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For members of the nursing team of the VA Greater Los Angeles Healthcare System, participation in pilot testing of surprise JCAHO visits is about continuous readiness and maintaining quality patient care.

One hundred hospitals have volunteered to take part in the pilot testing of unannounced accreditation surveys-which many nurses dub "The Visit"-and Annya Slaughter, RN, said the surprise inspections could be a healthy change.

"I've been through accreditation at several facilities, and there was definite anxiety as the date approached-everybody wanted to take a vacation," said Slaughter, who works as a critical care nurse for the Veterans Administration Greater Los Angeles Healthcare System. "It's always been 'Let's get ready,' and now it will be 'Let's be ready, all the time.' "

That sentiment is also what prompted Children's Memorial Hospital in Chicago to be the first in the nation to volunteer for unannounced regular surveys in 2004 by the Joint Commission on Accreditation of Healthcare Organizations, which sets compliance standards for quality care and patient safety.

The pilot program is designed to smooth the way to make such unscheduled visits permanent in 2006.

"We always felt well-prepared for JCAHO visits, but I like the change to unannounced surveys," said Shelley Uttley, RN, special projects manager at Children's. "There was a tendency to go into high gear as the survey time got closer, and the approach now is that we always want to be in high gear.

"What I'm really trying to do is change people's mind-sets, so if surveyors walk through the door tomorrow, we're ready."

Linda Murphy-Knoll, vice president for accreditation service operations for the Joint Commission, said a paradigm shift will take place in survey procedures starting Jan. 1, with the transition to unannounced visits in 2006 being the final step in the process.

Patient focus

Under revised JCAHO guidelines, scoring will be eliminated, along with general departmental inspections and many formal interviews, Murphy-Knoll said. Instead, surveyors "will really look at patient care. They'll follow specific patients through the system and look at the critical issues from that point of view."

Before such performance evaluation, hospitals will prepare self-assessments-now called periodic performance reviews-related to quality care and patient safety. "We'll look at the processes and make sure they're in compliance with our standards before ever going on-site," Murphy-Knoll said.

She said she has received positive e-mails from staff nurses who like the new idea of randomly selecting patients for evaluating standards of care.

"Nurses see the process as very credible, and many have been pushing for this for years. They want us to really look at what's happening in hospitals, not at what is prepared for an accreditation visit."

Uttley said she's been "living and breathing" JCAHO awareness since being in charge of preparing Children's Memorial nurses and staff for unannounced visits and the changes in how evaluations will be done.

She said nurses were taking part in a big push to keep patient safety and staff effectiveness "in people's heads" and that a JCAHO preparedness fair was being planned. The fair would use entertaining ways to educate the staff, such as flash cards, games and interactive computer programs that focus on safety standards and optimal practices, Uttley said.

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