The Joint Commission has published proposed standards (PDF, 225KB) for accredited behavioral health organizations providing services to individuals with eating disorders. The proposed standards are the result of collaboration between the TJC Behavioral Health Care Accreditation Program and leaders of several prominent eating disorder programs throughout the country. The goal is to offer Behavioral Health standards that focus directly on eating disorder programs and ensure that those standards support best practices in the field. The proposed standards are applicable to organization accredited under the BHC manual who provide outpatient or residential eating disorders treatment services. They are not applicable to organiztions accredited under Hospital standards but TJC is looking into that for the future. The proposed standards are posted on the TJC website and TJC is eliciting feedback from the field through August 17. Highlights are as follows:
Assessments
Requirements for specific tests, screenings, and procedures within 48 hours including:
- Complete blood count
- Comprehensive serum metabolic profile
- Thyroid function test
- Electrocardiogram
- Body Mass Index
- Heart rate
- Screening for eating disorder behaviors
- Collection of health information from previous providers
- Assessment of emotional support received from family friends and others
- Assessment of fall risk
- Assessment for refeeding syndrome
Treatment Planning
Requirements for an initial plan of care and a comprehensive plan of care. The plan of care must provide for “sufficient nutritional rehabilitation to support regular and consistent weight gain (including expected rates of controlled weight gain), and/or measurable improvement in eating disorders behavior (for example, restricting, binge eating, purging).”
Outcomes of Care
Requirement to assess outcomes of care based on data collected at admission including history and physical, frequency of binging and purging, BMI, heart rate, date of last period and other appropriate lab tests. Also, data collection using valid and reliable instruments such as the Beck Depression Inventory, Eating Disorder Quality of Life scale, SF-36 and Eating Disorder Inventory-3 as well as client satisfaction data.
Staffing
For organizations providing 24-hour care to individuals with eating disorders, a registered nurse must be on duty 24 hours a day, 7 days a week.
Requirement for services of a registered dietician specifically trained in the age group served
Requirement for an MD or DO with experience in treating eating disorders to be on staff or available 24/7. If MD/DO is not on staff, an advance practice nurse must be on staff.
Requirement for a psychiatrist or psychologist with experience in treating eating disorders to be on staff or available 24/7. If clients are younger than 18 years, the psychiatrist must be board certified or board eligible in child/adolescent psychiatry.
Care Coordination
Requirement for minimum types of clinical services to be provided weekly (individual and group therapy, medication monitoring, etc.). Specific requirements for content of the discharge plan and communication with after-care providers.
So, if your organization operates a program for individuals with eating disorders, it’s important to provide feedback to TJC on these proposed standards. We encourage you to review them in their entirety and submit your comments by August 17.