Engineering Department 2015- 1 © Copyright, The Joint Commission Top 8 Findings & SAFER Matrix for the 2017 ACE Summit & Expo February 20, 2017 Atlanta, GA Larry F. Rubin CHFM, CHSP, CPE, CEM Life Safety Code Surveyor The Joint Commission
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Top 8 Findings & SAFER Matrix for the
2017 ACE Summit & Expo
February 20, 2017Atlanta, GA
Larry F. Rubin CHFM, CHSP, CPE, CEMLife Safety Code SurveyorThe Joint Commission
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Disclosure Statement
The employees and/or speakers for this presentation have disclosed that they do not have any financial arrangements or affiliations with corporate organizations that either provide educational grants to this program or may be referenced in this activity.
Furthermore, each of the previously named speakers has also attested that their discussions will not include any unapproved or off-label use of products.
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Learning Objectives:
At the conclusion of this presentation, the participant will be able to:
ID the top 8 compliance issues in the LS & EC areas
Be able to describe and implement tips for a successful survey
Understand the new survey process using the SAFER Matrix
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Top Eight Cited Standards: 2012 – 2015
Standard 2015 2014 2013 2012
EC.02.06.01: Built Environment #1 #1 #8 #7
EC.02.05.01: Utility Systems Risks #3 #2 #4 #10
LS.02.01.20: Means of Egress #4 #4 #1 #2
LS.02.01.30: Protection #6 #8 #6 #6
LS.02.01.10: General Building Requirements #7 #7 #3 #3
LS.02.01.35: Extinguishment #8 #9 #9 #9
EC.02.03.05: Fire Safety Systems #9 #6 #7 #5
EC.02.02.01: HazMat & Waste #10 #10 #11 #11
Please Note: Other standards not listed are clinical or leadership related.
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WHY?
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EC.02.05.01 – The hospital managesrisks associated with its utility systems
January 2017
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EC.02.05.01 – Top Findings (Based on 1,111 findings)
#1 - Inappropriate Room Pressurization - 469 findings (42.2%)
#2 – Failure to Label Electric Panel - 304 findings (27.4%)
#3 – Lack of Emergency Lighting - 83 findings (7.5%)
#4 – Failure to Label Utilities - 59 findings (5.3%)
#5 – Inappropriate Electrical Issues - 47 findings (4.2%)
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#1 - Inappropriate Room Pressurization - 469 findings (42.2%)
NEED PIC
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#2 – Failure to Label Electric Panel - 304 findings (27.4%)
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#3 – Lack of Emergency Lighting - 83 findings (7.5%)
NEED PIC
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#4 – Failure to Label Utilities - 59 findings (5.3%)
NEED PIC
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#5 – Inappropriate Electrical Issues - 47 findings (4.2%)
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#5 – Inappropriate Electrical Issues - 47 findings (4.2%)
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LS.02.01.20 – The hospital maintainsthe integrity of the means of egress.
January 2017
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LS.02.01.20 – Top Findings (Based on 1,573 findings)
#1 - Obstructions in Means of Egress - 507 findings (32.2%)
#2 – Inappropriate Electromagnetic Lock Usage - 266 findings (16.9%)
#3 – Inappropriate Locking Mechanisms - 174 findings (11.1%)
#4 – Suite Issues - 164 findings (10.4%)
#5 – Storage in Stairways - 145 findings (9.2%)
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#1 - Obstructions in Means of Egress -507 findings (32.2%)
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#1 - Obstructions in Means of Egress -507 findings (32.2%)
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#2 – Inappropriate Electromagnetic Lock Usage - 266 findings (16.9%)
NEED PIC
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#3 – Inappropriate Locking Mechanisms - 174 findings (11.1%)
NEED PIC
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#4 – Suite Issues - 164 findings (10.4%)
“An accommodation with two or more contiguous rooms comprising a compartment,
with or without doors between such rooms, that provides sleeping, sanitary, work,
and storage facilities.” And: “A series of rooms or spaces or a subdivided room
separated from the remainder of the building by walls and doors.”
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#5 – Storage in Stairways - 145 findings (9.2%)
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#1 - Obstructions in Means of Egress -507 findings (32.2%)
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EC.02.06.01 – The hospital establishes and maintains a safe, functional environment.
January 2017
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EC.02.06.01 – Top Findings (Based on 3,109 findings)
#1 - Medical Gas Storage – Cylinder - 934 findings (30.0%)
#2 – Safety Hazard - 506 findings (16.3%)
#3 - Air Flow & HVAC Issues - 273 findings (8.8%)
#4 - OR Humidity - 238 findings (7.7%)
#5 - Nurse Call – Pull Cord - 205 findings (6.6%)
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#1 - Medical Gas Storage – Cylinder -934 findings (30.0%)
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#2 – Safety Hazard - 506 findings (16.3%)
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#3 - Air Flow & HVAC Issues - 273 findings (8.8%)
Guidelines for Design & Construction of Health Care Facilities, FGI
Ventilation: • i.e. doors held open by air pressure; odors
Temperature: • Hot / Cold calls
Humidity• Primary concern is for areas >60%RHo Mold growth is possible
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Air Balance Issues con’t
This is NOT considered repaired
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#4 - OR Humidity - 238 findings (7.7%)
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#4 - OR Humidity - 238 findings (7.7%)
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#5 - Nurse Call – Pull Cord - 205 findings (6.6%)
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EC.02.03.05 – The hospital maintainsfire safety equipment and fire safety building features.
January 2017
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EC.02.3.05 – Top Findings (Based on 2,172 findings)
#1 - Lack of Inventory - 651 findings (30.0%)
#2 - Insufficient Documentation - 618 findings (28.5%)
#3 - Standard not Listed - 446 findings (20.5%)
#4 - Incorrect Duration – 316 findings (14.5%)
#5 - Incorrect Test Method - 88 findings (4.1%)
#6 – Repairs not Performed - 22 findings (1.0%)
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#1 - Lack of Inventory - 651 findings (30.0%)
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#2 - Insufficient Documentation - 618 findings (28.5%)
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Time Defined
The Joint Commission EC chapter defines time as:
Daily, weekly, monthly are calendar references
Quarterly is once every three months +/- 10 days
Semi-annual is 6 months from the last scheduled event month +/- 20 days
Annual is 12 months from the last scheduled event month +/- 30 days
3 years is 36 months from the last scheduled event month +/- 45 days
NOTE 1: The above does not apply to required frequencies
NOTE 2: An alternative of developing either a unique, written policy or adopting NFPA definitions when available is acceptable
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#5 - Incorrect Test Method - 88 findings (4.1%)
It’s important to compare this test’s results to previous fire-pump-under-flow
tests to look for any system degradation. This comparison is typically done
using a performance (graphic) curve of pressure versus flow but can also be
accomplished with written data.
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#6 – Repairs not Performed - 22 findings (1.0%)
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LS.02.01.10 - Building and fireprotection features are designed andmaintained to minimize the effects of fire, smoke, and heat.
January 2017
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LS.02.01.10 – Top Findings (Based on 2,354 findings)
#1 - Penetrations - 962 findings (40.9%)
#2 - Fire Door Failure - 709 findings (30.1%)
#3 – Fire ratings - 176 findings (7.5%)
#4 - Fire Door Hardware - 165 findings (7.0%)
#5 - Fire Door Labels - 149 findings (6.3%)
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#1 - Penetrations - 962 findings (40.9%)
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#2 - Fire Door Failure - 709 findings (30.1%)
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#3 – Fire rating - 176 findings (7.5%)
Fire door to
mechanical room
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#4 - Fire Door Hardware - 165 findings (7.0%)
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#5 - Fire Door Labels - 149 findings (6.3%)
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LS.02.01.30 – The hospital providesand maintains building features to protectindividuals from the hazards of fire and smoke.
Smoke barriers extend from the floor slab to the floor or roof slab above, through any concealed spaces (such as those above suspended ceilings and interstitial spaces), and extend continuously from exterior wall to exterior wall. All penetrations are properly sealed.
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LS.02.01.30 – Top Findings (Based on 2,488 findings)
#1 - Door Issues - 966 findings (38.8%)
#2 - Penetrations - 548 findings (22.0%)
#3 - Latch Failure - 342 findings (13.7%)
#4 – Smoke barriers - 209 findings (8.4%)
#5 - Suite Issues - 207 findings (8.3%)
#6 –Separation of Hazardous Areas - 190 findings (7.6%)
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#1 - Door Issues - 966 findings (38.8%)
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#2 - Penetrations - 548 findings (22.0%)
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#3 - Latch Failure - 342 findings (13.7%)
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#4 – Smoke barriers - 209 findings (8.4%)
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#5 - Suite Issues - 207 findings (8.3%)
• Suites are used to create groupings of rooms and spaces that can function more
efficiently than individual rooms located off of a corridor.
• The specific limitations on suite size and design in the 2000 LSC limit their
efficiency and the ability for facilities to accommodate suites in their building
space, which results in undue burden.
• Sections 18/19.2.5 of the 2000 LSC requires every habitable room to have an
exit access door leading directly to an exit access corridor;
• Allows for exit access from a suite to include intervening rooms only under
certain circumstances;
• Requires suites of certain size to have two exit access doors remotely located
from one another;
• And limits the size of sleeping room suites to 5,000 ft2.
In the 2006 LSC, NFPA began to include additional provisions to further
accommodate the use of suites, and continue to be reflected in sections
8/19.2.5.7 of the 2012 LSC.
• See CMS Waiver
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2012 LSC 18/19.2.5.7 Suites
18/19.2.5.7.2.1(B) which allow, under certain circumstances, one of the exit access doors in a sleeping suite be permitted to be directly to an exit stair, exit passageway or exit to the exterior;
18/19.2.5.7.3.1(B) which allow, under certain circumstances, one of the exit access doors in a non-sleeping suite be permitted to be directly to an exit stair, exit passageway or exit to the exterior;
18/19.2.5.7.1.2 which allow, under certain circumstances, suites to be separated by corridor wall requirements;
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#6 –Separation of Hazardous Areas -190 findings (7.6%)
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LS.02.01.35 – The hospital provides and maintains equipment for extinguishingfires.
Piping for approved automatic sprinkler systems is not used to support any other item.
Sprinkler heads are not damaged and are free from corrosion, foreign materials, and paint.
There is 18 inches or more of open space maintained below a sprinkler deflector to the top of storage.
The hospital meets all other Life Safety Code automatic extinguishing requirements related to NFPA 101-2012: 18/19.3.5.
Prior to July 5th, 2016 is considered existing. (Approved plans)
January 2017
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LS.02.01.35 – Top Findings (Based on 2,444 findings)
#1 - Cables/Wiring - 479 findings (19.6%)
#2 - Dust/Foreign Material - 443 findings (18.1%)
#3 - Ceilings/Installation/Damage - 413 findings (16.9%)
#4 - Storage/Signage - 338 findings (13.8%)
#5 - Fixtures/Equipment - 320 findings (13.1%)
#6 - Escutcheon/Obstructions - 286 findings (11.7%)
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#1 - Cables/Wiring - 479 findings (19.6%)
NEED PIC
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#1 - Cables/Wiring - 479 findings (19.6%)
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#2 - Dust/Foreign Material - 443 findings (18.1%)
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#3 - Ceilings/Installation/Damage - 413 findings (16.9%)
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This is NOT considered art
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#4 - Storage/Signage - 338 findings (13.8%)
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#5 - Fixtures/Equipment - 320 findings (13.1%) (EP 4 & EP 6)
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#6 - Escutcheon/Obstructions - 286 findings (11.7%)
NEED PIC
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#6 - Escutcheon/Obstructions - 286 findings (11.7%)
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EC.02.02.01 – The hospital manages risks related to hazardous materials and waste.
The hospital minimizes risks associated with selecting, handling, storing, transporting, using, and disposing of hazardous chemicals.
The hospital minimizes risks associated with selecting and using hazardous energy sources.
January 2017
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EC.02.02.01 – Top Findings (Based on 1,150 findings)
#1 - Eye Wash None - 308 findings (26.7%)
#2 - Eye Wash Inspection - 192 findings (16.7%)
#3 - Eye Wash Temperature - 138 findings (12.0%)
#4 - Lead Apron Inspection - 101 findings (8.9%)
#5 - Lead Apron Storage - 54 findings (4.7%)
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#1 - Eye Wash None - 308 findings (26.7%)
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#2 - Eye Wash Inspection - 192 findings (16.7%)
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#3 - Eye Wash Temperature - 138 findings (12.0%)
What is “tepid” water? For the purposes of
eyewash safety, the American National
Standards Institute (ANSI) defines it as
between 60° and 100° F.
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#4 - Lead Apron Inspection - 101 findings (8.9%)
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#5 - Lead Apron Storage - 54 findings (4.7%)
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Survey Analysis for Evaluating Risk (SAFER)
A transformative approach for identifying and communicating risk levels associated with deficiencies cited during surveys
Helps organizations prioritize and focus corrective actions
Provides one, comprehensive visual representation of survey findings
Replaces current scoring methodology
Implementation: January 2017 Was implemented June 6th, 2016 for deemed Psychiatric Hospitals only
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Immediate Threat to Life
Lik
eli
ho
od
to
Ha
rma
Pa
tie
nt/
Vis
ito
r/S
taff
HIGH MM.03.01.01, EP8 MM.03.01.01, EP7
MODERATE
MS.01.01.01, EP5
PC.01.02.01, EP4
PC.01.02.03, EP6
PC.01.03.01, EP1
PC.01.03.01, EP5
IM.02.02.01, EP3
MS.08.01.01. EP1
MS.08.01.03, EP3
IC.02.01.01, EP2
IC.02.02.01, EP4
LOW RC.01.01.01, EP19
RC.02.03.07, EP4
LIMITED PATTERN WIDESPREAD
A Picture is Worth 1000 Words…
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What is NOT Changing?
1. Adverse decision process
2. Immediate Threat to Life process Determination of Condition Level Deficiency (CLD) process (applies to those using TJC for deeming purposes)
3. Onsite survey activities utilized during survey (i.e. Tracer Methodology, Record Review, etc.)
4. Risk icons within ICM will remain same
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Questions?
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Accreditation and Certification Operations (ACO)
Tim Markijohn, MBA/ MHA, CHFM, CHE
Field Director
Larry F. Rubin, M.Ed., CHFM, CHSP, CPE, CEM, Green Belt
Life Safety Code Surveyor
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The Joint Commission Disclaimer
These slides are current as of January 2017. The Joint Commission reserves the right to change the content of the information, as appropriate.
These slides are only meant to be cue points, which were expounded upon verbally by the original presenter and are not meant to be comprehensive statements of standards interpretation or represent all the content of the presentation. Thus, care should be exercised in interpreting Joint Commission requirements based solely on the content of these slides.
These slides are copyrighted and may not be further used, shared or distributed without permission of the original presenter or The Joint Commission.
Engineering, Facilities & Construction TrackTop Trends in Healthcare Construction
Presenter:
Russ Alford, General Manager,
Turner Medical & Research
Solutions
DD
CD
Construction
SD
Final Equipment Decision
Equipment Planning Equipment
Plan
Placeholder Equipment Selected
18-24 mosHCD…AORN….RSNA…ASHE…ACE
EQUIPMENT TIMELINE
Planning
Cost Estimate Development
User Group Meetings & Clinical Input
Architectural Document Development (DD/CD/Revit)
Detailed Cut Sheets and/or Vendor Design Submittals
Design Coordination
Reports
Key Activities for Planning and Coordination during Design:
Revit
Procurement
Key Activities in Procurement:
Prioritization Schedule
Structured Approach
Bid Packages
Status Report
Item Level Comparison by Supplier
Supplier Summary
Status Report
Status Report
Item Level Comparison by Supplier
Item Level Comparison by Supplier
Receiving Management PhaseKey Aspects of Receiving Management Phase:
Communication / Collaboration
Coordination: 2 levels
• Design Coordination
– Construction Coordination Matrix
• Field Coordination
– Field Observation Reports
Delivery Management
• Scheduling, Tracking and Documentation
– ROJ Date & Delivery Schedule
• Warehouse Management
– Warehouse vs. JIT deliveries
• Onsite Delivery and Receiving
DD
CD
Construction
SD
Group 1 Equipment Deliveries
Equipment Planning
Equipment Plan
Placeholder Equipment Selected
18-24 mosHCD.. AORN..RSNA…ASHE..ACE
Managing the Gap:
Design Coordination Field Coordination
Post-Const
OnsiteDeliveries
Receiving Management Phase
Consensus Building Through Virtual Reality
Interactive Immersive BIM Visualization System
“Walk” through the BIM model
Visualize the space that creates a “Real” experience
Why we need VR
August 9, 2016
User View
Why we use VR
• Create true-to-life experiences
• VR works to pull feelings, emotions & physiological responses
• Able to memorize information in a highly realistic & interactive environment
• Presence is the key characteristic
Benefits
Feel . . . . . . . . . . . . . . . . . . . . . .
Portable . . . . . . . . . . . . . . . . . .
Experience . . . . . . . . . . . . . . . .
Eliminates 2D Confusion . . . . .
Collaborative . . . . . . . . . . . . . .
Reduced Learning/Decision Time
Reduced Clinician/Client Time
Raises Confidence/ Understanding
Functional – change on the fly
Test Solutions with Group
Team View
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