JCAHO goes nuts, again

I was going to go crazy on this, but then found it had already been done:

Movin’ Meat: JCAHO Again!

JCAHO Again!

Sorry for the prolonged radio silence. Real life gets in the way of blogging sometimes. As my hero, Monty Burns said: “Family, religion, friends.. these are the three demons you must slay if you wish to succeed…” Well, I’m back with an annoyed rant, yet again on the Joint Commission. Apparently they have recovered from the temporary bout of sanity which caused their earlier hesitation and reinstated this odious rule:

Read the rest, and wonder at the world JCAHO thinks actually exists in an ED.


  1. So I read the new rule as best I could without my glasses on:
    “Please remember that licensed independent practitioner control means that the licensed independent practitioner is physically present with the patient while the medication is being administered.”


  2. ED PharmD says:

    Yep, the hospital at which GruntDoc and I work received a “Requirement for Improvement” from JCAHO on this very issue. So, we have thirty days to implement prospective review of all orders – and not just in the ER but also in endoscopy, interventional radiology, pre-op holding, PACU, etc., etc. Impossible…

  3. Goatwhacker says:

    Ed PharmD, is this being pushed by the pharmacy organizations or is this something JCAHO came up with on their own?

  4. The doctors have a hard enough time moving patients through the dept. as it is since it’s, ya know, BUSY. Now they have to sit and watch me push a med like a nursing instructor? How belittling is that?

    Hey doc, I’m going to push morphine down the Hall in Room 14. Wanna come watch? I’m not terribly certain that I know how to do this. I’ve only done it a stich under 10,000 times or so. Yes, put down that chart and quit admitting the patient and reviewing his critical lab results and ordering appropriate treatments. You’re needed in Room 14 to watch me push meds. And when you’re done, there are sick people in 15 and 16 that need you to watch me push anti-emetics and pain meds too. Please and thanks. Don’t bother looking at that chart with the Hgb of 3.4 and ordering blood until you’re done watching me do what I’ve been doing forever.

  5. By the way, I meant no disrespect of your blog title in my 3rd comment on Nurse Ratched’s Place’s posting (in which I retort to Universal Health blog’s criticism of nursing blog titles such as Nurse Ratched and others and nurses’ word choices in their blog postings):


    I simply used your title to make a tongue-in-cheek point about “stereotypes” and how they don’t mean anything in blog titles, etc.

  6. ED PharmD says:

    I’m thinking this is a JCAHO thing all the way. I haven’t heard any pharmacy organizations supporting it. But maybe we should! With the increased demand for pharmacists, our salaries would probably double! (Just kidding…)

  7. GruntNurse. Heh. I need to get that URL now…(and I did).

  8. I read the rule and had a question. How is “licensed independant practitioner” defined?

    I think the nursing organizations should be up in arms about this more than anybody because what JCAHO is in essense saying is that nurses can not be trusted to administer medications. If we take away the nurses ability to do this task, we relegate them to “bed pan changer” and that is frankly quite offensive.

    They have worked hard to earn their title, and deserve to be treated as the intelligent, capable, experienced professionals that they are. Suggesting that it takes a doctoral level degree to actually dispense a little vicodin is absurd.

    I would love it if one of the super smart bloggers out there explained to me the history of JCAHO, who they actually are, and where they get their input from when they make decisions like this.

  9. Bad Shift says:

    Fire JCAHO!

  10. TheNewGuy says:

    What is it about healthcare that attracts these Lampreys?

  11. JCAHO or Joint Commission as they now want to be called, is made up of numerous retired Physicians, Nurses, and Administrators. They attend the required training “brain-washing” sessions about how a hospital should run (Utopia – Perfect World). They do some mock testing and then go out with trained surveyors “master brain-washers” and do inspections.
    Once deemed “properly brain-washed” they are given sites to survey and “spew” the “brain-washed language and ideals” forth on the medical community.
    What is worse is “WE” the hosptial community pay for them to come in and tell us we are doing a “bad” job and are putting our patients at risk.
    Now after 17 years of nursing experience and two master’s degrees later I think that I may have wasted my money on education. Since I am no longer competent to give Aspirin without a physician looking over my shoulder.
    Insurance companies have gotten us into this situation. They don’t pay if you go to a facility that is not JCAHO reviewed. No money means we close our doors and everyone suffers.

  12. Lovely little story:
    Joint Commission surveyor arrives to facility and has a medical problem that brings him to the ED.
    C/O chest pain, radiation to left arm, nausea. HR 97, B/P 85/40, RR 24, SaO2 94%. Rates pain 8/10. Seen by MD, orders written.
    RN walks in to room to draw blood and start a saline lock. “I’m sorry, due to regulations I am not allowed to give you this prescribed medication unless it has been approved by the pharmascist or unless the physician is in attendance. This delay may increase your complications and result in you being in pain for an extended period of time, but we must follow the rules. I can draw your blood and start a saline lock, but can not flush it until the MD arrives. This may cause it to clot and I will need to poke you again.”
    30 minutes later, “Please rate your pain for me on the scale of 1 – 10.” Patient rates pain 10/10. MD notified that pain has increased but no medications have been given because they are not approved by the pharmasicist and the MD has not come back to the room for the RN to give the medications.
    Cardiac monitor now shows increased ST-elevation and pain is still 10/10, pt with B/P 80/40. “I’m sorry, I still can not give you this medication that could save your life because I have to wait for the MD to observe me give it. I understand it is a stupid rule, but JCAHO put it in place to make sure you are safe when you receive medications at our facility.”
    10 minutes later, monitor now shows asystole and the patient is unconscious, Code Blue initiated. 10 minutes later, Code is called, patient died of cardiac arrest.
    Moral of this story, “Don’t tie the hands of the people who could save you.”

  13. Goatwhacker says:

    Good to read a story with a happy ending, Nurse 1961.