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JCAHO Resident Identifier Regulations

Diaries
by Bill Graves
Posted on Wed Jan 03, 2007 at 08:56:08 AM EST

--from the diaries -- lots of good discussion in the comment section -- joe

To band, or not to band....

We recently had a JCAHO survey, and the issue of resident identifiers came up.  According to JCAHO regulations, there needs to be 2 identifiers available to nursing staff to ensure that they are dispensing medications, treatments, etc. to the appropriate resident.  In the past we had a photo of the resident in our MAR, and the residents wore name bands - just like in a hospital.  As part of our Culture Change journey, we've eliminated the wrist bands.  We felt that our Consistent Assignments were enough to satisfy the regulation.  In addition, we have the resident's name outside the door to their room, and their name is on the footboard as well.  Our JCAHO survey didn't feel that either the consistent assignments or the resident names were enough to meet their requirement, and although I think our surveyor understood the intent of Resident directed care, she still felt that in order to comply with the reg, we needed to reinstitute the name bands.  Obviously, we don't want to do that, and I wanted to ask other facilities if they've experienced the same type of issue, and how did you handle it?

< Looking Back......and Forward | Cultural Change: Getting Residents Out of Wheelchairs >



Banding Together to resolve it (4.00 / 1)

Bill- Wow! This is something I hadn't thought about. As a nurse I have always felt the safety of the "band" as another level of checking. I know if I have to wear one in the hospital, I can't get it off fast enough. It is not a good fit with "home" and I can't imagine having to year one for months or years. Yet, given med errors, new staff etc. what is the answer? I will be anxious to see what creative things people are doing or can think of trying that would address all concerns. It may go back to recognizing that one size does not fit all and individualizing the approach to resident identifiers. Seems like there might be a place for technology here, but as a technophobic I wouldn't know the answer there.  I wonder what they do at Greenhouse? I wonder if Jack York has anythoughts on this?
thanks for raising the question
Joanne Rader

by Joanne Rader on Sun Jan 07, 2007 at 03:48:03 PM EST
Resident Identifiers (4.00 / 1)

If you can establish with certainty what are the minimum set of identifiers needed by the surveyors, then I suggest turning to customized jewelry as the logical solution.  Your local gem and mineral clubs, most of which are associated with regional mineralogical federations, could assist you in making all sorts of jewelry your residents will adore. Best of all, the costs will be minimal and you will have partnered with another group to enhance the lives of your residents.

Kaye Brown


by Kaye Brown on Tue Jan 16, 2007 at 08:30:57 AM EST
Custom Jewelry instead of wrist bands (4.00 / 1)

Excellent suggestion.  You'll notice that all Medic Alert devices are done in exactly that way.  Why?  Because no one is going to voluntarily wear a plastic hospital band for the rest of  his or her life or even a small part of it.  There are many, many small seemingly insignificant demeaning practices that are inflicted on long-term care residents "for their own good" that the rest of the world wouldn't put up with for a second.   This is definitely one of them.  

by kate ricks on Wed Jan 17, 2007 at 04:45:50 PM EST
[ Parent ]
Great idea - but what more can we do? (4.00 / 1)

This idea is something that we had thought of as well, but were hesitant to use. I agree that the use of more jewelry like bracelets is better than the hospital band, but it still comes back to resident choice.  I can't think of one of my male residents that would choose to wear jewelry, any more than then they would choose to wear a hospital bracelet.  This may be the best we can do, but anytime that phrase that is used, I always feel like we're taking the easy way out.  
There has to be something else - the ultimate answer would be a change in interpretation of the JCAHO standard.  I know that in their home care surveys, JCAHO does NOT require the use of two patient identifiers if the home care agency uses consistent staff to care for the patient.  I think there's an argument to be made for the same exception in the SNF setting.  Our consistent caregivers spend eight hours a day in the resident's home. Consistent home care staff obviously spend less than that with their patient.  
I'm certain I'm preaching to the choir here, but with all of the work that so many people have done around these issues, our regulatory and reimbursement agencies need to begin to look at what we're doing and recognize that it's 180 degrees from what we were doing 5 years ago.  We've changed things for the better - it's time that more of our "overseers" do too.

by Bill Graves on Fri Jan 19, 2007 at 07:52:41 AM EST
[ Parent ]
Right! (none / 0)

I've thought about this issue since posting my first reply.  You are right, of course.  Jewelry is a work-around but not a fix.  On the resident/family side of these issues we are seeing many regulations that are restrictive, some to the point of actually imposing limits on civil rights.  The problem, as we see it, is that there is not and never has been equal representation of residents, families, and advocates on the committees writing these laws and regulations.  

On JCAHO specifically, we find certain sections of their regulations not to be particularly friendly to residents and families in long-term care situations.  It's one thing to try to improve quality through regulation but it's counter-productive if in doing so you impose severe restrictions on the residents themselves and that is what is currently happening.


by kate ricks on Mon Jan 22, 2007 at 12:58:23 PM EST
[ Parent ]
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