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Safety surveys for acquired clinics within your hospital system

Q: Our medical system has recently acquired a handful of external medical clinics. We have included these clinics in our annual safety surveys as we have acquired them, treating them as clinical areas needing to be surveyed at least twice annually. I was told yesterday that in the next year we could acquire as many as 30 more clinics. If we acquire that many, it is clear that we will need to change the way we survey for safety.

Are B occupancy facilities, even though they are medical clinics, required to be surveyed by the safety survey team? Do we have to conduct bi-annual surveys of these areas as we do within the hospitals? Are there other models out there that you are aware of for surveying?

A: The thing is, The Joint Commission (TJC) standards don’t differentiate based on occupancy type, but rather utilization, so for areas that are surveyable by TJC (and that’s an important point to keep in mind), hazard safety tours need to occur semi-annually in areas providing services to patients, which is going to be a great big pain in the tuchus if you add 30 sites.

Now I suppose you could request additional resources to cover these extra practices, or at least ask to be able to do an initial assessment of the practices as part of the pre-purchase due diligence process (actually, as I look at your question, you said acquire, which could be different from purchase from a regulatory standpoint).

I think, from a comfort standpoint, you should really push on the pre-survey – you don’t want your organization to get waist deep in this only to find that they’ve got safety violations up to their eyeballs, and as the new “owners,” your organization is on the hook for corrections.

Beyond that, if no additional resources are forthcoming, then the deal has to be that you would coordinate one survey per year and that the other would be a self-survey. While there is a requirement to do twice per year, it doesn’t say that the process for each has to be identical. Perhaps the self-survey is a quick 20-question list and your survey is the more comprehensive of the two; the bottom line is to make sure that folks in the off-sites are appropriately safe — in terms of the environment and in terms of how they manage that environment.

Involve your entire facility in Life Safety Code® compliance

As the life safety officer, you may be the expert in your facility on code compliance — always on the lookout for violations with fire walls, integrity of egress, and fire safety management.

Although some of these may escape the everyday scrutiny of front line staff members, corridor clutter is one top five Life Safety Code® violation in which both nurses and hospital leadership can play a significant role in compliance. [more]

Understanding the nuances of isolation rooms

Q: I’ve got some questions about what rooms are required to be isolation rooms and what ones are negative pressure rooms.  Also, we seem to have a lot of confusion here about the difference between the two, so I really need some help defining them and understanding what the requirements for each are.

A: Let’s cover a couple of basic things first; strictly speaking, when we are talking about air pressure differentials, the “brass tacks” revolve around negative pressure and positive pressure.

Negative pressure is used when you have something in a space that you don’t want to get out (say a contagion) and positive pressure is used when you have something outside of the space that you don’t want to get in (say you have an immunocompromised patient). Both differentials can serve as isolative or protective environments, it’s basically a question of what you’re dealing with – are you protecting the patient or are you protecting everyone else? [more]

CT hospital cited for workplace violence incidents

A post on OSHA Healthcare Advisor last week detailed an OSHA citation to Danbury (CT) Hospital which led to a $6,300 fine.

The investigation found several instances where workers were injured by act of violence from patients in the psychiatric, emergency, and general medical floors, reports OSHA. [more]

Should children be safer at home than they are in our facilities?

The 2008 edition of the National Electrical Code will require the use of tamper-resistant receptacles in new and renovated dwellings.

Now I know that this doesn’t necessarily include hospitals as a specific concern, but can we, in good conscience, fail to adopt what NFPA clearly indicates is a best practice. You can try to risk assess your way out of this one, but if you decide not to adopt this practice in areas with your vulnerable patients (and I’d include behavioral health in the mix), you’ll likely anger the gods of risk management – never a good plan if one aims to remain in good graces with one’s insurers and attorneys.

Click here for  a helpful Q&A from the folks at NFPA.

Testing fire pumps under emergency power

I recently had a reader ask me about fire pump testing. He said that since Joint Commission does not ask to see that the hospital fire pump is tested under emergency power at peak capacity (150% of nameplate rating), then why should we perform that test?

The Joint Commission does not often (if ever) ask to see the fire pump tested under emergency power at peak capacity (150% of nameplate), even though it is a NFPA 25 requirement. However, other authorities having jurisdiction (AHJ) may very well expect that you comply with this requirement, such as CMS, the state department of public health, state and local fire marshals, and insurance companies.  [more]

Safety professionals: Give us your feedback

If you have a minute in the next day or so, we have a quick reader survey up to gather information about your on future educational opportunities, particularly thoughts on virtual seminars on Life Safety Code® requirements.

Please take a moment to complete the following survey.

By taking part in this survey, we will enter your name into a drawing for a $50 HCPro gift certificate. If you’re having trouble with the link above, please just copy and paste this address into your browser:

Vegas hospital takes EM drill a bit too far

It’s certainly worthwhile to make sure your emergency management drills are realistic and practical, but there is a line, and one Las Vegas hospital may have crossed it.

Officials at St. Rose Dominican Hospital — Siena Campus conducted a drill back in May, in which an off-duty police officer acted as a terrorist, storming the hospital’s intensive care unit and herding staff members into a room with a handgun. Teressa Conley, the hospital’s chief operating officer, told state investigators that at 10 am she heard a “code grey” over the intercom, meaning an assault or threat by an unarmed aggressor in the ICU. Minutes later that was upgraded to a “code silver,” which indicates a hostage situation with an armed suspect, according to the Las Vegas Sun. [more]

Fire evacuations in the procedural areas

One of the key activities in any survey – mock or the real thing – are those precious moments when surveyors “corner” a front line staff person to answer some pertinent questions. The fact of the matter is that a lot of your survey success rests in the hands of the folks at the point of care and point of service in your organization. You may have the most pristine documentation imaginable, but the folks in the trenches need to be able to articulate competencies well beyond the “just doing my job” everyday functions.

So, when a survey traces through surgical procedure-related areas such as the cardiac cath lab, endoscopy, PACU, same-day surgery, and the operating areas – even your emergency department – it is very likely that questions will be raised regarding the management of surgical fire risk. And I can tell you that it is most disturbing as a consultant to hear that staff in some of these areas don’t take part in fire drills because they are “in the middle of cases” when these practice exercises are conducted. [more]

An OSHA Q&A on an infectious disease standard

Our sister blog, OSHA Healthcare Advisor has an interesting “web-exclusive” that partners with an article that was featured in the latest issue of Medical Environment Update.

The newsletter submitted questions directly to OSHA regarding the possibility of an infectious disease standard. Here’s one of the answers they got back: [more]