1. Thompson, Elizabeth M. RN, CNOR, MSN

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Now that The Joint Commission is conducting un-announced visits, the process of ensuring staff preparedness has taken on new dimensions. The stakes are high: meeting The Joint Commission's standards means continued Medicaid and Medicare reimbursements and shows the public the institution's dedication to the safety and quality care of its' patients. Accreditation also affects the recruitment of healthcare workers who are seeking work in a quality environment.

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Organizational leaders are often reluctant to place the focus on preparing for a Joint Commission visit, and instead emphasize continuous quality patient care. Despite this effort, perioperative nurses know the tracer methodology increases the likelihood they will speak to auditors at their point of care.


Providing valuable information

It's a challenge to ensure that staff is "ever ready" and able to respond to issues The Joint Commission auditors may address. Managers must provide information that's pertinent to their practice and identify areas that may need more development.


As we try to offer creative methods of sharing information with OR staff, nurses are sorting through the data and deciding what information they need to provide quality patient care. Any other information becomes superfluous.


Our surgical division provides education using multiple approaches: e-mails, daily Joint Commission tips at report, weekly newsletters, quarterly staff development programs, parodies of game shows, and other methods. Ultimately, it's up to the individual perioperative nurse to process the information and incorporate the concepts in their practice. This won't happen unless the information presented is valued.


Putting knowledge to the test

The ultimate test of whether OR staff have internalized these messages are emergency situations. Cir-cumstances that are high acuity and low volume are the most difficult to address effectively. Fire in the OR is a good example of a situation where perioperative nurses need to respond quickly and efficiently. Due to the rare chance of a fire and despite intensive training, staff may not respond well under the stress of the situation. The physiologic reason for this is a fight or flight response. Blood is shunted away from the brain and diverts to the brain stem or reptilian brain. This reaction is frustrating for everyone-those coaching employees and the employees.


Just talking to a Joint Commission auditor can also cause stress, leaving OR staff unable to speak about their practice fluently and with confidence. Preparation and repetition are the keys.


As an educator having taught and reinforced the RACE/PASS acronyms for fire response, the best approach is to present information in multiple methodologies. Not only does this recognize variations in learning (reading, seeing, and doing), the repetition reinforces the message. Seeking and using current practice issues as examples when they surface in everyday practice is valuable. It also provides a context or framework for the concept that enhances learning and meaning.


Perioperative nurses handle a great deal of infor-mation in their everyday practice. Preparing for a Joint Commission visit is another ball in the juggling act. It's up to leadership to ensure the ball isn't dropped in preparing for a visit from The Joint Commission by supporting staff readiness on a daily basis.


Elizabeth M. Thompson, RN, CNOR, MSN


Editor-in-Chief, Nursing Education Specialist, Mayo Clinic, Rochester, Minn.