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Mac's Safety Space
- Volume
17
Issue
2

Mac's Safety Space: Who knows where the time goes?

February 13, 2023
Accreditation & Survey Preparation, Environment and Facilities, Behavioral & Mental Health, Physical environment
Originally, I had planned this for sometime in January, but suddenly I find myself on the cusp of February and the “packing up the decorations” conversation is way past due. ...
Inside Accreditation & Quality
- Volume
5
Issue
2

Infection control, supply storage, food services top ACHC survey deficiencies

February 07, 2023
Accreditation & Survey Preparation, Infection Control
Beware of repeat deficiencies. CMS is pressing accrediting organizations (AO) to deal more harshly with hospitals that have repeat citations, including elevating a recurring finding to a condition-lev...
Healthcare Safety Leader
- Volume
31
Issue
2

ACHC surveyor findings: Samples of physical environment deficiencies, tips for compliance

February 07, 2023
Accreditation & Survey Preparation, Infection Control
Here are some samples of physical environment and life safety deficiency findings found at acute care hospitals surveyed by the Accreditation Commission for Health Care (ACHC) from June 1, 2021, to Ma...
Healthcare Safety Leader
- Volume
31
Issue
2

ACHC hospitals: Facilities managers stretched thin as physical environment deficiencies grow

February 07, 2023
Accreditation & Survey Preparation, Infection Control
More than 40% of ACHC hospitals were cited for eight of the top nine most frequently listed physical environment deficiencies. ...
Mac's Safety Space
- Volume
17
Issue
2

Location, location, location!

February 06, 2023
Accreditation & Survey Preparation, Environment and Facilities
Any time there’s a shift in focus when it comes to healthcare leadership, I like to ponder how it might end up impacting the management of the physical environment. ...
Medical Environment Update
- Volume
33
Issue
1

TJC: Antibiotic stewardship updates effective January 1, 2023

December 20, 2025
Accreditation & Survey Preparation, Infection Control, Quality & Errors
The Joint Commission (TJC) has several updated antibiotic stewardship elements of performance (EP) that took effect on January 1, 2023. These EPs include requirements to have an antibiotic stewardship...
Accreditation & Quality Compliance Advisor
- Volume
17
Issue
5

It’s official: COVID-19 public health emergency to end on May 11

January 31, 2023
Accreditation & Survey Preparation
As promised, the White House is giving ample notice—the COVID-19 public health emergency (PHE) will end on May 11. ...
Inside Accreditation & Quality
- Volume
5
Issue
1

Joint Commission moves to three-year appointment cycle—now what?

January 31, 2023
Accreditation & Survey Preparation
The Joint Commission’s time frame for evaluating licensed practitioners’ ability to provide care, treatment, and services has been updated from two years to three years, and is intended to better alig...

Rural Emergency Hospitals Conditions of Participation December 2023

Thu, 01/26/2023 - 09:58 - - Accreditation & Survey Preparation
Inside Accreditation & Quality
- Volume
5
Issue
1

CMS final rule on rural emergency hospitals offers flexibility on 24-hour observation limit

January 24, 2023
Accreditation & Survey Preparation
In its final rule, CMS included behavioral health and low-risk maternal labor and delivery on the list of services allowed under the rural emergency hospital (REH) designation. However, some hospitals...

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OSHA Dental Facilities Update - November 2023

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Tab 2, Medical Facilities OSHA Manual- August 2023

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Chapter 2: Chapter Format and Tracer Planning

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  • News & Analysis
    • Accreditation & Quality Compliance Advisor
    • Mac's Safety Space
    • Inside Accreditation & Quality
    • Healthcare Safety Leader
    • Medical Environment Update
    • Patient Safety Monitor Journal
  • CMS Compliance Crosswalk
  • OSHA Program Manuals
  • Resources
    • Accreditation 101
    • Mock Tracers & Checklists
    • E-Books
    • Survey Training Essentials Toolkit
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  • Membership
    • Become a Member
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