Managers: Please review these Questions and Answers with your staff/teams this week.
Providers and Staff: Please review and be ready to answer these questions.
We are in the window for an unannounced site visit/survey by The Joint Commission. To access preparation resources, including the comprehensive Reference Guide, visit the Survey Readiness section.
If you have questions, please contact Lisa LeClair, Accreditation and Regulatory Specialist.
How will you know that Joint Commission surveyors have arrived onsite?
Once we are notified to expect surveyor arrival, regulatory leaders are paged, followed by an organization-wide email and overhead announcement will be given at University hospital. Word will spread quickly.
What do you do if an individual presents to your area stating he/she is a surveyor?
A surveyor should never be in our clinical areas without an organizational escort. Have the person wait in an attended area and contact your immediate supervisor or the Administrator on Call.
What does RACE and PASS stand for?
In a fire use RACE:
To use the Fire Extinguisher use PASS:
Where in Health Link would you findif a patient has an advance directive and if it is activated?
The advance directive can be accessed by clicking on FYI in Health Link looking under the legal/consent tab or in the in-patient setting clicking on the FYI in the banner.
Where can you find information on physician privileges and NP/PA prescriptive authority?
Physician privileges and NP/PA prescriptive authority is located on U-Connect under Clinical Apps - Privilege List - Privilege List Search.