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CMS: Physicians and nurses can text, just not medical orders

CMS is clearing up recent confusion on what medical providers can text each other. The agency confirmed care team members are allowed to text patient information over a secure messaging app. However, texting medical orders is still verboten.

Some providers have taken to secure messaging platforms as a way to contact providers during emergency, to consult on medical cases, or send photos of the patient. The confusion started on December 18 after an article by the Health Care Compliance Association (HCCA) cited emails CMS had sent to two hospitals saying that “texting is not permitted.” People thought this meant “texting is never permitted” instead of “texting medical orders isn’t permitted.”

“Secure texting is an integral part of a community platform for organizations,” one manager told the HCCA. “If you pull secure texting out of that pathway, you have disrupted a huge chain of communications that will have a broader effect.”

Luckily, CMS explained this wasn’t the case in its newest S&C memo, and that it knows the value of instant messaging in the workplace.

“CMS recognizes that the use of texting as a means of communication with other members of the healthcare team has become an essential and valuable means of communication among the team members,” wrote David R. Wright, director of CMS’ Survey and Certification Group. “In order to be compliant with the CoPs or CfCs, all providers must utilize and maintain systems/platforms that are secure, encrypted, and minimize the risks to patient privacy and confidentiality as per HIPAA regulations and the CoPs or CfCs. It is expected that providers/organizations will implement procedures/processes that routinely assess the security and integrity of the texting systems/platforms that are being utilized, in order to avoid negative outcomes that could compromise the care of patients.”

Prepping hospitals for winter storms

With the biting cold and heavy snow that struck the East Coast this month, and with more on the way healthcare organizations should take a look at their preparation plans for blizzards and snowstorms.  The following tips come from Allina Health in Minneapolis, MedStar Montgomery in Olney, Md., and University of Maryland Medical Center (UMMC) in Baltimore.

1.    Plan for the long haul. Plan out sleeping accommodations for staff who will be working on-site during the storm. Also ask all scheduled staff to arrive ahead of the storm.
2.    Expect travel and road conditions to be treacherous well after the storm. Different travel routes often receive different priority when it comes to plowing and clearing, and there can be a large difference in travel conditions even just a few blocks down the road.
3.    Remember that staff are people, too. Make sure staff is taken care of as well. Movies, popcorn, and other entertainment can go a long way toward allowing your staff some rest and relaxation.
4.    Review your business continuity plan. If the storm damages your facility and requires repairs or relocation of services, make sure you have a business continuity plan to keep revenue moving.
5.    Emphasize smooth communication. Outside lines of communication are often disrupted during a storm or emergency. Healthcare organizations’ internal communication should be on point in order to pick up that slack.
6.    Review and practice your disaster management protocols. The regular review and execution of the disaster drills required of your hospital by The Joint Commission is important to stay prepared for when a disaster finally does happen—and it will.

For more articles like this, check out our sister publication Inside the Joint Commission. https://www.codingbooks.com/inside-the-joint-commission 
 

Joint Commission: Life Safety revisions for behavioral healthcare

The Joint Commission has revised its Life Safety standards LS.04.01.20 through LS.04.02.50 for its Behavioral Health Care Accreditation program. The changes apply to residential behavioral health care facilities and go into effect July 1, 2018. The revisions change the “residential occupancy” requirements so they align with the 2012 edition of the National Fire Protection Association’s NFPA 101: Life Safety Code®.

The accreditor says these changes aren’t major, and they mostly address two things:

•    Updating the NFPA chapter references used in the elements of performance
•    Making it easier to discern between the requirements for existing and new buildings and for small and large organizations.

You can read the prepublication standards here. 

CMS and Joint Commission change hospital eligibility requirements

Both organizations have changed their expectations on the defintion of a hospital. CMS’s new S&C Memo 17-44-Hospitals says that surveyors will use average daily census (ADC) and average length of stay (ALOS) data to determine if the hospital is primarily engaged in providing services to inpatients, and “a hospital must have inpatients at the time of survey in order for surveyors to directly observe the actual provision of care and services to patients, and the effects of that care” to determine if the facility is meeting the Conditions of Participation (CoP) in Medicare.

In addition, both CMS and The Joint Commission say that hospitals will need at least two active inpatients on site for an accreditation survey to be done. This change is effective immediately.

CMS memo defines ligature risk and clarifies expectations

A new CMS memo creates a definition of a ligature risk, a time frame for correcting them, and interim guidance for surveyors, plus requirements for requesting a time extension for a plan of correction taking longer than 60 days. CMS says that while not all ligature risks can be eliminated, hospitals are expected to show how they identify patients at risk and the steps they are taking to minimize those risks.

According to the S&C Letter 18-06, a ligature risk (or point) is “anything which could be used to attach a cord, rope, or other material for the purpose of hanging or strangulation.” That includes handles, coat hooks, pipes, shower rails, radiators, bedsteads, window and door frames, ceiling fittings, hinges, and closures.

CMS is still collaborating with healthcare organizations and patient safety groups on more comprehensive guidance on ligature risks. The agency says it expects to have the update done in six months. Until then, accrediting organizations (AO) are allowed to use their own judgment on ligature risks. That includes the definition of a ligature risk, plans for correction, how deficiencies are ranked, and how long a facility has to correct the problem. Facilities should double-check with their AO’s ligature risk and self-harm requirements.

Joint Commission to Increase Hand Hygiene Focus

The Joint Commission will soon be scrutinizing hand hygiene more closely.

Starting in 2018, if a surveyor from the accrediting organization witnesses an individual who directly cares for patients fail to perform required hand hygiene, the person’s healthcare organization will receive a citation under The Joint Commission’s Infection Prevention and Control (IC) standard IC.02.01.01, element of performance 2, which requires organizations to use precautions such as hand hygiene to reduce infection risk. In addition, healthcare facilities must meet National Patient Safety Goal (NPSG) 07.01.01, which requires them to implement and maintain a hand hygiene program.

The change, announced Thursday, will go into effect on January 1, 2018.

Previously, healthcare organizations were not penalized for an individual failure to perform proper hand hygiene if that organization had an otherwise compliant hand hygiene program. But under this change, if a surveyor spots an individual who does not properly wash his or her hands, the surveyor will cite the organization for a deficiency resulting in a Requirement for Improvement.

In 2004, TJC first required all healthcare organizations to implement hand hygiene programs and keep track of individual performance within that plan. Proper hand hygiene, of course, is critical for preventing infections in a healthcare setting.

FDA bans 24 ingredients in healthcare antiseptics

The FDA has banned two dozen active ingredients used in healthcare products because they weren’t generally recognized as safe and effective for use in over-the-counter (OTC) products. The ban is specifically aimed at OTC products used primarily in medical settings like hospitals, clinics, and doctors’ offices. The ingredients had been used in antiseptic hand washes and rubs, surgical hand scrubs, and patient antiseptic skin preps.

“Ensuring the safety and effectiveness of over-the-counter health care antiseptics has been a priority for the FDA, not only because these products are an important component of infection control strategies in health care settings, but also because of the role these products may play in contributing to antimicrobial resistance if they’re not manufactured or used appropriately,” said FDA Commissioner Scott Gottlieb, MD. “Health care providers are on the front lines of care. They need and deserve to have safe and effective means for preventing the spread of infection.”

With the exception of triclosan, none of the ingredients are currently being used in any marketed health care antiseptic products. And at industry urging, the FDA is deferring their final rulemaking for a year for six ingredients to give manufacturers more time to complete the scientific studies on their safety: alcohol (ethanol), isopropyl alcohol, povidone-iodine, benzalkonium chloride, benzethonium chloride, and chloroxylenol (PCMX).

 

2018 version of “Patient Safety Systems” Chapter available

The Joint Commission has released the most recent versions of it’s PS Chapter for hospitals, nursing care centers, critical access hospitals, behavioral healthcare centers, laboratories, and more.

Main manual for CMS’ hospital Interpretive Guidelines updated

For the first time in two years, the online version of CMS’ State Operations Manual, Appendix A — also known as SOMA by some — is showing it has been revised!

The date on the appendix, which offers CMS surveyors Interpretive Guidelines to follow when implementing the hospital Conditions of Participation (CoP), is now Nov. 17, 2017. The last revision had been in November 2015.

The most recent update appears to mainly reflect changes to how CMS defines a hospital for survey. Those changes were announced in S&C memo 17-44-ALL-Hospitals.

And more changes should be on the way, especially in light of the recent publication of a new S&C memo on ligature risk. Among other things, S&C 18-06-Hospitals memo notes changes under Tag A-0701 that appear to delete references to emergency preparedness — now under their own set of CoP outlined in Appendix Z— and adds guidelines for checking out other physical safety concerns along with ligature risk within the environment of care.

Study: Concurrent surgeries are safe

A review of more than 2,000 neurosurgical cases published in the Journal of the American Medical Association, found no greater risk of postoperative complications for patients operated on by surgeons conducting overlapping surgeries. This casts a new light on the controversial practice, which is routine at many facilities nationwide.

The study, published earlier this month, examined patients who underwent neurosurgical procedures at Emory University Hospital in Atlanta from 2014 to 2015. Of the 2,275 cases reviewed, about 43% had the surgeon remain with the patient through the entire procedure. In the other 57% of cases, the primary surgeon performed two procedures in different operating rooms.

In the 90 days following their operations, no difference was found in morbidity, mortality, or worsened outcome measures between the two groups of patients. The researchers concluded that this data suggests overlapping neurosurgeries are safe and may benefit patients by allowing sought-after specialists to see more patients.

That said, researchers did note that overlapping surgeries were notably longer than when one surgery was done at a time. And guidelines from the American College of Surgeons require that patients be informed that they’ll be undergoing a concurrent surgery.

“Surgeons must use their experience, keen intuition and respect for their own ability and limitations to carefully select patients” for overlapping surgery, the authors wrote.