The Joint Commission
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is a non-profit organization based in the United States that offers accreditation to health care facilities as well as various health programs. The goal of the organization is to “continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. ” (http://www. jointcommission.org)
As a non-profit organization, the Joint Commission continues to set forth standards by which the quality of patient care is measured. In addition to providing official accreditation, after thoroughly evaluating a health care facility or program, the Joint Commission also sets safety goals for the health care industry in order to improve overall quality of care. The Joint Commission has put forth safety goals purposed to decrease the frequency of human error and promote a more secure environment for patients.
Safety goals include ensuring proper patient identification, appropriate use of medicine, enhanced communication, infection prevention and risk identification. The Joint Commission hopes to encourage the prevention of surgical mistakes and patient falls. With concern to the geriatric population, most, if not all of the safety goals may need to be integrated into health care routine. The Joint Commission’s safety goal regarding fall prevention is especially pertinent to the geriatric population.
The geriatric patient is susceptible to falls in general due to decreased vision, coordination, strength, flexibility, increase in cardiovascular disease, vertigo or cognitive impairment. Injury to a geriatric patient resulting from a fall often causes greater complications than would typically occur in a younger patient. Elderly patients are more prone to fracture due to bone density loss and extensive bruising from certain medications or loss of protective adipose tissue. Geriatric patients are also likely to obtain serious skin injuries resulting from falls because of thinning skin.
Fractures could result in a patient losing mobility which could potentially lead to more serious complications such as pressure sores, urinary tract infections, thrombi or loss of joint function due to lack of movement. Injuries to the skin obtained from a fall could become infected. A simple fall to an elderly patient could result in a dramatic turn for the worse regarding overall health. “Among people 65 years and older, falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma. ” (http://www. CDC.org)
The Joint Commission addresses this concern with its goal to reduce the risk of falls. This particular goal is broken down into five elements of performance intended to predict risk for fall, intervene to reduce risk, educate and evaluate. The first of the elements of performance is an assessment of the patient’s risk for fall. This includes assessing patient’s mental status, sleep patterns, medications, blood pressure, voiding frequency, vision, gait, strength, balance and history of falls. After evaluation of a patient’s risk of falling, an interventional plan should be formulated to prevent such an incident.
The Morse Fall Scale, or MSF, is a tool that is used to assess the likelihood of a patient falling. It takes into consideration a specific patient’s history of falling, secondary diagnosis, ambulatory aid, IV/Heparin lock, gait and mental status. “The MFS requires systematic, reliable assessment of a patient’s fall risk factors upon admission, fall, change in status, and discharge or transfer to a new setting. ” (http://www. patientsafety. gov) Equipment can be utilized to prevent falls and environmental hazards can be cleared. Referrals could be made, as needed, to ophthalmology, cardiology or physical rehabilitation.
Medications can be considered and altered if they cause orthostatic hypotension, a condition in which a patient becomes dizzy upon standing due to quick drop in blood pressure. Bowel and bladder assistance programs can be implemented to reduce frequency and incontinence issues that may lead the patient to leave the bed unassisted. Educating the patient, as well as their families is critical in fall prevention. Involvement of all who care for the geriatric patient can lessen the likelihood of a fall occurring in the absence of a health care provider.
Falls can occur while attempting to help a geriatric patient bathe, while assisting in transportation, or maneuvering through their home. This is especially important to the geriatric patient who has returned home resume acts of daily living without constant supervision. There may be environmental hazards within the home that pose risk to the patient. It is also possible that the patient may not administer medications properly, or cannot safely perform hygiene, feeding, cooking or cleaning. Such acts of daily living are essential remain or become healthy.
A vast array of variables exists with regards to fall prevention. Hence, the Joint Commission recommends that the overall success of the interventional measures be evaluated and altered as needed. Follow up evaluation allows for further adjustments, if needed. The Joint Commission is a non-profit organization serving to promote health care organizations to be their best in all aspects of patient care. Their mark of accreditation has become a respected seal of approval, indicating that a particular facility or program meets a particular set of high standards.
They have put forth safety goals intended to encourage nurses and other health care providers to approach potential dangers with a multifaceted plan for intervention and prevention of errors, accidents and injury. Preventing falls will be an ongoing, evolving and improving process with regard to future nursing practice. Nurses will always need to think critically and utilize the knowledge, tools and equipment available to keep patients from falling and injuring themselves. Futuristic equipment may provide a more convenient, safer, faster way to assist patient mobility.
Computer health care networking may make complete health history more readily available for review and consideration. Nothing, however, can replace the critically thinking nurse. “Nurses are leading practice innovations to systematically assess patients’ risk for falls and implement population based prevention interventions. ” (http://www. nursingworld. org) For this reason, The Joint Commission sets standards and safety goals to encourage those within the field of nursing to actively assess, prevent, educate and evaluate. With due diligence, such standards and safety regulations can greatly increase overall patient care.
