assessment includes determining the need for additional specialized assessments.Intent of AOP.1.8The initial assessment process may identify a need for other assessments such as dental, hearing and language, and so on. The organization refers the patient for such assessments when available within the organization or the community.Measurable Elements of AOP.1.8 1. When the need for additional specialized assessments is identified, patients are referred within the organization or outside the organization. 2. Specialized assessments conducted within the organization are completed and documented in the patients record.

StandardAOP.1.8.2 All patients are screened for pain and assessed when pain is present.During the initial assessment and reassessments, the organization identifies patients with pain. When pain is identified, the patient can be treated in the organization or referred for treatment. The scope of treatment is based on the care setting and services provided.When the patient is treated in the organization, a more comprehensive assessment is performed. This assessment is appropriate to the patients age and measures pain intensity and quality such as pain character, frequency, location, and duration. This assessment is recorded in a way that facilitates regular reassessment and follow-up according to criteria developed by the organization and the patients needs.

Measurable Elements of AOP.1.8.2 1. Patients are screened for pain. 2. When pain is identified, the patient is referred or a comprehensive assessment is performed, appropriate to the patients age and measuring pain intensity and quality such as pain character, frequency, location, and duration. 3. The assessment is recorded in a way that facilitates regular reassessment and follow-up according to criteria developed by the organization and the patients needs.

Standards PFR.1.1 Care is considerate and respectful of the patients personal values and beliefs. PFR.1.1.1 The organization has a process to respond to patient and family requests for pastoral services or similar requests related to the patients spiritual and religious beliefs.

Intent of PFR.1.1 and PFR.1.1.1Each patient brings his or her own set of values and beliefs to the care process. Some values and beliefs are commonly held by all patients and are frequently cultural and religious in origin. Other values and beliefs are those of the patient alone. All patients are encouraged to express their beliefs in ways that respect the beliefs of others.

Strongly held values and beliefs can shape the care process and how patients respond to care. Thus, each care provider seeks to understand the care and services they provide within the context of the patients values and beliefs.

Spiritual Support (PFR)When a patient or family wishes to speak with someone related to religious or spiritual needs, the organization has a process to respond to the request. The process may be carried out through on-site religious staff, local sources or family referred sources. The process to respond is more complex, for example, when the organization or country does not officially recognize and/or have sources related to a religion or belief for which there may be a request.

Even if that religion is not recognized in the countryHow to respond to complicated requests

Measurable Elements of PFR.1.1 1. There is a process to identify and respect patient values and beliefs, and when applicable, those of the patients family. 2. Staff use the process and provide care that is respectful of the patients values and beliefs.Measurable Elements of PFR.1.1.1 1. The organization has a process designed to respond to routine as well as complex requests related to religious or spiritual support. 2. The organization responds to requests for religious or spiritual support.

PFR.2.4 The organization supports the patients right to appropriate assessment and management of pain.Intent of PFR.2.4Pain is a common part of the patient experience and unrelieved pain has adverse physical and psychological effects. A patients response to pain is frequently within the context of societal norms and traditions. Thus, patients are encouraged and supported in their reporting of pain. The organizations care processes recognize and reflect the right of all patients to appropriate assessment and management of pain.

Measurable Elements of PFR.2.4

1. The organization respects and supports the patients right to appropriate assessment and management of pain. 2. The organizations staff understand the personal, cultural, and societal influences on the patients right to report pain, and accurately assess and manage pain.

PFR.2.5 The organization supports the patients right to respectful and compassionate care at the end of life.Intent of PFR.2.5Dying patients have unique needs for respectful, compassionate care. Concern for the patients comfort and dignity guides all aspects of care during the final stages of life. To accomplish this, all staff members are made aware of patients unique needs at the end of life. These needs include treatment of primary and secondary symptoms; pain management; response to the patients and familys psychological, social, emotional, religious and cultural concerns; and involvement in care decisions

Measurable Elements of PFR.2.5

1. The organization recognizes that dying patients have unique needs. 2. The organizations staff respects the right of dying patients to have those unique needs addressed in the care process.

Intent of PFE.4

The organization routinely provides education in areas that carry high risk to patients. Education supports the return to previous functional levels and maintenance of optimal health.The organization uses standardized materials and processes in educating patients on at least the following topics: Safe and effective use of all medications taken by the patient (not just discharge medications), including potential medication side effects Safe and effective use of medical equipment Potential interactions between prescribed medications and other medications (including over-the-counter preparations) and food; Diet and nutrition; Pain management; and Rehabilitation techniques.

Standard PFE.4 Patient and family education include the following topics, as appropriate to the patients care: the safe use of medications, the safe use of medical equipment, potential interactions between medications and food,nutritional guidance, pain management, and rehabilitation techniques.

From the United States (will be confusing)

The white paper Living Well at the End of Life synthesizes research on chronic illnesses in the last phase of life. Download helpful guides to Living With Advanced Congestive Heart Failure (CHF) or Living With Advanced Lung Disease in PDF format. You may also read the guides in HTML format.

Palliative Care Tools, Training & Technical AssistanceSearch results 205 items matching your criteria. Pain protocols [100%] Re:Pain protocols [97%] documentation to prevent pain and symptoms [92%] Pain & Symptom Management [90%] Re:Re: Assessment tools [88%] Re:documentation to prevent pain and symptoms [88%] Oncology Nursing and the Treatment of Pain [87%] http://www.capc.org/search?SearchableText=pain

Pathwayshttp://www.guideline.gov/National Guideline Clearing HousePalliative care. Institute for Clinical Systems Improvement - Private Nonprofit Organization. 2007 Jan (revised 2008 May). 58 pages. [NGC Update Pending] NGC:006526

Pathwayshttp://www.guideline.gov/National Guideline Clearing HouseClinical practice guidelines for quality palliative care. National Consensus Project - Disease Specific Society. 2004 May (revised 2009 Jan). 80 pages. NGC:007218

Centers of ExcellenceThe Heart by SirirajThai-German EndoscopySiriraj GI Endoscopy CenterOrgan Transplant CenterBone Marrow Transplant CenterSiriraj Robotic Surgery CenterThe Breast Center

*Our mission is a simple one but also challenging and humbling one---To improve the safety and quality of care in the international community. We strive to fulfill our mission in a variety of ways. We disseminate the rich experience of JCs almost 100 years of knowledge and from JCIs work in over 60 countriessharing lessons learned and exchanging information about best practices / known vulnerabilities.

All of us in this room probably share a common goal. That goal is reflected in this mission.Those in health care that choose to live their lives working in health care, no matter where they live, language they speak, share this that is a common/consistent goal to improve the safety and quality of care provided to their patients.Can do this is a variety of ways education, publications, consultation, and accreditation.