Det Norske Veritas Healthcare (DNV) Det Norske Veritas Healthcare (DNV) is a company that has held “deemed status” approval from the Centers for Medicare & Medicaid Services (CMS) to assess facilities for quality of care and patient safety, and to approve or disapprove of these facilities for reimbursement since 2008. In other words, it is one of only three organizations that can award accreditation to hospitals. The Joint Commission (TJC), the Centers for Medicare and the Healthcare Facilities Accreditation Program are the other two. DNV differs from TJC in the following ways: DNV states that it employs “a highly collaborative survey process that encourages innovation and does not force hospitals to accept a generic template for patient safety goals. We help you find your highest levels of performance.” On the other hand, TJC sets the priorities for the facility. DNV uses the ISO 9001 Quality Management System, with a focus on process improvement. TJC uses The Comprehensive Accreditation Manual for Hospitals. DNV has created The National Integrated Accreditation for Healthcare OrganizationsSM (NIAHO) Manual. Surveys by DNV are annual. They occur in 3-year cycles for TJC, with an annual self-review or on-site TJC survey (the Periodic Performance Review). TJC is not accountable to CMS, while DNV is. The DNV’s accreditation standards are thus fully consistent with CMS and stable, while TJC’s accreditation standards change frequently. Perhaps the biggest difference is that the TJC’s findings determine accreditation status, while DNV’s findings do not. TJC has accredited approximately 18,000 facilities (an estimated 5000 of which are hospitals). DNV has accredited 1200 health care facilities worldwide (an estimated 27 hospitals). Areas of focus DNV focuses on the following areas during surveys: Patient care in all settings Staff member activities, equipment, documentation, building structure, sounds and smells, etc Integration of all services Whether quality improvement is an organization-wide activity Interaction between various hospital departments Activity reports to assure quality management oversight Storage, security, and confidentiality of medical records More about the survey DNV uses tracer methodology and department/patient audits to include staff interviews and open medical record review. The organization must respond with Corrective Action Plans for all nonconformities. Once this plan is accepted and approved, a copy of the survey schedule and the NIAHO Report and Corrective Action Response are submitted for review by the Accreditation Committee. The clinical surveyor(s) look at all patient care units. The generalist surveyor(s) look at the Quality Management Program, medical staff, Human Resources Department, and ancillary areas. The physical environment surveyor(s) look at the physical environment, life safety, and biomedical engineering. More about the NIAHO Manual The standards incorporate the CMS conditions of Participation and the ISO 9001 Quality Management System. The manual contains 25 chapters and addresses standards, among others, for Staffing Management, Patient Rights, Medication Management, Discharge Planning, Utilization Review, and Physical Environment. About Dietary Services and the NIAHO Manual According to the NIAHO Manual, facilities can carry out dietary services either internally or through a contract with a nutrition management company. Either way, it is necessary to have regular interaction with medical staff regarding dietetic policies that could impact patient care. The person responsible for the management, direction, and accountability of food and nutrition services must work full time and have training with suitable qualifications and experience. This person must ensure that administrative and technical employees are educated and competent in their jobs. The facility also must have a registered dietitian (RD) or registered dietitian nutritionist (RDN) available as needed. All menus must meet the following requirements: Are prescribed by a practitioner who is responsible for the patients’ care Meet the: – Nutritional needs of the patients – Standards of current recognized dietary standards The diet manual: Clearly defines all therapeutic diets Has approval of both the RD or RDN and the medical staff Is located in an area available to all staff who are either directly or indirectly responsible for ensuring that patients receive appropriate nutritional services References and recommended readings DNV Healthcare Inc. DNV accreditation program frequently asked questions. http://dnvaccreditation.com/pr/dnv/document/FAQ.pdf. Published March 11, 2013. Accessed November 14, 2013. Managing risk. DNV Accreditation Web site. http://dnvaccreditation.com/pr/dnv/default.aspx. Accessed November 14, 2013. Meldi D, Rhoades F, Gippe A. NAMMS The big three: side by side matrix comparing hospital accrediting agencies. Synergy. 2009;January/February:12-14. http://www.namss.org/portals/0/advocacy/namss_synergy_janfeb09_accreditation_grid.pdf. Accessed November 14, 2013. Review Date 11/13 G-1686