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August 1996
Volume 60 |
Number 8
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| Joint Commission
Standard Clarified: Locked Anesthesia Carts |
William L. Collins, M.D.
Hospital Accreditation Program/Professional and Technical Advisory
Committee
Eugene P. Sinclair, M.D.
Ambulatory Care/Professional and Technical Advisory Committee
Joint Commission on Accreditation of Healthcare Organizations
Recently, concerns have been expressed on GASNet, the Internet
anesthesia discussion group, relative to a perceived Joint Commission
on Accreditation of Healthcare Organizations requirement that
anesthesia carts be locked. Several individuals have posted on
GASNet their experiences with indications by Joint Commission
surveyors for a requirement for locking anesthesia carts/drug
storage areas between cases.
ASA President Norig Ellison, M.D., directed ASA representatives
to the Joint Commission Ambulatory Care/Professional and Technical
Advisory Committee and to the Hospital Accreditation Program/Professional
and Technical Advisory Committee to investigate the issue.
The Joint Commission standard in question is TX.3.5.5 (in the
1996 Comprehensive Accreditation Manual for Hospitals, Section
on Care of Patients), which states the requirement that "emergency
medications are consistently available, controlled and secure
in the pharmacy and patient care areas." It appears that
one or more surveyors interpreted this standard to require locking
of anesthesia carts at all times between cases, which most anesthesiologists
would believe to be unreasonable. One ASA representative, Eugene
P. Sinclair, M.D., spoke by telephone with a senior Joint Commission
standards development person. The other representative, William
L. Collins, M.D., spoke with the Executive Vice-President for
Accreditation Operations. Both representatives were advised that
these surveyors' interpretation does not reflect the Joint Commission's
position and that "gratuitous comments by a surveyor"
may have been misinterpreted as official policy.
The Joint Commission does not have a requirement that all anesthesia
equipment and drug carts be locked when not in immediate use nor
does it intend to develop one. The "available, controlled
and secure" language in the standard could be reasonably
interpreted to require a lock or seal on carts that are accessible
to the public or where there is noncontrolled traffic such as
anesthesia carts in some obstetrical services areas.
If you disagree with a surveyor's comments, ask for the standard
that covers the issue. If you have a different interpretation
of the standard, scoring guidelines or examples for compliance,
state your position politely. The Joint Commission Executive Vice-President
advises that you call the Joint Commission if you have concerns
during a survey. Also, your organization will be provided with
the name of a contact person at the Joint Commission for your
individual organization's survey, whom you can contact if you
have a problem or disagreement during your survey.
If you have a serious disagreement with the interpretation of
a standard, you are advised to write a letter to that person and/or
the Joint Commission Executive Vice-President before the final
survey report comes in. You can also write a response to the final
report should you disagree with it. Be sure to cite the standard,
intent statement and any examples to support your dissent. Disagreement
with the standard itself might have some effect in the future
but not likely on the current survey.
You may contact the Joint Commission on Accreditation of Healthcare
Organizations at 1 Renaissance Blvd., Oakbrook Terrace, IL 60181;
telephone: (630) 916-5600; e-mail: Lhead@jcaho.org
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