On August 27, 2012, the Joint Commission published revisions to the deeming requirements for hospitals and critical access hospitals (CAHs). The changes were made to maintain Joint Commission alignment with recent CMS regulations. The new revisions modify multiple elements of performance (EPs) of Joint Commission standards.

For hospitals, the Joint Commission’s changes to the deeming requirements include:

• Elimination of guidance regarding timeframes for authenticating verbal orders (Notes 1 and 2 to EP 4 for RC.02.03.07). The eliminated notes required authentication of verbal orders in 48 hours, assuming no state law otherwise, and permitted authentication by another practitioner.
• Clarification that an EP related to authentication of records and orders applies to all Joint Commission hospitals; and authorization to write orders should be in accordance with hospital policy, law, and regulation as well as medical staff bylaws, rules, and regulations (Note 3 to EP 4 for RC.01.02.01).
• Addition of the requirement that hospitals have pre-printed and electronic standing orders, order sets, and protocols for medication orders, including procedural guidelines. (EP 15 for MM.04.01.01).
• Addition of “or other practitioner” to requirements that (a) care, treatment and services must be ordered prior to providing such services (EP 1 for PC.02.01.03), and (b) medications are prepared and administered according to the licensed independent practitioners (EP 5 for MM.05.01.07. Additionally, medications must be prepared and administered in accordance with hospital policies and medical staff bylaws, rules, and regulations.
• Addition of “quality assessment” to administrative responsibilities related to infection control (EP 4 for LD.01.02.01).
• Addition of permission for podiatrists to be “responsible for the organization and conduct of the medical staff”. The list also includes MDs, DOS, and, as permitted by state law, DMDs or DDSs (EP 7 for LD.01.05.01).
• Clarification that one or more individuals (previously “an individual”) are responsible for outpatient services (EP 8 for LD.04.01.05).
• Addition of the requirement that medication issues shall be reported “as appropriate” to the organization-wide “quality assessment” (EP 6 for MM.07.01.03).
• Deletion of the requirement that staff, other than doctors, to have special training for blood transfusion and IV medication administration was deleted (EP 19 for HR.01.02.01).
• Clarification of requirements regarding restraint-related deaths (EP 1-3 for PC.03.05.19).

The Joint Commission made the same changes to the deeming requirements for CAHs but, as appropriate, limited the requirements to rehabilitation and psychiatric distinct part units in CAHs. However, the Joint Commission also modified two other standards which include:

• Requirements that CAHs provide services that meet patient needs no longer reference “direct services” (EPs 8 through 11 for LD.04.03.01).
• Requirements that CAHs must educate patients and families involved in self-administration of medication and determine that the patient or family member who administers the medication is competent to do so (EPs 4 and 7 for MM.06.01.03).

The Joint Commission’s modifications are effective as of September 1, 2012.  Thus, hospitals should be prepared for these changes as soon as possible.