ESSENTIAL 2 The survey team will review OPO safety records for evidence of OPO Category I and II employees BBP education Maps to TR 4.2 for each of the three years involving the accreditation cycle. The survey team shall use a minimum 10% sampling 100% of OPO Category I and II of employee safety records to validate training. employees undergo BBP training annually ESSENTIAL 3 The survey team will review OPO board (advisory OR governing) records for evidence of the OPO Quality Plan's Maps to QI 1.2 review for each of the three years involving the accreditation cycle. The OPO Quality Plan is reviewed by the OPO board annually. ESSENTIAL 4 The survey team will review OPO donor records for evidence of OPO documentation of authorization for each of Maps to CL 3.2 the three years involving the accreditation cycle. The survey team shall use the minimum sampling method used 100% of OPO donor records sampled for routine donor record review. contain evidence of authorization for organs recovered ESSENTIAL 5 The survey team will review OPO donor records for evidence of the donor hospital's documentation of patient Maps to CL 2.2 death for each of the three years involving the accreditation cycle. The survey team shall use the minimum 100% of OPO donor records sampled sampling method used for routine donor record review. contain evidence of patient death declaration prior to beginning organ recovery surgery ESSENTIAL 6 The survey team will review OPO donor records for evidence of OPO documentation of donor infectious disease Maps to CL 4.D.2.1 for each of the three years involving the accreditation cycle. The survey team shall use the minimum sampling 100% of donor records sampled method used for routine donor record review. contain evidence of completed infectious disease testing STANDARD INTERPRETIVE GUIDELINES ADMINISTRATION STANDARD AS 1 GOVERNING AND ADVISORY BODY An organized governing and advisory The surveying team should determine that the OPO has a governing and advisory board. board must be established.
ESSENTIAL 2 Maps to TR 4.2 100% of OPO Category I and II employees undergo BBP training annually The survey team will review OPO safety records for evidence of OPO Category I and II employees BBP education for each of the three years involving the accreditation cycle. The survey team shall use a minimum 10% sampling of employee safety records to validate training. ESSENTIAL 3 Maps to QI 1.2 The OPO Quality Plan is reviewed by the OPO board annually. The survey team will review OPO board (advisory OR governing) records for evidence of the OPO Quality Plan's review for each of the three years involving the accreditation cycle. ESSENTIAL 4 Maps to CL 3.2 100% of OPO donor records sampled contain evidence of authorization for organs recovered The survey team will review OPO donor records for evidence of OPO documentation of authorization for each of the three years involving the accreditation cycle. The survey team shall use the minimum sampling method used for routine donor record review. ESSENTIAL 5 Maps to CL 2.2 100% of OPO donor records sampled contain evidence of patient death declaration prior to beginning organ recovery surgery The survey team will review OPO donor records for evidence of the donor hospital's documentation of patient death for each of the three years involving the accreditation cycle. The survey team shall use the minimum sampling method used for routine donor record review. ESSENTIAL 6 Maps to CL 4.D.2.1 100% of donor records sampled contain evidence of completed infectious disease testing The survey team will review OPO donor records for evidence of OPO documentation of donor infectious disease for each of the three years involving the accreditation cycle. The survey team shall use the minimum sampling method used for routine donor record review. STANDARD INTERPRETIVE GUIDELINES ADMINISTRATION STANDARD AS 1 GOVERNING AND ADVISORY BODY An organized governing and advisory board must be established. The surveying team should determine that the OPO has a governing and advisory board.
PROPOSED_REVISIONS_REDLINE_AOPO_Standards_and_Guidelines_2015-07-28.docx