The Joint Commission's home care accreditation program accredits more than 4,000 organizations, including hospitals. The home care organizations provide home health services, personal care and support services, home infusion (intravenous or IV therapy) and other pharmacy services, durable medical equipment services, and hospice services.

The majority of the medical equipment management requirements for home care can be found in the "Equipment Management (EQ)" chapter of The Joint Commission's 2009 Comprehensive Accreditation Manual for Home Care.

EQ Standards

The medical equipment standards are divided into the following two categories:

1. Management of Equipment Provided to Patients

   EQ.01.01.01: Selection and Delivery of Equipment and Supplies

   EQ.01.02.01: Setup of Medical Equipment in Patient's Home

   EQ.01.03.01: Maintaining, Testing, and Inspecting Equipment Provided to Patients

   EQ.01.04.01: Emergency Maintenance, Replacement, or Backup of Equipment

   EQ.01.05.01: Storage of Medical Equipment and Supplies

2. Management of Equipment Used by Staff in the Provision of Care

   EQ.02.01.01: Maintaining, Testing, and Inspecting Equipment

Each standard has a compliance grid that identifies which elements of performance (EP) are applicable to the different home care services like home health, hospice, durable medical equipment, respiratory equipment, etc.

EQ.01.01.01

This standard has 12 EPs and includes a requirement that the organization has a process of selecting and acquiring medical equipment and supplies that are provided for the patients. The durable medical equipment, prosthetics, orthotics, and supplies should meet applicable FDA regulations and safety and effectiveness standards. It also requires that the organization deliver the medical equipment and supplies in a sanitary, clean, and undamaged condition.

EQ.01.02.01

This standard requires the organization to safely set up medical equipment in the patient's home. It has eight EPs. One of the requirements is to determine if the equipment can be used safely in the patient's home. It also requires an evaluation of the condition of electrical outlets and extension cords, grounding and the likelihood of circuit overload, exposure to heat sources, liquids, and the availability of emergency power.

EQ.01.03.01

This standard addresses the requirements for maintenance, testing, and inspecting the medical equipment it provides to patients. It has eight EPs. The requirements include that the medical equipment undergo routine and preventive maintenance at defined intervals and according to manufacturer guidelines. If there are no manufacturer guidelines for routine and/or preventive maintenance, the organization should establish such guidelines and use a method that is effective. In addition, the maintenance should be documented. Besides maintenance, safety, operation, function checks, and repairs should be performed and documented according to the organizational policy and manufacturer guidelines.

Volumetric Test for Infusion Pumps

Basic safety and operational checks of infusion pumps should be performed and must include the performance of the volumetric test for the accuracy of each pump's infusion rate between use by different patients when used in the home. When used in a freestanding ambulatory infusion center, the organization can define the intervals for safety and operational checks between use by different patients.

The organization should perform documented inspections on medical equipment between use by different patients. Also, recalls and equipment hazard notices should be acted upon, including notifying patients, staff, and prescribing physicians.

EQ.01.04.01

This standard addresses the requirements for emergency maintenance, replacement, or backup of equipment. It has 10 EPs and includes the requirement that the organization identify the medical equipment that it provides that would threaten the life or health of the patient if it fails or malfunctions. For the equipment that would threaten the life or health of the patient if it fails or malfunctions, the organization is required to provide patients with access to services 24 hours per day, 7 days per week, and a backup system that duplicates the function of the equipment to be replaced.

For ventilator-dependent patients, the backup system must duplicate the function of the ventilator for a minimum of three times the organization's maximum response time.

For patients receiving life-sustaining infusions, the organization must provide infusion control devices with an alternate power source that can provide service for a minimum of three times the organization's maximum response time.

For patients receiving oxygen therapy, the organization must provide a backup oxygen supply that will last a minimum of three times the organization's maximum response time and function at the prescribed flow rate, frequency, and duration.

EQ.01.05.01

This standard addresses the requirements for storage of medical equipment and supplies at its location. It has five EPs and includes the requirement that the organization clearly identify and separate areas for storing different categories of equipment, such as obsolete, dirty, clean, patient-ready, and those requiring maintenance or repair. It requires the cleanliness of all storage areas and patient-ready medical equipment. It references the infection control standards for cleaning and disinfection.

EQ.02.01.01

This standard addresses the maintenance, testing, and inspection of equipment used by staff in the provision of care. It has five EPs and includes the requirement that the medical equipment undergo routine and preventive maintenance at defined intervals and according to manufacturer guidelines. If there are no manufacturer guidelines for routine and/or preventive maintenance, the organization should establish such guidelines and use a method that is effective. The maintenance should be documented. Besides maintenance, safety and operational checks should be performed and documented according to the organizational policy and manufacturer guidelines. It also requires that the organization certify the laminar flow hoods and clean rooms every 12 months and document the performance of these checks.

For detailed requirements of each standard, refer to The Joint Commission's 2009 Comprehensive Accreditation Manual for Home Care at www.jcrinc.com/Accreditation-Manuals/2009-CAMHC/1324/.

Arif Subhan, MS, CCE, is a senior clinical engineer, Masterplan, Chatsworth, Calif; adjunct assistant professor, biomedical engineering, University of Connecticut; and a member of 24x7's editorial advisory board. For more information, contact .