The March issue of The Joint Commission Perspectives contains an article on the latest change in the diagnostic imaging standards that have new requirements effective September 2016. Fortunately you have hopefully been reading and anticipating these for a long time as they have been in development and published by TJC on several occasions.
There are two new HR requirements and one update to an existing MS standard that will require a small effort this year. The first change in at, EP 19 and this will require your CT technologists to obtain advanced level certification from the American registry of radiologic technologists (ARRT), or the nuclear medicine technology certification board (NMTCB), or they must meet alternative criteria involving state licensure and documentation of training. The second new HR requirement is for technologists who perform diagnostic CT exams to participate in education that prepares them to achieve advanced level CT certification by January 1, 2018. This basically means that if they don’t have the advanced level certification today, but they meet the alternative criteria permitted by EP 19 of , there is an end date when alternative criteria will no longer be accepted.
The last change to mention is the Medical Staff requirementto approve the job descriptions and competencies for radiology staff who use equipment and administer procedures. Now there will be a note added stating that the CT technologists will at a minimum meet the new requirements stated above for EP 19 of .
The action item here is to share the new standards with your radiology administrator asking:
1. Do the staff already meet the new advanced level certification criteria specified in
2. If staff do not have the advanced level certification stated in EP 19, do they meet the alternative criteria which is sufficient until 1/1/18?
3. If staff meet the expectation using the time limited criteria, is there an action plan to enable them to meet the advanced criteria by 1/1/18?
4. Does the HR file for these staff include evidence that they meet the criteria?
Then based on what you hear from the radiology administrator, tickler a date to verify the paper trail is sufficiently clear to you, and in turn to a surveyor to pass muster on survey.
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