For many years I owned and operated a surgical equipment business. Most of our customers were small 1-2 O.R ASC's. Plastic surgeons, pain management etc. These were, for the most part de novo facilities.
During the initial planning stages of the new ASC, I would become involved with the Accreditation consultant the ASC hired to get them through the initial survey. One thing that really struck me was just how different these consultants were in how they approached their job.
Most consultants approached their job with knowledge and professionalism. They worked closely with their client and made sure they passed their survey and developed a lasting relationship. There were others who performed poorly.
Just as there are differences in consultants, there are differences in their interpretation of what is or is not required by the accrediting organizations. An example of this is daily log book forms. The documentation that nurse staff fill out each day prior to surgery to show all is in order to begin surgery.
Today, you can look at the forms of a single O.R. plastic surgeon ASC, then go to another plastic surgeon with the exact same facility layout and accrediting organization and they will have different forms. Why? Simple, they had different consultants with different interpretations.
Consultants will interpret things differently. One will say "A" is required by the accrediting organization while another will say "B" is required. One will say "Surveyors want to see this in your documentation", another will not even mention it.
This brings up the issue of Surveyors. They are well trained professionals who are vetted by the accrediting organizations. Surveyors do have proficiency requirements and they must be current in the regulations and rules. Unlike consultants, they cannot just decide to be a surveyor, they must be approved by the accrediting organization. Many surveyors are also Physicians.
Surveyors and consultants do have one thing in common; they have opinions. One surveyor will want to see "A" on a form and another will want to see "B". Three years later, a new surveyor will want something else. This further increases the difference in the log book forms in our Plastic surgery ASC's mentioned above.
Let's shift the discussion to the nurse staff of an ASC that bears the weight of what Surveyors and consultants agree or disagree on. What is "required" on a form and what is "requested".
Filling out forms takes time. The more information required on a form, the more time it takes to complete it. Autoclave forms can be very simple or very complex. There is confusion as to when a biological test is required and when not. One facility I know of was told to do a biological test EVERY load!
With Surveyors interpretation's and consultant's interpretations of daily log book form requirements, making it easier and less time consuming for compliance is a distant dream for nurse staff.
Making accreditation compliance easier and less confusing is simple; Standardized forms.
A crash cart in a 1 O.R facility is the same as one in a 6 O.R. facility regardless of accrediting organization. Checking equipment, eye wash stations, cleaning and disinfecting are the same regardless of size or speciality of an ASC.
Standardizing forms opens up tremendous opportunity to bring accreditation compliance into a more modern and efficient system. By having standard daily log book forms you eliminate "opinions". They can also be placed in an electronic format to be used by anybody.
You can use an iPad as an example to move about the facility and enter log book data.. Nurse staff can always be current with their log books. Years worth of forms are stored in the cloud to be accessed by a surveyor who can view log book data and compliance in report formats they can choose.
Standardized electronic forms can be built upon. Daily log books, life safety and more. Nurse staff can get pop up reminders when tasks have not been completed. Another advantage of electronic forms is the prevention of backdating log book entries. Surveyors get highly accurate reporting.
It took an act of Congress to modernize and bring EMR into doctors offices. Perhaps the accrediting organizations can do the same for ASC's?
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