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The October and November 2004 HHN Accreditation Strategies columns addressed the new Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) home care and hospice survey process describing in detail components of each survey activity. This column builds on the foundation laid in the two columns and focuses on survey process nuances for complex organizations, specifically pertaining to hospital-based agencies and hospices. Therefore, all discussion and examples in this column will pertain to home health agencies and hospices that are a department of a hospital seeking Joint Commission accreditation.

Contracted services have gained greater emphasis in the home care standards and survey process over the past several years, especially as they relate to the quality and safety of the services provided. This column reviews 2004-2005 standard LD.3.50, its applicable elements of performance, and discusses the Joint Commission's requirements for evaluating the care and services provided by contracted providers.

Coding accurately is one of the main principles of a successful practice. Some changes that we will see shortly include deletion of the term "separate procedure," deletion of the term "with and/or without," deletion of the term "any method," revision of the criteria for choosing E/M levels, and 52 new and revised Hand Surgery codes. Some other changes to come will be category II and category III codes. More changes are occurring as this is written, and the best advice is to stay tuned. It is obvious to the authors that coding is mainly for reimbursement purposes. The orthopedic surgeon must remain vigilant and must not pass this task on to someone else. Ignorance of coding methods is not an excuse [2]. We must all watch carefully and speak up when necessary. In this day of decreasing reimbursement, we can all increase our revenue stream without working any harder if we code our work properly, completely, and promptly.

Administrators, managers, and clinicians need to be up-to-date on all aspects of the new Needlestick Safety and Prevention Act recently passed into law. This article gives the background and foundation needed to implement policies, procedures, and actions that will assure compliance with the law and increased worker safety.

The changes in the format of the 2001-2002 CAMHC are tremendously helpful for organizations that provide multiple types of home care programs. At last, reviewing the common and service-specific standards can identify the applicable standards. The most significant change is the change in the aggregation methodology that places home care and hospice organizations at higher risk for type 1 recommendation(s). The next Accreditation Strategies column will review the changes in the standards in the 2001-2002 CAMHC from the chapter entitled "Improving Organizational Performance" through the chapter entitled "Surveillance, Prevention and Control of Infection".

These are just a few of the forthcoming changes facing accredited home care and hospice organizations. The next "Accreditation Strategies" column will review the changes in the standards from the 2001-2002 Comprehensive Accreditation Manual for Home Care, discuss the new aggregation rules, and explain what the changes mean for accredited home care and hospice organizations.

In today's homecare environment, optimizing operational efficiency and making data-driven decisions is essential. Home infusion therapy organizations that are accredited by the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) will find a heavy emphasis on the standards for improving organizational performance during the homecare survey process. The standards from the "Improving Organizational Performance" chapter are reviewed, and the Joint Commission's requirements for meeting the intent of the standards are discussed.

Antibiotic-resistant microorganisms can spread to other home care patients by an infected or colonized patient receiving home care services and the home care staff member unknowingly carrying it to another home care patient's home. Controlling the transmission of antibiotic-resistant microorganisms is the primary responsibility of those providing direct patient care. The ultimate goal for home care is to prevent staff colonization and cross-contamination to other home care patients.

Implementing sound, rational infection control practices in home care has been challenging since guidelines, standards, and most references have been developed for the acute care setting. This article provides guidance for adapting appropriate infection control interventions for patient care practices to the home care setting. Such practices include handwashing, home infusion therapy, respiratory care, wound care, urinary tract care, and isolation precautions. Assessment of the home care environment, cleaning and reprocessing of equipment, surveillance, implications for occupational health, and program design are also discussed.

The thesis of this article is that for family nursing to be effectively provided, a transcultural perspective must be incorporated. The underlying rationale for the integration of transcultural knowledge and values is presented, as well as an approach for integrating cultural aspects into family assessment and intervention. Black and Latino families are discussed in terms of their culturally-derived familial patterns.