RSSAll Entries in the "Patient Safety" Category

Study: Concurrent surgeries are safe

A review of more than 2,000 neurosurgical cases published in the Journal of the American Medical Association, found no greater risk of postoperative complications for patients operated on by surgeons conducting overlapping surgeries. This casts a new light on the controversial practice, which is routine at many facilities nationwide.

The study, published earlier this month, examined patients who underwent neurosurgical procedures at Emory University Hospital in Atlanta from 2014 to 2015. Of the 2,275 cases reviewed, about 43% had the surgeon remain with the patient through the entire procedure. In the other 57% of cases, the primary surgeon performed two procedures in different operating rooms.

In the 90 days following their operations, no difference was found in morbidity, mortality, or worsened outcome measures between the two groups of patients. The researchers concluded that this data suggests overlapping neurosurgeries are safe and may benefit patients by allowing sought-after specialists to see more patients.

That said, researchers did note that overlapping surgeries were notably longer than when one surgery was done at a time. And guidelines from the American College of Surgeons require that patients be informed that they’ll be undergoing a concurrent surgery.

“Surgeons must use their experience, keen intuition and respect for their own ability and limitations to carefully select patients” for overlapping surgery, the authors wrote.

Door alarms limit OR foot traffic and infection risks

A new study published in Orthopedics has found the best way to cut the number of unnecessary foot traffic in the operating room (OR) is by installing a door alarm. About a third of door openings during surgery are for unessential reasons, like future planning and social visits.

The opening and closing of doors during surgery increases the risk of infection to the patient, particularly in rooms where air pressure is controlled to prevent the airborne bacteria from infecting immune-compromised patients. One study has found that any increase in the number of door openings during surgery increases the risk of infection by 70%.

During the study, opening the OR door would trigger a double chime that would repeat every three seconds until the door was shut again. Using this method, they were able to reduce the average “open door” time from 14 minutes to 10. Other methods aren’t nearly as effective, according to the study’s authors. Rules restricting OR access are often ignored, and locking the door can impede patient care.

That said, the researchers noted that once alarm fatigue sets in, the door alarms would lose their effectiveness.

“Despite the limited long-term effect of this alarm, it should bring further attention to excessive operating room traffic,” they write. “Continuing education and awareness may be necessary to maintain the results found in this study.”

Webinar: Suicide Prevention in Hospitals: Reduce Risk and Comply With Joint Commission Requirements

Presented on: Tuesday, November 21, 2017, 1:00-2:30 p.m. EST
Speaker: Ernest E. Allen, ARM, CSP, CPHRM, CHFM
Program Level: Intermediate 
Registration: http://hcmarketplace.com/suicide-prevention-in-hospitals

Summary:  Hospitals are continually working to reduce the risk of patient suicide in their facilities, but the problem persists. The Joint Commission has placed particular emphasis on reducing suicide risk, including a National Patient Safety Goal and a recent Sentinel Event Alert.

In this webinar, former Joint Commission surveyor Ernest E. Allen, ARM, CSP, CPHRM, CHFM, will explain how hospitals can identify and reduce suicide risks and improve compliance with Joint Commission requirements.

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

  • Identify suicide risks in hospitals
  • Be able to reference applicable Joint Commission standards and Sentinel Event Alerts
  •  Learn prevention methods to help lower suicide risk

USP deadline on hazardous drug handling postponed until 2019

The U.S. Pharmacopeial Convention (USP) has announced it intends to push back the compliance deadline for USP Chapter <800> “Hazardous Drugs; Handling in Healthcare Settings” from July 1, 2018, to December 1, 2019.

USP <800> applies 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 stake-holders through education and outreach,” the organization wrote in a press release.

How to deal with unclear infection prevention guidelines

Written by Tinker Ready at HealthLeaders Media

A team of physicians from the University of Iowa Hospitals and Clinics has put forward a strategy that aims to standardize infection prevention guidelines for procedures performed outside the operating room. The team contends that for most procedures, from skin biopsies to chest tube insertions, there is no authoritative guidance on infection prevention.

Writing in the American Journal of Infection Control, it also notes that there is little published evidence for existing practices.

The strategy emerged from a hospital epidemiology leadership meeting, says Vincent Masse, MD, the study’s lead author.

They discussed a scenario whereby an interventional radiologist had been asked to wear a surgical hat and a mask while doing a fine needle aspiration. The radiologist had not worn the protection in 20 years of doing the procedure.

So the clinician asked what the hospitals policy was.

“Not only were we unable to provide evidence to support this practice, but we also had no comprehensive policy regarding infection prevention practices for medical procedures performed outside an operating room,” the authors write.

Masse and his fellow researchers looked at what kind of research had been done.

“We realized that there is very little data for most procedures and there is no simple model to follow,” he said.

Little Guidance

The researchers reviewed the available literature: textbooks, technical notes, and practice guides, but described them as unhelpful.

The Spaulding Classification guides the disinfection of devices and equipment, but does not go far enough, in the eyes of the study authors. “It would be nice if there were a similar model for outside-the-OR procedures,” says Masse.

“Most of these sources referred, at some point, to ‘your local policy’,” they write.

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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)

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.

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.

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.

Crucial accreditation deadlines on the horizon for pain management and emergency preparedness

Time is running out to meet the new emergency management (EM) Conditions of Participation (CoP) and The Joint Commission’s revised pain management standards. The EM Interpretive Guidelines go into effect on November 15 while the pain management standards go into effect January 1.

Emergency management

The new EM CoPs fill gaps CMS’ previous regulations by compelling hospitals to communicate and coordinate their emergency plans with other healthcare organizations and government agencies. They also require regular emergency preparedness training with staff and disaster contingency planning.

Steve MacArthur, a safety consultant at The Greeley Company, pointed out that a lot of the new requirements include things that hospitals should have already been doing.

“While this rule is new to the ‘marketplace,’ there are really no new concepts contained therein,” he says. “This may provide some guidance for CMS surveyors as they drill down on organizational preparedness activities. But none of this is groundbreaking or in any way representative of a change in how hospitals have done, and will continue to do, business. [It’s] just another set of official ‘eyes’ looking through the compliance microscope.”

Pain management

The Joint Commission prepublished its new pain management standards back in June. The accreditor said it used the revision to address disparities between its standards and what the literature recommended. Some of the changes include:

•    Enabling clinician access to prescription drug monitoring program databases

•    Performance improvement activities focusing on pain assessment and management to increase the safety and quality for patients

•    Identifying the leader or leadership team responsible for pain management and safe opioid prescribing

•    Involving patients in developing their treatment plans and setting realistic expectations and measurable goals

•    Identifying and monitoring high-risk patients as a way to promote safe opioid use

Facilities should assign teams to research best practices in pain management, get the medical staff working on revising protocols and deter¬mining how to gather data on pain management effectiveness, and alert your information technology and electronic health records experts that they will be needed.

The annual fire and smoke door testing requirements will also be due by January 2018.