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Joint Commission Urges Hospitals to Protect Workers from Abuse

This story originally ran on HCPro’s OSHA Healthcare Advisor.

The Joint Commission is the latest healthcare heavy-hitter to call for better protection of healthcare workers, announcing on Tuesday the creation of Sentinel Event Alert 59, which addresses violence—physical and verbal—against healthcare workers.

About 75% of workplace assaults occur in healthcare and social service sector each year, and violence-related injuries are four times more likely to cause healthcare workers to take time off from work than other kinds of injuries.

The purpose of the new alert is to help hospitals and other healthcare organizations better recognize workplace violence directed by patients and visitors toward healthcare workers and better prepare healthcare staff to address workplace violence, both in real time and afterward, The Joint Commission wrote in this latest Sentinel Event Alert publication.

Sentinel Event Alert 59 has some overlap with Alerts 40 and 57—which were released in 2008 and 2017, respectively, and focused on the development and maintenance of safety culture—and therefore were not addressed in this alert.

Per the Occupational Safety and Health Administration (OSHA), about 75% of workplace assaults annually occurred in the healthcare and social service sector. Violence-related injuries are four times more likely to cause healthcare workers to take time off from work than other kinds of injuries, according to the Bureau of Labor Statistics (BLS).

The Joint Commission cites both of those facts in this Sentinel Event Alert publication and adds that Joint Commission data show 68 incidents of homicide, rape, or assault of hospital staff members over the past eight years—and that’s mostly only what hospitals voluntarily reported.

The Joint Commission is calling for each incident of violence or credible threat of violence to be reported to leadership, internal security, and—if necessary—law enforcement, and it also wants an incident report to be created. Under its Sentinel Event policy, The Joint Commission says that any rape, any assault that leads to death or harm, or any homicide of a patient, visitor, employee, licensed independent practitioner, or vendor on hospital property should be considered a sentinel event and requires a comprehensive systematic analysis.

Additionally, The accreditor says it’s up to the healthcare organization to specifically define unacceptable behavior and determine what is severe enough to warrant an investigation.

This Sentinel Event Alert, which you can download here along with other resources, comes on the heels of an emergency preparedness rule from CMS that recently went into effect and efforts from the National Fire Protection Association to fast-track its new standard for active shooter events and other violent incidents. OSHA is also considering a standard to help protect healthcare and social workers from violence.

Avoid Eyewash-Related Regulatory Compliance Issues

Eyewash stations continue to confuse and confound healthcare organizations (HCO). Not only can they pose infection control and safety issues for workers, they can be a point of contention between HCOs and surveyors, who often seem to work by different sets of rules.

During this 90-minute webinar on May 31, former hospital administrator and accreditation expert John R. Rosing, MHA, FACHE, will explain what regulators like CMS, The Joint Commission, and OSHA expect from an HCO’s eyewash stations. He will provide the steps personnel can take to keep staff safe and the organization in compliance with rules and regulations. Attendees will learn how to avoid eyewash-related regulatory compliance issues, how to perform a risk assessment to determine when an eyewash station is necessary, and what type of eyewash station they need.

At the conclusion of this program, participants will be able to:

  • Avoid eyewash-related regulatory compliance issues
  • Perform a risk assessment to determine when an eyewash station is needed
  • Identify what type of eyewash station is needed
  • Properly maintain eyewash stations

Presented on:
Thursday, May 31, 2018
1:00-2:30 p.m. ET

Presented by:
John R. Rosing, MHA, FACHE

Level of Program:

Intermediate

To register or get more information, please visit the event page at HCMarketplace.com.

The Joint Commission: Comments open on proposed suicide risk NPSG through May 7

Wishing you could weigh in on The Joint Commission’s expectations about suicide risk? You have your chance. Through May 7, The Joint Commission is accepting comment on proposed revisions to National Patient Safety Goal 15 on reducing the risk of patient self-harm.

The Joint Commission published the revisions on its Standards Field Reviews web page on March 26. The revisions, which will require hospitals to be more proactive in removing risks from the physical environment, include proposed changes to both the general Hospital and the Behavioral Health Care accreditations programs.

Under the Hospital Accreditation program, a revised Element of Performance (EP) 1 applies only to hospitals, whereas the rest of the now seven EPs — up from just three — will apply only to those patients in psychiatric hospitals or being treated for behavioral health problems in general hospitals, according to the field review information.

The other EPs for both programs outline expectations of conducting suicide assessment of patients, documenting a patient’s risk and the plan to deal with that patient’s suicidal ideation, the need for written policies and procedures and quality monitoring of the programs, among other things.

You can comment on the proposed revisions online or by mail. To read the full set of revisions, and for links and instructions on how to comment, go to the Field Reviews page, https://www.jointcommission.org/standards_information/field_reviews.aspx. — A.J. Plunkett (aplunkett@h3.group)

Lawmakers want more AO oversight

In a letter to CMS Administrator Seema Verma, the committee is asking for what could be reams of information from the agency about patient harm and incidents of misconduct at acute care hospitals. The committee has also asked for similar information from each of the four hospital accrediting organizations (AOs).

The committee was particularly concerned about information in a report to Congress published last summer that indicated AOs “conducting hospital surveys did not report 39% of ‘condition level’ deficiencies that were subsequently reported following validation surveys conducted by [CMS] State Survey Agencies no later than 60 days following the AO survey.”

“Although CMS has worked to strengthen its oversight of AOs, the committee is concerned about the adequacy of CMS’ oversight as well as the rigor of the accrediting organization survey process,” wrote the committee leaders.

Noting that the Department of Health and Human Services, through CMS, must provide oversight of accrediting organizations, including CMS’ own survey agencies, “the Committee is concerned about the adequacy of CMS’ oversight as well as the rigor of the AO survey process,” read the letter to Verma.

More coverage of this story will be in the May edition of Briefings on Accreditation and Quality

Joint Commission releases 2017 sentinel event stats

Unintended retention of a foreign body, patient falls, and wrong-site surgery top The Joint Commission’s full list of reported sentinel events for 2017.

Every year, The Joint Commission complies a list of all the sentinel events that hospitals reported to them. Since the list only comes from self-reported data, it tends to underrepresent the real frequency of these problems. However, it’s useful in identifying trends, causes, and outcomes of adverse events. The top 10 sentinel events in 2017 were:

  1. Unintended retention of a foreign body
  2. Falls
  3. Wrong patient, wrong site, wrong procedure
  4. Suicide
  5. Delays in treatment
  6. Other unanticipated events
  7. Criminal events
  8. Medication errors
  9. Operative/postoperative complication
  10. Self-inflicted injury

The only new addition to the list since 2016 is “self-inflicted injuries,” which replaced “perinatal death/injury.” While a few hopped up or down one on the list, for the most part, there wasn’t much change.

CMS Cites Baltimore Hospital for Abandoning Patient in January

A Baltimore hospital was cited by CMS in a report released this week for its actions in removing a mentally ill patient from its emergency room (ER) and leaving her at a bus stop wearing just a hospital gown. The Washington Post reports that the University of Maryland Medical Center (UMMC) was cited for failing to comply with the Emergency Medical Treatment and Labor Act (EMTALA).

The hospital came under fire in January after a bystander filmed the incident as the woman was left by security guards at a bus stop on a cold night. According to the Post, the patient was admitted to the hospital earlier that day after a fall from a motorized bike. She was cleared for discharge, but resisted and refused to dress, the report said. Security then dropped the patient off at a nearby bus stop, where the man who filmed the incident and then called for an ambulance. The woman was brought back to the hospital and then taken to a homeless shelter in a taxi without an exam, and it was not registered that she returned to the facility, the Post reports.

According to the Baltimore Sun, CMS found that UMMC violated a federal law that hospitals must protect and promote each patient’s rights. The hospital also was found to have violated the woman’s right to receive care in a safe setting, to be free from all forms of abuse or harassment, and her right to confidentiality of records because non-clinical staff were given access to or made aware of part of the patient’s medical history. CMS also found that UMMC failed to meet data collection and analysis standards and failed to perform quality improvement activities.

The Sun reports that the hospital has now begun to record every time patients visit the ER. It also conducts audits of the patient log each month, provides additional staff training on federal requirements, and keeps ER doors unlocked. The staff bylaws were updated to specify who can perform medical screenings.

In a statement reported by the Post, a UMMC spokesperson admitted that mistakes were made. “We take responsibility for the combination of circumstances in January that failed to compassionately meet our patient’s needs beyond the initial medical care provided. While our own thorough self-examination revealed some shortcomings, the regulatory assessment punctuates the necessity to more firmly demonstrate our unwavering commitment to safety quality, compassionate patient care.”

EMTALA, in general, requires hospitals to care for patients with emergent conditions, regardless of their ability to pay. Violations of EMTALA are often cited by CMS surveyors under patients’ rights or failure to do an adequate medical screening exam. In addition to potentially impacting a hospital’s accreditation or ability to bill Medicare, EMTALA violations can also come with a civil penalty, which can reach nearly $105,000 for each citation. The newspaper reports did not mention whether the hospital was fined in relation to the CMS findings.

Joint Commission changes for March 2018

Deleted: RI.01.01.01, EP 8

Effective immediately, The Joint Commission (TJC) has deleted element of performance (EP) 8 from Rights and Responsibilities of the Individual (RI) standard 01.01.01. While it’ll take some time to come out of the manual, surveyors can no longer survey for it. The EP said that a hospital must respect the patient’s right to pain management. The accreditor said that after reviewing its comprehensive pain assessment and management requirements, the EP was found to be irrelevant.

Revised: EC.02.03.05, EP 25

The point of this revision is to provide extra clarity on non-rated doors. TJC made the revision to make the Environment of Care (EC) chapter align with the Life Safety Code (LSC). This revision applies to ambulatory care, behavioral healthcare, critical access hospitals, home care, and hospitals. You can read the program-specific EPs here.

Revised: EC.02.05.01, EP 27

The purpose of this revision is to address environmental features of areas administering inhaled anesthetics. TJC made the revision to make the EC chapter align with the LSC. This revision applies to ambulatory care, critical access hospitals, hospitals, and office-based surgery practices. You can read the program-specific EPs here.

Joint Commission plans to make new suicide prevention standards

This December, The Joint Commission (TJC) convened the fourth meeting of a suicide prevention expert panel. The accreditor announced in the March edition of Perspectives that the recommendations they came up with went beyond what’s in the standards. So they intend to convert some of them into new Elements of Performance in National Patient Safety Goal 15.01.01. When they are finished updating the NPSG, it will be sent out for national field review, just like it normally would.

The first and second panels were published in November and centered on inpatient psychiatric units, general acute inpatient settings, and emergency departments. The third panel discussed other behavioral healthcare settings and had its recommendations published in January.

Involving patients and representatives in care decisions

Involving patients in their care isn’t just polite, it’s a CMS requirement. Condition of Participation (CoP) §482.13(b)(2) says that patients have the right to make informed choices about their care and be involved in crafting their care plan. And CoP §482.13(a)(1) requires hospitals to take reasonable steps to decide who the patient’s designated surrogate is when the patient is unable to make the decision.

According to CMS, patients have the right to make informed choices about their care and be involved in crafting their care plan. Diana Topjian, a patient safety coach with Studer Group, says that when talking to patients about their care plan, it must be clear that they understand the risks and benefits of agreeing or declining to the treatment regimen.

“It’s incumbent upon us as providers to ensure we present the plan of care in such a way that the patient (and/or family) understand and clearly can follow the information we used in reaching those decisions,” Topjian says.

“I believe that this is a two-part process,” adds Erin Shipley, RN, MSN, a patient safety coach with Studer Group. “Not only continuing to involve the patient and family as much as possible in the planning around their plan of care and any preferences that they have, but also assessing for any changes to these wishes, and deliberate teach-back with the patient, to ensure that the knowledge and information taught and shared has been retained.  This also helps improve the engagement of the patient to understand any perceived or actual barriers the patient and family has with following the plan developed.”

Editor’s note: you can read more about this in Briefings on Accreditation and Quality. 

Like CMS, you should pay attention to sexual harassment

With all the recent focus on sexual harassment in the workplace, healthcare organizations shouldn’t expect to avoid scrutiny. Especially not from CMS or the press. Sexual harassment always has been an issue in healthcare, and it’s not hard to find examples. Like the California surgeon who slapped a nurse’s rear every morning while saying “I’m horny.” That behavior and the facility’s inaction led to a $168 million lawsuit, plus months of bad publicity.

“I suspect we’re going to see much more attention to this in healthcare, because it’s in the headlines,” says Kate Fenner, PhD, RN, managing director of Compass Clinical Consulting. “We know that we have some healthcare incidents that have gotten national attention. We know that CMS takes this seriously, Joint Commission takes this seriously. So healthcare organizations need to review their vows about how they provide a safe working environment for employees.”

The Joint Commission requires that its accredited facilities meet all applicable laws (Civil Rights Act of 1964, Title IX, for example, the recognition of sexual harassment as an infringement on civil rights for employees), and CMS is stringent about protecting patient rights (CMS Tag A-0145), including the right to receive care without harassment.

“Regulators and surveyors (CMS and The Joint Commission) pay careful attention to the news and trends in public interest,” Fenner says. “Allegations of improper conduct such as that recently lodged against a physician then practicing at a highly regarded medical center pique regulator interest and focus attention.”

Editor’s Note: You can learn more about sexual harassment in the April editions of Patient Safety Monitor Journal and Briefings on Accreditation and Quality.