All Entries in the "Security" Category
Using alcohol-based hand sanitizers in psychiatric areas
Someone on HCPro’s Patient Safety Talk listserv recently asked about using alcohol-based hand sanitizers in psych units.
The key here is whether the results of your organization’s risk assessment indicate that you can safely place the dispensers in that particular care environment. A psych patient population is absolutely unique to a given organization, and when it comes to matters of safety as a function of medical condition/diagnosis, you really need to use that uniqueness (uniquity?) as the basis of the evaluation.
Also, consider these concerns:
- What product do you use? Foam-based products might be a little safer in a psych application than a liquid.
- How is the psych environment configured? Is there a safer way to install the dispensers?
Particularly with the likely scrutiny of this type of a thing as a function of The Joint Commission’s National Patient Safety Goals, there will be any number of folks who will take issue with whatever you end up doing. The psych safety zealots will condemn you for using the alcohol-based hand rubs and the infection control zealots will chastise you for not using the product.
I’d work the process through and base the decision on what will work for your patient population.
November 26, 2008 | Steve MacArthur | Comments 0
Preview of this month’s Briefings on Hospital Safety
Hi everyone, it’s Scott Wallask logging on today.
I just wanted to remind all Hospital Safety Center subscribers that the latest issue of Briefings on Hospital Safety is available online.
You can check out the following articles:
- An overview of the challenges coming in The Joint Commission’s new life safety chapter
- Why one hospital endured a tough CMS review following two patient suicides
- How moving patients to new buildings offered two hospitals chances to fine-tune their evacuation plans
If you’re not a subscriber to the Hospital Safety Center and want to learn more, click here.
November 07, 2008 | Scott Wallask | Comments 0
A stress on security from a Virgin Mary lookalike
Hi everyone, it’s Scott Wallask logging in today.
A story getting some attention up here in Massachusetts has to do with an apparition of the Virgin Mary on a window pane of an office building at Mercy Medical Center in Springfield.
Brushing aside religious discussions, to me an interesting aspect is that 500 people showed up on hospital property on Wednesday to view the image, which is on a window of an unoccupied office, according to The Republican of Springfield.
Think about the following security-related concerns that have cropped up Mercy Medical, and how they might apply to more urgent incidents:
- Police have been called in to direct traffic in the area
- Hospital security officers have worked to corral the onlookers to one end of the facility’s parking lot
- Gatherers have placed flowers and votive candles at a makeshift shrine near the entrance
As you’d expect in this type of situation, the crowd has been peaceful. But if a throng was more unruly, 500 people outside the hospital would present challenges to any security department, particularly if police couldn’t immediately assist.
Back in 2003, another Massachusetts medical facility, Milton Hospital, had to deal with 25,000 unexpected visitors over a two-week period after it, too, became home to an window apparition of Mary.
That hospital had to exert some unusual tactics, such as asking onlookers to only come between 5:30 p.m. and 8:30 p.m. each day to view the image. During “non-viewing” hours, the hospital put a tarp over the window containing the likeness. The facility also had to hire extra security officers.
How would you deal with hundreds of onlookers outside your hospital?
October 02, 2008 | Scott Wallask | Comments 0
No national regulations to lock utility rooms, but . . .
Someone asked me about whether clean and dirty utility rooms need to be locked. The short answer is no, a clean utility room does not have to be locked, at least in terms of a regulatory requirement.
The longer answer is the overriding expectation that organizations will, as a function of the safety and security risk assessment process, identify those areas in which access and egress must be controlled due to the nature of the contents, accessibility of contents, etc.
A soiled utility room is somewhat similar in that, again, the risk assessment process would come into play. However, the risk assessment process will probably have to go a little bit further due to the fact that there are sometimes regulatory requirements at the state or local level that must be taken into consideration, as well as taking into account patient populations, etc.
For instance, in Massachusetts, the state public health regulations require soiled utility rooms to be locked. I don’t necessarily agree with this–I think that if the soiled utility room is in active use for disposal of contaminated materials, having to unlock a door to access the room increases the exposure risk for staff.
In that light, I have been able to negotiate with state inspectors that the risk of intrusion by unauthorized persons is very small compared to the increased risk of an exposure or spill while trying to access the locked soiled utility room.
That said, there are environments–behavioral health units, pediatrics units, maybe maternity (if there’s a fair amount of sibling visitation)–in which the risk of unauthorized intrusion is sufficient to go with securing the soiled utility room (and maybe even the clean utility room–almost certainly with behavioral health).
The first step is to document the decision making process. That way, if the question arises during survey, you will be able to discuss the process and how you reached the decisions that you made, including any interventions.
September 17, 2008 | Steve MacArthur | Comments 1
Safety + security = safe-curity
Let’s talk for a moment about what I like to call “safe-curity”–in other words, the combining of safety and security functions into EC.02.01.01 in the 2009 Joint Commission (formerly JCAHO) standards.
The safety and security risk assessment processes (which includes appropriately managing the risk in the EC) have been folded into EP 3. This will continue to be the general duty clause section of the EC standards; anything surveyors see that they don’t like becomes fodder.
Folks are going to have to be very diligent in documenting the decision-making process when identifying risk strategies. For instance, there is a nonbinding ANSI standard that requires the testing of eyewash stations on a weekly basis; however, if any organization chooses to test at a lesser frequency, it must have a documented risk assessment supporting that decision, otherwise a citation can occur.
I can see similar risk exposures relative to under-sink storage, management of crash carts, handling IV solutions, and all that.
By the way, are you coming to our September 5 seminar in Boston, Environment of Care for 2009? We’d love to see you there.
August 20, 2008 | Steve MacArthur | Comments 0
What to monitor within your EC management programs
I recently chatted with someone about items you need to monitor in the EC.
There are myriad activities, primarily represented through the “C” elements of performance (EPs) in the EC chapter, that revolve around the “care and feeding” of the care environment–medical equipment, life safety equipment, emergency power equipment, conduction of safety rounds, and the like.
A solid EC program is going to have a process for monitoring compliance with all these “have to” elements, just to ensure that the EC program’s baseline competencies, if you will, are in place and functioning appropriately.
Beyond the activities and processes that you “have to do,” things get a whole lot grayer in very short order.
The key standard for the rest of the monitoring expectations is EC.9.10 (the hospital monitors conditions in the environment). These expectations are pretty much a function of the risk management process in the care environment. There are six EPs involved in EC.9.10, pretty much divided into constant activities and periodic (at least annually) evaluations of the whole kit and caboodle.
More on this topic in my next post . . .
July 23, 2008 | Steve MacArthur | Comments 0
The 2009 standards are here–shuffling the deck!
Did you hear that great sighing sound earlier? In all candor, I have to tell you that I was one of those sighers.
(Is “sighers” a word? Probably not, but the blogosphere can’t rest on such formalities).
The other shoe has dropped, and The Joint Commission 2009 standards changes have (finally!) been posted on the Web.
The question then becomes: Celebration or commiseration? What do we do?
For the moment, it appears that a moderately restrained celebration will suffice. The key words indicating the disposition of the current standards I noted in reviewing the materials are the following:
- Retention–No change in the applicable EP, i.e., the song remains the same.
- Consolidation–A slight change, a blending, if you will, of risk management activities under a general umbrella. For instance, all the safety education elements are now living in one happy house, EC.03.01.01, and, perhaps most controversially, the safety and security standards have become one under EC.02.01.01.
- Split–EPs previously containing multiple component requirements are broken down into the individual components. For instance, EC.3.10, EP #3 under the 2008 standards speaks to the risk management of chemicals, which has been further broken out in the 2009 standards under EC.02.02.01 to reflect the risk management of hazardous chemicals, radiation equipment and lasers, and hazardous gases and vapors.
As near as I can tell (and this has pretty much been the indication as this initiative has rolled out), there are no new requirements, per se. What appears to be changing is more a function of how EPs could be scored during a survey, especially those (banana) splits.
In my client work, I have often compared the current survey process’ arrival at “jeopardy” as not so much death by a sucking chest wound, but more death by a thousand cuts–and the Swiss survey knife appears to have grown a couple more blades. While my obsessive-compulsive disorder has not yet resulted in my counting up the number of EPs in play, rest assured I will.
There is a fundamental constant that every time The Joint Commission deck gets shuffled, there is a likelihood of some resulting confusion, not only in the EC community at large, but also in the surveyor community.
And that’s not counting the new emergency management and life safety chapters. More on that September 5–you’ll have to come to Boston for the full scoop.
July 01, 2008 | Steve MacArthur | Comments 0
2009 EC, life safety, and emergency management standards posted today
Hi everyone –
It’s Scott Wallask at HCPro logging in.
Just a quick FYI, The Joint Commission has posted its 2009 standards, including the revised EC and new life safety and emergency management chapters:
I’m sure Steve Mac will have more to say on this soon on the blog.
Meanwhile, I’d also like to mention that HCPro has an upcoming seminar on September 5 that will dig into all these new standard changes prior to January 1 effective date.
Thanks…Scott W.
July 01, 2008 | Scott Wallask | Comments 0
Managing media access and photography
I was talking about photography policies and hospital security last week in the blog, and a related concern is media actions during a big news story.
Unfortunately, due to immediate media saturation of almost any event, it is frequently (and to my mind, rightly so) a primary concern of organizations to develop an approach/policy for the management of photography, not only within the walls of the hospital, but also on the grounds of the hospital.
My experience has been that hospitals need to maintain a very strict line on the media, as any precedent-setting “permission” to the media (even for pleasant circumstances) can make it that much more challenging when the media breaches the hospital as they pursue a story that might be considerably less flattering to the hospital.
Thus, it is important to determine ahead of time how much access can be granted, regardless of the situation, and how that access would be managed (preferably in the form of some sort of neutral ground, but that’s not always possible).
June 30, 2008 | Steve MacArthur | Comments 0
Another quick thought about risk assessment reporting
Yet another interesting risk assessment strategy is to identify a severity score for an unprotected risk, then using a matrix format, identify the interventions you’ve implemented to manage the risk and determine a score for the “protected” risk.
This works really well with security stuff because of the wide variety of interventions that can come into play (CCTV, access control, panic alarms, alarms, security presence, etc.).
June 27, 2008 | Steve MacArthur | Comments 0
