The final outcome of patient’s health has been a concern since the early part of the 20th century. It was then; medical professionals started looking at developing a standard in which they could determine whether patients were receiving the best treatment. The first standards were put in place by the American College of Surgeons, which instituted the practice of hospital inspections. Out of seven hundred inspections only eighty-nine were deemed to make the grade. At that time, the standards were only a page long.
Forty years later with the formation of the Joint Commission on Accreditation of Hospitals, now known as the Joint Commission, 3,200 hospitals gained accreditation. Currently, this organization has grown larger and has higher standards that hospitals must meet. The Joint Commission is now the authority for inspection of health care facilities in most states. The Centers for Medicare and Medicaid Services set standard approval guidelines and determines whether or not the organization can take part in the Medicare and Medicaid program.
Responsibilities have increased with the expansion of the inspection program for all those involved. The development of the Core Measures has been the most significant change due to the way in which they measure the level of patient care. This is the first time any progress has taken place in over a century.
According to the Joint Commission, these Core Measures are defined as “criteria that produce the greatest positive impact on patient outcomes when hospitals demonstrate improvement on them.” Therefore, they are now classified as Accountability Measures.
In order to avoid being penalizes by the Joint Commission, all health care organizations must make regular reports on how they meet these Core Measures. The reports must address critical areas of nursing, health care and the increased job requirements for nurses.
Five Categories of Core Measures for Nurses
Nurses must meet the criteria in this category that addresses the needs of patients admitted to hospitals when they are suffering from pneumonia. These requirements include having blood culture tests completed within twenty-four hours of admission before antibiotics are administered.
Congestive Heart Failure
Patients who have been in hospital with Congestive Heart Failure (CGF) must receive discharge instructions from the nurse before they leave the hospital. Where applicable, it should include advice on reasons to quit smoking. Some of the tests that must be performed prior to discharge include a left ventricular systolic function test. The test checks how well the heart is able to pump blood. Other tests that should be performed are a test of angiotensin-converting enzyme inhibition and angiotensin Receptor Blockers to evaluate the patient for left ventricular systolic disease.
Acute Myocardial Infraction
Nurses have a lengthy checklist to go through for patients with Acute Myocardial Infraction when they arrive at the hospital for the delivery of treatment with aspirin. They also have to make sure that the patient has a prescription to take home. Counseling and tests identical to CHF measures are performed along with notation on times for blood coagulation therapy and percutaneous coronary intervention.
Steps are being taken to set the standards for nurse accountability in this category. The present Core Measures include treatments used while the child is in hospital, the type of corticosteroids used, advice and counseling for parents and guardians at home.
Improvement in Surgical Care
Improvement on preventing infection and surgical outcomes following surgery has required nurse care to evaluate the use of beta blocker, embolism preventative intravenous medications, and antibiotics, as well as hair removal from the surgical site prior to surgery and catheter removal within two days following surgery.
A majority of healthcare organizations have created checklists to document nursing care being evaluated for core measures. Adhering to the guidelines defined by Centers for Medicare and Medicaid Services and the Joint Commission will assure the improvement on the level of care that patients can expect along with continued refinement in the quality of patient outcomes.
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