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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

Thoughts about all that documentation the CoPs require? CMS wants to know

Have thoughts about the paperwork you have to generate because of Medicare’s Conditions of Participation (CoP)? Or rather, do you have thoughts you’d like to share with the public, as well as the Department of Health and Human Services (HHS)?

Now’s your chance. CMS has posted a call for comments on the paperwork required under the regulations that govern almost every aspect of operations at hospitals nationwide that also want the ability to bill Medicare for their services.

The call for public comment is periodic request, mandated in turn by the Paperwork Reduction Act of 1995. (So yes, it’s a regulatorily required chance to comment on extraneous regulations.)

And it’s one of many CMS puts out through the year. This particular request, according to the formal notice placed in the Federal Register Nov. 13, concerns the regular collection of information “needed to implement the Medicare and Medicaid Conditions of Participation (CoP) for 4,890 accredited and non-accredited hospitals and an additional 101 critical access hospitals (CAHs) that have distinct part psychiatric or rehabilitation units (DPUs). CAHs that have DPUs must comply with all of the hospital CoPs on these units. Thus, this package reflects the burden for a total of 4,991 hospitals (that is, 4,890 accredited/non-accredited hospitals and 101 CAHs which include 81 CAHs that have psychiatric DPUs and 20 CAHs that have rehabilitation DPUs).”

Translated, that’s most of the hospitals in the nation, minus the 1,183 CAHs without distinct part psychiatric or rehabilitation units. They operate under a separate set of CoP, according to the notice.

“The CoPs and accompanying regulatory requirements are used by our surveyors as a basis for determining whether a hospital qualifies for a provider agreement under Medicare and Medicaid. CMS and the health care industry believe that the availability to the facility of the type of records and general content of records is standard medical practice and is necessary to ensure the well-being and safety of patients and professional treatment accountability,” according to the notice.

CMS estimates that the paperwork required to meet the CoPs of the combined 4,991 respondents generates 1,342,424 responses a year, requiring a total of 18,840,617 hours a year.

That’s about 3,775 hours per hospital. Or 72 hours a week. Or basically two full-time positions a year.

(You might not want to ask one of those people to generate the report to send to Medicare, if you do decide to submit a comment.

Or you might.)

Comments must be received by Jan. 12, 2018.

After the notice is published on Nov. 13, to comment electronically — no physical paperwork needs to be generated! — go to www.regulations.gov, search for “2017-24524,” hit the button that says “COMMENT NOW” and follow the instructions.

Note the warning that the comments will be made public.

Or you can send comments by regular mail: CMS, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention: Document Identifier/OMB Control Number 2017-24524, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

To read the request of information first, go to https://www.gpo.gov/fdsys/pkg/FR-2017-11-07/pdf/2017-24134.pdf 

— Written by A.J. Plunkett (aplunkett@h3.group)

What books should we write in 2018?

Hello!

It’s book season at HCPro (also Halloween/Thanksgiving/sweater season) and we need your help!

This is the time when we come up with possible book ideas for 2018. But of course, we don’t want to write about something readers aren’t interested in, and want to hear your thoughts.

We need your feedback to get these books into production, so please share your thoughts by taking this short survey https://www.surveymonkey.com/r/66K3C7J 

And if you have other book ideas, we’re always open to suggestions!

Thanks

Brian Ward

Associate Editor, Briefings on Accreditation and Quality 

 

Joint Commission updates diagnostic equipment SEA

The Joint Commission has announced additions to Sentinel Event Alert (SEA) 47, which was first issued in 2011 and focuses on the radiation risks of diagnostic equipment. While most of the language in the alert remains the same, The following changes were made:

  1. Hospitals must comply with the Image Gently Alliance’s guidelines when using imaging radiation or fluoroscopy on pediatric patients..
  2. The alert contains a link to SEA 57, The essential role of leadership in developing a safety culture, replacing the previous link to SEA 43. Both alerts talk about leadership’s role in creating a safety culture, but SEA 57 is more recent. 
  3. The list of references has been updated to show which ones had been recently accessed.

Throwback Thursday: Boston Medical Center reduces alarm fatigue by recalibrating alarm limits

Siren

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!

If you walk onto the medical-surgical units in Boston Medical Center (BMC), you may notice something strange: silence.

On a unit that is typically a cacophony of beeping emanating from cardiac monitors, silence is a strange occurrence. But thanks to BMC’s pilot study that began in August 2012, the unit is significantly quieter, the nurses are noticeably happier, and the hospital has positioned itself as a national model for reducing alarm fatigue-a recent hot topic in the patient safety world.

What began as a pilot study on one unit transformed into a hospitalwide initiative that reduced alarms on all medical-surgical units from 1 million to 400,000 per week.

“Our nurses threatened us that if we ever went back to the old settings; they never wanted us to end the pilot program,” says Deborah Whalen, MSN, APRN, ANP-BC, clinical service manager and cardiology nurse practitioner at BMC, and one of the coauthors of the study published in the Journal of Cardiovascular Nursing. “Initially they were terrified that there would be all these crisis alarms, but in fact, we made the changes and did it on a Monday at noon, changed the order sets on the pilot unit and educated staff, and then we stood there and there were no alarms.

“As a matter of fact I called Jim, our clinical engineer, at 2 a.m. to say the system was broken.”

The proof was in the pilot

The overwhelming success of the pilot study on one unit prompted BMC to expand the program to every medical-surgical unit and the hospital quickly became identified as a national leader in alarm management, during a time of heightened awareness and a new National Patient Safety Goal from The Joint Commission. Over the past several months The Boston Globe, NPR, and two local news channels have done stories about the hospital’s program. In May 2013, BMC’s work was featured in a Joint Commission webinar, exemplifying the steps hospitals could implement to better manage alarms and improve patient safety.

The results of the pilot program were published online in December in the Journal of Cardiovascular Nursing, which showed a reduction of 89% in total mean weekly audible alarms by dropping averages from 12,546 per day to 1,424. Weekly alarms averaged 87,823 but dropped to 9,967 during the pilot. The most significant decrease came from changes for bradycardia, tachycardia, and heart rate parameter limits, which started at 62,793 per week and dropped to 3,970 per week.

Perhaps the most telling statistic: The decibel level on the floor dropped from 90 decibels before the pilot to 72 decibels, the equivalent of noise levels generated by heavy traffic to normal conversation.

“It’s not silent by any stretch of the imagination, but it’s quiet and there aren’t these alarms constantly going off in the background,” Whalen says.

What made the study particularly appealing to other hospitals searching for ways to better manage alarms in their own facility was the fact that there were no adverse events related to missed cardiac events, and the pilot study required no additional resources or technology.

“While some hospitals are looking to add technology to combat this issue, BMC’s approach demonstrates the opportunity for clinicians to interact with current alarm systems more effectively to decrease clinical alarm fatigue while simultaneously capturing and displaying all important alarms,” James Piepenbrink, BSBME, director of clinical engineering at BMC and a study coauthor, said in a press release.

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Joint Commission deletes standards during third phase of EP review

On April 25, The Joint Commission announced it had completed the third phase of its Element of Performance (EP) review project. Phase three looked at standards from seven Joint Commission programs, deleting those deemed duplicative or have become standard operating procedure.

It should be noted that what was deleted varies based on each program. For example, an EP deleted for the hospital program might still exist for home care. Chapters affected include Environment of Care and Infection Prevention and Control.

Below are links to the various prepublication standards, which are effective July 1, 2017.

Family-centered ICUs improve outcomes

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

1:00-2:30 p.m. ESTHCPro Webcast Icon

Presented by:
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

Sign up today! 

 

Study: Quality isn’t affected by physician employment

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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Boston Scientific issues immediate recall of device guidewires

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.