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Assisting the impaired clinician

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! 

How to overcome barriers to recognition

By the time the general public hears about an impaired clinician, whether it’s a nurse, technician, or physician, it is often too late to head an incident involving that clinician off at the pass-whether that incident is a medical error, diversion of medication, or something even worse, like the technician recently accused of inadvertently exposing thousands of patients to hepatitis C.

But the healthcare industry is well aware that ­impaired clinicians exist, and it has methods for addressing, confronting, and helping these medical professionals. Where are the industry’s gaps to success in ­preventing this far too common occurrence? BOAQ recently sat down with Jill Pollock, RN, LMFT, administrator of Loma Linda University Behavioral Medicine Center and ­frequent lecturer on chemical dependency recognition and intervention, to discuss this topic.

It takes a case as shocking as the hepatitis C outbreak in New Hampshire to bring a topic like this to light, she says.

“I think it’s difficult for people in healthcare to wrap their heads around it,” says Pollock. “What do you think one of our biggest barriers is to recognition of addiction and confronting it? If I can get people to talk just a little bit, we start hearing how there is a fear that confronting someone’s addiction could ruin someone’s life.”

For many healthcare professionals, the thinking is backward, she says–they’re focused on saving a coworker’s career. But we have a professional responsibility to our patients, our loved ones, and the public in general.

“What happens if someone drives impaired and kills someone in a car crash? Would you worry about their professional life?” says Pollock. “Or if your facility has an outbreak of hepatitis C?”

After talking with audiences about the possible outcomes of not confronting versus trying to help the impaired professional, she has found that the best tactic is to bring in personal, relatable example scenarios. “If someone is diverting drugs, then that patient, that ­mother or father, son or daughter, husband or wife, is not getting their pain medications,” she says. “Or, ­alternately, is being cared for by an impaired nurse. I try to bring it home to something we can all relate to.”

Who would you want taking care of your loved one? Pollock asks. Would you be comfortable with a caregiver who is impaired or thinking about where to find his or her next fix?

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Proposed seven-day limit to opioid bill enters Congress

A new Senate bill would limit the amount of opioids a patient can initially receive for acute pain. If passed, physicians could only prescribe seven days’ worth of opioids when first treating a patient’s condition.

The bill was put forward by Senators John McCain (R-Ariz.) and Kirsten Gillibrand (D-N.Y.) as a way to prevent opioid addiction. The limit is backed up by medical literature and is there are nine states with similar opioid laws in place.

“Our legislation builds on the important steps taken by Arizona Governor Doug Ducey last fall to tackle a root cause of this epidemic by limiting the supply of an initial opioid prescription for acute pain to seven days. We have a long way to go to end the scourge of drugs across our communities, but this legislation is an important step forward in preventing people from getting hooked on these deadly drugs,” said McCain in a press release.

“Too many lives have been destroyed, too many families have been torn apart, and too many communities all over New York are suffering because of this tragic epidemic. I am proud to join with Senator McCain in this urgent fight against the overprescription of opioids, and I look forward to seeing it pass through the Senate as quickly as possible,” said Gillibrand in a press release.

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Joint Commission urges providers to prevent medication compounding-related errors

In a recent blog post, The Joint Commission called on providers to work toward the elimination of medication compounding-related infections (MCRI). When not mixed in sterile conditions, compounded medicines can cause several types of infections, including bacterial bloodstream infections and cases of fungal meningitis.

MCRIs were in the news recently, after a three-month trial wrapped up last month in which the president of a Boston compounding pharmacy was convicted of racketeering and mail fraud stemming from a 2012 fungal meningitis outbreak that infected 778 and killed 76.

“The health care community, including The Joint Commission, recognize that as the need for compounded medications continues to grow it is more important than ever to ensure safe policies and procedures are being appropriately and effectively implemented to prevent patient harm,” wrote Robert Campbell, PharmD.

In the post, Campbell reminds providers that guidelines for compounding medications (sterile and non-sterile) are derived from the United States Pharmacopeial Convention’s (USP) General Chapters <797>, <795>, and <800>. USP Chapter <800> goes into effect in 2018 and covers guidelines for compounding hazardous materials.  All three chapters have requirements on the environment, personnel, and products used during compounding.

Campbell writes that many facilities still struggle with compounding compliance. In response, The Joint Commission unveiled a new Medication Compounding Certification (MCC) program in January. All compounding pharmacies are eligible to enroll in the program including organizations not accredited by The Joint Commission. The accreditor says that the goal of the MCC program is to:

•    Ensure pharmacies are compliant with USP and Joint Commission standards
•    Reduce the risk and harm stemming from drug compounding
•    Uncover and fix problems in existing compounding policies and procedures
•    Train personnel on the correct use of PPE and aseptic techniques
•    Ensure the physical environment meets guidelines for cleaning and documentation
•    Ensure the proper labeling, dating, and sterility of compounded products

TBT: North Carolina hospital uses Lean methodology to reduce patient falls

Editor’s Note: The following is a free Patient Safety Monitor Journal article from yesteryear! If you like it, check out more of our work covering quality and patient safety!

One year ago the patient fall rate at New Hanover Regional Medical Center (NHRMC) in Wilmington, North Carolina was deemed “acceptable” compared to national standards. Statistically, the hospital wasn’t any worse off than hospitals of a similar size, but patient safety experts and administrators within the institution still felt there were missed opportunities to reduce their rates and improve patient care.

“We were doing a good job,” says Mary Ellen Bonczek, chief nurse executive at NHRMC. “It’s not like we had a problem compared to national organizations our size, but we clearly felt like we could do a better job and we began to change our mind-set towards prevention and elimination.”

The facility had already seen some positive gains in reducing infections simply by focusing on prevention and elimination strategies, and administrators within the facility felt they would see the same progress if they applied those principles toward reducing patient falls.

One year later, patient falls have decreased 22% to 2.5 falls per 1,000 patient stays, which translated to an estimated $500,000 in savings, according to an op-ed by NHRMC President and CEO Jack Barto published on WilmingtonBiz.com.

“This is but one example of how healthcare providers, by standardizing best processes and consistently following them, can change the delivery of care, one improvement at a time,” Barto wrote. “Over time, these improvements will add up to better patient experience, better quality of care and significant savings.”

The patient fall reductions that the facility saw were a result of a few simple, no-cost interventions developed by a patient services fall team, which implemented a patient risk assessment, standardized best practices, hourly rounding, and visual cues to focus on eliminating preventable falls.

“We challenged ourselves to look at things differently and begin to change our mind-set around patients at risk for falls,” Bonczek says.

Reevaluated patient falls

Although NHRMC already had a fall prevention team, last summer it applied Lean methodology to improve its process of discovering preventable patient falls. The multidisciplinary team?consisting of physicians, nurses, therapists, pharmacists, transportation employees, and environmental services employees?utilized value-stream mapping to uncover process improvement and design modifications.

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ECRI Introduces HIT-based Patient Identification Tools

The toolkit aims to prevent patient misidentification through the use of health information technology.

Patient misidentification is a big and likely underreported problem for hospitals and health systems, as well as for patients.

The consequences can be significant. ECRI Institute research shows that 9% of patient misidentification events lead to temporary or permanent harm or death.

That’s why the ECRI Institute and a stakeholder collaborative it convened, the Partnership for Health IT Patient Safety, has launched a new patient identification resource to help prevent patient misidentification through the use of health information technology.

ECRI is a Pennsylvania-based nonprofit that works to improve the safety, quality, and cost-effectiveness of patient care.

The toolkit divides its recommendations into two sections:

  1. Attributes addresses “the information-gathering aspects of patient identification, including the fields and the formats that are available to accommodate acquisition of required information.”
  2. Technology addresses “new technologies to improve identification and ways to leverage existing technologies for safe patient identification.”

Continue reading at HealthLeaders Media. 

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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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 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.