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Brian Ward

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

Joint Commission: screening for violence

In the October edition of Perspectives, The Joint Commission reiterated the need to screen patients for potential risks to themselves or others. This is part of a long-standing and ongoing effort to change the sky-high rates of workplace violence in healthcare.

More than 70% of the 23,000 significant injuries resulting from workplace assault in 2013 happened in healthcare and social service settings, according to the Bureau of Labor Statistics. The settings with the highest rates of workplace violence are emergency departments, behavioral healthcare settings, extended care facilities, and inpatient psychiatric units.

After reviewing 145 sentinel events between 2013 and 2015, The Joint Commission wrote that a common cause of violence was an inadequate behavioral health assessment of patients to identify aggressive tendencies. Sometimes, these assessments weren’t done at all, and the results ranged from assault to rape and even death.

“In order to accurately assess the needs of an individual for care planning, it is important to collect data about the individual’s past emotional and behavioral functioning, to assess his/her current needs and goals, and to analyze the data collected in order to develop a plan of care, treatment, or services that effectively addresses the risk of harm to self or others,” The Joint Commission writes. “These steps are also important to determine if there is a need to collect additional information.”

This includes checking to see if the patient has a history of violent behavior. If so, is there anything in their record that could determine if they’ll repeat their actions?

“If there is a history of aggression, or if the individual is admitted in an agitated state, staff should be alerted and the preliminary plan of care, treatment, or services should address the interventions required to maintain the safety of the individual and others,” “…the Perspectives article continued. “Interventions in the preliminary plan of care would likely include close supervision and monitoring of the individual, individualized de-escalation strategies, and adjustments to the environment of care as needed.”

Here are some other free resources and training on workplace violence prevention:

1.    Workplace Violence Prevention Resources for Health Care Portal (www.jointcommission.org/workplace_violence.aspx)    
2.    OSHA’s Guidelines for Preventing Workplace Violence in Healthcare and Social Services (www.osha.gov/Publications/osha3148.pdf)
3.    OSHA’s Preventing Workplace Violence: A Road Map for Healthcare Facilities (www.osha.gov/Publications/OSHA3827.pdf)
4.    The Center for Health Design’s Safety Risk Assessment Toolkit
(www.goo.gl/eH9IbG)
5.    The CDC’s Workplace Violence Prevention for Nurses course (www.cdc.gov/niosh/topics/violence/training_nurses.html)
6.    The Emergency Nurses Association’s Workplace Violence Toolkit
(www.goo.gl/0GXblW)
7.    ASIS International’s Managing Disruptive Behavior and Workplace Violence in Healthcare
(www.goo.gl/MDGsrf)

Joint Commission updates EM standards to match CMS

In response to CMS’ final emergency preparedness rule issued earlier this month, The Joint Commission announced revisions to its emergency management (EM) standards. CMS is expected to approve the updated standards before they go into effect on November 15.

Accredited organizations can access the proposed drafts on their Joint Commission Connect™ extranet site, with more information on the way.

The Joint Commission’s standards come with new Elements of Performance on the following topics:

•    Continuity of operations and succession plans
•    Documentation of collaboration with local, tribal, regional, state and federal emergency management officials
•    Contact information on volunteers and tribal groups
•    Annual training of all new or existing staff, contractors, and volunteers
•    Integrated healthcare systems
•    Transplant hospitals

Several of the new requirements merely provide more specifics on what The Joint Commission already expects. This includes including documentation for existing practices and annual training for staff.

CMS first announced the emergency preparedness CoPs in September 2016, compelling hospitals to communicate and coordinate their emergency plans with other hospitals and government agencies.

They also require regular emergency preparedness training with staff and disaster contingency planning. CMS published the final version of the new Appendix Z of Medicare’s State Operations Manual online, and state surveyors will use newly created E-tags to score deficiencies and expectations set in it.

 

HFAP revises emergency management standards

HFAP has revised its Emergency Management standards in our Acute Care, Critical Access, and Ambulatory Surgical Center manuals to be in compliance with “Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, Final Rule.” The chapter is the only change to the manuals.

The updated requirements include the need for:

  1. A written Emergency Operations Plan (EOP)
  2. Conducting a Hazards Vulnerability Analysis (HVA)
  3. Policies and procedures that address evacuation, staff responsibilities, transportation, communication, use of volunteers, and more
  4. Emergency testing (disaster drills) and evaluation twice per year

Acute Care Hospitals, Critical Access Hospitals, and Ambulatory Surgical Centers must implement and be in full compliance by November 15, 2017. This is the same date that The Joint Commission and CMS’ emergency requirements will go into effect. 

Webinar: USP <800>: Hazardous Drug Compliance and Safety in 2018

Presented on: 1:00-2:30 p.m. EST, Monday, October 30, 2017  

Presented by: Patricia C. Kienle, RPh, MPA, FASHP

Level of Program: IntermediateHCPro Webcast Icon

Who should listen: Accreditation specialists, regulatory officers, safety officers, pharmacists, and any healthcare staff who work with hazardous drugs

Registration: https://hcmarketplace.com/usp-800-drug-compliance-safety-2018 

Summary: Making drugs is risky business, even when it’s done in hospital pharmacies. From the person carrying the chemicals from the loading bay to the person doing the actual mixing, improper exposure to hazardous medication compounding substances can have lasting and devastating health effects.

On December 1, 2019, the U.S. Pharmacopeial Convention’s (USP) Chapter <800> will become fully enforceable by regulators. This chapter addresses the physical environment and equipment needed to maintain sterility and protect the 8 million healthcare workers potentially exposed to hazardous vapors and particles each year. USP is expected to be adopted by many regulators and accreditors, such as state pharmacy boards and The Joint Commission.

 

Join expert speaker Patricia C. Kienle, RPh, MPA, FASHP, for this 90-minute webinar, as she dives into the different types of hazardous drugs and the requirements for compliance. Kienle will also teach participants how to perform an Assessment of Risk and how to stay safe when handling hazardous drugs.

 

Registration is still open, sign up now!

 

 

USP <800> deadline on hazardous drug handling postponed until 2019  

The U.S Pharmacopeial Convention (USP) announced today that it is pushing back the compliance deadline for General Chapter <800> Hazardous Drugs; Handling in Healthcare Settings, from July 1, 2018 to December 1, 2019.

USP <800> covers from the moment a hazardous drug is received at the loading dock all the way through to the medicine’s disposal. Its standards apply to anyone who comes into contact with hazardous drugs: nurses, physicians, pharmacists, pharmacy technicians, loading dock personnel, etc.

“USP encourages early adoption and implementation of General Chapter <800> to help ensure a safe environment and protection of healthcare practitioners and others when handling hazardous drugs.  We will continue to support our stakeholders through education and outreach,” the organization wrote in a press release.

For more on the chapter, please join us for a webinar on October 30 with expert speaker Patricia Kienle.

Mass shooting tests Las Vegas hospitals with surge of more than 500 patients

Moments after shots rang out along the iconic Las Vegas strip Sunday night, sending thousands of concertgoers scrambling for cover, the city’s hospitals sprang into action.

Dignity Health-St. Rose Dominican Hospital treated more than 50 people across its three campuses; the city’s only Level 1 trauma center, University Medical Center, treated another 100 people; and Sunrise Hospital and Medical Center—the trauma center located closest to the strip—treated more than 175 patients, according to a statement from the American Hospital Association (AHA).

“With at least 58 people killed and more than 400 taken to area hospitals with injuries, this tragedy painfully reminds us why violence is now viewed as one of the major public health and safety issues throughout the country,” said AHA Chairman Gene Woods, MBA, MHA, FACHE, president and CEO of Carolinas HealthCare System based in Charlotte, North Carolina, in a statement. “Like all of you, my heart is heavy and my thoughts and prayers are with the victims and their families. My mind is also focused on our colleagues in Las Vegas who are working tirelessly in an overwhelming, mass casualty situation to provide life-saving support to those in need.”

Those colleagues undoubtedly faced a gruesome scene overnight. In its own statement, Sunrise Hospital and Medical Center said 14 of the patients it treated had died. About 30 surgeries had been performed at the site—thus far.

“This has been an unprecedented response to an unprecedented tragedy,” Sunrise CEO Todd Sklamberg, MBA, said in the statement. “Our trauma team and all supporting nursing units, critical care areas and ancillary services are all at work this morning in the aftermath of this tragedy—and most stayed throughout the night—to help the victims and to assist their loved ones.”

 

CMS temporarily suspends some Medicare requirements for hurricane-stricken hospitals

Joint Commission also suspending surveys of hurricane affect hospitals temporarily

CMS Administrator Seema Verma announced the agency is temporarily suspending certain Medicare requirements for healthcare providers assisting with Hurricane Irma recovery efforts in Florida, Puerto Rico, and the U.S. Virgin Islands. The Joint Commission also announced that it would be suspending survey activities in the affected areas for the time being.

At the moment, CMS is waiving the following enrollment requirements:
•    Payment of the application fee
•    Fingerprint-based criminal background checks
•    Site visits
•    In-state licensure requirements

“CMS is dedicated to making it as easy as possible for the individuals and families impacted by Hurricane Irma to access medical care during this difficult time,” said Verma. “There are healthcare providers and suppliers in the aftermath of the hurricane that are ready and willing to help. CMS has established a hotline for providers and temporarily suspended certain Medicare requirements so that these healthcare professionals can provide services to those in need.”

The toll-free hotline she’s referring to is for non-certified Medicare Part B providers and other practitioners so they can enroll in federal health programs and receive temporary Medicare billing privileges. First Cost Service Option, a Medicare Administrative Contractor, will work to assist providers in these areas to temporarily enroll healthcare providers. The number is 855-247-8428, and it’s in service between 8 a.m. and 6 p.m. ET

Starting September 18, 2017, providers will be able to initiate temporary Medicare billing privileges over the phone and on the same day. In addition, CMS is:

•    Allowing providers not currently enrolled to initiate temporary billing privileges by providing limited information. This information includes (but isn’t limited), National Provider Identifier (NPI), Social Security Number (SSN) or a business Employer Identification Number taxpayer identification numbers (SSN/EIN/TIN), and valid in-state or out-of-state licensure.
•    Temporarily ceasing revalidation efforts for Medicare providers in areas directly impacted by Hurricane Irma.
•    Waiving the practice location reporting requirements
•    Not taking administrative actions on providers who fail to notify them about their temporary practice location. This temporary process will remain in effect from September 7 until the disaster designation is lifted. After that, it must be reported through appropriate channels.

“CMS will continue to work with all states and geographic areas in the path of hurricanes Irma and Harvey,” according to the press release. “The agency continues to update its emergency page (www.cms.gov/emergency) with important information for state and local officials, providers, healthcare facilities, suppliers and the public.”

To read previous updates regarding HHS activities related to Hurricane Irma and Hurricane Harvey, please visit https://www.hhs.gov/about/news/hurricane-response/index.html.

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.