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Millennium and JCI Anesthesia and Surgical Care

Accreditation Standards
September 1, 2008
Introduction
The purpose of this white paper is to present Cerner’s opinions concerning how it believes
Millennium and associated solutions can potentially support the efforts of clients to comply with
many of the standards contained in the Anesthesia and Surgical Care (ASC) section (pp.107-115)
of the 2007 Joint Commission International (JCI) Accreditation Standards for Hospitals, 3rd
Edition (effective January 2008).
The white paper and the information and opinions it contains have not been reviewed or
endorsed in any way by JCI. While every effort was made to ensure the accuracy and
completeness of information in the white paper when it was published, it should be used only for
reference purposes. Interested parties should contact Cerner directly to obtain the most up-todate information concerning solution offerings and functionality, and to discuss how they might
be used to address specific JCI standards.
General Focus of the Standards
The general focus of the accreditation standards in this area can be summarized as follows:
- That operative or other procedures and/or use of moderate or deep sedation/anesthesia are
planned
o Patients subject to such procedures are under pre- and post-operative plans of care
o Patients subject to such procedures are closely monitored
- That care is delivered in an interdisciplinary manner including coordination internally
and externally of resources required for patient care
- Coordination of assessments, procedural care, and post-op orders is planned and executed
throughout the surgical case
- Procedures are appropriate and risks are evaluated throughout the surgical case
Millennium’s Role in Enabling Compliance
The standards found within the Anesthesia and Surgical Care requirements section of the JCI
accreditation standards are focused on the continuous management of sedation and surgical care
delivered to the patient. There are specific requirements around proper assessments being
completed at specific times during each surgical case. There are care planning and
documentation requirements around sedation and patient monitoring of patient status during
procedures which are achieved through PowerPlans and Documentation Management. The
specific requirements around surgical planning, and documentation before, during, and after the
procedure is achieved through the use of PowerPlans and SurgiNet. Post-surgical activities are
scheduled and planned through the system.
Cerner Corporation
Confidential Information
©Cerner Corporation. All rights reserved. This document contains confidential and/or proprietary information which
may not be reproduced or transmitted without the express written consent of Cerner.

and services referenced in this white paper may not be available in all markets. personnel and facilities are available from a patient scheduling standpoint – and maintain awareness of resource availability. laws.     Anesthesia services meet applicable local and national standards. At a more granular level. this is typically limited to what can be documented as a Cerner Corporation Confidential Information ©Cerner Corporation. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. Surgical system does support documenting surgical assessments in surgical notes. the system can enable scheduling of all those resources. Adequate. and regulations. For invasive diagnostic imaging exams. Outside sources are selected based on recommendations of the director. an acceptable record of performance.1 – Anesthesia services are available to meet patient needs. compliance with applicable laws and regulations.The key Millennium solutions involved include: - Order Management PowerPlans CareNet Documentation Management INet eMAR PowerPOC Results review Discern Expert Patient Management Patient Privacy SurgiNet FirstNet ProCure Note: The solutions. The system can help with resource scheduling to assure the correct equipment. . Organization and Management ASC.) The JCI standards that are highlighted for comment are those that seem to most directly imply a system role in compliance. All rights reserved. laws. Millennium can assist in enabling compliance with these standards in the ways described below. and regulations and professional standards. Anesthesia services are available for emergencies after normal hours of operation. If the resources defined for a surgical service or invasive diagnostic imaging service include pre. (Specific JCI accreditation standards are stated followed by the abilities of Millennium to enable compliance. regular and convenient anesthesia services are available to meet patient needs.and post-op resource as well as the surgical team/package. solution functionality. and all such services meet applicable local and national standards.

Responsibilities include maintaining quality control programs. e) special qualifications or skills of staff involved in sedation process.        Anesthesia services are under the direction of one or more qualified individuals.     Appropriate policies and procedures.3 – Policies and procedures guide the care of patients undergoing moderate and deep sedation. implementing.3. (Also see GLD. guide the care of patients undergoing moderate and deep sedation. ASC. c) special consent considerations. to evaluate risk and appropriateness of the sedation for the patient. Individual(s) carries out the responsibilities. and maintaining policies and procedures. Cerner Corporation Confidential Information ©Cerner Corporation. or other special considerations. Responsibilities include administrative oversight. b) documentation required for the care team to work and communicate effectively. [NOTE: The following section is from the intent statement. .2 participates in the development of the policies and procedures.3.part of the pre-procedure checklist and is typically documented post procedure through the Technologist comment field if done in the system at all. (Also see Glossary. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. (Also see GLD. ME 2 and MMU. (Also see AOP. All rights reserved. according to organization policy. GLD 5) Responsibilities include developing. h) appropriate monitoring. addressing at least the elements a) through f) found in the intent statement. The qualified individual(s) identified in ASC.5.4.5) The system does not play a direct role in this requirement other than providing security by role for who can document and order these types of services. d) patient monitoring requirements.] Sedation policies identify a) how planning will occur including the identification of differences between adult and pediatric populations. ASC. The qualified practitioner responsible for the sedation is qualified in at least elements g) through k) in the intent statement.2. Responsibilities include recommending outside sources of anesthesia services.2 – A qualified individual(s) is responsible for managing the anesthesia services.] Sedation policies identify g) techniques of various modes of sedation. There is a presedation assessment. and f) availability and use of specialized equipment. ME 1) Responsibilities include monitoring and reviewing all anesthesia services. if appropriate. ME 1) [NOTE: The following section is from the intent statement.

1. This can be done through telemetry interfaces with the medical devices if available. A qualified individual monitors the patient during sedation and during the period of recovery from sedation and documents the monitoring. The system can support documentation of sedation/anesthesia administration in surgical documentation. The two assessments are performed by individual(s) qualified to do so. For invasive diagnostic imaging exams. Cerner Corporation Confidential Information ©Cerner Corporation. Moderate and deep sedation are administered according to hospital policy. ME 1) Patients are re-evaluated immediately before the induction of anesthesia. The plan is documented. and k) at least basic life support. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. All rights reserved.   The anesthesia care of each patient is planned.5 – Each patient’s anesthesia care is planned and documented. j) use of reversal agents. For invasive diagnostic imaging exams. this is typically limited to what can be documented as a part of the pre-procedure checklist and is typically documented post procedure through the Technologist comment field if done in the system at all. The two assessments are documented in the clinical record (also see Glossary). Surgical system does support documenting surgical assessments in surgical notes.4 – A qualified individual conducts a preanesthesia assessment and preinduction assessement.1. ASC. See Response to ASC. this is typically limited to what can be documented as a part of the pre-procedure checklist and is typically documented post procedure through the Technologist comment field if done in the system at all. Any alarms or notifications of possible patient distress would be a function of the medical devices themselves. The system can support making documentation elements required in anesthesia documentation that is present to administer and monitor anesthesia during the surgical procedure.  i) response to complications. (Also see AOP. . Anesthesia Care ASC.1. The system can support documentation of monitoring activities during the procedure in the same documentation. Surgical system does support documenting surgical assessments in surgical notes. but the actual continuous posting of the telemetry is usually outside the scope of system use.     A preanesthesia assessment is performed for each patient.

ASC. The system can support documentation of monitoring activities during the procedure in the same documentation. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.1. All rights reserved. benefits. This information may be identified as required information for entry as part of the surgical documentation for the patient’s record.   The patient. (Also see AOP. ME 1) The results of monitoring are entered into the patient’s anesthesia record. the scheduling system can assist with sequencing of scheduled procedures to help assure that diagnostic testing is done in the appropriate sequence relative to other activities. ME 6 and MCI.   The anesthesia used is written into the patient’s anesthesia record.5.19. . System does not directly provide ability to administer plan of care for plans of care in surgery or invasive procedures – but views the invasive procedure as an order or schedulable procedure.1.2. his or her family. and alternatives of anesthesia. The system may be used to capture the documentation of the fact that education was provided and complications/options discussed. The anesthesiologist or another qualified individual provides the education. (Also see MCI.1. benefits. For scheduled surgical or diagnostic imaging procedures. ASC. ME 4) The system can support documentation of sedation/anesthesia administration in surgical documentation.5. but structured plans of care are not currently supported by SurgiNet. family and decision makers are educated on the risks.2.3 – Each patient’s physiological status during anesthesia administration is continuously monitored and written in the patient’s record   Physiological status is continuously monitored during anesthesia administration. Cerner Corporation Confidential Information ©Cerner Corporation. and alternatives are discussed with the patient. This can be done through telemetry interfaces with the medical devices if available.19.5.1 – The risks.Anesthesia may be scheduled as a part of the scheduling of the patient’s surgical procedure. ME 4) The anesthetic technique used is written into the patient’s anesthesia record. but the actual continuous posting of the telemetry is usually outside the scope of system use. or those who make decisions for the patient.2 – The anesthesia used and anesthetic technique are written in the patient record. ASC. (Also see COP.

and the patient is discharged from the recovery area by a qualified individual or by using established criteria. . Patients are discharged from the postanesthesia unit in accordance with the alternatives described in a) through c) found in the intent statement. [NOTE: the following section is from the intent statement.5. Recovery area arrival and discharge times are recorded.1. based on the results of the assessment. such as a cardiovascular intensive care unit. ME 3. See response to ASC.6. ME 3) Prior to the procedure.7 – Each patient’s surgical care is planned and documented.1.5. b) The patient is discharged by a nurse or similarly qualified individual in accordance with postanasthesia criteria developed by the hospital’s leaders. Surgical Care ASC.1. (Also see MCI. (Also see MCI. a perioperative diagnosis is documented.   Patients are monitored appropriate to their condition during the postanesthesia recover period. 2.3.6 – Each patient’s postanethesia status is monitored and documented. The assessment information is available to the surgeon and surgical team as needed. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. and the discharge is documented in the patient’s record. and the planned care and perioperative diagnosis may be captured as required elements of surgical documentation. ME 1.1. The system can help with resource scheduling to assure the correct equipment.19. ME 2) Prior to the procedure. 1. (Also see AOP.     Each patient’s surgical care is planned. and AOP. neurosurgical intensive care unit. AOP. the planned surgical care is documented. ME 3) Monitoring findings are entered into the patient’s record.4. c) The patient is discharged to a unit which has been designated as appropriate for postanesthesia or postsedation care of selected patients. All rights reserved. among others. The discharge criteria used and the arrival and discharge times may be recorded as required elements of the surgical documentation.2. If the resources defined for a surgical service include pre and post op resource as well as the surgical team/package.] a) The patient is discharged by a fully qualified anesthesiologist or other individual authorized by the individual(s) responsible for managing the anesthesia services. the system can enable scheduling of all those resources.5.ASC. personnel and facilities Cerner Corporation Confidential Information ©Cerner Corporation. (Also see AOP. ME 4) Results of these activities can be documented in surgical documentation.19. The planning process considers all available assessment information.

1. The patient’s surgeon or other qualified individual provides the education. The above elements of surgical documentation can all be defined as required elements in the system. benefits.1 – The risks. and alternatives are discussed with the patient and his or her family or those who make decisions for the patient. ASC. (Also see AOP.are available from a patient scheduling standpoint – and maintain awareness of resource availability. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.2. family and decision makers are educated on the risks. . and alternatives to blood and blood product use.1. (Also see COP.     A post operative diagnosis is documented. is available before the patient leaves the postanesthesia recovery area. or a brief not in the patient’s record. ME 1) The patient’s physiological status is monitored during the immediate post surgery period. There is not a current capability to define consent requirements for procedures or to be aware of consent requirements at time of scheduling of procedures that may require informed consent. Consent administration is typically done procedurally. ME 1) The education includes the need for.3 – Each patient’s physiological status is continuously monitored during and immediately after surgery and written in the patient’s record. Witnessing can also be documented through this same means.3.6. A description of the surgical procedure. ASC.2. ME 2) See response to COP. MEs 1 and 2) The names of the surgeon and surgical assistants are documented The written surgical report. and the appropriate clinical personnel verify that it has been collected prior to the time of a procedure or an examination as a part of pre-procedure or pre-surgical checklist processes. ME 1) Cerner Corporation Confidential Information ©Cerner Corporation.4.2 – The surgery performed is written in the patient record. ASC.5.6. (Also see PFR. risk and benefits of. (Also see AOP.7. benefits. Consent forms signed offline can be scanned in as electronic documents or administered and signed electronically and associated to the encounter for which the procedure is scheduled or provided. (Also see PFR. findings and any surgical specimens is documented.2. All rights reserved.    The patient.7. potential complications and alternatives related to the planned surgical procedure.7.   The patient’s physiological status is monitored continuously during surgery.

This can be done through telemetry interfaces with the medical devices if available.7. ME 4) The system can support documentation of monitoring activities during the procedure in the same documentation. To the extent that the system may support the scheduling of post surgical care activities. Cerner Corporation Confidential Information ©Cerner Corporation. This document contains confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. and documented as a part of the surgical documentation. ASC.4 – Patient care after surgery is planned and documented. The system also may be used to document the post surgical care plan. the system does not provide a structured way for surgical care plans to be assigned or ordered.   Each patient’s medical. Such activities may be scheduled or ordered as appropriate. All rights reserved.1. The plan(s) is documented in the patient’s record.19. but the actual continuous posting of the telemetry is usually outside the scope of system use. but as stated before. Findings are entered into the patient’s record. (Also see MCI. . nursing and other post surgical care is planned. the system can help coordinate the scheduling of such events.