To improve medical outcomes in intensive care units, some hospitals are attempting to make units more accessible for patients’ family and caregivers. Allowing patients to have more access to their families have been shown to reduce hospital stays, improve satisfaction, and help prepare patients for post-discharge, according to Giora Netzer, MD, a critical care specialist at the University of Maryland Medical Center (UMMC) in an interview with The Baltimore Sun.
“It’s not just more humane care, it ends up being better healthcare,” Netzer said.
Netzer also helped develop guidelines for the Society of Critical Care Medicinethat give providers strategies to better include family members in patient care. This includes having an “open or flexible” place by the patient’s bed, having a place for family members to sleep, and educating the family as part of clinical care. It also includes giving patients’ family’s mental, emotional, and spiritual support to reduce anxiety, stress, depression, or risk for post-traumatic stress disorder in certain instances.
The UMMC has implemented the guideline recommendations and now offers larger rooms to accommodate family members. The facility eliminated visiting hours and makes social workers available to work with relatives on the discharge instructions. UMMC is also has a pilot program where family members attend medical rounds.
Last Chance: “How Parkland Health & Hospital System Successfully Implemented a Suicide Risk Screening Program Webinar”
Date: Tuesday, February 7
Kimberly Roaten, PhD, CRC
Celeste Johnson, DNP, APRN, PMH CNS
Level of Program: Intermediate
Suicides were the third most common sentinel event of 2015. Universal screening is the best strategy to identify patients in general healthcare settings whose suicide risk would otherwise go undetected. This webinar will take a case study approach to bring to light proven methods to reduce patient suicide.
Join Parkland Health and Hospital System expert speakers Kimberly Roaten, PhD, CRC, and Celeste Johnson, DNP, APRN, PMH CNS, as they explain how Parkland became the first in the nation to establish a universal suicide screening program in all its departments. Parkland was recognized in Sentinel Event Alert 56 for making significant progress in suicide prevention. Roaten and Johnson will discuss processes for implementation, strategies to obtain support, universal screening data, and lessons learned from implementation.
At the conclusion of this program, participants will be able to:
- Discuss the process for implementation of a hospitalwide suicide screening protocol
- Describe strategies for obtaining nursing and physician stakeholder support for universal suicide screening
- Describe the prevalence data collected from the first two years of a universal screening program
- Apply lessons learned from the implementation of the program in a large hospital system
A new study published in the Annals of Internal Medicine found that between 2003 and 2012, the number of hospitals hiring physicians jumped up by 13%. Despite this, the authors caution that the glut in physicians will have little impact on care quality.
Forty-two percent of hospitals were employing physicians in 2012, the majority of which were teaching hospitals, nonprofits, and larger facilities. The study’s authors then looked at key quality metrics between 803 hospitals that switched to the employment model vs. 2,085 hospitals that didn’t. They wanted to see if there was a noticeable difference in length of stay, patient satisfaction, mortality, and 30-day readmissions when hospitals changed their employment style. What the researchers found was that hiring physicians had almost no impact on any of these metrics. Mortality rates, for example, were only 0.1% better in hospitals that switched compared to those that didn’t. The only exception was for pneumonia (secret and public) which saw a 0.6% improvement in switched hospitals.
“Our study, which used contemporary national data, suggests that a fundamental improvement in care delivery will require more than mere changes in hospital-physician integration, and if physician employment is a key ingredient, it must be linked to other key goals, such as hospital prioritization of quality, to be successful,” the authors wrote.
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The Boston Scientific Corp. issued an urgent medical device recall of its RotaWire “Elite” core wires and wireClip Torquer guidewires on November 27. The company said the guidewires may crack and detach from the Rotablator Rotational Atherectomy System (RRAS). The RRAS is used to open narrow arteries and cut away at plaque, improving blood flow to the heart. When the guidewires crack, the pieces can be left inside the artery causing tamponade or heart attacks. Boston Medical has learned of three incidents of guidewires cracking so far, with one case resulting in a patient’s death.
The recall comes in the wake of a FDA safety communication on intravascular devices. Since 2014, the FDA has received 500 medical device reports on peeling hydrophilic and/or hydrophobic coatings on intravascular devices, with the majority of reports submitted for vascular guidewires.
The FDA encourages healthcare professionals and patients to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program. Facilities still using these guidewires are told to stop using them immediately. All affected products should be returned to Boston Scientific and distributors should notify any customer who may have received the product.
One of the most interesting parts of my job is helping folks through the actual Joint Commission survey process. Even as a somewhat distant observer, I can’t help but think that the average survey (in my experience) is about a day longer than it needs to be. Now, I recognize that some of that on-site time is dedicated to entering findings into the computer, so I get that. But there are certain parts of the process, like, oh I don’t know, the EC/EM interview session, that could be significantly reduced, if not dispensed with entirely. Seriously, once you’ve completed the survey of the actual environment, how much more information might you need to determine whether an organization has its act together?
At any rate, I suppose this rant is apropos of not very much, but the thought does occur to me from time to time. So I ask you: is there anybody out there who feels the length of the survey was just right or, heaven forbid, not long enough? As I’ve always maintained, TJC (or, for that matter any regulatory survey type—including consultants) tend to look their best when you see them in the rear view mirror as you drive off into the future. I know the process is intended to be helpful on some level, but somehow, the disruption never seems to result in a payoff worth the experience. But hey, that may just be me…
Any thoughts you’d like to share would be most appreciated.
The problem of clinical alarm fatigue is so pervasive in hospitals that The Joint Commission created a new National Patient Safety Goal to address it. With so many device alarms going off, staff may tune them out and miss important warnings that can lead to adverse patient events.
In this webcast scheduled for Wednesday, October 14 at 1 p.m. Eastern, Deborah Whalen and Jim Piepenbrink of Boston Medical Center will explain how their facility successfully reduced alarm fatigue through process management, collaboration, and governance. Register today for “Clinical Alarm Management: Reduce Alarm Fatigue and Meet The Joint Commission’s National Patient Safety Goal” and get the knowledge you need to improve alarm management in your facility.
Visit here for more information.
I know that we’ve visited (and revisited) this topic once or twice over the last little while, but it continues to be (at least in my mind’s eye), the most significant vulnerability for every healthcare organization that uses The Joint Commission (TJC) for accreditation services: the management of temperature, humidity, and air pressure relationships (THAPR—How’s that for an acronym? It’s pronounced “thapper” or, if you’re from Boston, “thappah”) in the care environment. Folks continue to be cited for issues in this regard; other folks are jumping on board (a little late, but better than never) but are in the closing section of their survey window; and others still have not quite grasped the importance of having a stranglehold (if you will) on those areas for which there are THAPR requirements. Those of you who’ve accompanied me in the blogosphere for a while know that I do not do a lot of product marketing (even my own product), but I will encourage you once again: if you do not have a copy of ASHRAE 170—2008 Standard for Ventilation of Health Care Facilities, you are not in possession of what may be (at least at the moment) the single most important slab of information in the physical environment pantheon (yes, we will always have a place in our hearts for the 2000 edition of NFPA 101 Life Safety Code®; probably for too long, based on the ever-so-slow-to-adopt new things track for the 2012 edition).
While I’m not suggesting that you memorize ASHRAE 170 (it is fairly brief and those of you with eidetic memories probably won’t be able to keep yourselves from doing so), I am suggesting that you need to go to the table on pages 9-11 and start identifying the areas in your organization that have specific requirements and start figuring out where you stand in relation to those requirements, and perhaps more importantly, come to some sort of sense as to how reliably your systems can support those requirements. And you really need to go through the entire table; TJC certainly is. Just last week, I heard of pressurization issues in lab and pharmacy areas (labs are to be under negative pressure; pharmacies under positive) that added up to condition-level survey results.
Make sure you know where you have sterile storage in your organization; sterile storage areas are to be under positive pressure and should be monitored for temperature and humidity. But the reality of the situation is that you have sterile supplies in locations throughout your organization, so you have to define what does and what does not represent sterile storage (my best advice is to coordinate with your infection control and surgical folks on this one—it’s beginning to look a lot like a risk assessment—everywhere you go!). That way, you have a solid foundation for determining what needs to be managed from an environmental standpoint; it’s the only thing that will keep you out of the hottest water during survey.
Two final thoughts before signing off for this week; make sure that routine bronchoscopies are being performed under negative pressure (urgent or emergency bronchoscopies may not have quick enough access to the appropriate environment, so make sure that folks know what protective measures need to be considered to protect themselves and the patient when they’re aerosolizing potential bugs). There are still instances in which this is being cited during survey, so I think my best advice is to go and check with your respiratory therapy folks, as well as the folks in surgery, critical care, infection control, etc., and ask the question: Are bronchoscopy procedures being performed, and if so, where are they being performed? Then you can start walking it back to a point where you can be assured that they are being done in an appropriate environment.
The last thing is a brief reminder that the process for the survey of the physical environment (again, as it is currently being administered) involves all of the survey team – when it comes down to this are of concern, there is no more “clinical” versus “non-clinical”; everything that occurs within the four walls of your organization are patient care activities, direct or indirect (you may have noticed TJC has been splitting its performance elements using that very same language). Coordination of the various hospital services, etc., has never been more heavily scrutinized and never been found more wanting during survey. There is a paradigm shift afoot, my friends, and we need to get on the good foot.
September 23, 2015
1:00-2:30 pm EST
Lisa Pryse Terry, CHPA, CPP
Christian M. Lanphere, PhD, FP-C, NRP, CEM
Active shooters and armed violence represent a rapidly growing issue in America’s hospitals and healthcare facilities. These incidents occur on a near-weekly basis, which means it is time to face the fact that they can also happen in your facility.
Don’t wait until it’s too late to develop an emergency response plan! Join HCPro for a live webcast presented by healthcare safety experts Lisa Pryse Terry, CHPA, CPP, and Christian M. Lanphere, PhD, FP-C, NRP, CEM. They will teach participants how to lessen the risk of a violent confrontation and how to prepare facility staff in the event an armed intruder comes through their doors.
For more information and to register for the webcast, click here.
The Joint Commission has clarified its expectations for the Life Safety (LS) and Environment of Care (EC) portions of its accreditation surveys, according to an article in the August issue of The Joint Commission Perspectives. The accreditor now requires hospitals to have staff available to assist the Life Safety Code® surveyor with document review.
The Joint Commission’s Survey Activity guide has been updated to include an LS and EC document list and review tool, which lists documents the Life Safety Code surveyor will review. The Joint Commission has also revised its sample LS survey agenda to include more detail on what the surveyor will do.
Read the Joint Commission’s revised LS and EC document list and review tool.
The FDA issued a safety communication on Friday urging all healthcare facilities to stop using the Hospira Symbiq infusion systems due to potential cybersecurity vulnerabilities. The system may be accessed or “hacked” from outside the hospital’s network. The infusion system is a computerized pump designed for continuous delivery of general infusion therapy for a broad patient population.
“We strongly encourage that healthcare facilities transition to alternative infusion systems, and discontinue use of these pumps,” the FDA says in the report. Both the FDA and the U.S. Department of Homeland Security are aware of vulnerabilities, but as of yet, there have been no reported breaches in security.
Read the safety communication to learn more and for tips on how to disable the system from your network.