Category Archives: JCI Standards MCI

JCI Standard MCI.13 – Use of standardised diagnosis codes, procedure codes and definitions

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As a Health Information Management (HIM) / Medical Records (MR) practitioner, you will be very familiar with data collected in manual forms and in electronic systems along with the clinical and medical terms the care providers use  in your hospital to document the patient care.

To go on with the Joint Commission International (JCI) Standard MCI.13 from my previous post JCI Standard MCI.13 – Use of standardised symbols and abbreviations (this link will open in a new tab of your current browser window), I think you need to know a little introduction about data since you will be part of the Management of Communications and Information Committee discussing along side with a representative from the hospital Information Technology (IT) department. The Joint Commission International (JCI) Standard MCI.13 does not specify a need to know about data elements and the workings of a Hospital Information System (HIS).

A piece of data that you encounter each day is the data element, which is a basic unit of information collected about anything of interest – for example, a pharmaceutical name or the city in which a patient lives. All the data elements reside in a data dictionary which is a collection of data element and their definitions. The data set refers to a commonly agreed upon collection of data elements found in your HIS and is a standard method for collecting and reporting these individual data elements. The data set used for collection and reporting purposes depends on patient type, for example a data set for oncology (study of cancer) when data is collected on cancers in acute care hospitals and reported to a national cancer registry nationwide.

What a HIM/MR practitioner does need to know that concerns this standard is about what is a medical vocabulary, medical nomenclatures, and classification systems.

A nomenclature is a systematic listing of the proper names. When health care providers document patient care they use a medical nomenclature, for example the Systematized Nomenclature of Medicine (SNOMED) which is a vocabulary of clinical and medical terms (e.g., myocardial infarction, diabetes mellitus, appendectomy, and so on), is used in more than 40 countries (Prathibha 2010).

Medical vocabulary is a system of disease names with explanations of their meanings. A medical coding system (or medical classification system) then organises the clinical and medical terms in a medical vocabulary (the medical nomenclature) into categories according to similar conditions, diseases, procedures, and services and establishes codes (numeric and alphanumeric characters) for each.

Several medical classification systems exist, of which any HIM/MR practitioner  would be most familiar with is ICD-10, which is entitled the International Statistical Classification of Diseases and Related Health Problems (ICD-10). While most WHO member states had started to adopt ICD-10 by 1994, the health care system in the United States continues to use the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) as its official system of assigning codes to diagnoses and procedures related to hospital use. Also in the U.S., ICD-10-PCS, a procedural classification system is intended to replace ICD-9 volume 3 for reporting of inpatient procedures while Current Procedural Terminology (CPT) is still used for all outpatient procedures.

Diagnoses and procedures codes are reported to third-party payers for reimbursement as in the U.S., to external agencies for data collection, and internally for education and research in most countries. Standard terminology enables data capture to proceed in a structured manner, facilitating the collection of information and enhancing the ability to perform data analyses.

Your hospital will be checked for compliance to this standard and hopefully your hospital is prepared to fully meet the four (4) measurable elements of JCI Standard MCI.13 which measure if (i) only standardised diagnosis codes and procedure codes for example ICD-10 or ICD-10 PCS are used and monitored, and (ii) standardised definitions, symbols,  and abbreviations are used and their usage monitored but (iii) ensuring that those symbols and abbreviations not to be used are identified and monitored as well.

Potential sources of errors at each step of the disease coding process using standardised diagnosis codes and procedure codes must be monitored by the HIM/MR department during routine and/or random checks of medical records to ensure code accuracy. Increased attention  to monitoring code accuracy is important as it directly impacts the quality of decisions that are based on codes as a result of the application of ICD codes for purposes other than those for which the classifications were originally designed as well as because of the widespread use for making important funding for example casemix, clinical, and research decisions.

Standardised definitions, symbols, and abbreviations use – taking into account those symbols and abbreviations that are not to be used (that is the Do Not Use List) must be monitored as  I posted in my previous post JCI Standard MCI.13 – Use of standardised symbols and abbreviations (this link will open in a new tab of your current browser window).

A hospital must also ensure that standardisation of diagnosis codes and procedure codes, definitions, symbols,  and abbreviations usage is consistent with recognised local and national standards and even international standards and best practices.

With this post, I think I briefly blogged about the implications of JCI Standard MCI.13 and your role as a HIM/MR practitioner in ensuring compliance to this standard.

References :
Joint Commission International 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA

Michelle, AG & Mary, JB 2011, Essentials of Health Information Management: Principles and Practices, 2nd edn, Delmar, Cengage Learning, NY, USA

Prathibha, V (ed.) 2010, Medical quality management : theory and practice, 2nd edn,  Jones and Bartlett Publishers, Sudbury, MA, USA

JCI Standard MCI.13 – Use of standardised symbols and abbreviations

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The Joint Commission International (JCI) Standard MCI.13 is about the uniform use of standardised diagnosis codes, procedure codes, symbols, abbreviations (which includes a “do not use” listing), and definitions in a hospital which supports data aggregation and analysis and which facilitates comparison of data and information within and among organisations by using such standardised terminology, definitions, vocabulary, and nomenclature consistent with recognised local and national standards.

I shall be writing in the context of what a Health Information Management (HIM) / Medical Records (MR) practitioner on a need-to-know and what-to-do basis about this standard and its intent. To write all about the intents of this standard will take several posts, and I do not wish to be publishing text-book material here. I only plan to blog about what you need to know as an HIM/MR practitioner and what you need to plan and implement for your role as a HIM/MR practitioner, from the perspective of a quality practitioner with the background of as a HIM/MR practitioner.  I do not intend to publish a long posts, so this post is all about an official (approved) abbreviation list and the first post of a series of posts on the JCI Standard MCI.13, perhaps covering 2 or 3 more posts.

I believe every hospital  should establish a policy to maintain an official (approved) abbreviation list as to which abbreviations, acronyms, and symbols (and their meanings) can be documented in the patient record.

One does not wait for his or her hospital to be seeking JCI or other agency hospital quality assurance accredited status before embarking on a policy and an approved abbreviation list.

Here I am listing tasks for the HIM/MR practitioner and the Medical Records Committee (MRC) of a hospital :

  1. the HIM/MR practitioner should initiate an approved abbreviation list for discussion during a MRC meeting if he or she finds there in no approved abbreviation list or if the existing one needs a much-needed revision
  2. the MRC should set a dateline for medical-staff of the hospital to review and submit a revised list by distributing the existing list
  3. if there is no existing list, the HIM/MR practitioner should source for a sample list which can be downloaded from many Internet websites (check for copyright information; if written permission is required to reproduce, then it is wise to write to the copyright owner)
  4. modify and customise for local use, present at the MRC meeting and if approved for distribution, distribute to medical-staff of the hospital to review and submit a revised list by a set dateline
  5. the revised abbreviation list of an existing list or a newly created abbreviation list after review should be presented to the MRC
  6. the Chairman of the MRC who is usually a clinician, would then make it easier the task of final approval of this abbreviation list by using his or her influence among fellow clinicians in all medical disciplines of the hospital for consensus
  7. the abbreviation list is deemed finally an approved abbreviation list after one last meeting agenda to approve it officially at a scheduled MRC meeting
  8. the abbreviation list is forwarded to the hospital top management for final approval and signature before it is formated in an appropriate format and printed for distribution to all disciplines and patient care areas of the hospital
  9. a hospital policy must be created by the HIM/MR practitioner to document the approved abbreviation list as to which abbreviations, acronyms, and symbols (and their meanings) can be documented in the patient medical record of the hospital.

If your hospital is already JCI accredited, I am taking a guess the Management of Communication and

Information (MCI) Committee (MCIC) which has oversight on all matters pertaining to MCI, had initiated the approved abbreviation list of a revised existing list or created a new approved abbreviation list. The MCIC notifies the MRC about the necessity for compliance to JCI Standard MCI.13, and the MRC carries out tasks outlined as above for a hospital already JCI accredited or a hospital seeking JCI accreditation.

Usage of abbreviations, acronyms, and symbols found in the medical record during routine and/or random checks is monitored by the HIM/MR Department for any hospital. For JCI accredited or JCI accreditation seeking hospitals, checks are also done during a Medical Records  Review process session(s) and unapproved abbreviations, acronyms, and symbols  checked against an approved abbreviation list are documented and reported in a report to the Medical Records  Review Committee (MRRC) which in turn then forwards its meeting minutes highlighting anomalies from the report to the MCIC. The MCIC sends in a report or a letter to the MRC Chairman for his or her attention and appropriate action.

Before I end this post, I need to say that the JCI standards have not explicitly required an approved list of abbreviations. However, a “do not use” list which is a  “(JCI 2011) written catalog of abbreviations, acronyms, and symbols that are not to be used throughout a hospital – whether handwritten or entered as free text into a computer – due to their potentially confusing nature”, it is appropriate that a “do not use” list forms a part of the approved abbreviations list. You can view the Official Do Not Use List as it stands today released in 2004 by the Joint Commission (UnitedStates)  after you download it from
http://www.jointcommission.org/assets/1/18/Do_Not_Use_List.pdf (this link will open in a new tab of your current browser window).

My post on an approved abbreviation list ends here, and allow me to continue in my next post more on other concerns of the JCI Standard MCI.13

References :
Joint Commission International 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA

Michelle, AG & Mary, JB 2011, Essentials of Health Information Management: Principles and Practices, 2nd edn, Delmar, Cengage Learning, NY, USA

JCI Standard MCI.16 – Leadership and Planning, records and information are protected

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A hospital ensures to maintain the security and confidentiality of data and should be especially careful about preserving the confidentiality of sensitive data. The hospital is also usually expected to determine the level of security and confidentiality maintained for different types of information.

When the Joint Commission International (JCI) examines how a hospital practices in the area of information management at an overall level during a hospital accreditation survey, its surveyors would normally check how the hospital addresses the Standard MCI.16 which requires that “Records and information are protected from loss, destruction, tampering, and unauthorized access or use”.

Natural or man-made disasters could destroy paper-based or electronic patient records when heat, water, fire, or other damage is likely to occur. Medical records, other data and information should  be stored in locations that are secure and protected at all times.

fire door

Image credit: sandor.com.my

It is common for the record room to contain fire walls or at minimum fire doors that prevent a fire from spreading from one area to another. The file area should also have a sprinkler system in place in case of fire. What is often overlooked here in Malaysia is an enclosed top shelf to help protect them from water damage in the event of sprinkler system malfunction.

Health Information Management (HIM) / Medical Records (MR) practitioners here in Malaysia or elsewhere should check with their local fire departments on fire codes that dictate clearance needed between the ceiling and the shelves as well the space required between file rows. The file area should also contain a fire extinguisher and a fire pull switch, and staff must be trained in the use of each.

The official portal for the Fire and Rescue Department Malaysia (FRDM) classifies fires caused by paper as Class A Fire and fire caused by electrical sources as Class E Fire. The portal recommends fire and safety tips but I am listing among other tips those of which that will be applicable to HIM/MR departments here in Malaysia, namely to install smoke detectors on the ceiling, no smoking on premise (obviously prohibited in a hospital), and avoiding power supply extensions that burden the electric circuitry. An HIM/MR practitioner and his or her staff should familiarise with the easy steps to use a Fire Extinguisher (there is a poster for quick facts) as given in this portal.

floodRecords must also be protected from water damage due to malfunctioning sprinkler systems or flooding. Records should not be stored on the floor, as this presents a safety hazard to staff members and records could be damaged in the event of flooding. Records that are maintained in closed files are more protected from water damage than records located on open shelf units.

Medical information when documented and collected, is important for understanding the patient and his or her needs and for providing care and services over time. This information may be in paper or electronic form or a combination of the two.

A hospital must respect such information as important for patient care and establishes policies and procedures to address issues related to the security, and as such has implemented policies and procedures that protect such information from loss or misuse. A hospital must also respect the confidentiality of patient information, and thus also establishes policies and procedures to address issues related to confidentiality, and implements processes to prevent unauthorised access to confidential information.

A policy implemented by a hospital is a Medical Records Policy, that includes policy statements on matters like the security of medical records information, access to medical records and medical information and the process to gain access when permitted, either paper-based and electronically stored information or a combination of the two.

Standard Operating Procedures should be constructed to provide (i) procedures on security from loss due to natural and man-made disasters, and (ii) procedures on access to medical records and the process to gain access when permitted that protect such information from misuse (tampering) but also theft.

An effective process on confidentiality defines the following:

  • Who has access to information
  • The information to which an individual has access
  • The user’s obligation to keep information confidential
  • When release of health information or removal of the medical record is permitted
  • How information is protected against unauthorised intrusion, corruption, or damage
  • The process followed when confidentiality and security are violated

Patient information is protected from theft when only authorised personnel have access to the file area. For example, procedures that protect patient information areas would include processes such as :

  • if a HIM/MR staff member is not available in the file area to retrieve a record, the area must be secured
  • if the file area is locked, only those authorised to access the area should have a key or use authorised swipe cards (similar to those used for hotel rooms)
  • when the file area is not staffed (e.g., evenings, nights, weekends), procedures must be established to allow limited access to records
  • a nursing supervisor will be provided with a key to the file area and assigned responsibility for retrieving patient records if needed

One must not forget that patient information located in patient areas (e.g., nursing units) must be evaluated for protection against loss from fire, water, and theft.

Image credit : http://www.butdoctorihatepink.com/

Computerised health information also needs to be protected from loss due to fire, water, or theft. It is common to create a backup file of all computerised patient information and to store the backup file off site (at a location other than the facility). In the event of loss, the backup can be used to re-create patient information.

Patient medical records and other data and information should always be secure and protected at all times portable computer security (e.g., laptops, mobile devices, and so on). The risk of theft increases when someone can simply “walk off” with a laptop, resulting in stolen patient information. I have posted enough material on Bring Your Own Devices (BYOD) and Bring Your Own Cloud (BYOC) hazards in past posts of this blog on how hospitals and HIM/MR departments need to establish appropriate controls to address this issue.

I would think that a Contingency Plan by the HIM/MR department is necessary to respond to an emergency or other occurrence (e.g., fire, vandalism, system failure, and natural disaster) that damages paper-based and electronically stored information or a combination of the two.

For an HIM/MR working with Electronic Medical Records (EMRs), the Contingency Plan would address (Michelle AG & Mary JB 2011) a data backup plan and disaster recovery plan to create and maintain retrievable exact copies and to restore any loss of data to enable continuation of critical business processes in an emergency mode, ensure testing and revision procedures for periodic testing and revision of contingency plans, and include applications and data criticality analysis to determine the potential losses which may be incurred if components of applications and data were not available for a period of time.

I believe all said and done, that better protection of medical information will require efforts in improving public policy at a centralised command level if your hospital is part of a group of hospitals. The lack of uniform policies and procedures for the privacy and security of medical information creates particular problems for a group of hospitals’ organisation that serves its hospitals in multiple states and creates additional confusion for patients regarding their rights.

Overall, if security policies and procedures are not established and enforced, concerns might be raised about the security of patient information during legal proceedings. This could result in questioning the integrity of the medical record.

It is imperative that HIM/MR practitioners working in any hospital setting understand the importance of security and confidentiality of Protected Health Information (PHI) and medical records, and work towards understanding the uniform policies and procedures if any – or just his or her hospital policies and procedures, and ensures that medical records and other information are protected from loss or destruction, tampering and unauthorised access or use.

The implementation of the above measures would enable a hospital that had acquired JCI accreditation status or one that is seeking JCI accreditation status, to have met or fully meet the Standard MCI.16 and its two (2) MEs.

References:
Joint Commission International 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA

Michelle AG & Mary JB 2011, Essentials of Health Information Management: Principles and Practices, 2nd edn, Delmar, Cengage Learning, NY, USA

Official Portal Fire and Rescue Department Malaysia(FRDM), viewed 27 July 2012 <http://www.bomba.gov.my/main.php>

JCI Standard MCI.12 – a policy on the retention time of records, data, and information

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Paper-based medical records is the way most public and private hospitals in Malaysia continue to preserve their patient medical records. Existing filing space for the efficient storage of newer medical records is a common problem, and for most Health Information Management (HIM) / Medical Records (MR) practitioners, it is a never-ending battle against overcrowded files and the struggle to find more space.

The need for adequate storage space for newer and older medical records (as you already know, older medical records placed in storage and rarely accessed are called archived records or inactive records) is driven by medical reasons, legal reasons and management reasons.

Medical records must be kept for so long as they are necessary to support patient care in the treatment and management of cases.

The legal documentation reason has heightened the importance of medical record retention (the length of time a hospital for example will maintain an archived record ) from the threat of medical malpractice suits, as patient and their families become more aware of the rights to quality care, and solicitors ever willing to take on medical malpractice suits.

Thus, the medical records must be kept for so long as long as the threat of a medical malpractice suit exists. So if the medical records are necessary for the purpose of a court case, the medical records must be kept until the case is concluded, a process which may take many years. A doctor may be in court as a litigant or a witness. Even as a witness in a case which is heard many years after the events in question, the doctor may need to refer to the original medical records.

Collection of hospital statistics, disease coding, claims processing, communicable disease reporting, incident reporting, morbidity and mortality reviews are some management reasons.

Does this mean that, if at all possible, medical records should be maintained indefinitely?

Given the hospital’s administrative constrains to provide additional space with additional cost implied versus the statutory mandates to maintain medical records for a defined period for legal reasons, the medical reasons, and the management reasons,.a hospital needs a strategic plan for preserving medical records for a definite period of retention.

Image credit : silverdane.com

The hospital must develop a medical record retention policy and must be guided by its own activities, research and education activities.

This policy will dictate how medical records are to stored (records can be stored on paper, microfilm, magnetic tape, optical disk, or as part of an electronic (or computer) system), where will they be stored, what happens to the medical records that have lapsed the retention period , all of which are guided by statute, regulation, law and guidelines.

I shall refrain from posting the methods of storage of newer and older medical records and the destruction of medical records that have lapsed the retention period, as I intend to only discuss on establishing a hospital retention policy for medical reasons and legal reasons but briefly and discuss a little more the quality assurance reasons.

HIM/MR practitioners already know that medical records serve for the continuity of medical and nursing care while in hospital, and follow-up care. HIM/MR practitioners also know that medical records must be maintained for specific periods for legal reasons and I like to list the relevant statutes, laws and guidelines that prevail in Malaysia :

  1. The statute of limitations, Act 254, cited as the Limitation Act 1953, dated 19 February 1953, is an Act to provide for the limitation of actions and arbitrations (which is the time period during which a person may bring forth a lawsuit including medical malpractice suits), but applies to Peninsular Malaysia only.
      1. Section 6(1) of this Act limits actions in tort to commence not more than six years after the occurrence of the damage and unlike laws in Australia, the United Kingdom and in Singapore, does not contain provisions for the discretionary extension or exclusion of the time limit allowed by law in relation to tort or personal injuries.
      2. Include in the policy if patient is under a legal disability, that the records should be kept for a minimum of 7 years from the date when the patient’s legal disability ceases or the patient’s death, whichever is earlier, as provided for under Section 24(1) of this act.
  2. Act 629, the National Archives Act 2003 (incorporating all amendments up to 1 January 2006), is an Act to provide for the creation, acquisition, custody, preservation, use and management of public archives and public records (records officially received or produced by any public office for the conduct of its affairs or by any public officer or employee of a public office in the course of his official duties and includes the records of any Government enterprise) and for other matters connected therewith.
      1. The National Archives of Malaysia had supported and agreed to a Ministry of Health Malaysia proposal for a uniform medical records retention and disposal schedule for all public hospitals in Malaysia. Through its letter of approval allowable under Section 27 (1) of the Act 629, the National Archives Act 2003, an approval dated 30 November 2006 was released by the National Archives for a comprehensive and standarised medical records retention and disposal schedule for all public hospitals and health facilities in Malaysia.
      2. The retention period for all medical records with the exception of medical records of psychiatric, obstetric and paediatric cases will be retained for a period of seven (7) years from the last date of treatment.
      3. A copy of this approval can be obtained from a Ministry of Health Malaysia Guideline Manual on Medical Records Management published by the Medical Development Division and released through a Director General of Health Malaysia directive No. 17 of 2012 (Pekeliling Ketua Pengarah Kesihatan Bil 17/2010, Garispanduan Pengendalian Dan Pengurusan Rekod Perubatan Pesakit Bagi Hospital-Hospital Dan Institusi Perubatan Kementerian Kesihatan Malaysia, Bahagian Perkembangan Perubatan Kementerian Kesihatan Malaysia, a document in Malay).
      4. The standarised medical records retention and disposal schedule for all public hospitals and health facilities in Malaysia was circulated through a MoH circular MOH/PAK/121.06.(GU), Mac 2007 in March 2007(Jadual Pelupusan Rekod Perubatan, MOH/PAK/121.06.(GU), Mac 2007 – in Malay).
  3. Act 586, Private Healthcare Facilities And Services Act 1998 (incorporating all amendments up to 1 May 2006) is an Act to provide for the regulation and control of private healthcare facilities and services and other health-related facilities and services. Section 107, (2), (f) under ‘Power to make regulations’ requires that the records to be kept of patients and persons treated in the private healthcare facilities or services but does not stipulate a retention policy.
      1. I think such private healthcare facilities or services could however plan for a retention policy for the reasons given in second paragraph of this post.
      2. The same provision of a minimum period of seven (7) years from the last date of treatment for the retention of all medical records with the exception of medical records of psychiatric, obstetric and paediatric cases could b adopted into a private hospital’s retention policy.
      3. Likewise other contents of the medical records retention and disposal schedule for all public hospitals and health facilities in Malaysia could be availed and incorporated into its own private hospital medical records retention policy.
  4. Act 21, this Act cited as the Age of Majority Act 1971 dated 30 April 1971 is an Act to amend and consolidate the law relating to the age of, states under Section (2) that the minority of all males and females shall cease and determine within Malaysia at the age of eighteen years and every such male and female attaining that age shall be of the age of majority.
      1. Since the minimum period for the retention of all medical records with the exception of medical records of psychiatric, obstetric and paediatric cases is seven (7) years from the last date of treatment, then for minors medical records should be retained for another 7 years from the age of majority, that is for 25 years.
  5. The Medical Defence Malaysia Berhad (MDMB) website at http://www.mdm.org.my/articles.php?newsID=2 (clicking on this link will open the website page in a new tab in your current window) presents a page on Medical Records: Preservation And Matters Of Evidence.  MDMB a “not-for-profit” company limited by guarantee, functioning as a mutual medical defence organisation that aims to provide support in areas such as medico-legal counselling and the development of educational resources.

HIM/MR practitioners must also know that if their hospital is in the process for accreditation of a quality program, then the medical records retention policy must be updated, readily available, complete and relevant. In order to be complete and relevant, I would recommend that this policy be jointly developed with the full knowledge and participation of the medical staff  who have contributed to a medical record content.

HIM/MR practitioners would provide secretarial support, coordinate the updating and completion of a up-to-date and revised hospital medical records policy. This policy will be measured against the Joint Commission International (JCI) Standard MCI.12 which states that “The organization has a policy on the retention time of records, data, and information”, if your hospital is on the path to be accredited or is to be re-surveyed for new period of accredited status when adopting the JCI accreditation process.

So if your hospital has a policy on retaining medical (patient clinical) records and other data and information, the retention process provides expected confidentiality and security, and all of your records, data, and information are destroyed appropriately after the retention period, then clearly this policy will comply with the JCI Standard MCI.12, ME 1 to ME 3.

This is not to imply you only rush to comply with JCI compliance (the JCI Standard MCI.12 merely states this requirement to comply with their standards compliance and accreditation status but does not necessarily mandate record retention schedules) but the policy is relevant for all the reasons as I have given above, once again to reiterate federal and local (if any) retention laws, legal requirements, need for continuing patient care and follow-up, research/educational uses, and management uses.

In closing, do take note that a  policy on retention of medical records is meant to serve as a guide on the retention periods for medical records, and do get the help of a legal counsel of your hospital or organisation if you are not sure about the Laws and their interpretations to be included in the policy.

References:
Edna,  KF 1983, Medical Records Management, 7th edn, Physician Records Company, Illiniois, USA

Joint Commission International 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA

Margaret, AS 2003, Health Information Management, 5th edn, Jossey-Bass, San Framsico, USA

World Health Organisation 2006, Medical Records Manual: A Guide for Developing Countries, WHO Regional Office for the Western Pacific, Philippines

JCI Standard MCI.3 – Communication with Patients and Families, provided in an understandable format and language

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Patients can only make informed decisions and participate in the care process if they understand the information provided to them. This includes their follow-up care through information about educational and training resources available from the hospital or from community resources through relationships established by the hospital. Community resources help support continuing health promotion and disease prevention education. This follow-up care information from  the hospital or from established community resources is to meet the patient’s ongoing health needs or to achieve their health goals.

Particular attention is given to the format and language used in communicating with and providing education to patients and families. Patients respond differently to spoken instructions, printed materials, videotapes, demonstrations, and so on. Also, it is important to understand the language preferred.

A written statement appropriate to a patient’s age, understanding, and language posted in a hospital is an example to inform the patient and the family’s responsibility on their rights and to understand their responsibilities in the care process of the patient as an inpatient or registration as an outpatient.

Medicine information leaflets is another example of printed materials, but associated with the distribution of medicines. The format used in medicine information leaflets must take into account the order of information which is presented. This order effect is related to the perceived importance of the information which affects people’s understanding and memory of the information presented. For example, patients are likely to remember better about side effects of medicine administered to them irrespective of its relative position in a medicine leaflet in contrast to instructions on dosage and how to take their medicine, which they ought to remember better. Thus the need for key information about drug administration to be given near to the start of a medicines information leaflet.

Hospitals frequently serve communities with a diverse population. One or more languages spoken by patients in the community serviced by the hospital could be used in a loose-leaf folder or file cards. Translators in your community can help build standardised lists for the most commonly heard languages in your community. Technical terms, slang, or phrases with a double or colloquial meaning should be avoided.

Research has shown that a patient speaking the same native language as the doctor (as well as a nurse of other healthcare provider) has the advantage of greater rapport with a patient. They gave better explanations of treatment. Patients had better understanding of instructions, showed a greater recall and asked questions, and undoubtedly understood printed materials better.

If there are differences in the language used between doctors (as well as a nurse or other healthcare provider) and patients, then family members or interpreters/translators may need to assist with the education or translate materials.

Wherever possible, it is better to use a professional interpreter. A trained interpreter often understands the culture of the person, as well as the language. The skilled interpreter can explain nonverbal cues, in addition to what the patient says.

The interpreter is an invaluable staff resource  rather than a family member, child translator – a child member of the family, should be used only as a last resort especially to communicate important clinical and other information and education, and non-family members.

A hospital could also develop a list of its employees or individuals to contact in the community who speak a second language and are willing to act as translators of printed materials, videotapes, demonstrations, and so on.

Sometimes, a family member or significant other can act as an interpreter. Having a member of the family translate may be inappropriate. It is important for the doctor as well as a nurse or other healthcare provider to recognise the limitations of family members and non-family members when they are used to translate or interpret in overcoming any patient barriers to communication and understanding.

The foregoing paragraphs ensues the compliance with the Joint Commission International (JCI) Standard MCI.3, that is “Patient and family communication and education are provided in an understandable format and language.”

In a hospital that is undergoing the process of accreditation and has adopted the JCI quality standards, then the hospital must comply with providing patient and family communication and education in an understandable format and in an understandable language as I have outlined above. The hospital would therefore satisfy the JCI Standard MCI.3, ME 1 and 2.  If the hospital has a policy and practices to engage professional interpreters rather than using family members as interpreters and translators and ensuring that child translators are only used as last resorts, then the hospital complies with the JCI Standard MCI.3, ME 3.

References:
Caroline, BR & Mary, TK 2012, Textbook of basic nursing, 10th edn, Wolters Kluwer Health, Lippincott Williams & Wilkins, Philadelphia, USA

Dianne, B 2007, Health communication Theory and practice, Open University Press, NY, USA

Joint Commission International 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA

Sue, CD & Patricia, KL 2011, Fundamentals of Nursing: Standards & Practice, 4th edn, Delmar, Cengage Learning, NY, USA