On January 30, President Trump signed a new executive order declaring a “one-in, two-out” rule for executive departments or agencies, including healthcare. Under the executive order, for a new healthcare regulation to be implemented, two older regulations will have to be eliminated.
“If you have a regulation you want, number one, we’re not going to approve it because it’s already been approved probably in 17 different forms,” Trump said during the signing. “But if we do, the only way you have a chance is we have to knock out two regulations for every new regulation. So if there’s a new regulation, they have to knock out two.”
The order also sets an annual cap on the cost of new regulations and cuts the regulatory budget for fiscal year 2017 to zero. This means the only way to afford new regulations issued between now and September 30, 2017 is by repealing existing regulations.
While each agency will decide which regulations they think can be cut, the White House will ultimately decide which ones to gut. Regulations dealing with national security, foreign affairs, and the organization, management, or personnel of federal agencies are exempt.
Accredited organizations now receive a new SAFER Matrix Tool and a user guide, following their first survey with the new matrix. The SAFER Matrix was announced last July as a replacement for the old “Category A and C” method of evaluating safety issues. As of January 1, all accredited organizations now receive the SAFER matrix after their surveys.
The new tool can be used to filters out specific portions of the SAFER report, such as Requirements for Improvement, which then can be saved and sent to people within the facility. The guide shows users how to:
- Use filters
- Select specific survey or review events to view
- Switch between different accreditation programs
- Switch between accreditation and certification
The tool and guide can be found on Joint Commission Connect in the “Post-Survey” section of the “Survey Process” tab.
Earlier this month, the American Society of Health-System Pharmacists (ASHP) released a new set of nationally recognized drug diversion prevention guidelines. The purpose of the guidance is to help healthcare facilities create effective strategies to prevent the theft and misuse of medications and controlled substances.
“Diversion of controlled substances by healthcare workers remains a serious problem that increases the potential for serious patient safety issues, causes harm to the diverter and elevates the liability risk to healthcare organizations,” said David Chen, BSPharm, MBA, senior director of the ASHP Section of Pharmacy Practice Managers, in a press release. “These guidelines give pharmacists tools to not only improve controlled substances management, but also to play a prominent role in systemwide diversion prevention efforts at their practice sites.”
The 2015 National Drug Threat Assessment found that controlled prescription drugs are abused more often than cocaine, methamphetamine, heroin, Ecstasy, and PCP combined. And there have been cases of healthcare workers potentially infecting patients by using needles filled with diverted drugs and putting them back into circulation.
The guidelines can be applied to a number of healthcare settings and is based off best practices and recommendations from the Drug Enforcement Agency, state hospital associations, and scientific literature. You can read the guidelines in full here , along with the ASHP announcement.
The Food and Drug Administration’s (FDA) ban on powdered medical gloves went into effect on January 18. The use, advertising, and marketing of powdered surgeon’s gloves, patient examination gloves, and absorbable powder for surgeon’s gloves at medical clinics and hospitals is now strictly forbidden.
Powders have been used to lubricate gloves for easy removal for more than 100 years. However, the powder currently used in medical gloves has been shown to cause severe airway and wound inflammation, granulomas, and post-surgical adhesions in the tissue between internal organs. In addition, powdered latex gloves carry the risk of allergic reaction in patients.
“This ban is about protecting patients and healthcare professionals from a danger they might not even be aware of,” said Jeffrey Shuren, MD, director of FDA’s Center for Devices and Radiological Health in a press release. “We take bans very seriously and only take this action when we feel it’s necessary to protect the public health.”
The agency’s most recent push to get rid of powdered gloves came after receiving three citizen petitions between 2008 and 2011. The proposed rule was published last March; the FDA estimates the reduction in patient harm and the rise of affordable powdered glove alternatives will save the health industry between $26.6 million and $29.3 million annually.
“We need to take every measure to ensure patient well-being, complete healing and satisfaction with their surgery,” wrote Linda Gylland, QLS, MLS (ASCP), lab safety officer at Sanford Health, N.D., in an email. “I am surprised it has taken this long (since 1997 when the FDA was aware of this) to reach this decision. We have more good glove alternatives than we had 10 years ago, so in my opinion, this shouldn’t be a factor. We need to be proactive and prevent possible problems to patients with powder.”
The Joint Commission seeks feedback on the proposed requirements for Pain Assessment and Management for Hospitals. Comments will be accepted until February 20, 2017.
The accreditor hopes that by aligning its requirements with existing best practices, it will be able to better promote patient safety and quality of care.
The Joint Commission
Standards and Survey Methods
Hospital Pain Assessment and Management Field Review
One Renaissance Blvd.
Oakbrook Terrace, IL 60181
Webinar: How Parkland Health & Hospital System Successfully Implemented a Suicide Risk Screening Program
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
The Joint Commission is now using its SAFER Matrix with all accredited organizations. The matrix replaces the old scoring method of categorizing risk using “A” and “C” rankings.
The SAFER matrix is a three-by-three grid labeling the level of risk and harm observed for a standard. The approach is meant to help organizations prioritize and focus their efforts on the direst areas of risk.
To see our previous Accreditation Insider on the SAFER Matrix, click here.
Briefing on Accreditation and Quality subscribers can view or the following stories.
- Joint Commission unveils revised scoring system
- Q&A: Joint Commission exec answers SAFER matrix questions
Based on data collected from more than 2,800 hospitals, researchers were able to prove the effectiveness of the Hospital Readmission Reduction Program (HRRP). Harvard and Beth Israel Deaconess Medical Center researchers added that facilities that were penalized the most saw the greatest improvement in readmission reduction. Nearly $1 billion in penalties have been imposed so far.
“It’s a quite clear example that when hospitals are reimbursed, not just for how much they do but how well they do it, it makes an impact on their behavior,” study co-senior author Robert W. Yeh, MD, told HealthLeaders. “That is what you would expect from an individual and this seems to incentivize organizations to act collectively to move in the same direction.”
Researchers looked at 30-day readmission rates for patients with acute myocardial infarction (AMI), congestive heart failure, or pneumonia. In January 2008, the readmission rates at penalized institutions were 21.9% for AMI, 27.5% for heart failure, 20.1% for pneumonia, compared to 18.7%, 24.2%, 17.4%, at non-penalized facilities. However, once HRRP was announced in March 2010, rehospitalization rates declined notably faster at penalized hospitals. Compared to non-penalized facilities, penalized hospitals decreased their AMI readmissions by 1.24%, 1.25% for heart failure, and 1.37% for pneumonia.
On January 9, 2017, Joint Commission Leadership (LD) standard 01.03.01,element of performance (EP) 12, for home health and hospice will be expanded to apply to hospitals, critical access hospitals, and ambulatory surgical centers.
The standard requires that the leadership/governance of a healthcare facility is the one ultimately held accountable for the facility’s safety, quality, and compliance. Previously, however, the Joint Commission standard didn’t have an EP that referred to leadership’s legal responsibility. In addition, the EPs varied between different types of facilities on what to do if leadership failed to meet its responsibilities.
The Joint Commission announced it was expanding EP 12 to the additional settings as a way to standardize compliance across all accredited facilities and to come into alignment with CMS’ Conditions of Participation.
Hard copy versions of accreditation manuals published after November 2016 will include the new EP, and the change will be made to the accreditor’s E-dition in January. For more information, contact Laura Smith, Joint Commission project director, at email@example.com.
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Earlier this year, The Joint Commission updated its National Patient Safety Goal (NPSG) on catheter-associated urinary tract infections (CAUTI) for hospitals and critical access hospitals. It also created a new CAUTI NPSG for nursing care centers.
“An estimated 1 to 3 million healthcare-associated infections strike nursing home residents annually, and many of these are infections related to urinary catheters,” wrote David Baker, MD, MPH, FACP, Joint Commission executive vice president, in a blog post. “CAUTIs can lead to serious complications and hospitalizations. And, the rate of these infections is even higher for hospital patients. This is why The Joint Commission felt it was important to implement its new National Patient Safety Goal for nursing care centers and an updated goal for hospitals and critical access hospitals to reflect the latest scientific evidence.”
Among the new changes are requirements to:
• Educate staff on how to correctly use and insert indwelling catheters.
• Educate patients and family on CAUTI risks and prevention
• Use evidence-based guidelines to write catheter use policies.
• Follow written procedures based on established evidence-based guidelines for inserting and maintaining an indwelling urinary catheter.
• Maintain an up-to-date record of catheter use; who has one inserted, when was it implanted, etc.
All the changes go into effect on January 1, 2017 and are meant to improve staff training, educate patients, and update policies with evidence-based practices. In addition, the Department of Health and Human Services announced that it wants to see a 50% reduction in CAUTI by 2020.
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