Accreditation and Regulatory Bootcamp
October 14, 2021 to October 15, 2021
This activity will provide the participants with a foundational understanding of the continuous readiness process from a regulatory / accreditation perspective. Participants will learn about the history of healthcare regulations / accreditation; regulatory / accreditation sources of truth; managing the continuous readiness process prior to, during and following an external survey visit. Each session will include perspective from those who have successfully addressed requirements and/or a resource to help the participant in their compliance strategy. There will be facets of this program that address knowledge, competence and performance.
Target Audience
- Nurses
- Quality leaders
Learning Objectives
- Describe foundational concepts of Accreditation and Licensure
- Describe Accreditation professional role and responsibilities
- Identify key components of Continuous Accreditation compliance program
- Identify key components of a Survey Management Plan
- Summarize the role of an accreditation professional during survey
- Identify key components of Command Center management
- Describe foundational concepts of Federal and State regulations for the Licensure of hospitals
- Describe foundational concepts of the Centers for Medicare & Medicaid Services (CMS) State Operations Manual (SOM)
- Describe foundational concepts of the Centers for Medicare & Medicaid Services (CMS) conditional of participation (CoPs)
- Describe foundational concepts of the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs) Interpretive Guidelines
- Summarize The Joint Commission (TJC) Survey Activity Guide (SAG) required documentation
- Describe how to develop State agency 2567 survey response and action plans
- Identify key components of Appendix V Emergency Medical Treatment and Labor Act (EMTALA)
- Identify key components of Appendix I Life Safety Code
- Describe how to develop Centers for Medicare & Medicaid Services (CMS) 2567 survey responses and action plans
- Summarize challenging TJC standards
- Summarize CMS 2567 current trends
- Verbalize key concepts of contract management and monitoring
- Describe the reporting requirements for restraints
- Summarize concepts of hand off communication
Additional Information
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Live via webinar
United States
Relevant financial relationships: Planning committee members and presenters have nothing to disclose.
Planning committee members
Twila Loudder, RN, MS, BSN, CPHQ
Accreditation Advisor, Advisory Services
Vizient, Inc.
Gail Turner, RN-BC, MSN, CNML, CPHQ
Manager Accreditation and Regulatory Affairs
Lawrence & Memorial Hospital
Natalie Webb, MHA, RN, CPHQ (nurse planner)
Accreditation Director
Vizient, Inc.
Course reviewer
Natalie Webb, MHA, RN, CPHQ (nurse planner)
Accreditation Director
Vizient, Inc.
Presenter
Twila Loudder, RN, MS, BSN, CPHQ
Accreditation Advisor, Advisory Services
Vizient, Inc.

Joint Accreditation Statement:
In support of improving patient care, Vizient, Inc. is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
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Designation Statement:
NURSING
This activity is designated for 7.00 contact hours.
NATIONAL ASSOCIATION FOR HEALTHCARE QUALITY
This program has been approved by the National Association for Healthcare Quality for a maximum of 7.00 CPHQ continuing education credits for this event
CEU
Vizient, Inc. will award CEUs to each participant who successfully completes this program. The CEU is a nationally recognized unit of measure for continuing education and training programs that meet certain criteria (1 contact hour = 0.1 CEU).
Available Credit
- 7.00 ANCC
- 7.00 CPHQ – Certified Professional Healthcare Quality
- 7.00 General CE - Attendance