RSSAll Entries in the "Hospital safety" Category

I don’t think you’re spending enough time in the restroom…

In preparation for our journey into the restrooms of your mind (sorry—organization), you might consider a couple of things. Practicing this during surveillance rounds is probably a good thing; increasing folks’ familiarity with the potential expectations of the process is a good thing. But in practicing, you can also consider identifying an organizational standard for responding to restroom call signals, that way you can build at least a little flexibility into the process, maybe enough to push back a little during survey if you can allow for some variability.

Another restroom-related finding has had to do with the restrooms in waiting areas in clinic settings (ostensible restrooms that can be used by either patients or non-patient who may be in the waiting area). There is a requirement for a nurse call to be installed in patient restrooms, but there is no requirement for a nurse call to be installed in a public restroom. So what are these restrooms in waiting areas? I would submit to you that, in general, restrooms in waiting areas ought to be considered public restrooms and thus not required to have nurse calls. Are there potential exceptions to this? Of course there are—and that’s where the risk assessment comes into play. Perhaps you have a clinic setting in which the patient population being served is sufficiently at risk to warrant some extra protections. Look at whether there were any instances of unattended patients getting into distress, etc. (attended versus unattended is a very interesting parameter for looking at this stuff). Also, look at what the patients are being seen for; maybe cardiac patients are at a sufficiently high enough risk point to warrant a little extra.

At the end of the process, you should have a very good sense of what you need to have from a risk perspective. That way if you have a surveyor who cites you for not having a nurse call in a waiting area restroom, you can point to the risk assessment process (and ongoing monitoring of occurrences, etc.) as evidence that you are appropriately managing the associated risks—even without the nurse call. In the absence of specifically indicated requirements, our responsibility is to appropriately manage the identified/applicable risks—and how we do that is an organizational decision. The risk assessment process allows us the means of making those decisions defensible.

How are you celebrating Fire Safety Week (October 5-11)?

We’ve been observing Fire Prevention Week (Fire Safety Week’s “real” name) since 1920, when President Woodrow Wilson issued a proclamation establishing National Fire Prevention Day, and was expanded to a week in 1922. If you’re interested in the “story” of Fire Prevention Week, please check out the National Fire Protection Association (NFPA) website—it even includes mention of Mrs. O’Leary’s cow.

While there is much to applaud in the healthcare industry relative to our maintaining our facilities in fire-safe shape, there are still improvement opportunities in this regard. And one of the most compelling of those opportunities resides in the area of surgical fire prevention. According to the Association of periOperative Registered Nurses (AORN) in the October 2014 issue of AORN Journal, 550 million to 650 million surgical fires still occur annually in procedural environments where the risks of fire reach their zenith.

As we’ve seen from past experiences, AORN is certainly considered a source of expert information and guidance and I think the surgical environments would be well-served to start looking at the three strategies for strengthening their fire safety programs:

–          Bring together a multidisciplinary team of fire safety stakeholders

–          Think about fire safety in the context of high reliability to tackle the systematic and non-systematic causes for surgical fires

–           Make fire prevention part of daily discussion

I don’t want to steal all the thunder, so my consultative advice is to seek out a copy of the article (you can try here and make preventing surgical fires part of your Fire Prevention Week).

Sometimes miracles really do happen…BREAKING NEWS!

In what is clearly one of the busiest years for regulatory upheaval in the healthcare safety world (at least in recent memory), CMS has, yet again, turned things on their ear—and to what all appearances seems to be a most positive potential outcome—in its ongoing series of categorical waivers. And this on a topic that has caused a ton of gnashed teeth and much sorrowful wailing: the use of relocatable power taps.

You will recall (it seems no more than minutes ago) that back in June (2014), George Mills, director of The Joint Commission’s Department of Engineering, was tasked with the dubious honor of announcing to the world that, basically, the use of relocatable power taps to power medical equipment in patient care areas was on the no-no list. Since then, many (okay, probably just about everyone to one degree or another) facilities and safety folks have been spending countless hours trying to figure out how to make this happen. So I guess this means that CMS has decided that Mr. Mills doesn’t have to get painted with the “bad guy” brush any longer as they have issued a categorical waiver that provides a fair amount of flexibility for the presence of RPTs in the patient care environment.

Now history has taught us, if nothing else, that that flexibility is going to vary quite a bit depending on your facility and the results of the inevitable risk assessment; but presumably you’ve already started the risk assessment process like good little girls and boys, yes? There is a lot of fairly useful (at least at first blush—we also have learned how useful can become useless in the blink of an eye) information to be had in the memo, which you can find here. If you have not yet had a chance to look this over, I would encourage you to do so before you make any “big” decisions on how you’re going to manage these pesky little items (hopefully, this “relief” is not coming too late to avoid having undo sweeping seizures of power strips, etc.).

Maybe it’s Christmas come a bit early (or maybe we just power-shifted into winter), but I would encourage you to unwrap this present very carefully (some assembly required) and try not to break it on the first day…

No doubt there will be questions, so please use this forum as you wish.

Transformers: When finders become fixers

Way back when (and it was way longer ago than I might have thought—time flies when you’re having fun), we first discussed the idea of finders and fixers in the healthcare world (go here for a refresh on that conversation). Since then, I have proselytized that fairly simple concept in a majority of my consulting work, but I recently had kind of a breakthrough that I wanted to throw out there for your consideration.

One of my personal primary directives when I am consulting is that if I find something that I can resolve on my own, I feel it is my obligation to fix it. So you may see me doing something as simple as picking up trash as I walk along (even outside) or wiping up a spill in a refrigerator—basically conditions that one could consider “quick” fixes. I started thinking about how we could kind of take things to the “next” level in the evolution of the finder and fixer equation. And I came up with a hybrid creation of finder/fixers; wouldn’t that be a pretty nifty way of managing minor conditions and deficiencies in the environment? Folks at the point of care/point of service that are so empowered that they, as a matter of course, would just resolve the issue on their own. I think that would be pretty cool.

Part of me thinks that the finder/fixer thing might be a little bit of a bridge too far, but maybe just imagining such a world might make it a little more possible. So: do you have any finder/fixers in your organization? And if you do, did you “grow” them or did they emerge fully-formed? I’m really trying to spread this accountability for managing the environment as far as I can and any data/information can only help.

What do you do when everything goes wrong?

In reflecting on the healthcare safety news items of the last 12 months, the one that gives me the most pause is the situation involving missing patient at a hospital in San Francisco last fall, solely because it seems to have been so preventable (and yes, I recognize that hindsight is 20/20), even if I also recognize it could potentially have happened at any medium- to large-sized facility.

I guess the answer to the rhetorical question is that the only thing you can do is learn from what happened and make the necessary improvements to ensure that the chances of recurrence are pretty close to zero (this is in recognition that perfection is often a nice objective, but very tough to pull off). It does appear that a number of failure modes were identified (and shared—that’s a good thing—see the story) and I’m sure there have been changes to procedures that reflect what was learned.

How often do patients go “missing”? I don’t know that we’d ever be able to gain a full sense of how many folks are unattended for any length of time. Patients go out for air (smoky air, maybe), or just want to stretch their legs inside. It’s a very slippery slope to try and control every patient’s every waking moment, at least the ones who are mobile (from a risk management perspective, we probably focus more on the movements of the less mobile patients—falls are a big deal too). I don’t think you can, from a practical standpoint, query every patient you might encounter during rounds, though I suppose you could invoke the customer service “Can I help you find something?” to ease that type of encounter. Ah well, I guess this is likely to remain an issue of some complexity, but if anyone out there in the blogosphere would care to share their thoughts and ideas in this forum, I think there would be a great deal of interest.

You’ve got the power!

Howdy, folks! I just wanted to share with you a recent development relative the changes to the emergency generator testing requirements proposed by CMS. I’m not sure how many of you folks are familiar with Dan Chisholm of MGI Consulting, Inc. Dan provides emergency power consulting services to healthcare and mission critical organizations, as well as being a member of the NFPA 110 and NFPA 99 electrical section Technical Committees.

At any rate, Dan responded to the CMS request for feedback relative to the proposed changes, which, in turn, resulted in CMS requesting from him information regarding estimated costs for performing generator tests while operating on emergency power. So, to assist in helping CMS make as informed a decision as possible in this matter (and I think it is in our collective best interests to ensure that they make a well-informed decision), Dan is asking for assistance in gathering this performance data.

When I saw this request, I offered to share the request with you folks out in the blogosphere: I would appreciate anything you folks could do to be of assistance. I recognize that isn’t necessarily within everyone’s “wheelhouse,” but if this isn’t yours, I would appreciate it if shared it with the folks in your organization who oversee the emergency power supply systems. The goal is to supply CMS with as much factual information regarding costs and environmental impact before the comment period closes on February 25.

Please email the following information to with “CMS EPSS Data” in the subject line:

1.  The total kW load supplied by all generators during a normal monthly test when all ATSs are transferred to the emergency position.
2.  The total facility square footage, excluding parking garages, supplied with emergency power.
3.  Type of facility:  Acute, CAH, or LTC
4.  Diesel or natural gas powered generators

A new year and a period of transition

Those of you in the audience paying close attention to the content of the blog may well have noticed a heretofore gap in “fresh” materials, so I wanted to take a moment to comment on that, to offer my wishes for this brave new year, and to update you on what’s been going on in my sphere of influence.

So, first things first: I have absolute confidence that 2014 will be an improvement over 2013—or, at the very least I will remain hopeful until proven otherwise (it’s how I roll!) And so, I offer this aspiration for your professional existence: I hope 2014 kicks serious keister!

I’m back in the swing of things (though if you know someone who is in need of a gently used EC/LS/EM consultant, please point them in my direction) and you can expect at least weekly updates in these pages, as well as (hopefully—yes, I am full of…hope! Shame on those who thought I was full of something else) an updated version of the Hospital Safety Director’s Handbook (the update will include a new title, but we’ll save that for later) to be published later this year. There been a boatload of changes in the healthcare safety landscape since the last edition was published; if you have anything you’d like to see included, now would be a very excellent time to weigh in.

And how might one weigh in? I’m glad you asked! I’ve set up an email account to handle professional communications, so if you have questions, comments, concerns, suggestions, thoughts, curses, etc., I can be reached at It has been one of the great pleasures of my existence to have gotten to know you folks over the past 10 years and I have every intention of continuing that relationship—and this community—for the foreseeable future. On that note, I’m going to close things out for the moment, but in the words of my esteemed ancestor, Dugout Doug, I shall return!

New webcast provides training on OSHA HazCom revisions, GHS updates

OSHA requires hospitals to have completed training by December 1, 2013 on its revised Hazard Communication Standard for all staff who come into contact with hazardous chemicals. On Wednesday, January 8, 2014, HCPro is presenting a webcast to help you understand the changes and train staff on the GHS updates. In this 90-minute program, expert speakers Marge McFarlane and Paul Penn will explain what staff need to know to be safe and to implement the GHS changes. In addition, McFarlane and Penn will participate in a live question-and-answer session.

You can find more information and register for the webcast here.


If you don’t have pictures, you don’t have —!

As you are all no doubt familiar, sometimes those educational topics surrounding safety can come across as a bit dry and that dryness all too frequently ends up being the focal point of safety presentations. Now, one of the fun little quirky things that you run into when flying is that every time you get on a plane, you have to go through orientation (if only we as healthcare safety professionals could “capture” an audience as frequently as the airlines do) and sometime those orientations are very much less than compelling. And so, I thought that you might find the following offerings from NPR and The Telegraph of some interest, entertainment, and perhaps some inspiration. As I like to say during my consulting visits, this stuff doesn’t have to be torture. At any rate, I hope you enjoy these, and maybe you’ve got some homegrown footage you’d want to share (or perhaps already have shared); there’s no reason we can’t all partake of such splendor.