RSSAll Entries in the "Quality" Category

Workplace violence prevention resources

More than 70% of significant WPV injuries occur in healthcare and social service settings. That number has been on the rise, and the victims are primarily healthcare workers. Here are some other free resources and training on workplace violence prevention in your healthcare organization:

1.    The Center for Health Design’s Safety Risk Assessment Toolkit
2.    The CDC’s Workplace Violence Prevention for Nurses  
3.    OSHA’s Guidelines for Preventing Workplace Violence in Healthcare and Social Services    
4.    OSHA’s Preventing Workplace Violence: A Road Map for Healthcare Facilities
5.   The Emergency Nurses Association’s Workplace Violence Page
6.    ASIS International’s Managing Disruptive Behavior and Workplace Violence in Healthcare

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.”

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.

Joint Commission announces four survey focus areas

Representatives from The Joint Commission, URAC, DNV-GL, the Healthcare Facilities Accreditation Program (HFAP), and National Committee for Quality Assurance (NCQA) took the stage at the 2017 NAMSS Educational Conference & Exhibition to share what they have learned from this year’s accreditation surveys and to tell audience members about relevant standards changes

The Joint Commission announced four areas of focus:

1.    The SAFER Matrix: Implemented in January 2017, the SAFER Matrix has nine boxes that measure the likelihood to harm a patient on one axis and scope of occurrence (limited, pattern, widespread) on the other.

2.    Antimicrobial stewardship: The CDC reported that 20% to 50% of antibiotics were prescribed unnecessarily or inappropriately annually. Medical staffs must reduce their antimicrobial use and have a medical staff process to demonstrate an effective use of antibiotics or antimicrobials in their organizations.

3.    Ligature risks for behavioral healthcare units: Due to the increasing rise of inpatient suicides (1,200 to 1,500 each year), 70% of which are by hanging, ligature risks are no longer acceptable in areas specified for the treatment of behavioral healthcare patients with suicide risk.

4.    Culture of safety:Leaders must ensure a culture of safety and identify areas to improve culture of safety. Staff must be comfortable and able to report issues of safety to leadership. This is already a culture of safety standard in the Leadership chapter and the accreditor will unveil a related standard in the Medical Staff chapter in 2018.

According to Louis Goolsby, MD, FACOG, FACHE, the most common citations from the Medical Staff chapter still come from MS.01.01.01, specifically EP3 (specific requirements and associated details are included in the medical staff bylaws) and EP5 (the medical staff complies with the medical staff bylaws). Another common citation is MS.03.01.01 (practitioners only practice within their scope of privileges).

Editor’s note: 
The following article was originally published on the Credentialing Resource Center, October 24, 2017.

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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Seeking nominees for The Platinum Awards

The Platinum Awards sets the standard for recognizing professionals and organizations who demonstrate success in the overarching healthcare continuum.

Like no other awards program in the industry, the Platinum Awards brings professionals and organizations together to highlight their work, be publicly recognized, celebrate successes and collectively recognize that working as a team can ensure a safe, quality and sustainable healthcare system.

Another delay of CMS hospital star ratings system

CMS will delay an update to its controversial hospital star rating system for the second time in four months. The update was expected to launch this month and the new setback means the tool might not be available to the public until 2018.

CMS told reporters that it needed more time “to continue its examination of potential changes to the Star Rating methodology based on public feedback.” Until CMS releases the update, the ratings from December 2016 will remain on the Hospital Compare website.

The star ratings are intended to provide patients with more transparency on hospital quality, and are based on seven different latent variable models. Hospital scores are calculated using 57 quality measures broken up into seven categories:
•    Mortality
•    Patient experience
•    Readmissions
•    Safety of care
•    Care effectiveness
•    Care timeliness
•    Efficient use of medical imaging

However, since the day it was proposed many hospitals and healthcare organizations have argued against the five-star system. Some argued it unfairly penalized hospitals with poorer or sicker patients, that the methodology it uses is flawed, and that patients’ perceptions aren’t the same as quality.

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!

 

 

New may not be better: hospital returns to paper and happier docs

The Illinois Pain Institute (IPI) was having trouble with its electronic health records (EHR). So they got rid of them and went back to paper. And they aren’t planning on going back anytime soon.

Two years ago, all 70 members of the IPI voted unanimously to get rid of its EHR saying it was slowing down care and alienating patients.

“We felt the level of patient care was not enhanced by an electronic health record. We saw it was inefficient and added nonproductive work to physicians’ time,” John Prunskis, MD, IPI founder and co-medical director told Becker’s Hospital Review. 

Since the switch, IPI has reported greater ease communicating information between hospital systems, less time spent on data entry, happier patients and staff.

“The EHR hinders data exchange,” he says. “One EHR doesn’t talk to another EHR, and there’s many reasons for that. The other thing is when you dictate a paper note with the relevant clinical findings and history, it’s rather succinct, but with the EHR, there’s a problem. The EHR is pages and pages of mind-numbing text, where important labs and information can be lost. Before, a note might be a half-page long, but now it can be five, six pages long, and doctors frequently can’t find what’s relevant through the reams of text and clutter.”

The IPI’s feelings are echoed by many physicians, according to the Mayo Clinic, which in 2016 found in EHR usage reduces physician satisfaction and increases burnout. Another study from the same year found that for every hour physicians spend with patients, they spend two hours interfacing with their EHR.

“Electronic health records hold great promise for enhancing coordination of care and improving quality of care,” said Tait Shanafelt, MD, Mayo Clinic physician and lead author of the study, in a statement. “In their current form and implementation, however, they have had a number of unintended negative consequences including reducing efficiency, increasing clerical burden and increasing the risk of burnout for physicians.”

 

Fire and smoke: CMS clarifies which doors must be inspected annually

After pushback, federal officials backed away from their claim that smoke barrier doors must be inspected and tested annually.

More than three weeks after a well-publicized compliance deadline passed, CMS announced Friday that the deadline would be pushed back nearly six months, giving facilities until New Year’s Day 2018 to comply with an annual testing requirement for certain doors.

David Wright, director of the CMS Survey and Certification Group, made the announcement in a memo to state survey agency directors. He acknowledged that there had been a fair amount of confusion concerning the change, and he offered some pretty consequential clarifications that could affect whether the new requirement applies to your facility at all.

“[C]onsidering the level of reported misunderstanding of this requirement, CMS has extended the compliance date for this requirement by six months,” Wright wrote.

Within the National Fire Protection Association’s (NFPA) 2012 Life Safety Code® (LSC), which CMS adopted last year, there is a requirement that fire doors and smoke barrier doors be tested annually. Officials with CMS had taken the position that the new requirement applies to healthcare occupancies; that position, however, was met with pushback.

A petition objecting to the CMS position was discussed at length in June by members of the NFPA Healthcare Interpretations Task Force (HITF), says Brad Keyes, CHSP, owner of Keyes Life Safety Compliance. That petition objected to the notion that the LSC specifically requires annual inspections of smoke barrier doors in healthcare occupancies.

“The HITF members did discuss the issue and agreed that healthcare occupancies were exempt from complying with section 7.2.1.15.2 … because the healthcare occupancies did not specifically require compliance with that section,” Keyes says in an email.

The committee decided to table its decision on the matter to give CMS an opportunity to review its position, as it did, Keyes says.

“I am pleased that the system worked in favor for the many hospitals that are certified by the Federal agency,” he adds.

Although the LSC does include provisions requiring annual inspections of smoke barrier doors and fire doors alike, section 7.2.1.15.1 states that these standards apply only where required by Chapters 11–43. Since the chapters governing healthcare occupancies make no direct reference to Section 7.2.1.15.1, the door inspection provisions do not apply to healthcare occupancies, Wright acknowledged in his memo.

Based on that conclusion, Wright spells out a few key takeaways:

  1. Fire doors. In healthcare occupancies, all fire door assemblies must be inspected and tested annually in healthcare occupancies, based on section 8.3.3.1 of the 2012 LSC, which applies to all occupancies.
  2. Smoke barrier doors. Non-rated doors (including smoke barrier doors and corridor doors to patient care rooms) aren’t subject to the annual inspection and testing requirements, but they “should be routinely inspected as part of the facility maintenance program.”
  3. Deadline. The compliance deadline has been pushed back from July 6, 2017, to January 1, 2018.
  4. Citations. Any LSC deficiencies related to annual fire door inspections should be cited under K211—Means of Egress—General.

But what if a healthcare organization was already cited at some point during the three-week gap between the original compliance date and the clarifying memo (July 6–28) for a failure to conduct an annual test of its smoke doors? Multiple CMS representatives did not respond to requests for an answer. Keyes says CMS has been a stickler in the past, holding that a finding cannot be removed once it is written on a survey report.

“There was an accreditation organization [AO] that used to allow findings to be removed from their survey report if the hospital could demonstrate compliance at the time of the survey,” Keyes says. “CMS has said that the AOs may no longer remove findings, even if the hospital was compliant at the time of the survey.”

The Joint Commission stated in the July edition of Perspectives that it requires annual testing for fire door and smoke door assemblies alike, despite acknowledging that the healthcare occupancy chapters don’t cite section 7.2.1.15 specifically. (To support the requirement, The Joint Commission noted that Section 18/19.2.2.2.1 references section 7.2.1, and cited a belief that the annual tests are beneficial.)

Keyes adds a word of caution: “The AOs are not locked into complying with everything CMS says or does. The AOs may have standards that exceed what CMS requires.”

That means the guidance in Wright’s memo might not trickle down to the AOs and state agencies that conduct surveys at your facilities, especially considering how widely advertised the original compliance date has been.

“So, I suspect many of the AOs will keep the start date at July 5, 2017, since they are already enforcing that,” Keyes says.

With that in mind, he recommends that all healthcare facilities have their fire doors tested as soon as possible, rather than waiting until the new deadline—because another authority having jurisdiction might keep to the stricter timeline.