Accreditation Update—2011 JCI Hospital Standards Coming in July 2010

The fourth edition of the Joint Commission International (JCI) Standards for Hospitals will be published in July 2010 and effective for surveys scheduled after 1 January 2011.

The Standards Subcommittee of JCI’s Accreditation Committee met in Frankfurt on 2–3 February 2010 (see Photo 1 below) to review proposed changes to the third edition hospital standards. From that meeting came new and revised standards that went to field review 22 February through 12 March before full approval by the Accreditation Committee 31 March 2010.

Although changes to the third edition standards in 2007 were far-reaching, the fourth edition standards organizations are less extensive. Significant changes will include the following:

► “Improve the Safety of High-Alert Medications,” International Patient Safety Goal 3, will cover all high-alert medications used
by the organization.

► The “Access to Care and Continuity of Care” chapter (ACC) will have new requirements on the need to stabilize emergency
patients prior to transfer to another organization and the need to strengthen the integration of outpatient information for patients
provided ongoing care from multiple clinics.

► The “Patient and Family Rights” chapter (PFR) will now include a requirement that the organization supports the patient’s right
to obtain second opinions.

► The “Assessment of Patients” chapter (AOP) will include a new requirement regarding timely reporting of critical results of
diagnostic tests.

► The “Quality Improvement and Patient Safety” chapter (QPS) will include expanded requirements on comprehensive risk
management framework as a tool for the reduction of adverse events and two new standards are intended to focus organizations
on the quality of the data they collect and use in their improvement activities.

► The “Prevention and Control of Infections” chapter (PCI) will include expanded requirements regarding the reuse of single-use
devices.

► The “Governance, Leadership, and Direction” chapter (GLD) will call for greater oversight of organizational contracts and
independent practitioners, as well as establishing a framework for ethical management to ensure that patient care is provided
within business, financial, ethical, and legal norms and that protects patients, their families, and employees.

More information will be available in the July 2010 issue of JCInsight or at www.jointcommissioninternational.com.

Photo 1. Members of the JCI Standards Subcommittee met in Frankfurt on 2–3 February 2010 to
approve the fourth edition of the JCI standards for hospitals. Picture are (seated, from left)
Annette Jolly, Aut Even Hospital, Kilkenny Ireland; Claudia Jorgenson, Associate Director,
Standards Development and Interpretation, JCI; Marlis Daerr, JCI Surveyor; Ana Tereza Cavalcanti
de Miranda, CBA, Rio de Janeiro, Brazil; Cathy Hwei-ying Wung, Taiwan Joint Commission on Hospital
Accreditation and Quality Improvement, Taipei, Taiwan; (standing, from left) Lee Chien Earn, Ministry
of Health, Singapore; Paul Hoffman, Hoffman Healthcare Group; Walid A. Fitaihi, International Medical
Center, Jeddah, Saudi Arabia; Carlo Ramponi, Managing Director, European International Office, JCI;
Paul vanOstenberg, Senior Executive Director, Standards, Performance Measures and New Products, JCI;
David Marx, University Hospital, Prague, Czech Republic; Jorge Augusto Vasco Varanda, Portugal;
Stanley Kent, NorthShore University Health System; Stuart Whittaker, Council for Health Services Accreditation
of Southern Africa, Pinelands, South Africa.