Monitoring and evaluation in the special care unit: the JCAHO ten-step process.

Monitoring and evaluating the quality and appropriateness of patient care in the special care unit is the basis for quality assurance activities. To make the monitoring and evaluation process helpful, health care professionals in special care units must be involved in each step of the process. The focus must be on patient care, specifically on clinical aspects of care rather than on structural specifications or technical processes. In addition to assisting the special care unit to meet accreditation requirements, ongoing monitoring and evaluation assist that unit to assure high-quality care. Monitoring and evaluation activities also assist the special care unit manager in responding to demands of state and federal regulators by providing an objective assessment of the care provided to Medicare and Medicaid patients. These activities also can provide assistance in responding to concerns about lawsuits involving alleged negligence in provision of special care; and in meeting pressures from third-party payers to reduce costs associated with unnecessary treatment in special care units. This chapter describes how the ten-step monitoring and evaluation process can be used to help assure high-quality patient care in the special care unit.