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Brian Ward

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

Joint Commission FAQs on H&P and titration orders

The Joint Commission has released new FAQs regarding the new updates to history and physical (H&P) updates and titration orders. The FAQs apply to hospitals, hospital clinics, and critical access hospitals.

The FAQs cover questions such as:

 When is an H&P update required?

What specific elements are required for titration orders? And what other safety and quality factors should be considered?

What are the requirements for updating an H&P after a procedure requiring anesthesia is performed after admission?

Throwback Thursday: Perfecting infection control on everyday items

Editor’s Note: The following is a free Briefings on Accreditation and Quality article from yesteryear! If you like it, check out more of our work covering quality and accreditation! 

After reading this article, you will be able to:

  • Identify everyday items that may require additional thought when it comes to infection control procedures
  • Describe who should be involved when developing policies for cleaning everyday items in the patient room
  • Discuss the development process of disinfection policies for certain challenging items
  • Describe leadership’s role in building an effective policy for patient room equipment cleaning routines

Think back to your last visit to a hospital as a patient or family member. Every patient care area has recognizable, ubiquitous items, such as automated blood pressure pumps, compression pumps, and IV pumps. But how do you know if those items were cleaned and/or disinfected? Were they used with the last patient, or have they sat dormant for weeks? Such items are easy to overlook, but in terms of patient safety and infection control, they need to be addressed in every facility.

One organization, St. Joseph’s Healthcare System-which includes St. Joseph’s Regional Medical Center in Paterson and St. Joseph’s Wayne Hospital in Wayne, N.J.-has implemented a method for cleaning these everyday items and identifying them as clean without adding an additional burden to its staff.

“As you know, in healthcare it can be challenging to change processes,” says Anne Marie Pizzi, M.Ed., RN, HACP, TeamSTEPPS trainer, Six Sigma Green Belt, and performance improvement coordinator with St. Joseph’s. “This began as a work in progress three or four years ago as we were struggling with preventing infection control issues and trying to find a way to make life easier for staff to clearly identify items that were already clean, or that needed to be cleaned.”

So the organization-a regional tertiary medical center and an acute care community hospital-brought together all the key departments, including infection prevention and control, nursing, central sterilization processing, and environmental services, to work collaboratively to improve the process.

“In the beginning, the problem boiled down to a real estate issue,” says Pizzi. “The hardest thing for us to decide when we talked about the equipment was, whose job is it to clean it?”

In addition, the team looked at what type of equipment was involved, how frequently it needed to be cleaned, and what kind of cleaning was necessary.

“Anything requiring more than low-level disinfection is not left to the staff on the unit,” says Pizzi. “So there were specific pieces of equipment that had to go to central supply or to individual departments where staff are trained to clean and care for that equipment.”

The equipment that environmental services or the staff on the units will typically clean include automated blood pressure pumps, Accu-Chek® meters­, pulse oximeters, and IV pumps.

“You may believe that you have designed a solid process when discussing it in a meeting, but when it is rolled out to the staff, change can be a challenge,” says Pizzi. “So it was really important we talked to the staff to determine the processes they were using and the possible solutions they would suggest.”

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NQF recommends reduction of quality metrics

Cut Red RibbonThis March the federal government received an unusual suggestion from the National Quality Forum’s (NQF) Measure Applications Partnership (MAP). In MAP’s 2017 guidance to the Department of Health and Human Services (HHS),the organization recommended eliminating around 51 out of 240 of all federal quality metrics used to determine payment in seven federal healthcare programs. This is meant to make the requirements for providers more efficient and streamlined.

MAP’s job is to review the quality measures put out by NQF each year. however, it’s CMS’s job to decide which of those measures to use.

“We want to make sure we can take away measures that are adding burden but not value,” said Helen Burstin, MD, MPH, FACP, NQF’s chief scientific officer, in a call with reporters. “This is really just the start.”

Many in the healthcare field state that the 634 quality measures applicable to federal healthcare programs is putting an undue burden on providers. However, as the industry is switching between payments based on quality rather than volume, the need for quality metrics is apparent. MAP aims to work towards both ends by culling measures that are redundant or pointless.

The measures that MAP recommends eliminating come from several programs, such as the Prospective Payment System—Exempt Cancer Hospital Quality Reporting Program, the Ambulatory Surgery Center Quality Reporting Program, the Inpatient Psychiatric Facility Quality Reporting Program, and the Home Health Quality Reporting Program. It also recommends eliminating:

•    Four out of 18 measures used in the End-Stage Renal Disease Quality Incentive Program
•    13 out of 29 used in the Outpatient Quality Reporting Program
•    Six out of 62 used in the Inpatient Quality Reporting Program

WHO aims to slice medication errors in half 

The World Health Organization (WHO) last week announced its new global initiative, which seeks to halve the rate of medication-related errors by 2022.  The Global Patient Safety Challenge on Medication Safety will combat medication errors by

  • Addressing weakness and flaws in how drugs are prescribed, distributed, and consumed
  • Providing education on safer and more effective prescribing habits and methods
  • Increasing patient and provider awareness on the dangers of medication errors

Logo-WHO“Most harm arises from systems failures in the way care is organized and coordinated,” the WHO wrote in a press release. “Especially when multiple health providers are involved in a patient’s care. An organizational culture that routinely implements best practices and that avoids blame when mistakes are made is the best environment for safe care.”

In the U.S alone, 1.3 million people are injured annually due to medication errors. Worldwide, med errors cause at least one death per day and cost an estimated $43 billion annually (1% of global health expenditures). Rates of medication-related adverse events are similar regardless of whether one is in a high-, middle-, or low-income nation. However, in less wealthy nations, the impact of these events are about twice as much in terms of the number of years of healthy life lost.

“We all expect to be helped, not harmed, when we take medication,” said Dr. Margaret Chan, WHO director-general, in the press release. “Apart from the human cost, medication errors place an enormous and unnecessary strain on health budgets. Preventing errors saves money and saves lives.”

AMA: Surprise surveys improve mortality rates

A new study published in the Journal of the American Medical Association found that patients are less likely to die if they are treated on the same day as a surprise Joint Commission survey. During a survey week, patients had a 1.5% better chance of survival within 30 days of admissions, as compared those treated three weeks before or after the survey. At teaching hospitals, the presence of surveyors caused a 5.9% decrease in fatalities.

Researchers suspect that when they know they’re being watched, physicians work extra hard to provide quality care and follow standards.

“This study highlights that there is potential for us to learn what is going on during those weeks that is associated with better patient outcomes,” Vineet Arora, a researcher at University of Chicago Medicine who wasn’t involved in the study, told Reuters. “The question is whether it is due to a concerted effort on the part of the hospitals to follow safe practices or whether there is something else going on.”

The study was conducted by Harvard Medical School and Harvard T.H. Chan School of Public Health researchers. They analyzed Medicare admissions data from 1,984 surveyed hospitals, with more than 1,462,000 patients admitted in the three weeks before and after a survey and 245,000 during.

Joint Commission seeks comments on proposed suicide prevention requirements

The Joint Commission is seeking comments on its proposed requirements on National Patient Safety Goal (NPSG) 15.01.01 for suicide prevention in healthcare facilities. Specifically, it’s seeking feedback the revisions for hospitalcritical access hospital, and behavioral health accreditation programs. The comment period ends on May 1.

Joint Commission: More details on self-harm assessments

The Joint Commission announced that as of March 1, its surveyors will place special focus on suicide, self-harm, and ligature observations in psychiatric hospitals and units. Now, surveyors will document any and all observations of ligature or self-harm risks in the environment during the survey. The six major areas of assessment will be:

  • Plans and policies on harm mitigation
  • Effective coordination of staffing to deal with mitigation plans
  • Patient suicide risk-assessment processes
  • Policies and practices on what to do for at-risk patients
  • Staff awareness of a patient’s level of risk
  • Facilities’ improvement processes for things like:
    • Tracking patients’ histories
    • Root-cause analyses of safety events
    • Compliance monitoring
    • Response to non-compliance

Each observation will be documented, classified as a requirement for improvement, scored at EC.02.06.01, element of performance 1, and placed on the facility’s SAFER Matrix.

See our previous Accreditation Insider and Briefings on Accreditation and Quality coverage on suicide risks.

Joint Commission focuses on MRI safety programs

The Joint Commission’s newest Quick Safety edition shines a light on MRI safety programs. The report says that vigilance is needed because the electromagnetic fields used during the MRI process can cause harm. Examples include risks such as:

  • Heating flesh and tissue
  • Inducing electrical currents
  • Displacing implants and medical devices
  • Disrupting patient monitoring equipment
  • Turning metal objects into projectiles

Quick Safety 31 gives suggestions and advice on implementing a MRI safety program and can be viewed here.

ECRI: Top patient safety concerns of 2017

TheECRI INSTITUTE LOGO ECRI Institute has published its 2017 list of top patient safety hazards and concerns. The Institute publishes the list to highlight and educate healthcare workers on various dangers affecting patients. The list includes guidance on how to effectively respond to these concerns, along with implementing priorities and corrective action plans. This year the list includes:

1.    Information Management in electronic health records (EHR)
2.    Unrecognized patient deterioration (UPD)
3.    Implementation and use of clinical decision support
4.    Test result reporting and follow-up
5.    Antimicrobial stewardship
6.    Patient identification
7.    Opioid administration and monitoring in acute care
8.    Behavioral health issues in non-behavioral-health settings
9.    Management of new oral anticoagulants
10.  Inadequate organization systems or processes to improve safety and quality

“The 10 patient safety concerns listed in our report are very real,” Catherine Pusey, RN, ECRI associate director told HealthLeaders. “They are causing harm (often serious harm) to real people.”

The proper use and timely access to EHRs for patient information management was the main concern this year, Lorraine B. Possanza, program director for ECRI’s Partnership for Health IT Patient Safety said in a press release. She says the vast storehouses of patient data now available to physicians have created new challenges.

“The object is still for people to have the information that they need to make the best clinical decision,” she wrote. “Health information needs to be clear, accurate, up-to-date, readily available, and easily accessible.”

The second concern, UPD, has recently been the subject of increased training, education, better clinical protocols, and public awareness campaigns. However, despite faster recognition and response, UPD is still a major concern.

“People have seen how well the campaigns have worked for stroke and STEMI and how much they’ve improved outcomes,” Patricia N. Neumann, RN, ECRI senior patient safety analyst and consultant told HealthLeaders. “What if those same principles could be applied to other conditions that require fast recognition and management? We could have a big impact on improving outcomes.”

Read more at HealthLeaders Media

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