The fight against antimicrobial-resistant (AMR) infections has become a hot topic in 2016, and the United Nations (UN) has now joined the fray. This year, The Joint Commission and CMS making antimicrobial stewardship programs (ASP) mandatory for all healthcare facilities. At the World Economic Forum in Davos, 74 drug makers, 11 diagnostic test manufacturers, and nine industry groups signed “The “Declaration on Combating Antimicrobial Resistance.” Two different disease strains were found to be resistant to the “last-resort” antibiotic colistin.
During the 71st session of the UN General Assembly in New York City last week, the world’s governments discussed the increasing dangers posed by AMR infections and doubled down on the need for national and international AMR action plans. This makes AMR infections the fourth health issue in history to be taken up by the U.N. General Assembly after HIV, noncommunicable diseases, and Ebola.
“Antimicrobial resistance threatens the achievement of the Sustainable Development Goals and requires a global response,” said H.E. Peter Thomson, president of the 71st session of the UN General Assembly, in an address to delegates. “Member states have today agreed upon a strong political declaration that provides a good basis for the international community to move forward. No one country, sector, or organization can address this issue alone.” [more]
Despite the onset of electronic medical records and other ways of identifying patients, wrong-patient procedures still occur with distressing frequency. In a newly published analysis, the ECRI Institute reviewed 7,600 wrong-patient events in 181 hospitals. Roughly 9% of those errors resulted in a patient being hurt or dying, despite the fact that most of the identification mistakes were preventable.
“Although many healthcare workers doubt they will actually make a mistake in identifying their patients, ECRI Institute [Patient Safety Organization (PSO)] and our partner PSOs have collected thousands of reports that show this isn’t the case,” says William M. Marella, MBA, MMI, ECRI Institute executive director of PSO Operations and Analytics. “We’ve seen that anyone on the patient’s healthcare team can make an identification error, including physicians, nurses, lab technicians, pharmacists, and transporters.” [more]
On January 1, 2017, The Joint Commission will delete 51 Elements of Performance (EP) from its hospital accreditation standards. The deletion is part of an ongoing effort to remove similar, duplicative, or unneeded EPs from the accreditation process.
Despite the many promises to the otherwise, electronic health records (EHR) haven’t simplified physicians’ lives. Instead, the average physician today spends twice as much time working with EHRs than interacting with patients.
One study by the Office of the National Coordinator for Health Information Technology (ONC) found that 14% of physicians have experienced a potential medication error due to their EHR in the past month. Another 14% said that the excessive amount of alerts had caused them to overlook something important.
To solve this problem, the Johns Hopkins Armstrong Institute for Patient Safety and Quality and the Pew Charitable Trusts held a summit with 70 EHR systems experts from across the medical field. The group discussed the best possible solutions of preventing EHR medical errors, improve care quality, and improve workflow. The group published a fact sheet on their findings this month, outlining three major problems and their solutions.
“By raising the bar on testing for usability, measuring performance, and opening up ways to share learning on problems and solutions stakeholders can make progress on EHR usability and safety and help clinicians deliver safe, patient-centered, high-quality care,” they write.
Problem: Inadequate testing requirements
Sometimes EHR vendors fail to conduct rigorous enough testing on their products before they are released. Whereas a small bug, glitch, or unexpected change would be a minor annoyance in other fields, improper testing of systems can result in patient harm.
Solution: Create minimum requirements for EHR testing
Currently, only summative testing (which is done after the EHR’s design process) is mandated by the ONC. The summit agreed that additional requirements be made for both formative testing (while the system is being developed) and post-implantation testing (after it’s been installed.)
Problem: insufficient measures of HER safety and usability
The group pointed to a lack of a universally accepted metrics of EHR performance as a major issue. Without them, there’s no way to set quality benchmarks or see if an issue is specific to one system or popping up everywhere.
Solution: Create and disseminate recommendations to the healthcare field
The National Quality Forum has come up with a list of recommended measures for hospitals, vendors, and patient safety organizations to use when improving EHR safety and usability.
Problem: Poor communication of EHR failures between facilities
Between fear of infringing on EHR vendor intellectual property clauses, and a lack of clear communication system, facilities are often unable or unwilling to discuss problems they’ve had with their EHRs. This results in hospitals having to reinvent the wheel every time there’s an issue, even if the same problem was already solved in a different facility.
Solution: Create an organization to examine and manage all EHR-related issues
This step is recommended by the ONC and the Institute of Medicine. The organization would be able to share providers’ experiences without violating copyright gag orders.
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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Between 2010 and 2015, hospital readmission rates have dropped an average of 8% nationally, with 100,000 unnecessary patient readmissions avoided in 2015 alone. CMS reported the news on its blog, stating that 49 states and the District of Columbia have seen reductions in avoidable 30-day readmissions of Medicare patients over the past five years.
Readmissions reduction has been a major goal for CMS, with an estimated $17 billion in Medicare spending spent annually on avoidable hospital readmissions. The agency also announced that it would be increasing its fines for high readmission rates in fiscal 2017. While hospitals may look to this new data as a sign of hope, a study in The New England Journal of Medicine cautions that the continuing the drop may not be possible.
“Presumably, hospitals made substantial changes during the study period but could not sustain such a high rate of reductions in the long term,” the authors wrote. [more]
The Joint Commission has updated its “notification of organization changes” policy for accredited facilities.
Previously, organizations had 30 days to notify The Joint Commission that a significant change had been made. The updated policy now requires organizations alert the accreditor the moment the changes are confirmed (i.e., once leadership has decided to move ahead with a change and has created a timeline for completion).
The updated regulations go into effect on October 1. The changes apply to all Joint Commission-accredited programs. Click here to read the revised policy.
A proposed CMS change to the 2017 Medicare Physician Fee Schedule will require surgeons document and report data every 10 minutes for new billing codes (G-codes). The penalty for not submitting this data is 5% of a facility’s Medicare reimbursement.
CMS’ plans to phase out 10-day and 90-day global surgery packages over the next two years. Instead, the fee schedule would have a zero-day package, with all preoperative and postoperative care bundled together on the day of the surgery. Surgeons would receive a lump sum for their work and bill CMS on a piecemeal basis for care provided before and after the day of surgery.
Surgeons and medical groups have loudly decried the move, calling it impractical, untested, and a huge waste of time and money. In one survey of 7,000 surgeons, 37% said the new codes will cost them between $25,000 and $100,000 per surgeon. Fifteen percent said it would cost them over $100,000 in hiring scribes to keep up with documentation, updating electronic health records, and having less time for patients.
Respondents also claimed that if the standards go into effect:
• 85.9% will have to modify EHR and billing systems
• 88.8% of physicians and 75.7% of staff will lose time tracking and processing global surgery information into EHR and billing systems
• 82.8% will have to develop new tracking and collecting methods for global surgery data
• 46.4% will need to buy more technology (such as handheld devices or stopwatches) to document time spent providing global surgery services
So far, the American College of Surgeons (ACS), the American Association of Orthopaedic Surgeons, the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), the American Medical Association, and several others have filed protests with CMS.
“The claims-based data collection mandate is so burdensome that most physicians will not be able to comply by January 1, 2017, which will result in CMS being unable to collect accurate and usable data, particularly in light of the unfinished final rule at the time of this writing,” the AANS and CNS wrote in a letter to CMS.
For more, read the full article at HealthLeaders Media.
HFAP this week released its prepublication manual for critical access hospital (CAH), and ambulatory surgical center (ASC) surveys. The manuals have been updated to include requirements of the 2012 Life Safety Code® (LSC), which was recently adopted by CMS. The CMS adoption of the 2012 LSC went into effect in July, and the new requirements will go into effect for HFAP facilities on November 1, 2016.
Preventing the theft of controlled substances at hospitals continues to be an issue even with increased security measures. Failed drug diversion programs in hospitals have led to record fines levied against facilities. The Mayo Clinic experienced a highly publicized case of drug diversion back in 2008, where a nurse was caught stealing fentanyl from patients about to have a catheter inserted. The incident prompted the Mayo Clinic to take proactive steps toward drug diversion, such as:
1. Having a zero tolerance policy for theft of any drugs from anywhere
This includes workers who fail to properly witness a coworker disposing a drug that is not ultimately given to the patient. Workers should be given pre-employment drug screening and receive education on the dangers of drug addiction and misuse.
2. Work with law enforcement agencies
This includes local police and U.S. Drug Enforcement Administration (DEA). Officials from these agencies can process search warrants of employees’ homes and cars to help prove a case. This also lets other facilities know whether a prospective job hire has been caught trying to steal drugs before.
3. Employ a 24-hour diversion hotline for workers to report suspicious behavior
Place advertisements for the hotline around the facility and make sure that those working on the hotline are qualified.