RSSAuthor Archive for Brian Ward

Brian Ward

Brian Ward is an Associate Editor at HCPro working on accreditation news.

Joint Commission provides tips for improving handoffs

This September, The Joint Commission posted an infographic on “high-quality hand-offs.” The infographic is a companion to the accreditor’s Sentinel Event Alert (SEA) 58 on inadequate handoff communications and its effect on patient care. Transferring a patient’s care between providers is major point of failure for healthcare. Every transfer runs the risk of key treatment information being garbled, forgotten, or not passed on.

“Potential for patient harm—from the minor to the severe—is introduced when the receiver gets information that is inaccurate, incomplete, not timely, misinterpreted, or otherwise not what is needed,” The Joint Commission wrote in SEA 58. “When hand-off communication fails, many factors are involved, such as healthcare provider training and expectations, language barriers, cultural or ethnic considerations, and inadequate, incomplete or nonexistent documentation, to name just a few.”

Along with the eight tips in the infographic, the SEA listed several steps to minimize handoff problems, including:

1.    Standardize the content that’s shared during a handoff. This includes standardized tools and methods (e.g., forms, templates, checklists, protocols, mnemonics, etc.) to communicate to receivers.
2.    Conduct face-to-face handoffs in locations free from distractions.
3.    Teach staff how to conduct a successful handoff as both the sender and the receiver.
4.    Use electronic health record capabilities and other technologies to enhance handoffs between senders and receivers.
5.    Measure how successful these interventions are at improving handoff communication and use the lessons to drive improvement.

George Mills lands gig with Chicago firm as his Joint Commission exit approaches

Two weeks after The Joint Commission confirmed that its engineering department director would be leaving the organization, a Chicago-based professional services firm proudly announced him as a new hire.

George Mills, MBA, FASHE, CEM, CHFM, CHSP, who worked 14 years for the accrediting organization, will transition next month into his new job as director of healthcare technical operations with JLL, the company said Wednesday in a statement.

“George’s vision and passion for the improvement of hospital operations will benefit the hospital systems we serve across the country,” said Peter Bulgarelli, executive managing director of JLL’s Healthcare group, in the statement. “In his new role with JLL, George’s direct work with healthcare organizations on regulatory and compliance matters through JLL solutions and technology will take our platform to the next level for our clients.”

Mills, who will take the lead on JLL’s healthcare technical operations platform, will manage teams focused on a number of areas, including not only compliance matters and facility management but supply chains, sustainability initiatives, and more, the company noted.

Mills said in the statement that his transition will enable him to put his teachings into practice and show healthcare organizations how to implement solutions proactively. “I believe together we can make a difference and show the industry that change is possible,” he said.

JLL Healthcare says it offers solutions related to facilities and real estate in order to push healthcare organizations forward both clinically and financially. The company says its clients include 540 hospitals.

The brand name JLL is a trademark registered to Jones Lang LaSalle Inc.

A spokesperson for The Joint Commission said August 24 that Mills would be leaving his current post effective October 9. John D. Maurer, SASHE, CHFM, CHSP, will take over as acting director on an interim basis.

What providers can do this National Suicide Prevention Week

National Suicide Prevention Week is September 10-16, bringing awareness to the 10th leading cause of death in the United States. This week is a time for physicians, nurses, and other providers to learn more about how their healthcare organizations can help suicidal patients.

Find out how your healthcare organization can help suicide patients

Find out how your healthcare organization can help suicide patients

In 2013, 9.3 million adults had suicidal thoughts, 1.3 million attempted suicide, and 41,149 died. Even more worrying is that the rate of suicides has increased 24% between 1999 and 2014. And as of March 2017, Joint Commission surveyors have been putting special focus on suicide, self-harm, and ligature observations in psychiatric units and hospitals. Surveyors are documenting all observations of self-harm risks, and evaluating whether the facility has:

  • Identified these risks before
  • Has plans to deal with these risks
  • Conducted an effective environmental risk assessment process

 

To learn more about suicide prevention in healthcare, check out the following websites and articles.

George Mills is leaving The Joint Commission

The Joint Commission confirmed Thursday afternoon that a key figure in standards interpretation for the healthcare accrediting organization will be departing this fall.

George Mills, MBA, FASHE, CEM, CHFM, CHSP, who has served as director of the organization’s engineering department for the past six years, will leave his post effective October 9. Mills has been with The Joint Commission for 14 years.

“During his tenure he has served as an advocate for healthcare organizations as they strive to improve the quality and safety of their physical environments,” a spokesperson for The Joint Commission said in an email.

The confirmation came after HCPro’s resident hospital safety expert, Steve MacArthur, safety consultant for The Greeley Company, blogged Thursday on murmurings of an impending Mills exit. The Joint Commission also confirmed MacArthur’s report that John D. Maurer, SASHE, CHFM, CHSP, will take over as acting director of engineering on an interim basis.

“I don’t anticipate that this will engender a significant change in how business will be conducted, including the practical administration of the Life Safety portion of the accreditation survey process,” MacArthur wrote, noting that he has always found Maurer to be “thoughtful, helpful, and equitable.”

Beginning October 9, Maurer will serve as acting director while a search for Mills’ successor is undertaken, the spokesperson said. Mills declined Thursday to comment on his forthcoming departure, and Maurer could not be reached.

 

Joint Commission deletes ORYX standard

The Joint Commission will delete performance improvement standard PI.02.01.03 and its single element of performance on January 1, 2018. The standard had required facilities to receive a composite performance rate of 85% or higher on the ORYX accountability measures.

The accreditor announced that it was deleting the standard because it wasn’t possible for facilities to accurately calculate their composite rates.

So many chart-based measures were retired to maintain alignment with CMS that there weren’t enough left relevant to this requirement. Also, since hospitals can submit data in several different ways, it threw off the composite rate calculations.

https://www.jointcommission.org/assets/1/18/Baking_Deletion_Prepublication.pdf

The measure had been suspended since 2015.

Crucial accreditation deadlines on the horizon for pain management and emergency preparedness

Time is running out to meet the new emergency management (EM) Conditions of Participation (CoP) and The Joint Commission’s revised pain management standards. The EM Interpretive Guidelines go into effect on November 15 while the pain management standards go into effect January 1.

Emergency management

The new EM CoPs fill gaps CMS’ previous regulations by compelling hospitals to communicate and coordinate their emergency plans with other healthcare organizations and government agencies. They also require regular emergency preparedness training with staff and disaster contingency planning.

Steve MacArthur, a safety consultant at The Greeley Company, pointed out that a lot of the new requirements include things that hospitals should have already been doing.

“While this rule is new to the ‘marketplace,’ there are really no new concepts contained therein,” he says. “This may provide some guidance for CMS surveyors as they drill down on organizational preparedness activities. But none of this is groundbreaking or in any way representative of a change in how hospitals have done, and will continue to do, business. [It’s] just another set of official ‘eyes’ looking through the compliance microscope.”

Pain management

The Joint Commission prepublished its new pain management standards back in June. The accreditor said it used the revision to address disparities between its standards and what the literature recommended. Some of the changes include:

•    Enabling clinician access to prescription drug monitoring program databases

•    Performance improvement activities focusing on pain assessment and management to increase the safety and quality for patients

•    Identifying the leader or leadership team responsible for pain management and safe opioid prescribing

•    Involving patients in developing their treatment plans and setting realistic expectations and measurable goals

•    Identifying and monitoring high-risk patients as a way to promote safe opioid use

Facilities should assign teams to research best practices in pain management, get the medical staff working on revising protocols and deter¬mining how to gather data on pain management effectiveness, and alert your information technology and electronic health records experts that they will be needed.

The annual fire and smoke door testing requirements will also be due by January 2018.

Solar Eclipse: Prepare for eye injuries

Healthcare providers should be on the lookout (no pun intended) for patients complaining of eye trouble over the next few days. 

Monday, August 21, a total solar eclipse will occur over the continental United States, the first one to do so since 1918. Over 12 million of people will be able to see the sun completely blocked out by the moon, with more able to see a partial eclipse.

While there have been plenty of PSAs and warnings about not looking directly at the sun (even when it’s partially obscured) healthcare organizations should be ready to deal with patients coming in complaining of eye pain or damaged vision.

New may not be better: hospital returns to paper and happier docs

The Illinois Pain Institute (IPI) was having trouble with its electronic health records (EHR). So they got rid of them and went back to paper. And they aren’t planning on going back anytime soon.

Two years ago, all 70 members of the IPI voted unanimously to get rid of its EHR saying it was slowing down care and alienating patients.

“We felt the level of patient care was not enhanced by an electronic health record. We saw it was inefficient and added nonproductive work to physicians’ time,” John Prunskis, MD, IPI founder and co-medical director told Becker’s Hospital Review. 

Since the switch, IPI has reported greater ease communicating information between hospital systems, less time spent on data entry, happier patients and staff.

“The EHR hinders data exchange,” he says. “One EHR doesn’t talk to another EHR, and there’s many reasons for that. The other thing is when you dictate a paper note with the relevant clinical findings and history, it’s rather succinct, but with the EHR, there’s a problem. The EHR is pages and pages of mind-numbing text, where important labs and information can be lost. Before, a note might be a half-page long, but now it can be five, six pages long, and doctors frequently can’t find what’s relevant through the reams of text and clutter.”

The IPI’s feelings are echoed by many physicians, according to the Mayo Clinic, which in 2016 found in EHR usage reduces physician satisfaction and increases burnout. Another study from the same year found that for every hour physicians spend with patients, they spend two hours interfacing with their EHR.

“Electronic health records hold great promise for enhancing coordination of care and improving quality of care,” said Tait Shanafelt, MD, Mayo Clinic physician and lead author of the study, in a statement. “In their current form and implementation, however, they have had a number of unintended negative consequences including reducing efficiency, increasing clerical burden and increasing the risk of burnout for physicians.”

 

Fire and smoke: CMS clarifies which doors must be inspected annually

After pushback, federal officials backed away from their claim that smoke barrier doors must be inspected and tested annually.

More than three weeks after a well-publicized compliance deadline passed, CMS announced Friday that the deadline would be pushed back nearly six months, giving facilities until New Year’s Day 2018 to comply with an annual testing requirement for certain doors.

David Wright, director of the CMS Survey and Certification Group, made the announcement in a memo to state survey agency directors. He acknowledged that there had been a fair amount of confusion concerning the change, and he offered some pretty consequential clarifications that could affect whether the new requirement applies to your facility at all.

“[C]onsidering the level of reported misunderstanding of this requirement, CMS has extended the compliance date for this requirement by six months,” Wright wrote.

Within the National Fire Protection Association’s (NFPA) 2012 Life Safety Code® (LSC), which CMS adopted last year, there is a requirement that fire doors and smoke barrier doors be tested annually. Officials with CMS had taken the position that the new requirement applies to healthcare occupancies; that position, however, was met with pushback.

A petition objecting to the CMS position was discussed at length in June by members of the NFPA Healthcare Interpretations Task Force (HITF), says Brad Keyes, CHSP, owner of Keyes Life Safety Compliance. That petition objected to the notion that the LSC specifically requires annual inspections of smoke barrier doors in healthcare occupancies.

“The HITF members did discuss the issue and agreed that healthcare occupancies were exempt from complying with section 7.2.1.15.2 … because the healthcare occupancies did not specifically require compliance with that section,” Keyes says in an email.

The committee decided to table its decision on the matter to give CMS an opportunity to review its position, as it did, Keyes says.

“I am pleased that the system worked in favor for the many hospitals that are certified by the Federal agency,” he adds.

Although the LSC does include provisions requiring annual inspections of smoke barrier doors and fire doors alike, section 7.2.1.15.1 states that these standards apply only where required by Chapters 11–43. Since the chapters governing healthcare occupancies make no direct reference to Section 7.2.1.15.1, the door inspection provisions do not apply to healthcare occupancies, Wright acknowledged in his memo.

Based on that conclusion, Wright spells out a few key takeaways:

  1. Fire doors. In healthcare occupancies, all fire door assemblies must be inspected and tested annually in healthcare occupancies, based on section 8.3.3.1 of the 2012 LSC, which applies to all occupancies.
  2. Smoke barrier doors. Non-rated doors (including smoke barrier doors and corridor doors to patient care rooms) aren’t subject to the annual inspection and testing requirements, but they “should be routinely inspected as part of the facility maintenance program.”
  3. Deadline. The compliance deadline has been pushed back from July 6, 2017, to January 1, 2018.
  4. Citations. Any LSC deficiencies related to annual fire door inspections should be cited under K211—Means of Egress—General.

But what if a healthcare organization was already cited at some point during the three-week gap between the original compliance date and the clarifying memo (July 6–28) for a failure to conduct an annual test of its smoke doors? Multiple CMS representatives did not respond to requests for an answer. Keyes says CMS has been a stickler in the past, holding that a finding cannot be removed once it is written on a survey report.

“There was an accreditation organization [AO] that used to allow findings to be removed from their survey report if the hospital could demonstrate compliance at the time of the survey,” Keyes says. “CMS has said that the AOs may no longer remove findings, even if the hospital was compliant at the time of the survey.”

The Joint Commission stated in the July edition of Perspectives that it requires annual testing for fire door and smoke door assemblies alike, despite acknowledging that the healthcare occupancy chapters don’t cite section 7.2.1.15 specifically. (To support the requirement, The Joint Commission noted that Section 18/19.2.2.2.1 references section 7.2.1, and cited a belief that the annual tests are beneficial.)

Keyes adds a word of caution: “The AOs are not locked into complying with everything CMS says or does. The AOs may have standards that exceed what CMS requires.”

That means the guidance in Wright’s memo might not trickle down to the AOs and state agencies that conduct surveys at your facilities, especially considering how widely advertised the original compliance date has been.

“So, I suspect many of the AOs will keep the start date at July 5, 2017, since they are already enforcing that,” Keyes says.

With that in mind, he recommends that all healthcare facilities have their fire doors tested as soon as possible, rather than waiting until the new deadline—because another authority having jurisdiction might keep to the stricter timeline.

Joint Commission revises Medication Management EPs

The Joint Commission has revised Medication Management elements of performance (EP) for several of its programs. The changes will go into effect on January 1, 2018 and will impact hospitals, ambulatory care, behavioral care, home care, nursing care centers, critical access hospitals, and office-based practices accredited by The Joint Commission. The revisions will require organizations to:

•    Record the date and time of any medication administered in the patient’s clinical record.
•    Implement a policy to provide emergency backup for essential medication dispensing equipment and for essential refrigeration for medications.
•    Have a written policy addressing the control of medications between when they are received by a provider and given to a patient. Those policies should now include what to do for the “wasting of medications.”
•    Implement a policy describing the types of medication overrides for automatic dispensing cabinets that will be reviewed for appropriateness and the frequency.

The revisions vary depending on the program.