RSSAll Entries in the "Patient Safety" Category

Patient Safety Strategies: Building a Fall Prevention Toolkit

When: May 30, 1-4 p.m. EST

Speakers: Virginia Hall, DNP, MSN/Ed. RN, CNE

Carole Eldridge, DNP, RN, CNE, NEA-BC

Registration: http://hcmarketplace.com/patient-fall-prevention

Patient falls are a fixture in The Joint Commission’s list of top 10 sentinel events; in fact, they were the third highest sentinel event reported to the accreditor in 2016. Causes of falls can include inadequate assessments, side effects from medications or diseases, and environmental hazards, as well as a lack of leadership or staff orientation.

During this three-hour virtual workshop, Carole Eldridge, DNP, RN, CNE, NEA-BC, and Virginia Hall, DNP, MSN/Ed. RN, CNE, will provide a step-by-step guide to setting up a successful and sustainable evidence-based multidisciplinary fall prevention program in your facility.

Learn more about the workshop here.

Seeking comment on suicide prevention book

Hello,

I’m working on new HCPro Book, a guide on suicide prevention and ligature risks in hospitals. It’ll have updated best practices, checklists, tools, the new CMS ligature requirements, and case studies.

Before I can get it approved I need to get feedback on what people think of the idea. If you have a minute, I’d like to hear your answers to these quick questions.

1. Is there an interest in suicide/self-harm prevention in hospitals? Do facilities struggle with this issue?

2. Should there be a new book made on self-harm best practices and policies? And what should be in said book?

I only need a few sentences for responses. I really want to get this book out and helping patients and I’d greatly appreciate any feedback you’d be willing to give.

You can email your responses to bward@hcpro.com 

Thanks!

Brian Ward, Associate Editor

Study: Link between infection control and antibiotic stewardship

Healthcare facilities must ensure that infection prevention and control (IPC) and antibiotic stewardship (AS) programs work together, according to a joint position paper released last week by the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), and the Society of Infectious Disease Pharmacists (SIDP).

An update to a 2012 paper that examined the roles of infection preventionists and healthcare epidemiologists in the use of antimicrobials, the new paper was published in the American Journal of Infection Control and Infection Control and Hospital Epidemiology. The new paper focuses on the synergy between IPC and AS programs, with emphasis on the importance of an effective IPC program as part of a strong AS strategy.

?The issues surrounding the prevention and control of infections are intrinsically linked with the issues associated with the use of antimicrobial agents and the proliferation and spread of multidrug-resistant organisms,? said lead author of the new paper Mary Lou Manning, PhD, CRNP, CIC, FSHEA, FAPIC, in an APIC press release. ?The vital work of IPC and AS programs cannot be performed independently. They require interdependent and coordinated action across multiple and overlapping disciplines and clinical settings to achieve the larger purpose of keeping patients safe from infection and ensuring that effective antibiotic therapy is available for future generations.?

AS programs strive to emphasize the appropriate use of antimicrobials to minimize overuse, improve patient outcomes, reduce microbial resistance, decrease infection spread, and preserve antibiotic efficacy, according to the release. AS programs are more effective when rolled out alongside IPC programs than they are on their own, the paper states.

A study recently released in the Joint Commission Journal on Quality and Patient Safety found that antimicrobial-resistant organisms lead to more than 2 million infections and 23,000 deaths each year in the U.S. The use of AS programs can reduce inappropriate antimicrobial use, length of stay, rates of antimicrobial-resistant infections, and cost, the researchers found.

This story originally ran in PSQH. 

CDC Warns of New Wave of Antibiotic-Resistant Germs in U.S.

A new Centers for Disease Control and Prevention (CDC) Vital Signs report released this week said health departments found more than 220 cases of germs with “unusual antibiotic resistance genes” in the United States last year. These germs include those that cannot be killed by all or most antibiotics, are not common to a geographic area or the U.S., or have specific genes that enable them to spread their resistance to other germs, according to a CDC release.

The CDC’s Antibiotic Resistance (AR) Lab worked with local health departments to deploy a containment strategy to stop the spread of antibiotic resistance. The first step is rapid identification of new or rare threats; after a germ with unusual resistance is detected, facilities must quickly isolate patients and begin aggressive infection control and screening actions, according to the release.

“CDC’s study found several dangerous pathogens, hiding in plain sight, that can cause infections that are difficult or impossible to treat,” said Anne Schuchat, MD, CDC’s principal deputy director, in the release. “It’s reassuring to see that state and local experts, using our containment strategy, identified and stopped these resistant bacteria before they had the opportunity to spread.”

After rapid identification of antibiotic resistance, the CDC strategy calls for infection control assessments, testing patients without symptoms who may carry and spread the germ, and continued assessments until the spread is stopped. It requires coordinated response among healthcare facilities, labs, health departments, and the CDC through the AR Lab Network.

The CDC study also found that about one in 10 screening tests of patients without symptoms found a hard-to-treat germ that spreads easily, which means the germ could have spread undetected in that facility. For carbapenem-resistant Enterobacteriaceae (CRE), the report estimates that the containment strategy would prevent as many as 1,600 new infections in three years in a single state, which would be a 76% reduction.

Story originally published by our friends at PSQH!

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)

Healthcare and Law Enforcement: Working Together Instead of Against Each Other

A working relationship with law enforcement is key to the safety, efficacy, and well-being of everyone in the hospital. That said, hospitals and law enforcement have different goals, and while the two usually work well together, they can find themselves at odds.

During this 90-minute webinar on May 22, industry expert Lisa Terry, CHPA, CPP, will review the hospital’s role in successfully partnering with law enforcement. She will discuss how to balance best practices for ensuring the safety of patients as well as the hospital staff. Participants will also learn how they should communicate with law enforcement, as well as how to plan and implement “crucial conversations” between hospitals and law enforcement.

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

  • Access and use the best resources on how hospitals who are treating patients “under arrest” should interact with the police
  • Plan and implement “crucial conversations” between the hospital/healthcare executive team and local law enforcement leadership
  • Use the tenets and teachings of “Verbal Judo” to benefit both clinicians and law enforcement first responders
  • Understand how hospitals can support and help facilitate law enforcement’s “guardians of the peace” mentality as they partner with hospitals
  • Apply enterprise security risk management (ESRM) to situations that may arise

Presented on:
Tuesday, May 22, 2018
1:00-2:30 p.m. Eastern

Presented by:
Lisa Terry, CHPA, CPP

Level of Program:
Intermediate

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

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

3 Ways to Knock C. diff Rates Down to Zero

For Necia Kimber, RN, CIC, MHA, infection control practitioner at Stillwater (Oklahoma) Medical Center, “one infection is too many.” Fortunately, when it comes to C. diff, Kimber has infection rates at the healthcare organization at just the right number: zero.

Thanks to a multifaceted approach, the 177-bed hospital with average daily census of 60 patients, has not seen a hospital-acquired case of C. diff since October 2017.

While the organization’s rates were not above the national average, Kimber still wanted to reduce the bioburden—particularly of C. diff, MRSA, VRE, and CRE—within the hospital.

“We didn’t have a high rate that made me say, ‘Oh, my goodness!’ It was just wanting to do overall good and making sure we were doing the best we could,” she says. “This is the hospital I’m going to bring my family to and I want to provide the best care for anybody who walks through that door.”

Here are three ways Kimber achieved lower infection rates at Stillwater Medical Center:

1. Education
Kimber spearheaded an antimicrobial stewardship program at the facility in 2017. There was also assessment of and education regarding ordering of C. diff testing.

“[As healthcare professionals], when you have a patient and you can’t find anything with normal testing, we tend to expound our testing,” she says. “Sometimes it would end up hurting us with pay-for-performance—if [the patient] tested positive for [C. diff, it] didn’t mean they were actually infected with it. They can just be colonized with it.”

The infection control team provided education on national standards for ordering C. diff testing, including testing only when patients were symptomatic of the infection. The IC team provided nurses and physicians with education on when to implement C. diff precautions with the intent that earlier intervention would prevent transmission.

2. Hand hygiene and cleanliness
Hand hygiene was a focus area for preventing the spread of infections at Stillwater.

“We do a program that’s a commitment to excellence,” she says. “Last year we did a huge push on hand hygiene.”

Each month, “secret shoppers” do direct observation on the units to assess issues regarding hand hygiene.

“What we check for is hand hygiene upon entering the room and upon leaving the room,” Kimber says.

To increase patients’ sense of safety, Kimber says she has reinforced hand hygiene practices with clinicians so that even if nurses or physicians have just cleaned their hands with alcohol foam or gel after exiting a room, they need to reapply it if they are going directly into a new room, even if they have not touched anything between rooms.

In addition, Stillwater Medical Center is using a bleach-based product to clean all rooms and equipment after a patient is discharged.

“We used to only [use bleach] on positive C. diff rooms,” Kimber explains. “Now we use it on all rooms because there are so many people who are carriers and not showing signs [of infection] until after they’ve been discharged.”

Kimber also educates environmental services staff on the “why” behind cleaning techniques.

“What we honed-in on is the actual cleaning of the area—friction and leaving the products on for the allotted time to disrupt the replication of cells and bacteria,” she says. “We’ve done a ton of education on how to clean, when to clean, and why to clean.”

3. Robots
While the campaign took place over a year, Kimber says it was the addition of pulsed xenon ultra-violet robots that drove C. diff rates down to zero.

“What we saw with our use of the UV robots, which we started in October 2017, was that for the last quarter of the year, our C. diff hospital onset cases have been zero,” she says. “I’ve been an infection control nurse for almost 18 years and I’d never seen a drop as dramatically as I had in C. diff after implementation of the UV robots.”

While the robots are not cheap, Kimber estimates that each machine costs about $100,000. Stillwater purchased six robots.

“You always worry about surgical-site infections, and you always worry about those infections that patients get in the hospital such as C. diff, MRSA, CRE, and VRE,” she says. “By national standards one C. diff infection is about $30,000 when you look at morbidity and length of stay. For surgical-site infection, if it’s a hip or a knee, you’re getting into the hundreds of thousands. So, for example, with surgical-site infections if you could just save one surgical-site infection—say a hip or a knee—you’ve already saved $100,000, so your ROI will be pretty quick in knocking your infection rates down.”

Kimber says she encourages infection control practitioners to talk with their colleagues about effective solutions for decreasing infections—whether it’s using education, technology, or something else.

“I recommend people do their own research and find out what’s best for their facility and what their actual needs are,” she says. “Infection control nurses have a pretty tight network, so talk to your colleagues and see what they’re doing in their hospitals. Talk to the ones that are the same size as you and bigger than you and see how you can glean information from that.”

Kimber says, “There were tons of things that went into [reducing hospital onset infections]. Having that rate down to zero for three months has been a huge accomplishment.”

Orignially published in HealthLeaders Media

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.