Suicidal Over JCAHO
JCAHO is truly the blight of the medical system. They are actually a private organization, smiled upon by the government, which came up with a "provision that hospitals accredited by JCAH are "deemed" to be in compliance" back in the fifties. In essence, they are an accrediting organization that's been around for more than a century. Nowadays, they come through the hospitals, looking for the piddleliest little things to ding hospitals with. By ding, I mean bring multi-thousand dollar fines against. Each hospital apparently gets its own list of wrongdoings, there's no consistency that I've noticed. Here at the Swiss Cheese, one of their issues are saline syringes. Even though there is no needle involved, and even though we are talking about sterile saltwater, apparently these saline syringes are too dangerous to be left to the meddling hands of patients and their families. These people might try to squirt someone in the eye.
Another thing that they are tremendously focused on are two points on our admission paperwork: whether patients are suicidal and whether they want to quit smoking. Focused is not a strong enough term, they are downright anal about these two essential parts of patient care. I've had several conversations with the managers on my unit about making sure that these questions get filled out. It's hard for me to remember to complete these parts, because I'm noncompliant with making this an issue. Hey, if you want to smoke, go ahead, it keeps jobs available for me when you get lung cancer. And suicide? Don't get me started on why people seem to be so unsuccessful with that.
Anyhow, there was a false alarm on Monday. Word gets out when JCAHO is in the house, meaning they are somewhere in the hospital making some employees miserable (and suicidal), while at the same time interrupting the much less important patient care. It's been rumored since we arrived in August that JCAHO was coming, so there has been this palpable tension building everywhere, as managers throughout the hospital develop hypertension and stress ulcers. Well, word came that the dreaded JCAHO goons were finally in house. That set off a frenzy of action, none of it remotely involved with patient care.
Of course, I was taking care of a patient who had been admitted over the weekend completely unresponsive. A spur of the moment decision to get a CT scan turned out to be very helpful, it showed that he'd had a horrific stroke, and one side of his brain was completely whited out. That explained why he didn't follow any commands at least. At any rate, the opportunity to ask him if he was ready to give up smoking or if he was suicidal never arose for me, on the three days I cared for him. I could have asked his family, but they never showed up. Unfortunately, the fact that I hadn't asked him those two essential questions meant that I had to face the manager.
It wasn't that she showed up to talk to me, after not even saying hello for weeks, just to point out that these two questions were incomplete on the admission form. It was plain enough to her when she saw the patient why I couldn't just ask him. It wasn't even that obviously this man had smoked his last cigarette, and that he was already on a different train to the afterlife. It was that she wanted me to call his family to ask them whether this man was suicidal or ready to quit smoking.
That's what really stunned me.
I'm getting good at my poker face, I've been working on it a lot here. In my head, I was heaping scorn onto her head like hot coals. I had all sorts of witty comments which I silently rebuked her with. But outwardly I was cool as Wisconsin nowadays, and put forth my best lie.
"I'll get right on it."
Later she sent the charge nurse to remind me that these questions still were unanswered. The poor girl was almost too sheepish to tell me, so I was nice to her. I didn't tell her that there was absolutely no way that I would stoop to such levels to follow such stupidity. Can you imagine that conversation?
"Hello. This is Bob's nurse. I am so sorry about the news about his stroke. But listen, I have a question for you. Do you think he is ready to give up smoking? How about suicide? Has he talked about wanting to kill himself recently?"
If she wants those questions answered, she'll just have to use the phone in her office to give that family a call.
That is what JCAHO does for our medical system, a private organization operating with government approval to hold hospitals hostage under the threat of massive fines for such total, complete pig patooey. No wonder we pay more per capita for our healthcare than any other country and yet so many get so little from it. 'Cause, God forbid someone steal some saline syringes, we need a massive organization to keep an eye on that.
Until next time, be safe.
