JCR CAMAC 2020
$178.21
Comprehensive Accreditation Manual for Ambulatory Care (CAMAC)
Published By | Publication Date | Number of Pages |
JCR | 2020 | 736 |
The CAMAC manual provides you with direct digital access to the elements of performance for ambulatory care standards, National Patient Safety Goals, and Accreditation Participation Requirements (APRs) effective January 1, 2020.
Key Topics:
Standards requirements including the standards, National Patient Safety Goals, and Accreditation Participation Requirements effective January 1, 2020
Standards and elements of performance for optional primary care medical home certification
Accreditation process information about Joint Commission policies and procedures and practical survey preparation information on the Early Survey Policy, documentation requirements, standards applicability, and more
Keys to successfully using the manual for survey preparedness
Key Features:
Regulatory requirements for deemed status
Icons to help navigate documentation requirements as well as risk areas
“What’s New” summary of changes made in 2019
Integrated regulatory requirements for ambulatory surgery center deemed status
Standards: All ambulatory care standards
Setting: Organizations accredited under the Ambulatory Care Accreditation Program, including surgery centers, community health centers, group practices, imaging centers, telehealth providers, sleep labs, rehabilitation centers, student health centers, urgent care clinics, and other ambulatory providers
PDF Catalog
PDF Pages | PDF Title |
---|---|
1 | What’s New 2020 CAMAC |
9 | Cover |
10 | Copyright |
11 | Contents |
13 | Introduction: How The Joint Commission Can Help You Move Toward High Reliability (INTRO) |
14 | I. Introduction to Joint Commission Accreditation |
18 | Table 1. Standards That Address Complex Care Issues in Ambulatory Care Organizations II. About the Comprehensive Accreditation Manual for Ambulatory Care |
34 | III. Steps to Achieving and Maintaining Compliance |
39 | IV. Get Extra Help |
43 | Patient Safety Systems (PS) Introduction |
44 | What Does This Chapter Contain? |
46 | Becoming a Learning Organization |
49 | The Role of Ambulatory Health Care Organization Leaders in Patient Safety |
54 | Data Use and Reporting Systems |
57 | Table 1. Defining and Comparing Analytical Tools |
58 | A Proactive Approach to Preventing Harm |
61 | Encouraging Patient Activation |
62 | Beyond Accreditation: The Joint Commission Is Your Patient Safety Partner |
64 | References |
67 | Appendix. Key Patient Safety Requirements Standard APR.09.01.01 Elements of Performance for APR.09.01.01 Standard APR.09.02.01 |
68 | Elements of Performance for APR.09.02.01 Standard EC.04.01.01 Elements of Performance for EC.04.01.01 |
69 | Standard EC.04.01.03 Elements of Performance for EC.04.01.03 Standard EC.04.01.05 Elements of Performance for EC.04.01.05 Standard HR.01.05.03 Elements of Performance for HR.01.05.03 |
71 | Standard HR.02.01.03 Elements of Performance for HR.02.01.03 Standard IC.01.03.01 Elements of Performance for IC.01.03.01 Standard LD.02.01.01 |
72 | Elements of Performance for LD.02.01.01 Standard LD.02.03.01 Elements of Performance for LD.02.03.01 Standard LD.03.01.01 Elements of Performance for LD.03.01.01 |
73 | Standard LD.03.02.01 Elements of Performance for LD.03.02.01 Standard LD.03.03.01 Elements of Performance for LD.03.03.01 Standard LD.03.04.01 Elements of Performance for LD.03.04.01 |
74 | Standard LD.03.05.01 Elements of Performance for LD.03.05.01 Standard LD.03.06.01 Elements of Performance for LD.03.06.01 |
75 | Standard LD.03.07.01 Elements of Performance for LD.03.07.01 |
76 | Standard LD.03.09.01 Elements of Performance for LD.03.09.01 |
78 | Standard LD.04.01.01 Elements of Performance for LD.04.01.01 |
79 | Standard LD.04.01.05 Elements of Performance for LD.04.01.05 |
80 | Standard MM.07.01.03 Elements of Performance for MM.07.01.03 |
81 | Standard MM.08.01.01 Elements of Performance for MM.08.01.01 Standard PI.01.01.01 |
82 | Elements of Performance for PI.01.01.01 |
83 | Standard PI.02.01.01 Elements of Performance for PI.02.01.01 |
84 | Standard PI.03.01.01 Elements of Performance for PI.03.01.01 Standard RI.01.01.01 Elements of Performance for RI.01.01.01 |
85 | Standard RI.01.01.03 Elements of Performance for RI.01.01.03 |
86 | Standard RI.01.02.01 Elements of Performance for RI.01.02.01 |
87 | Standard RI.01.03.01 Elements of Performance for RI.01.03.01 |
88 | Standard RI.01.05.01 Elements of Performance for RI.01.05.01 Standard RI.02.01.01 Elements of Performance for RI.02.01.01 |
91 | Accreditation Participation Requirements (APR) Overview |
92 | Chapter Outline |
93 | Requirements, Rationales, and Elements of Performance APR.01.01.01 Elements of Performance for APR.01.01.01 APR.01.02.01 Rationale for APR.01.02.01 |
94 | Elements of Performance for APR.01.02.01 APR.01.03.01 Elements of Performance for APR.01.03.01 |
95 | APR.02.01.01 Elements of Performance for APR.02.01.01 APR.03.01.01 Rationale for APR.03.01.01 Elements of Performance for APR.03.01.01 |
96 | APR.05.01.01 Rationale for APR.05.01.01 Elements of Performance for APR.05.01.01 APR.06.01.01 Elements of Performance for APR.06.01.01 |
97 | APR.07.01.01 Elements of Performance for APR.07.01.01 APR.08.01.01 Elements of Performance for APR.08.01.01 APR.09.01.01 |
98 | Elements of Performance for APR.09.01.01 APR.09.02.01 Rationale for APR.09.02.01 Elements of Performance for APR.09.02.01 APR.09.03.01 |
99 | Elements of Performance for APR.09.03.01 APR.09.04.01 Elements of Performance for APR.09.04.01 |
101 | Environment of Care (EC) Overview |
104 | Chapter Outline |
105 | Standards, Rationales, and Elements of Performance Standard EC.01.01.01 Rationale for EC.01.01.01 |
106 | Elements of Performance for EC.01.01.01 Standard EC.02.01.01 Rationale for EC.02.01.01 |
107 | Elements of Performance for EC.02.01.01 |
108 | Standard EC.02.01.03 Elements of Performance for EC.02.01.03 Standard EC.02.02.01 Rationale for EC.02.02.01 Elements of Performance for EC.02.02.01 |
110 | Standard EC.02.03.01 Elements of Performance for EC.02.03.01 |
111 | Standard EC.02.03.03 Rationale for EC.02.03.03 Elements of Performance for EC.02.03.03 |
112 | Standard EC.02.03.05 |
113 | Elements of Performance for EC.02.03.05 |
117 | Standard EC.02.04.01 Elements of Performance for EC.02.04.01 |
118 | Standard EC.02.04.03 Elements of Performance for EC.02.04.03 |
145 | Emergency Management (EM) Overview |
147 | Chapter Outline |
148 | Standards, Rationales, and Elements of Performance Standard EM.01.01.01 Rationale for EM.01.01.01 Elements of Performance for EM.01.01.01 |
149 | Standard EM.02.01.01 |
150 | Rationale for EM.02.01.01 Elements of Performance for EM.02.01.01 |
153 | Standard EM.02.02.01 Rationale for EM.02.02.01 Elements of Performance for EM.02.02.01 |
157 | Standard EM.02.02.03 Rationale for EM.02.02.03 Elements of Performance for EM.02.02.03 |
158 | Standard EM.02.02.05 Rationale for EM.02.02.05 Elements of Performance for EM.02.02.05 Standard EM.02.02.07 Rationale for EM.02.02.07 Elements of Performance for EM.02.02.07 |
160 | Standard EM.02.02.09 Rationale for EM.02.02.09 |
161 | Elements of Performance for EM.02.02.09 Standard EM.02.02.11 Rationale for EM.02.02.11 Elements of Performance for EM.02.02.11 |
163 | Standard EM.02.02.13 |
164 | Elements of Performance for EM.02.02.13 |
165 | Standard EM.02.02.15 |
166 | Elements of Performance for EM.02.02.15 |
167 | Standard EM.03.01.03 Rationale for EM.03.01.03 |
168 | Elements of Performance for EM.03.01.03 |
170 | Standard EM.04.01.01 Elements of Performance for EM.04.01.01 |
173 | Human Resources (HR) Overview |
174 | Chapter Outline |
175 | Standards, Rationales, and Elements of Performance Standard HR.01.01.01 Elements of Performance for HR.01.01.01 |
177 | Standard HR.01.02.05 Elements of Performance for HR.01.02.05 |
178 | Standard HR.01.02.07 Elements of Performance for HR.01.02.07 Standard HR.01.04.01 |
179 | Elements of Performance for HR.01.04.01 |
180 | Standard HR.01.05.03 Elements of Performance for HR.01.05.03 |
182 | Standard HR.01.06.01 Elements of Performance for HR.01.06.01 Standard HR.01.07.01 Elements of Performance for HR.01.07.01 |
184 | Standard HR.02.01.03 |
185 | Elements of Performance for HR.02.01.03 |
189 | Standard HR.02.01.05 Elements of Performance for HR.02.01.05 |
190 | Standard HR.02.02.01 Elements of Performance for HR.02.02.01 Standard HR.02.03.01 |
191 | Elements of Performance for HR.02.03.01 Standard HR.02.04.01 Elements of Performance for HR.02.04.01 |
192 | Standard HR.02.04.03 Elements of Performance for HR.02.04.03 |
193 | Standard HR.03.01.01 |
194 | Elements of Performance for HR.03.01.01 |
195 | Infection Prevention and Control (IC) Overview |
197 | Chapter Outline |
198 | Standards, Rationales, and Elements of Performance Standard IC.01.01.01 Elements of Performance for IC.01.01.01 |
199 | Standard IC.01.02.01 Elements of Performance for IC.01.02.01 Standard IC.01.03.01 Elements of Performance for IC.01.03.01 Standard IC.01.04.01 Elements of Performance for IC.01.04.01 |
200 | Standard IC.01.05.01 Elements of Performance for IC.01.05.01 Standard IC.01.06.01 |
201 | Elements of Performance for IC.01.06.01 Standard IC.02.01.01 Elements of Performance for IC.02.01.01 |
203 | Standard IC.02.02.01 Rationale for IC.02.02.01 |
204 | Elements of Performance for IC.02.02.01 Standard IC.02.03.01 |
205 | Elements of Performance for IC.02.03.01 |
206 | Standard IC.02.04.01 Elements of Performance for IC.02.04.01 |
207 | Standard IC.03.01.01 |
208 | Elements of Performance for IC.03.01.01 |
209 | Information Management (IM) Overview |
210 | Chapter Outline |
211 | Standards, Rationales, and Elements of Performance Standard IM.01.01.01 Elements of Performance for IM.01.01.01 |
212 | Standard IM.01.01.03 Elements of Performance for IM.01.01.03 |
213 | Standard IM.02.01.01 Elements of Performance for IM.02.01.01 |
215 | Standard IM.02.01.03 Elements of Performance for IM.02.01.03 |
216 | Standard IM.02.02.01 Rationale for IM.02.02.01 |
217 | Elements of Performance for IM.02.02.01 |
221 | Leadership (LD) Overview |
224 | Chapter Outline |
225 | Standards, Rationales, and Elements of Performance Standard LD.01.01.01 Rationale for LD.01.01.01 |
226 | Elements of Performance for LD.01.01.01 Standard LD.01.03.01 Rationale for LD.01.03.01 Elements of Performance for LD.01.03.01 |
227 | Standard LD.01.04.01 Elements of Performance for LD.01.04.01 Standard LD.01.07.01 Elements of Performance for LD.01.07.01 |
228 | Standard LD.02.01.01 Rationale for LD.02.01.01 Elements of Performance for LD.02.01.01 Standard LD.02.03.01 Rationale for LD.02.03.01 |
229 | Elements of Performance for LD.02.03.01 |
231 | Standard LD.03.01.01 Rationale for LD.03.01.01 Elements of Performance for LD.03.01.01 |
232 | Standard LD.03.02.01 Rationale for LD.03.02.01 Elements of Performance for LD.03.02.01 Standard LD.03.03.01 Rationale for LD.03.03.01 |
233 | Elements of Performance for LD.03.03.01 Standard LD.03.04.01 Rationale for LD.03.04.01 Elements of Performance for LD.03.04.01 |
234 | Standard LD.03.05.01 Rationale for LD.03.05.01 Elements of Performance for LD.03.05.01 Standard LD.03.06.01 Rationale for LD.03.06.01 Elements of Performance for LD.03.06.01 |
235 | Standard LD.03.07.01 Elements of Performance for LD.03.07.01 |
237 | Standard LD.03.08.01 Elements of Performance for LD.03.08.01 |
238 | Standard LD.03.09.01 Elements of Performance for LD.03.09.01 |
239 | Standard LD.03.10.01 |
240 | Rationale for LD.03.10.01 Elements of Performance for LD.03.10.01 Standard LD.04.01.01 Elements of Performance for LD.04.01.01 |
241 | Standard LD.04.01.03 Elements of Performance for LD.04.01.03 Standard LD.04.01.05 |
242 | Rationale for LD.04.01.05 Elements of Performance for LD.04.01.05 |
243 | Standard LD.04.01.07 Elements of Performance for LD.04.01.07 Standard LD.04.01.11 Rationale for LD.04.01.11 Elements of Performance for LD.04.01.11 |
244 | Standard LD.04.02.01 Elements of Performance for LD.04.02.01 Standard LD.04.02.03 Elements of Performance for LD.04.02.03 |
245 | Standard LD.04.03.01 Elements of Performance for LD.04.03.01 Standard LD.04.03.07 Rationale for LD.04.03.07 Elements of Performance for LD.04.03.07 |
246 | Monitoring Contracted Services |
248 | Standard LD.04.03.09 Elements of Performance for LD.04.03.09 |
249 | Standard LD.04.03.13 Elements of Performance for LD.04.03.13 |
251 | Life Safety (LS) Overview |
253 | Chapter Outline |
254 | Standards, Rationales, and Elements of Performance Standard LS.01.01.01 |
255 | Elements of Performance for LS.01.01.01 |
256 | Standard LS.01.02.01 Elements of Performance for LS.01.02.01 |
258 | Standard LS.03.01.10 Rationale for LS.03.01.10 |
259 | Elements of Performance for LS.03.01.10 |
261 | Standard LS.03.01.20 Rationale for LS.03.01.20 Elements of Performance for LS.03.01.20 |
264 | Standard LS.03.01.30 Rationale for LS.03.01.30 Elements of Performance for LS.03.01.30 |
268 | Standard LS.03.01.34 Elements of Performance for LS.03.01.34 |
269 | Standard LS.03.01.35 |
270 | Elements of Performance for LS.03.01.35 |
271 | Standard LS.03.01.40 Elements of Performance for LS.03.01.40 Standard LS.03.01.50 |
272 | Elements of Performance for LS.03.01.50 |
274 | Standard LS.03.01.70 Elements of Performance for LS.03.01.70 |
277 | Medication Management (MM) Overview |
280 | Chapter Outline |
281 | Standards, Rationales, and Elements of Performance Standard MM.01.01.01 Rationale for MM.01.01.01 Elements of Performance for MM.01.01.01 Standard MM.01.01.03 |
282 | Rationale for MM.01.01.03 Elements of Performance for MM.01.01.03 |
283 | Standard MM.01.02.01 Elements of Performance for MM.01.02.01 Standard MM.02.01.01 Elements of Performance for MM.02.01.01 |
284 | Standard MM.03.01.01 Rationale for MM.03.01.01 Elements of Performance for MM.03.01.01 |
285 | Standard MM.03.01.03 Rationale for MM.03.01.03 |
286 | Elements of Performance for MM.03.01.03 Standard MM.03.01.05 Rationale for MM.03.01.05 Elements of Performance for MM.03.01.05 |
287 | Standard MM.04.01.01 Elements of Performance for MM.04.01.01 |
288 | Standard MM.05.01.01 Elements of Performance for MM.05.01.01 |
289 | Standard MM.05.01.07 Elements of Performance for MM.05.01.07 Standard MM.05.01.09 |
290 | Rationale for MM.05.01.09 Elements of Performance for MM.05.01.09 |
291 | Standard MM.05.01.11 Elements of Performance for MM.05.01.11 Standard MM.05.01.15 Elements of Performance for MM.05.01.15 Standard MM.05.01.17 Elements of Performance for MM.05.01.17 |
292 | Standard MM.05.01.19 Rationale for MM.05.01.19 Elements of Performance for MM.05.01.19 Standard MM.06.01.01 |
293 | Elements of Performance for MM.06.01.01 |
294 | Standard MM.06.01.05 Rationale for MM.06.01.05 Elements of Performance for MM.06.01.05 Standard MM.07.01.01 Elements of Performance for MM.07.01.01 |
295 | Standard MM.07.01.03 Rationale for MM.07.01.03 Elements of Performance for MM.07.01.03 |
296 | Standard MM.08.01.01 Elements of Performance for MM.08.01.01 |
297 | Standard MM.09.01.03 Elements of Performance for MM.09.01.03 |
299 | National Patient Safety Goals (NPSG) Chapter Outline National Patient Safety Goals Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™ |
300 | Requirements, Rationales, and Elements of Performance NPSG.01.01.01 Rationale for NPSG.01.01.01 Elements of Performance for NPSG.01.01.01 NPSG.01.03.01 Elements of Performance for NPSG.01.03.01 |
301 | NPSG.03.04.01 Rationale for NPSG.03.04.01 Elements of Performance for NPSG.03.04.01 |
303 | NPSG.03.05.01 Rationale for NPSG.03.05.01 Elements of Performance for NPSG.03.05.01 |
305 | NPSG.03.06.01 Rationale for NPSG.03.06.01 Elements of Performance for NPSG.03.06.01 |
307 | NPSG.07.01.01 Rationale for NPSG.07.01.01 Elements of Performance for NPSG.07.01.01 |
308 | NPSG.07.05.01 Elements of Performance for NPSG.07.05.01 |
310 | UP.01.01.01 Rationale for UP.01.01.01 |
311 | Elements of Performance for UP.01.01.01 |
312 | UP.01.02.01 |
313 | Elements of Performance for UP.01.02.01 |
314 | UP.01.03.01 Rationale for UP.01.03.01 Elements of Performance for UP.01.03.01 |
317 | Provision of Care, Treatment, and Services (PC) Overview |
319 | Chapter Outline |
320 | Standards, Rationales, and Elements of Performance Standard PC.01.01.01 Elements of Performance for PC.01.01.01 |
321 | Standard PC.01.02.01 Elements of Performance for PC.01.02.01 Standard PC.01.02.03 Elements of Performance for PC.01.02.03 |
322 | Standard PC.01.02.07 Elements of Performance for PC.01.02.07 |
323 | Standard PC.01.02.09 |
324 | Rationale for PC.01.02.09 Elements of Performance for PC.01.02.09 |
325 | Standard PC.01.02.15 Elements of Performance for PC.01.02.15 |
326 | Standard PC.01.03.01 |
327 | Elements of Performance for PC.01.03.01 |
328 | Standard PC.02.01.01 Elements of Performance for PC.02.01.01 Standard PC.02.01.03 Elements of Performance for PC.02.01.03 Standard PC.02.01.05 |
329 | Elements of Performance for PC.02.01.05 Standard PC.02.01.07 Elements of Performance for PC.02.01.07 Standard PC.02.01.09 Elements of Performance for PC.02.01.09 |
330 | Standard PC.02.01.21 Elements of Performance for PC.02.01.21 Standard PC.02.02.01 |
331 | Elements of Performance for PC.02.02.01 Standard PC.02.02.03 Elements of Performance for PC.02.02.03 |
332 | Standard PC.02.03.01 Elements of Performance for PC.02.03.01 |
333 | Standard PC.02.04.01 Elements of Performance for PC.02.04.01 |
334 | Standard PC.02.04.03 Elements of Performance for PC.02.04.03 |
335 | Standard PC.02.04.05 Elements of Performance for PC.02.04.05 |
337 | Standard PC.03.01.01 Elements of Performance for PC.03.01.01 |
338 | Standard PC.03.01.03 Elements of Performance for PC.03.01.03 |
340 | Standard PC.03.01.05 Elements of Performance for PC.03.01.05 Standard PC.03.01.07 Elements of Performance for PC.03.01.07 |
341 | Standard PC.03.02.03 Elements of Performance for PC.03.02.03 Standard PC.03.02.07 Rationale for PC.03.02.07 Elements of Performance for PC.03.02.07 |
342 | Standard PC.04.01.01 Elements of Performance for PC.04.01.01 |
343 | Standard PC.04.01.03 Elements of Performance for PC.04.01.03 Standard PC.04.01.05 Elements of Performance for PC.04.01.05 |
344 | Standard PC.04.02.01 Elements of Performance for PC.04.02.01 |
347 | Performance Improvement (PI) Overview |
349 | Chapter Outline |
350 | Standards, Rationales, and Elements of Performance Standard PI.01.01.01 Elements of Performance for PI.01.01.01 |
352 | Standard PI.02.01.01 Elements of Performance for PI.02.01.01 |
353 | Standard PI.03.01.01 Elements of Performance for PI.03.01.01 |
355 | Record of Care, Treatment, and Services (RC) Overview |
357 | Chapter Outline |
358 | Standards, Rationales, and Elements of Performance Standard RC.01.01.01 Elements of Performance for RC.01.01.01 Standard RC.01.02.01 Elements of Performance for RC.01.02.01 |
359 | Standard RC.01.03.01 Elements of Performance for RC.01.03.01 Standard RC.01.04.01 Elements of Performance for RC.01.04.01 Standard RC.01.05.01 Elements of Performance for RC.01.05.01 |
360 | Standard RC.02.01.01 Elements of Performance for RC.02.01.01 |
362 | Standard RC.02.01.03 Elements of Performance for RC.02.01.03 |
364 | Standard RC.02.01.05 Elements of Performance for RC.02.01.05 Standard RC.02.03.07 Elements of Performance for RC.02.03.07 |
365 | Rights and Responsibilities of the Individual (RI) Overview |
367 | Chapter Outline |
368 | Standards, Rationales, and Elements of Performance Standard RI.01.01.01 Elements of Performance for RI.01.01.01 |
370 | Standard RI.01.01.03 Elements of Performance for RI.01.01.03 Standard RI.01.02.01 |
371 | Elements of Performance for RI.01.02.01 Standard RI.01.03.01 |
372 | Rationale for RI.01.03.01 Elements of Performance for RI.01.03.01 |
373 | Standard RI.01.03.05 Elements of Performance for RI.01.03.05 Standard RI.01.04.01 |
374 | Elements of Performance for RI.01.04.01 Standard RI.01.04.03 Elements of Performance for RI.01.04.03 |
375 | Standard RI.01.05.01 Elements of Performance for RI.01.05.01 |
376 | Standard RI.01.06.03 Elements of Performance for RI.01.06.03 Standard RI.01.07.01 Elements of Performance for RI.01.07.01 |
378 | Standard RI.02.01.01 Elements of Performance for RI.02.01.01 |
379 | Transplant Safety (TS) Overview |
380 | Chapter Outline |
381 | Standards, Rationales, and Elements of Performance Examples of Tissue and Cell Products |
383 | Standard TS.03.01.01 Elements of Performance for TS.03.01.01 |
384 | Standard TS.03.02.01 |
385 | Elements of Performance for TS.03.02.01 |
386 | Standard TS.03.03.01 Elements of Performance for TS.03.03.01 |
387 | Waived Testing (WT) Overview |
390 | Chapter Outline |
391 | Standards, Rationales, and Elements of Performance Standard WT.01.01.01 Elements of Performance for WT.01.01.01 |
392 | Standard WT.02.01.01 Elements of Performance for WT.02.01.01 |
393 | Standard WT.03.01.01 Elements of Performance for WT.03.01.01 |
394 | Standard WT.04.01.01 Elements of Performance for WT.04.01.01 Standard WT.05.01.01 |
395 | Elements of Performance for WT.05.01.01 |
397 | The Accreditation Process (ACC) Notices ACC Chapter Contents |
399 | Overview |
401 | Accreditation Policies |
406 | Table 1. Sampling for System Surveys by Size |
407 | Table 2. Sampling for System Surveys by Risk |
424 | Sidebar 1. Early Survey Policy |
427 | Before the Survey |
432 | During the Survey |
433 | Table 3. Exceptions to Unannounced Surveys*** |
434 | Table 3. |
443 | Table 4. Ambulatory Care–Specific Tracer Applicability and Objectives |
451 | After the Survey |
463 | Between Accreditation Surveys |
466 | Sidebar 2. Focused Standards Assessment (FSA) Options |
467 | Sidebar 2. |
476 | Decision Rules for Organizations Seeking Initial Accreditation |
480 | Decision Rules for Organizations Seeking Reaccreditation |
485 | Process for Organizations That Meet Decision Rule PDA02 for Patients Placed at Risk for Serious Adverse Outcomes Due to Signific |
487 | Process for Organizations That Meet Decision Rule PDA04 |
488 | Review and Appeal Procedures |
495 | Standards Applicability Process (SAP) |
496 | Ambulatory Care Services Applicability |
529 | Sentinel Events (SE) I. Sentinel Events |
535 | II. Goals of the Sentinel Event Policy III. Responding to Sentinel Events |
543 | IV. The Sentinel Event Database V. Determination That a Sentinel Event Is Subject to Review VI. Optional On-Site Review of a Sentinel Event |
544 | VII. Disclosable Information VIII. The Joint Commission’s Response |
545 | IX. Sentinel Event Measures of Success (SE MOS) X. Handling Sentinel Event–Related Documents |
546 | XI. Oversight of the Sentinel Event Policy XII. Survey Process |
547 | Appendix. Accreditation Requirements Related to Sentinel Events Standard LD.03.09.01 Elements of Performance for LD.03.09.01 |
551 | The Joint Commission Quality Report (QR) Introduction What Is The Joint Commission Quality Report? |
552 | What Will My Quality Report Contain? What Is Quality Check? |
553 | Can My Ambulatory Care Organization Comment on Its Quality Report? |
554 | What Are the Marketing and Communication Guidelines for Publicizing Your Accreditation and Commitment to Quality? |
557 | Required Written Documentation (RWD) |
559 | List of EPs Requiring Written Documentation for Ambulatory Care by Service Accreditation Participation Requirements (APR) Environment of Care (EC) Emergency Management (EM) Human Resources (HR) |
560 | Infection Prevention and Control (IC) Information Management (IM) Leadership (LD) Life Safety (LS) Medication Management (MM) |
561 | National Patient Safety Goals (NPSG) (including the Universal Protocol [UP]) Provision of Care, Treatment, and Services (PC) Performance Improvement (PI) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Transplant Safety (TS) Waived Testing (WT) |
562 | Accreditation Participation Requirements (APR) Environment of Care (EC) Emergency Management (EM) Human Resources (HR) |
563 | Infection Prevention and Control (IC) Information Management (IM) Leadership (LD) Life Safety (LS) Medication Management (MM) National Patient Safety Goals (NPSG) (including the Universal Protocol [UP]) |
564 | Provision of Care, Treatment, and Services (PC) Performance Improvement (PI) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Waived Testing (WT) Accreditation Participation Requirements (APR) |
565 | Environment of Care (EC) Emergency Management (EM) Human Resources (HR) Infection Prevention and Control (IC) Information Management (IM) |
566 | Leadership (LD) Medication Management (MM) National Patient Safety Goals (NPSG) (including the Universal Protocol [UP]) Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) |
567 | Rights and Responsibilities of the Individual (RI) Transplant Safety (TS) Waived Testing (WT) Accreditation Participation Requirements (APR) Environment of Care (EC) |
568 | Emergency Management (EM) Human Resources (HR) Infection Prevention and Control (IC) Information Management (IM) Leadership (LD) Medication Management (MM) |
569 | National Patient Safety Goals (NPSG) (including the Universal Protocol [UP]) Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Transplant Safety (TS) Waived Testing (WT) |
570 | Accreditation Participation Requirements (APR) Environment of Care (EC) Emergency Management (EM) Human Resources (HR) Infection Prevention and Control (IC) |
571 | Information Management (IM) Leadership (LD) Medication Management (MM) National Patient Safety Goals (NPSG) (including the Universal Protocol [UP]) Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) |
572 | Rights and Responsibilities of the Individual (RI) Waived Testing (WT) Accreditation Participation Requirements (APR) Environment of Care (EC) Emergency Management (EM) |
573 | Human Resources (HR) Infection Prevention and Control (IC) Information Management (IM) Leadership (LD) Medication Management (MM) National Patient Safety Goals (NPSG) (including the Universal Protocol [UP]) |
574 | Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Waived Testing (WT) Accreditation Participation Requirements (APR) Environment of Care (EC) |
575 | Emergency Management (EM) Human Resources (HR) Infection Prevention and Control (IC) Information Management (IM) Leadership (LD) |
576 | Medication Management (MM) National Patient Safety Goals (NPSG) (including the Universal Protocol [UP]) Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Accreditation Participation Requirements (APR) Environment of Care (EC) |
577 | Emergency Management (EM) Human Resources (HR) Infection Prevention and Control (IC) Information Management (IM) Leadership (LD) |
578 | Medication Management (MM) National Patient Safety Goals (NPSG) (including the Universal Protocol [UP]) Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Waived Testing (WT) |
579 | Accreditation Participation Requirements (APR) Environment of Care (EC) Emergency Management (EM) Human Resources (HR) Information Management (IM) Leadership (LD) |
580 | Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Accreditation Participation Requirements (APR) Environment of Care (EC) Emergency Management (EM) Human Resources (HR) |
581 | Information Management (IM) Leadership (LD) Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Accreditation Participation Requirements (APR) Environment of Care (EC) |
582 | Emergency Management (EM) Human Resources (HR) Infection Prevention and Control (IC) Information Management (IM) Leadership (LD) |
583 | Medication Management (MM) National Patient Safety Goals (NPSG) Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Transplant Safety (TS) |
584 | Waived Testing (WT) Accreditation Participation Requirements (APR) Environment of Care (EC) Emergency Management (EM) Human Resources (HR) Infection Prevention and Control (IC) |
585 | Information Management (IM) Leadership (LD) Medication Management (MM) National Patient Safety Goals (NPSG) Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) |
586 | Rights and Responsibilities of the Individual (RI) Waived Testing (WT) Accreditation Participation Requirements (APR) Environment of Care (EC) Emergency Management (EM) |
587 | Human Resources (HR) Infection Prevention and Control (IC) Information Management (IM) Leadership (LD) Medication Management (MM) |
588 | National Patient Safety Goals (NPSG) Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Waived Testing (WT) Accreditation Participation Requirements (APR) |
589 | Environment of Care (EC) Emergency Management (EM) Human Resources (HR) Infection Prevention and Control (IC) Information Management (IM) Leadership (LD) |
590 | Medication Management (MM) National Patient Safety Goals (NPSG) Provision of Care, Treatment, and Services (PC) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Waived Testing (WT) |
591 | Early Survey Policy (ESP) Accreditation Participation Requirements (APR) Environment of Care (EC) |
592 | Emergency Management (EM) Human Resources (HR) Infection Prevention and Control (IC) Information Management (IM) Leadership (LD) |
593 | Life Safety (LS) Medication Management (MM) National Patient Safety Goals (NPSG) |
594 | Provision of Care, Treatment, and Services (PC) Performance Improvement (PI) Record of Care, Treatment, and Services (RC) Rights and Responsibilities of the Individual (RI) Transplant Safety (TS) Waived Testing (WT) |
595 | Primary Care Medical Home Certification Option (PCMH) Overview Primary Care Medical Home Model |
599 | Standards, Rationales, Elements of Performance, and Scoring Specific to the Primary Care Medical Home Certification Option I. Patient-Centered Care Standard LD.03.04.01 Elements of Performance for LD.03.04.01 |
600 | Standard LD.03.07.01 Elements of Performance for LD.03.07.01 Standard LD.03.08.01 Elements of Performance for LD.03.08.01 |
601 | Standard LD.04.01.11 Elements of Performance for LD.04.01.11 Standard PC.01.03.01 Elements of Performance for PC.01.03.01 Standard PC.02.01.01 Elements of Performance for PC.02.01.01 Standard PC.02.01.21 |
602 | Elements of Performance for PC.02.01.21 Standard PC.02.02.01 Elements of Performance for PC.02.02.01 Standard PC.02.03.01 Elements of Performance for PC.02.03.01 |
603 | Standard PC.02.04.01 |
604 | Elements of Performance for PC.02.04.01 Standard PC.02.04.05 Elements of Performance for PC.02.04.05 Standard RC.02.01.01 Elements of Performance for RC.02.01.01 |
605 | Standard RI.01.01.01 Elements of Performance for RI.01.01.01 |
606 | Standard RI.01.01.03 Elements of Performance for RI.01.01.03 |
607 | Standard RI.01.02.01 Elements of Performance for RI.01.02.01 |
608 | Standard RI.01.03.01 Elements of Performance for RI.01.03.01 Standard RI.01.04.01 Elements of Performance for RI.01.04.01 |
609 | Standard RI.01.04.03 Elements of Performance for RI.01.04.03 |
613 | II. Comprehensive Care Standard HR.03.01.01 Element of Performance for HR.03.01.01 Standard PC.02.01.05 Element of Performance for PC.02.01.05 |
614 | Standard PC.02.04.03 Elements of Performance for PC.02.04.03 Standard PC.02.04.05 |
615 | Elements of Performance for PC.02.04.05 Standard RI.01.04.03 |
616 | Elements of Performance for RI.01.04.03 III. Coordinated Care Standard HR.01.02.07 Elements of Performance for HR.01.02.07 Standard PC.01.03.01 Elements of Performance for PC.01.03.01 |
617 | Standard PC.02.02.01 Elements of Performance for PC.02.02.01 Standard PC.02.03.01 Elements of Performance for PC.02.03.01 Standard PC.02.04.03 |
618 | Elements of Performance for PC.02.04.03 Standard PC.02.04.05 Elements of Performance for PC.02.04.05 |
619 | Standard PC.04.01.01 Elements of Performance for PC.04.01.01 Standard PC.04.01.03 Elements of Performance for PC.04.01.03 |
620 | Standard PC.04.01.05 Elements of Performance for PC.04.01.05 Standard PC.04.02.01 Elements of Performance for PC.04.02.01 Standard RC.01.01.01 |
621 | Elements of Performance for RC.01.01.01 IV. Superb Access to Care Standard PC.02.04.01 Elements of Performance for PC.02.04.01 |
622 | V. Systems-Based Approach to Quality and Safety Standard LD.03.04.01 Elements of Performance for LD.03.04.01 |
623 | Standard LD.03.07.01 Elements of Performance for LD.03.07.01 Standard LD.03.08.01 Elements of Performance for LD.03.08.01 |
624 | Standard LD.03.09.01 Elements of Performance for LD.03.09.01 |
626 | Standard LD.03.10.01 Elements of Performance for LD.03.10.01 Standard LD.04.01.05 Elements of Performance for LD.04.01.05 Standard LD.04.01.11 Elements of Performance for LD.04.01.11 |
627 | Standard MM.04.01.01 Elements of Performance for MM.04.01.01 Standard PC.01.03.01 Elements of Performance for PC.01.03.01 Standard PI.01.01.01 Elements of Performance for PI.01.01.01 |
628 | Standard PI.02.01.01 Elements of Performance for PI.02.01.01 Standard PI.03.01.01 Elements of Performance for PI.03.01.01 |
631 | Glossary (GL) |
667 | Index (IX) |