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Assisting the impaired clinician

Editor’s Note: The following is a free Briefings on Accreditation and Quality article from yesteryear! If you like it, check out more of our work covering quality and accreditation! 

How to overcome barriers to recognition

By the time the general public hears about an impaired clinician, whether it’s a nurse, technician, or physician, it is often too late to head an incident involving that clinician off at the pass-whether that incident is a medical error, diversion of medication, or something even worse, like the technician recently accused of inadvertently exposing thousands of patients to hepatitis C.

But the healthcare industry is well aware that ­impaired clinicians exist, and it has methods for addressing, confronting, and helping these medical professionals. Where are the industry’s gaps to success in ­preventing this far too common occurrence? BOAQ recently sat down with Jill Pollock, RN, LMFT, administrator of Loma Linda University Behavioral Medicine Center and ­frequent lecturer on chemical dependency recognition and intervention, to discuss this topic.

It takes a case as shocking as the hepatitis C outbreak in New Hampshire to bring a topic like this to light, she says.

“I think it’s difficult for people in healthcare to wrap their heads around it,” says Pollock. “What do you think one of our biggest barriers is to recognition of addiction and confronting it? If I can get people to talk just a little bit, we start hearing how there is a fear that confronting someone’s addiction could ruin someone’s life.”

For many healthcare professionals, the thinking is backward, she says–they’re focused on saving a coworker’s career. But we have a professional responsibility to our patients, our loved ones, and the public in general.

“What happens if someone drives impaired and kills someone in a car crash? Would you worry about their professional life?” says Pollock. “Or if your facility has an outbreak of hepatitis C?”

After talking with audiences about the possible outcomes of not confronting versus trying to help the impaired professional, she has found that the best tactic is to bring in personal, relatable example scenarios. “If someone is diverting drugs, then that patient, that ­mother or father, son or daughter, husband or wife, is not getting their pain medications,” she says. “Or, ­alternately, is being cared for by an impaired nurse. I try to bring it home to something we can all relate to.”

Who would you want taking care of your loved one? Pollock asks. Would you be comfortable with a caregiver who is impaired or thinking about where to find his or her next fix?

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Proposed seven-day limit to opioid bill enters Congress

A new Senate bill would limit the amount of opioids a patient can initially receive for acute pain. If passed, physicians could only prescribe seven days’ worth of opioids when first treating a patient’s condition.

The bill was put forward by Senators John McCain (R-Ariz.) and Kirsten Gillibrand (D-N.Y.) as a way to prevent opioid addiction. The limit is backed up by medical literature and is there are nine states with similar opioid laws in place.

“Our legislation builds on the important steps taken by Arizona Governor Doug Ducey last fall to tackle a root cause of this epidemic by limiting the supply of an initial opioid prescription for acute pain to seven days. We have a long way to go to end the scourge of drugs across our communities, but this legislation is an important step forward in preventing people from getting hooked on these deadly drugs,” said McCain in a press release.

“Too many lives have been destroyed, too many families have been torn apart, and too many communities all over New York are suffering because of this tragic epidemic. I am proud to join with Senator McCain in this urgent fight against the overprescription of opioids, and I look forward to seeing it pass through the Senate as quickly as possible,” said Gillibrand in a press release.

New CMS requirements for fire door inspection

The American Society for Healthcare Engineering (ASHE) recently published answers involving CMS’ new fire safety regulations. The new Conditions of Participation require fire doors be routinely inspected by “qualified persons.”

ASHE clarified to members that there isn’t any class or certification to qualify for door inspection. Anyone who’s familiar with the code requirements for fire doors will meet the “qualified” standard.

For more details, see the ASHE brief on the topic.

ECRI Introduces HIT-based Patient Identification Tools

The toolkit aims to prevent patient misidentification through the use of health information technology.

Patient misidentification is a big and likely underreported problem for hospitals and health systems, as well as for patients.

The consequences can be significant. ECRI Institute research shows that 9% of patient misidentification events lead to temporary or permanent harm or death.

That’s why the ECRI Institute and a stakeholder collaborative it convened, the Partnership for Health IT Patient Safety, has launched a new patient identification resource to help prevent patient misidentification through the use of health information technology.

ECRI is a Pennsylvania-based nonprofit that works to improve the safety, quality, and cost-effectiveness of patient care.

The toolkit divides its recommendations into two sections:

  1. Attributes addresses “the information-gathering aspects of patient identification, including the fields and the formats that are available to accommodate acquisition of required information.”
  2. Technology addresses “new technologies to improve identification and ways to leverage existing technologies for safe patient identification.”

Continue reading at HealthLeaders Media. 

Throwback Thursday: Medicine from afar

Editor’s Note: The following is a free Briefings on Accreditation and Quality article from yesteryear! If you like it, check out more of our work covering quality and accreditation! 

How one critical access hospital turned to telemedicine to better serve its community

After reading this article, you will be able to:

  • Describe the needs a telemedicine program meets at a ­rural or remote facility
  • Identify surmountable barriers to implementation for a telemedicine program using robotic instrumentation
  • Identify the types of programs or services a telemedicine link can help a remote facility provide
  • Describe the financial benefits, both to the organization and to patients, that come with having a strong telemedicine program in place
  • Discuss credentialing challenges that an organization ­implementing a telemedicine program might face

Tucked away on the far side of mountain passes in northeast Oregon, the 25-bed critical access Grande Ronde Hospital in La Grande provides much-­needed care for a populace that can be cut off from larger facilities by a single snowstorm. The hospital provides all that it can for the local population, but, as with every critical access facility, there are inherent limits to the services that can be provided on-site. Certain specialties and medical services simply do not have the demand to draw full-time physicians or other professionals to the area.Middle-aged man measures his blood pressure in front of virtual doctor. In the meantime, telemedicine physician is carefully looking at his brain x ray picture in the monitor.

Grande Ronde has, however, found a high-tech solution to this issue-one that ensures its patient population can receive services locally rather than traveling hundreds of miles, as might have been necessary in the past.

“We were asked by Saint Alphonsus Hospital in Boise to take part in a grant program,” explains Doug Romer, the hospital’s executive director of patient care services. “Their outreach director got in touch with us and said, ‘I have these robots through a grant. Would you like to try providing telemedicine services?’ “

At the time, Grande Ronde did not have a telemedicine program and was interested in taking part in the process. And so its robot, a nearly human-height, mobile machine with a monitor where the “face” would be, ­arrived at the facility.

The program is what is known as a hub-and-spoke model-the tertiary hospital, in this case Saint ­Alphonsus, is the hub, and the rural facilities are the spokes. This model has evolved for Grande Ronde and is now known as a remote presence healthcare network. The network connects Grande Ronde with four states and five cities for specialty healthcare. For example, patients in the Grande Ronde ICU receive telemedicine services from St. Louis.

“The physicians log in, can see our electronic medical records, review images, review labs, review vital signs, and they will come in and visit patients face-to-face [via the robot’s camera and monitor],” explains Romer. “They are able to assist and direct the care of patients throughout the day and through the night when our nurses have questions. They will call ICU doctors in St. Louis and they will make decisions or change therapies as needed.”

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@HCProAccred; bringing you the news

Hi everyone,

Yesterday we launched the HCPro Accreditation Twitter account to help you stay ahead of the quality and accreditation game.

Please take a moment to find and follow @HCProAccred on Twitter and receive:

  • Up-to-the minute news
  • Educational materialsHCPRo logo small
  • Details about upcoming events and webinars
  • Free Briefings on Accreditation and Quality  articles 
  • User polls on hot topics
  • And much more!

 

Thanks and have a great spring!

Brian W.

NQF recommends reduction of quality metrics

Cut Red RibbonThis March the federal government received an unusual suggestion from the National Quality Forum’s (NQF) Measure Applications Partnership (MAP). In MAP’s 2017 guidance to the Department of Health and Human Services (HHS),the organization recommended eliminating around 51 out of 240 of all federal quality metrics used to determine payment in seven federal healthcare programs. This is meant to make the requirements for providers more efficient and streamlined.

MAP’s job is to review the quality measures put out by NQF each year. however, it’s CMS’s job to decide which of those measures to use.

“We want to make sure we can take away measures that are adding burden but not value,” said Helen Burstin, MD, MPH, FACP, NQF’s chief scientific officer, in a call with reporters. “This is really just the start.”

Many in the healthcare field state that the 634 quality measures applicable to federal healthcare programs is putting an undue burden on providers. However, as the industry is switching between payments based on quality rather than volume, the need for quality metrics is apparent. MAP aims to work towards both ends by culling measures that are redundant or pointless.

The measures that MAP recommends eliminating come from several programs, such as the Prospective Payment System—Exempt Cancer Hospital Quality Reporting Program, the Ambulatory Surgery Center Quality Reporting Program, the Inpatient Psychiatric Facility Quality Reporting Program, and the Home Health Quality Reporting Program. It also recommends eliminating:

•    Four out of 18 measures used in the End-Stage Renal Disease Quality Incentive Program
•    13 out of 29 used in the Outpatient Quality Reporting Program
•    Six out of 62 used in the Inpatient Quality Reporting Program

WHO aims to slice medication errors in half 

The World Health Organization (WHO) last week announced its new global initiative, which seeks to halve the rate of medication-related errors by 2022.  The Global Patient Safety Challenge on Medication Safety will combat medication errors by

  • Addressing weakness and flaws in how drugs are prescribed, distributed, and consumed
  • Providing education on safer and more effective prescribing habits and methods
  • Increasing patient and provider awareness on the dangers of medication errors

Logo-WHO“Most harm arises from systems failures in the way care is organized and coordinated,” the WHO wrote in a press release. “Especially when multiple health providers are involved in a patient’s care. An organizational culture that routinely implements best practices and that avoids blame when mistakes are made is the best environment for safe care.”

In the U.S alone, 1.3 million people are injured annually due to medication errors. Worldwide, med errors cause at least one death per day and cost an estimated $43 billion annually (1% of global health expenditures). Rates of medication-related adverse events are similar regardless of whether one is in a high-, middle-, or low-income nation. However, in less wealthy nations, the impact of these events are about twice as much in terms of the number of years of healthy life lost.

“We all expect to be helped, not harmed, when we take medication,” said Dr. Margaret Chan, WHO director-general, in the press release. “Apart from the human cost, medication errors place an enormous and unnecessary strain on health budgets. Preventing errors saves money and saves lives.”

ECRI: Top patient safety concerns of 2017

TheECRI INSTITUTE LOGO ECRI Institute has published its 2017 list of top patient safety hazards and concerns. The Institute publishes the list to highlight and educate healthcare workers on various dangers affecting patients. The list includes guidance on how to effectively respond to these concerns, along with implementing priorities and corrective action plans. This year the list includes:

1.    Information Management in electronic health records (EHR)
2.    Unrecognized patient deterioration (UPD)
3.    Implementation and use of clinical decision support
4.    Test result reporting and follow-up
5.    Antimicrobial stewardship
6.    Patient identification
7.    Opioid administration and monitoring in acute care
8.    Behavioral health issues in non-behavioral-health settings
9.    Management of new oral anticoagulants
10.  Inadequate organization systems or processes to improve safety and quality

“The 10 patient safety concerns listed in our report are very real,” Catherine Pusey, RN, ECRI associate director told HealthLeaders. “They are causing harm (often serious harm) to real people.”

The proper use and timely access to EHRs for patient information management was the main concern this year, Lorraine B. Possanza, program director for ECRI’s Partnership for Health IT Patient Safety said in a press release. She says the vast storehouses of patient data now available to physicians have created new challenges.

“The object is still for people to have the information that they need to make the best clinical decision,” she wrote. “Health information needs to be clear, accurate, up-to-date, readily available, and easily accessible.”

The second concern, UPD, has recently been the subject of increased training, education, better clinical protocols, and public awareness campaigns. However, despite faster recognition and response, UPD is still a major concern.

“People have seen how well the campaigns have worked for stroke and STEMI and how much they’ve improved outcomes,” Patricia N. Neumann, RN, ECRI senior patient safety analyst and consultant told HealthLeaders. “What if those same principles could be applied to other conditions that require fast recognition and management? We could have a big impact on improving outcomes.”

Read more at HealthLeaders Media

Changes to post-survey categories

The Joint Commission has eliminated its post-survey category of “Contingent Accreditation.” Now organizations can only receive one of four decisions: Accredited, Accredited with Follow-up Survey, Preliminary Denial of Accreditation, or Denial of Accreditation.

Accreditation— Given to a facility that’s compliant with all applicable standards or has successfully addressed all Requirements for Improvement (RFI). Once the Evidence of Standards Compliance (ESC) is submitted, the organization will get a notice of full accreditation. Follow-up surveys must be done within six months to show that an organization is compliant with their ESC.

Accreditation with follow-up survey— Given to a facility that isn’t in compliance with specific standards that require a follow-up survey within 30 days to six months. Also requires that problem areas listed in an ESC submission are corrected. Once the ESC is submitted, the organization will get a notice of full accreditation. Follow-up surveys must be done within six months to show that an organization is compliant with their ESC.

Preliminary denial of accreditation— Given to a facility when there’s evidence of one or more of the following:
•    An immediate threat to health or safety to patients or the public
•    Falsified documents or misrepresented information was given to surveyors
•    The facility is missing a required license or certification
•    The facility is significantly out of compliance with Joint Commission standards

Additional rules for receiving a “Preliminary Denial of Accreditation” ranking have been listed in the “important updates” section of Joint Commission Connect and are as follows:
•    Failing to fix all Requirements for Improvement (RFI) after two opportunities to submit ESCs have passed
•    Failing a second Medicare Deficiency Survey for not meeting a Condition of Participation or a Condition Level Deficiency
•    Evidence reveals patients have been put in jeopardy due to potential fraud or abuse committed by the organization

A Preliminary Denial of Accreditation (PDA 02) decision is made; organizations are now expected to submit a Plan of Correction (POC) within 10 business days of the final report’s posting. After which, there’ll be a survey within two months to validate the implementation of the POC.  This will be done in lieu of submitting ESC within 60 days.

For PDAs, facilities can appeal The Joint Commission to review this decision.

Denial of accreditation - A facility is completely denied accreditation. This happens when a facility:
•    Doesn’t to pay its survey or annual fees
•    Refuses to let The Joint Commission conduct a survey
•    Fails to address the conditions of their Accreditation with Follow-up Survey status
•    Fails to submit an ESC

At this point, there are no more appeals or reviews that a facility can use to stay accredited.

Finally, The Joint Commission’s governance structure has changed. Now, decisions on accreditation matters will be made by an executive team rather than an Accreditation Committee. The executive team is now in charge of making accreditation decisions, considering survey reports, follow-up activities, staff recommendations, and any unusual problems raised by the organization seeking accreditation.
Check out Briefings on Accreditation and Quality to learn more about the importance of avoiding denial of accreditation.