In November, The Joint Commission and the Centers for Disease Control and Prevention (CDC) joined forces to create model infection control plans for outpatient settings. The initiative seeks to enhance the CDC’s existing guidance on infection control and prevention in ambulatory care centers.
For the initiative, The Joint Commission will be working with 12 outpatient-focused professional organizations and 10 ambulatory healthcare systems. The Joint Commission and CDC also will engage with local chapters of the professional organizations and state health departments that have an interest in enhancing infection prevention and control in their areas.
The goal of this effort, which is supported through a CDC Safety and Healthcare Epidemiology Prevention Research Development contract, is to create model infection control plans and expand the dissemination and adoption of these and other materials to prevent infections in outpatient settings.
The project will focus on a variety of free-standing ambulatory settings and services. The Joint Commission and CDC will select and work with 12 outpatient-focused professional organizations (e.g., medical specialties that primarily serve ambulatory patient populations), and 10 ambulatory health care systems. They also will engage with local chapters of the professional organizations and state health departments interested in improving infection prevention and control.
Joint Commission approves new behavioral standards for eating disorders and housing support services
The Joint Commission recently posted new behavioral facility standards for both outpatient and residential eating disorder programs as well as permanent housing support services standards.
The permanent housing support services standards are aimed at helping people with major mental illnesses, substance abuse issues, and other behavioral health issues get steady housing and care. The requirements for eating disorders address issues such as assessments, transitions of care and supervision of patients in eating disorder programs. Both sets of requirements will appear in the Comprehensive Accreditation Manual for Behavioral Health Care Organizations (CAMBHC) and will go into effect on July 2016.
The Joint Commission this week released revisions to its Patient Safety Systems (PS) chapter for 2016. The chapter, which first went into effect in January 2015, highlights the accreditor’s patient safety requirements.
The PS chapter explains how to become a learning organization, the role of hospital leaders in patient safety, use of data and reporting systems, conducting proactive risk assessments, and patient involvement.
In other news, The Joint Commission is creating a new set of measures for its advanced certification program for palliative care. Volunteer hospitals will be testing the measures until the end of January, with the finalized measures to be released mid-2016.
The Joint Commission is still working on six measures for its new advanced certification for total hip and total knee replacement and is seeking public comment up through January 2016.
The Joint Commission began accepting applications for its new program in December and on-site reviews for the program will being in early 2016. The certification is available for hospitals, critical access hospitals, and ambulatory surgery centers already accredited by The Joint Commission.
Update: Program requirements for total hip and total knee replacement advanced certification will go into effect in March 2016
In 2016, the Food and Drug Administration (FDA) will be taking a stronger stance on reporting medical device complications and deaths. The agency’s newly published draft guidance will allow it to report early warnings signs associated with medical devices before the reports have been fully analyzed.
The FDA currently releases safety warnings and recalls on its website. That said, prior to this guidance the agency was unable to release any information on possible complications and injuries related to said warnings until after the all reports had been fully analyzed. The issue was that the agency receives hundreds of thousands of device safety reports in need of vetting each year.
Despite being labeled a “never event,” surgical items are accidentally left inside a patient 4,500 to 6,000 times every year. In response, the Association of periOperative Registered Nurses (AORN) updated its Guidelines for Prevention of Retained Surgical Items. The guidelines recommend standardizing count and reconciliation procedures to prevent items being left inside a patient. Some of the recommendations include:
1. Doing the initial count before the patient arrives in the operating room.
2. Having both the RN circulator and scrub person conduct the counts. The same two individuals should perform all the following counts throughout the procedure.
3. Establishing a standardized protocol for recording the counts during surgery on a count sheet or count board.
4. Establishing a no-interruption zone in the operating room, where non-essential conversation and activities are restricted. This prevents the team from becoming distracted and losing track of items.
5. Checking instruments and devices immediately after removal from the surgical wound to see if any parts or fragments came off inside the patient.
The Joint Commission recently posted a new video Cleaning, High-Level Disinfection and Sterilization in Ambulatory Care Settings. The video covers infection control specialist Lisa Waldowski’s presentation on the benefits of infection prevention and the Joint Commission’s tracer program during their 2015 Annual Ambulatory Conference. The video is a prelude to The Joint Commission’s 2016 webinar Cleaning, High-Level Disinfection, and Sterilization for Ambulatory Care Organizations.
Joint Commission accepting hip and knee replacement certification applications; posts 2016 review guides
Starting December 17, The Joint Commission will be accepting advanced certification applications for total hip and total knee replacement. The new certification is available for hospitals, critical access hospitals, and ambulatory surgery centers already accredited by The Joint Commission. On-site reviews for the program will begin in 2016.
In other news, the Joint Commission also posted its 2016 review process guides for
disease-specific care, advanced certification for palliative care, healthcare staffing certification, and the corporate addendum to the healthcare staffing certification. There have been no changes to any of the guides since they were last updated.
The Joint Commission just posted prepublication standards for disease-specific care critical access hospitals, nursing care centers, laboratories and point-of-care testing. The standards have not been officially published in print or added to the Joint Commission’s collection of e-manuals.
The Centers for Disease Control and Prevention (CDC) formally announced a draft of its new opioid prescribing guidelines on December 14. The guidelines aim to stem the rise of opioid addiction in the U.S. while still providing pain relief to patients who need it. Some of the key provisions of the CDC guidelines are:
• Consider the use of non-pharmacologic therapy and non-opioid therapy for chronic pain. Opioids should only be prescribed if the expected benefits for pain and function are greater than the risks.
• Establish treatment goals before starting long-term opioid therapy. Physicians should only continue prescribing opioids if there is “clinically meaningful improvement” that outweighs safety risks.
• When starting opioid therapy, doctors should prescribe short-acting opioids instead of extended-release, long-acting opioids.
• When opioids are started, doctors should prescribe the lowest possible effective dosage.
• When prescribing for acute pain, the lowest effective dose of short-acting opioids should be prescribed and only in quantities for the expected duration of the pain.
• Patients should be evaluated within one to four weeks of beginning long-term opioid therapy, and be reevaluated at once every three months afterwards to assess benefits and harms of continued treatment.
The opioid guidelines have been postponed to later in the year. Within days of being release, the guidelines were criticized as unfairly restrictive to patients needing pain care. The CDC will have the National Center for Injury Prevention and Control’s Board of Scientific Counselors review the guidelines and public comments on January 7. The comment section is still open at this time.