All Entries in the "Environmental protection" Category

Panic in Detroit – Panic at the Disco – Panic at the Surgery Center…Fire in the Hole!

I’m presuming (and please don’t attempt to disabuse me of this notion) that you are all dutifully conducting security risk assessments on a regular basis. As you conduct them, I’m sure you find risks of some events that are greater than some other areas. So, I to ask: When you’ve completed your security risk assessment, do you identify specific strategies, including the use of technology, for minimizing those risks to the extent possible? If you’re not including that facet in the risk assessment process, you might want to consider doing so.

Recently, I was looking at a survey report in which an ambulatory surgery center was cited during a TJC survey because they had not installed a panic alarm “at the registrar’s desk in order to obtain immediate assistance in an emergent or hostile situation.” Now, as with so many things that have been popping up during surveys, I don’t disagree with the concept of having panic alarms at those customer service/interaction points where unhappy folks (or folks of any ilk) can experience the need to vent their frustrations, etc. But in that disagreement, I think I’d first be looking at what tools have been provided to staff to actively manage, if not de-escalate, these negative encounters. I would much prefer to avoid having to use a panic alarm by appropriately managing the encounter, much like I would just as soon not “need” to have an emergency eyewash station.

I’m a great believer in the proactive management of risk, but I’m also a great believer in implementing risk management and response strategies that make operational sense. So, the question to the studio audience is: Where have you installed panic alarms and where have you not installed panic alarms, and why? There’s always the risk that some surveyor will disagree with your strategy, but if that strategy was derived through thoughtful analysis of the involved risks, does that not meet the intent of all this?

I like the concept of best practice as much as anyone, but I also recognize that there is a tremendous amount of variability in the safety landscape. Just because something works in one place does not necessarily mean that it will work in all cases—that’s the mystical, magical, and ultimately mythical power of the panacea. One size doesn’t fit all—never has, never will. But if we’re going to be held to that type of an expectation, how does that help anyone? Ok, jumping down from soapbox for now, but rest assured, you’ll see me back up here before too long.

Take our survey for a chance to win $100!

HCPro is asking for your help! To ensure that we meet your training products and services needs in 2012, please take a moment to respond to a short survey.

Are you in infection control? Take this survey.

Are you more facility safety and security (environment of care, emergency management, etc.)? Take this survey.

Involved in OSHA? Take this survey.

Complete a survey and be entered into a drawing to win a $100 gift certificate to HCMarketplace, to be spent on any HCPro product of your choice.

No violations found in incident involving heavy equipment that injured two

OSHA found no violations in an incident at Advocate Good Samaritan Hospital in Downers Grove, IL, where a 3,000 pound piece of equipment came crashing down in a maintenance corridor, injuring two workers.

Kathy Webb, an OSHA area director in Aurora, IL, told The Chicago Tribune’s TribLocal of Downers Grove that OSHA will not issue any citations because there are no standards that cover removing air conditioning and heating equipment, which happened to be what fell on top of the men.

OSHA officials looked at the guidelines, as well as accepted industry practices and standards, and could not come to an agreement on the proper way to remove equipment that large.

How do you think OSHA should have handled the situation? Should citations have been issued? Let us know in our comment section.

Mac’s Safety Space: Hot! Hot! Hot! (part 1) – Hot Labs

I’m reasonably certain that when you folks are conducting your annual evaluations, you are looking at the content of your plans, hopefully including the list of areas you’ve identified as being security sensitive (for those keeping score, that would be EC.02.01.01, EP and doing at least a quick evaluation of how you are controlling access to and from these areas.

One item that has popped up during recent survey activity is that fabulously intimate setting—the hot lab in Nuclear Medicine (if you don’t provide Nuclear Medicine services at your organization, then this is probably less interesting than it might otherwise be). I know of at least one organization that was cited for not having identified the hot lab as a security sensitive area in their security management plan. Now I don’t disagree conceptually that if any spot in your organization is worthy of such lofty designation, the hot lab would be among your top three or maybe five, but I’m not entirely sure when the decision as to what did or did not merit that designation was given over to others.

Now I believe in this particular case that the failure to specifically identify the hot lab in the security management plan was more an oversight. For those of you working in healthcare for any length of time, the “security” of the hot lab existed long before the concept of security-sensitive showed up in any regulatory standards other than those promulgated through the good graces of the Nuclear Regulatory Commission (and now administered primarily at the state level). Now, I’m not saying that you should add the hot lab to the list if it’s not there (might not be a bad idea—but I’m not in the business of telling you what to do), but what you might want to do is maybe look at the security of the hot lab as a little performance improvement exercise. I’ve found in some hospitals lately that there have been little opportunities relative to managing material deliveries to these areas, changes in work flow, etc., that have benefited from a little look-see.

I think recent events in Japan might result in a little more scrutiny of all things radiological (management of lead PPE, especially in off-site settings not directly controlled by radiology; radiological decontamination, etc.) during Joint Commission surveys. Always better to have responses ready if the question gets asked.

Next week, we’ll look at another hot topic that’s surfaced during recent surveys.

Mac’s Safety Space: Temperature and humidity in the operating room

Q: My engineering manager is telling me that they only have to monitor temperature and humidity in the operating rooms on a quarterly basis. Can this be true? What’s the industry standard?

Steve MacArthur: Brace yourself: there is no specific requirement or standard that indicates the frequency with which one would monitor temperature and humidity in anesthetizing locations.

There are numerous guidelines that come into play for this: NFPA 99 Standard for Healthcare Facilities; the American Society of Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE) Standard 170 – Ventilation of Health Care Facilities; and the CDC Guidelines for Environmental Infection Control, none of which speak to monitoring temperature and humidity, never mind indicating a frequency, though in the CDC Guidelines, they do indicate that activities should occur in accordance with engineer or manufacturer recommendations for the system. To be honest, the only place that even hints at a monitoring requirement is in the Conditions of Participation Interpretive Guidelines, and even there the only indication of a requirement is that surveyors are instructed to review the temperature and humidity logs during a CMS survey.

To be honest, with what I know about the folks conducting the environmental surveys, in some instances their background is extremely limited and tends to reside around basic fire safety concepts. That’s not to say that a clinical surveyor might not ask the question, but as there is no specific frequency requirement (unless there’s something in the state regulations–they should probably check to make sure), quarterly may be acceptable. I would say that in a small majority of hospitals with building automation systems, they pretty much keep a constant record of building conditions, including temp and humidity in the ORs. But I find equally as often that they have no real process in place to respond to out of range conditions, so you have them print out the data (and nobody really looks at this in real time. This is really an inconsequential pressure point until there is a requirement to have some sort of alarm signal, etc. to indicate when levels are out of compliance) and ask them “what happened on such and such date when the humidity was at 72%” and they have no response.

Most of the “management” of this issue revolves around the personal comfort of the occupants as much as anything, so if nobody squawks that it’s too hot or too damp, it is generally not noted.

All that said, I would advise them to document a risk assessment that provides sufficient evidence that a quarterly frequency of monitoring temperature and humidity is effectively managing the environment (Infection Control has a role to play here, and actually have ultimate veto power when it comes to decisions that could impact infection rates, etc.)

California Children’s hospital fined for safety violations

California’s Division of Occupational Safety and Health (Cal/OSHA) fined Children’s Hospital and Research Center Oakland on February 22 for failing to offer policies and controls follow a violent, unsafe situation.

The safety violations were related to two separate incidents that occurred in the facility. In July, a homeless man took an employee hostage with a gun in the emergency room , while in October, a victim with a gunshot wound was left at the hospital entrance rather than the emergency room entrance, leaving nurses feeling unsafe, reports the San Francisco Chronicle.

The total cost for the citations is $10,350 and hospital officials plan to appeal. Officials blame unresolved union negotiations for the citations.

Is the hospital right to appeal the violations? Let us know in our comment section.

Healthcare provider uses technology to keep criminals away

Face recognition software is being used by a healthcare system to scan visitors entering the facility to detect whether they are “safe” or “dangerous.”

Atlantic Healthcare serves northern New Jersey and metropolitan New York and it instituted the technology to keep its staff and patients safe. Some of its buildings have 50 or 60 doors through which people can access the building, meaning the hospital chose to rely on technology because it simply does not have enough security guards, reports Security Director News.

Face recognition software has been installed in the emergency department that identifies high-risk people contained within the hospital database. Hospital staff upload photos of people who pique their interest so they’ll be alerted if these people enter the facility. The hospital is also able to identify whether a person has a criminal history by paying a monthly fee to access this information.

How does your facility keep out dangerous people? Let us know in our comment section.

Massachusetts facility fined for electrical safety issues

Northeast Hospital Corp., located in Beverly, MA, is facing a $63,000 fine after an investigation by OSHA.

The investigation was prompted by a worker’s complaint that hospital employees didn’t have or use personal protective equipment when handling electrical equipment.

OSHA also found that the hospital’s electrical protective equipment wasn’t tested regularly and electrical safety procedures were not executed properly.

OSHA issued a repeat citation for failing to prove unused openings in electrical panels and cabinet motor control centers had been closed since being cited in May 2010

The facility has 15 business days from the day of its citation, February 15, to comply with hospital safety standards.

What practices does your facility follow in electrical safety? Let us know in our comment section.

Hey, put that camera away

Laurie Shifler, who delivered her baby at Meritus Medical Center in Hagerstorn, MD, was banned from taking photos during delivery due to the hospital’s health and safety rules.

Meritus implemented photo and video restrictions during birth in November, after learning that other hospitals in the area had the same ban. Photos of newborn babies are allowed once the medical team has given approval, typically within seconds of birth, reports The New York Times. The hospital also requires cell phones to be turned off.

Shifler was outraged by the hospital’s request, telling The Times that it’s her right and her decision to take photos of her own flesh and blood. The hospital, however, is concerned about the privacy of its medical staff, saying many of them don’t want to be plastered all over YouTube or Facebook, as well as the potential for distraction and for the photographs and videos to be used in litigation.

Does your hospital implement restrictions on photography and videography during births? Let us know in our comment section.

Mac’s Safety Space: Safety committee meetings

Q: How often do you believe a safety committee should meet? I have always believed monthly, and have always thought the minimum should be every two months? I was recently asked whether quarterly was acceptable. I don’t think so. What do you think?

Steve MacArthur: First, a bit of history. Prior to the 2009 changes to the EC standards, (which included the establishment of the Emergency Management and Life Safety Chapters) the requirement for meeting frequency was indeed no less frequent than every other month.

However, beginning in 2009, the frequency requirement was removed (I believe it was most likely in response to smaller facilities for whom even the bi-monthly frequency was onerous) and replaced with the tacit expectation that each organization will, through a risk-assessment process, determine the appropriate frequency. That said, while there is certainly no regulatory requirement prohibiting quarterly meetings, my inclination would be to discuss the change as a function of the risk assessment process and then include an ongoing evaluation of that decision as a function of the annual evaluation process. That way they can’t cite you for not having made a “correct” determination.

I guess it all boils down to whether or not your committee can effectively manage risk in the physical environment meeting on a quarterly basis. It may be that you don’t really experience a lot of improvement opportunities, failure modes, etc. and that will work. There are certainly enough not-particularly-useful meetings in the mix as it is, so if you find that the meetings are not useful (and ensuring that this is because of the level of activity within the organization and not the level of interest on the part of participants), it is certainly worth looking at.