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Hospital shooting raises security questions

Hospital safety is being questioned after a patient shot and killed a doctor at Florida Hospital in Orlando on May 27.

Last month, a 53-year-old patient shot and killed a 41-year-old transplant surgeon in the hospital’s parking garage and then killed himself, reports the Los Angeles Times.

Since the murder, the hospital has stepped up its security and police escorts are available for those who need it.

Security experts say physicians are becoming more common targets of angry patients.

Mac’s Safety Space: Andy Rooney redux: Handwringing at its finest

One of the occupational hazards of my job is that I tend not to leave the job behind when I travel. I am forever looking at exit signs, blocked exit doors, testing battery-powered emergency lights in hotels, etc. One of the things that’s become somewhat the bane of my existence are certain configurations of hand washing facilities. Now I believe that if one has a manually operated sink, then one must have access to paper towels to turn off the water or risk re contamination of the hands.

Now I know the risk is probably fairly small, but it is a risk that can be managed pretty easily. I have no real preference between automatic and manual-op faucets (I tend to find the manual-op a little more reliable). But if there’s a manual-op sink, I want to see the paper towels (I refuse to use my shirt tail to turn off a faucet, toilet paper just doesn’t “feel” right, and leaving the water running is not very green). And I’ve heard about using elbows, etc. to turn off the water (try that with a knob-like fixture!), but somehow that doesn’t seem all that effective either. There’s a certain fast food restaurant (one tangential hint—its founder was the opposite of a buoyant substance) that uniformly has manual-op sinks and hand dryers in its restrooms, and it drives me nuts (a short distance to travel many days, but I digress).

In this age of superbugs, etc. (I’m writing this on May 19, so I’m assuming that some of us will still be around after this weekend’s departure on the part of whoever it is who’ll be departing: I don’t believe that I will be in that number, but if you are, I’m hoping the next plane doesn’t have as many hand washing challenges), hand washing remains one of, if not the most, effective means of protecting ourselves, and perhaps, all of humanity, from these pesky critters. So please, please, please (at this point, I have to drop to the ground, so I can don my cape) make sure that your hand washing setups are conducive to maintaining good hygiene. If you got manual-op faucets, give the washers something to turn off the faucet, and if we’re lucky, maybe the lights…

Missouri hospital evacuated safely during weekend tornado

The entire 367-bed St. John’s Regional Medical Center in Joplin, MO, needed to be evacuated after a tornado tore through the city May 22.

The tornado caused extensive damage to the hospital. The nine-story facility’s walls were moved 10 feet out of place, debris was strewn about patient rooms, and medical records and other documents were blown away, reports CBS News. Hospital staff promptly evacuated the 183 patients out of the facility and from the emergency room and set up a triage center in the parking lot. After evaluating patients, nurses sent them to other facilities for treatment.

St. John’s readied the facility before the tornado struck, declaring “Condition Gray,” , prompting patients and visitors to go into protected parts of the building such as stairwells.

A physician at the hospital, Jim Riscoe, MD, praised the hospital’s staff to CBS News, saying they acted professionally and communicated well.

Mac’s Safety Space: Meanwhile, on the other side of town…interim gas measures?

One little item that seems to be popping up with increasing regularity is citing deficiencies in medical gas and vacuum testing reports that are not being managed in a demonstrative way. In some instances, folks have been tagged for the amount of time between identification and resolution, others for not having demonstrably managing the risks associated with a delay in resolving something, etc.

Now we’ve certainly had the “you can live and die during a survey based on what your vendors are documenting” discussion before, though that exchange has tended to focus on life safety device testing. This has the appearance of a fairly significant sea change relative to survey findings and I believe that it represents an overall move towards a risk management process that is not unlike the process outlined under the interim life safety measure (ILSM) standard and associated performance elements. Only time will tell as to how this effects the tenor of surveys and survey results, but I would ask you to think about this:

Any time a deficiency (any type of deficiency—doesn’t specifically have to be a life safety deficiency) or otherwise “unsafe” condition cannot be resolved immediately; there is an inherent risk to be managed. That’s just the nature of the beast. And that risk can be fairly variable in terms of its impact on our facilities and occupants, but how do we know if we don’t run it up the ol’ risk assessment flagpole and see if salutes are forthcoming.

Certainly, it is within our purview to prioritize our responses to stuff that needs to get done, but it would seem that if we do not have our t’s crossed and i’s dotted (until our eyes are crossed), we could be at risk for citation for taking too much time to complete our corrective action (yeah, I know, how much is too much?). But I think if we have a solid, documented process for assessing the risk, identifying any interim strategies for minimizing the risks until such time as the condition can be corrected, we can effectively manage the risk involved with a delay, both from an operational standpoint and a survey management standpoint.

At the end of the day (cliché alert), it is our responsibility to ensure that the safety is maintained at an appropriate level (also meaning that it is our responsibility to identify what appropriate looks like) at all times, even when things are not in perfect shape. When things are not in perfect shape, the mission then becomes one of figuring out how we make sure that any gaps are bridged, which effectively means some sort of interim measure (if you look closely, you’ll see the concept of interim measure doesn’t just show up under the ILSM standard – it’s in the emergency power standards, as well as in the emergency management chapter). It is up to us to manage our resources effectively, and sometimes that means that we can’t fix everything right away – and that’s okay.

As long as we make sure that the associated risks are managed just as effectively as we manage those resources. So, keep close tabs on those maintenance and testing documents getting shoved under your door, any one of them could be trouble during survey.

Which reminds me, if your testing vendors are not providing you with a complete summary of any and all deficient findings identified during the testing and maintenance activities, I plead with you to demand this of them. The surveyors now have more than enough time to find that little mission critical device failure buried on page 15 of the testing report and they’re going to ask you what you’re doing about it. If you didn’t get to page 15 in the report, you’re going to end up with some egg on your face and a probably an RFI (Requirement for Improvement), which won’t make anyone happy. A simple executive summary of deficiencies (or, if they didn’t find anything, a simple statement that says “yes, we didn’t find anything”) gives you one place to look and one access point to managing the risks associated with the finding. I know I don’t have time to read through all those reports and I suspect your time can be better spent, but perhaps that’s just me…

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: Harvester of Data: Data collection—your pathway to compliance

At this point, if you’ve been managing your environment for any length of time, you know where, what, etc. you are likely to find at any given moment in terms of environmental opportunities—door wedges, unsecured oxygen cylinders, corridor clutter, penetrations, doors that don’t latch, uncovered linen carts, missing refrigerator temperatures, missing actions for out-of-range refrigerator temperatures—the list (well, my list anyways)  is endless.

These are the things that can go wrong during a survey—the 2011 survey year is bringing more eyes for more days—and how long do you think everyone in your organization can be “perfect” (less than perfect will get you loads of citations—ask anyone in your neighborhood who’s been surveyed this year)?

Your responsibility as a safety professional is to manage those imperfections in such a way as to minimize the negative impact of these failure modes (and that’s exactly  what they are, boys and girls) on the safety of the occupants. But how do you know if you’re doing that effectively (a rather good question, wouldn’t you say?)? In the nascent days of performance improvement, it was generally sufficient to know what got improved (or as we say in Boston, “got bettah”), but now things are starting to move in the direction of the next level of paradigm—you can know that something was improved, but the important metric is: How do you know it was improved?

Going back to the endless list at the beginning of this epistle—think of your “heavy hitters,” “frequent flyers,” whatever descriptor you’d like, and ask yourself the question: Has this imperfection moved closer to perfection, and if we think it has, do we have the measurements to back up that assessment?

We collect tons and tons of failure mode data; we issue work orders, we track those work orders, sometimes we make folks come to the EOC Committee to atone for their sins. But do we know what our compliance rate is for any of these opportunities? I certainly hope so, and I’ll tell you why.

In the past, during the post-Joint Commission survey clarification process, you could “audit” your compliance post-survey and use that as the basis for removing citations from the survey, as long as (for the most part—there are always exceptions, like those pesky “A” performance elements) you could demonstrate that you were at a compliance rate of 90% or better and you make the findings go away. Lately, it appears that there has been a shift away from accepting “current” compliance and a shift towards your compliance rate over time.

And so, I exhort you to start using all that data you’re harvesting and start looking at the compliance journey that it represents. Not everything gets better all the time and the closer handle we have when things start to slip-sliding away, we have a fighting chance of intervening before things get ugly.

Infected water system to be replaced in Washington hospital

The water system at Providence Sacred Heart Medical Center in Spokane, WA, will be treated with chlorine in an effort to kill bacteria that can cause Legionnaire’s disease.

Since January, three cases of bacteria have tested positive in patients at the facility. In January, two occurred in patients occupying the same room, and another case occurred in March, reports The Spokesman-Review. All three patients were elderly.

It is a major undertaking for the hospital to clean its water system, reports the paper. Water samples were collected on May 5 and tests will take place in the next two weeks to confirm the bacteria have been killed.

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 8) 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: Peeling back the layers of the onion—adventures in the kitchen

I cannot honestly say that this has been cropping up in Joint Commission surveys, but it has been enjoying a more prominent position during state survey.  And, since I’ve found that this one is not always uniformly understood, I figure it’s time to toss it out for the group’s consideration.

A year or so ago, a client facility was cited during a state survey with failing to conduct monthly inspections of their kitchen fire suppression system. Now, I will freely admit that my first response was “bull___,” entirely basing that response on what was enumerated in the Joint Commission standards, or, more precisely, what I “thought” was enumerated in the Joint Commission standards. So, journey with me to that most estimable of destinations: EC.02.03.05 EP #13, which says that hospitals must inspect kitchen’s automatic fire-extinguishing systems every six months and they are expected to keep a record of when these inspections are conducted.  There then follows two notes, one fairly straightforward, which says that fire-extinguishing systems do not need to be discharged, but the other is where we head to our next point in the journey: It says to consult NFPA 96, 1998 edition for performing inspection guidance.

OK, National Fire Protection Association (NFPA) 96 – 1998, let’s see what we have there. OK, so there are a couple of different types of systems that are considered (I don’t know that I would go so far as to say “allowed,” but I think we can intuit that much): carbon dioxide, automatic sprinklers, dry chemical, and wet chemical, with installation, etc. being in accordance with the applicable standard. For the purposes of this particular lesson, we turn to the standards associated with dry chemical (NFPA 17) and wet chemical (NFPA 17A) and find this lovely little item (this is in Chapter 9 in NFPA 17 – 1998 and Chapter 5 in NFPA 17A – 1998, but the requirements are identical; I’m using NFPA 17 here):

9-2 Owner’s Inspection

9-2.1 On a monthly basis, inspection shall be conducted in accordance with the manufacturer’s listed installation and maintenance manual or owner’s manual. As a minimum, this “quick check” or inspection shall include verification of the following:

(a) The extinguishing system is in its proper location.

(b) The manual actuators are unobstructed.

(c) The tamper indicators and seals are intact.

(d) The maintenance tag or certificate is in place.

(e) The system shows no physical damage or condition that might prevent operation.

(f) The pressure gauge(s), if provided, is in operable range.

(g) The nozzle blowoff caps, where provided, are intact and undamaged.

(h) Neither the protected equipment nor the hazard has been replaced, modified, or relocated.

9-2.2 If any deficiencies are found, appropriate corrective action shall be taken immediately.

9-2.3 Personnel making inspections shall keep records for those extinguishing systems that were found to require corrective actions.

9-2.4 At least monthly, the date the inspection is performed and the initials of the person performing  the inspection shall be recorded. The records shall be retained until the next semiannual maintenance.

So, you know the fire extinguisher-type tags that are hanging on your kitchen suppression actuators (or somewhere nearby)—somebody’s supposed to be filling out the monthlies. And guess who would be considered the owner … three guesses and the first two don’t count. Better get a PM started if this was a surprise!

Man accused of murder at Napa State Hospital will go to trial

In the ongoing saga at Napa State Hospital in Napa, CA, following a nurse’s murder by a patient, a judge has ruled that Jess Willard Massey will stand trial for murder.

Massey will be on trial for the murder of nurse Donna Gross on October 23. After speaking with Napa County Sheriff’s Detective Todd Hancock, Massey admitted to the killing, saying he heard voices telling him Gross was the devil, reports the Napa Valley Register.

A hearing will take place June 14. If convicted, Massey faces life in prison without possibility of parole.