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The exodus is here: Are you prepared?

Some say not so much.

First off, many thanks to the standards sleuths out there that assisted on solving last week’s missing EP caper; it’s nice to know that I am not merely orating into the void (oration being a somewhat hyperbolic description of this blog—lend me your eyes!).

Now, on to our continuing coverage of emergency management stuff.

The ECRI report outlining the Top 10 Patient Safety Risks for 2018 (if you missed it last week, you can download it here), does make mention of all-hazards emergency preparedness as #7 on the Top 10 list, though I have to say that their description of the challenges, etc., facing hospitals was whatever word is the opposite of hyperbolic (I did a quick search for antonyms of hyperbolic, but nothing really jumped out at me as being apropos for this discussion), pretty much boiling down to the statement that “facilities that were prepared for…disasters fared better than those that were not.” And while there is a certain inescapable logic to that characterization, I somehow expected something a bit weightier.

That said, the ECRI report does at least indicate that there may have been hospitals that were prepared, which is a little more generous than hospital preparedness was described in the report from our friends at the Johns Hopkins Bloomberg School of Public Health Center for Health Security (you can find the report here). The opening of the Hopkins report goes a little something like this: “Although the healthcare system is undoubtedly better prepared for disasters than it was before the events of 9/11, it is not well prepared for a large-scale or catastrophic disaster.” Now that is a rather damning pronouncement, and it may be justified, but I’m having a bit of a struggle (based on reading the report) with what data was used in making that particular pronouncement. I’m not even arguing with their recommendations—it all makes abundant sense to me from a practical improvement standpoint—and I think it will to you as well. But (I’m using a lot of “buts” today), I’m having a hard time with the whole “is not well prepared” piece (in full recognition that it is healthcare as a single monolithic entity that is not well prepared). Could hospitals be better prepared? Of course! Will hospitals be better prepared? You betcha! Could hospitals have more and better access to a variety of resources (including, and perhaps most importantly, cooperation with local and regional authorities)? Have the draconian machinations of the federal budgeting process limited the extent to which hospitals can become prepared? Pretty sure that’s a yes…

Could the nation (or parts therein) experience catastrophic events that significantly challenge hospitals’ ability to continue to provide care to patients? Yup. Will the nation (or parts therein) experience catastrophic events that significantly challenge hospitals’ ability to continue to provide care to patients? Probably, and perhaps (given only the weather patterns of the last 12 months or so) sooner rather than later. There have always been (and there always will be) opportunities for hospitals to improve their level(s) of preparedness (preparedness is a journey, it is not a destination), including building in resiliency to infrastructure, resources, command leadership, etc. And while I appreciate the thought and preparation that went into the report, I can’t help but think that somehow this is going to be used to bludgeon hospitals on the regulatory front. In preparation for that possibility, you might find it useful to turn your emergency management folks loose on a gap analysis relative to the recommendations in the report (again, I can’t/won’t argue with the recommendations—I like ’em), just in case your next accreditation surveyor tries to push a little in this realm.

Try to run, try to hide: Some random thoughts to open the 2018 Physical Environment campaign

I suspect that I may return to the coming changes to the Life Safety standards and EPs dealing with outpatient occupancy, but I wanted to toss a couple of other thoughts your way to start things off with a lesser potential for headaches derived from over-stimulation of the regulatory madness response.

Some of the funkiest findings that arise during survey are those relating to the euphemistic “non-intact surfaces.” The overarching concerns relate to how effectively non-intact surfaces can be cleaned/disinfected, with the prevailing logic being “not particularly well.” One of the surfaces that will encounter scrutiny during survey is the omnipresent patient mattress and I suspect a recent study by ECRI is only going to increase attentions in this regard because, to be honest, what they found is kind of disturbing. As we’ve discussed in the past, ECRI publishes an annual list of technology challenges, and #3 on the hit list this year involves the risks associated with “mattress ingress,” which roughly translates into blood and body fluids seeping into mattresses with non-intact surfaces. I think part of the dynamic at work is that mattresses are somewhat (and in some instances, very much) more expensive than in the “old days,” which decreases the ability for organizations to have a ready supply of backup mattresses for replacement activities. Of course, you have to have a robust process for identifying mattresses to be replaced and that process generally hinges on the active participation of the folks in Environmental Services. As one might imagine, this can become a costly undertaking if you’ve got a lot of cracked or otherwise damaged mattresses, but if you need some additional information with which to encourage the importance of the process, Health Facilities Management magazine has something that I think you’ll find useful.

Another one of those funky findings that I see bubbling up from time to time are those related to the use (including availability) of appropriate Personal Protective Equipment (PPE). From a practical standpoint, I know it can be a wicked pain in the butt to get folks to do what they’re supposed to when it comes to PPE use (especially when they are engaged in the inappropriate mixing of chemicals—yow!). While it is too early to tell whether this is going to be helpful or another bludgeon with which regulatory surveyors can bring to bear on safety professionals, the tag team of CDC and NIOSH have come up with a “National Framework for Personal Protective Equipment Conformity Assessment – Infrastructure” to help achieve some level of standardization relative to PPE use. It does (of course!) include the use of processes that very much resemble those of a risk assessment, including identification of risks and hazards and identification of PPE types needed to address those risks and hazards. Part of me is fearful that this is going to be just one more opportunity for field surveyors to muddy the waters even more than they are now (is that even possible? I hope not…). At any rate, this is probably something with which you should be at least passingly familiar; you can find the details, as well as the downloadable document, here.

As you’ve probably noticed over the last little while, these pages tend to focus more on TJC and CMS than most of the accreditation organizations, but I was happy (Pleased? Intrigued? Something else?) to see that the Health Facilities Accreditation Program (HFAP) had published a summary of its most frequently cited standards/conditions during 2017 in its annual Quality Report. I’ll let you look over the document in its entirety, but some of the EC/EM/LS findings were kind of interesting. In no particular orders, some topics and thoughts:

  • Business continuity: Effective recovery from an emergency/disaster is the result of thoughtful planning. The road to recovery should be clearly charted.
  • Emergency supplies: Apparently there is a move towards maintaining emergency supplies as a separate “entity”; also an inventory is important.
  • Security of supplies: Make sure there are provisions for securing supplies; I suspect this is most applicable during an emergency, particularly an extended-time event.
  • Personal Protective Equipment: Don’t forget PPE in your emergency planning activities.
  • Decontamination/Triage/Utilities/Volunteers: Make sure you have a handle on these in your emergency plan.
  • Environment of Care: Eyewash stations, ligature risks, dirty and/or non-intact surfaces, clustering of fire drills, past due inspections of medical equipment, air pressure relationships, open junction boxes, obstructed access to electrical panels, etc., risk assessment stuff, making sure that all care environments are demonstrably included in the program.
  • Life Safety: Improper installation of smoke detectors, exit/no exit signage concerns, fire alarm testing issues (not complete, no device inventory, etc.), egress locking arrangements, unsealed penetrations, rated door/frame issues.

Again, the link above will take you to the report, but there’s really nothing that couldn’t be found anywhere if there are “lapses of concentration” in the process. Right now, healthcare organization physical environments are being surveyed with the “bar” residing at the perfect level. I have encountered any number of very effectively managed facilities in the 16 years I’ve been doing this, but I can count the number of perfect buildings on the finger of no fingers. Perhaps you have one, but if you’ve got people scurrying around the place, I suspect perfection is the goal, but always a distance away…

Remember, technology is still a toddler

Or mayhap a preschooler…

When it comes down to the usual arc of things, our reliance on technology often exceeds technology’s “ability” to do everything we would want it to do when we want it done. In this regard, I imagine technology as a really precocious toddler that frequently astounds, but also frustrates more often than we would like (imagine when technology becomes a surly teen!), resulting in various and sundry risks, hazards, etc. Well, this is a landscape that the good folks at ECRI tend to watch very carefully, with the end result being regular recommendations to the folks actually dealing with the ups and downs (hopefully more ups) of technology operations, as well as the bosses. Now I will say that not everything on the ECRI list has a direct impact on the hospital safety world (though one could submit that the pervasiveness of technology provides potential issues for all manner of stuff) as information with which to be familiar. At any rate, this year there are two offerings, one to provide information to the folks occupying the environs of the C-suite, the most interesting/applicable offerings being those related to UV disinfection technology and the application of technology in caring for patients with opioid addiction (that one is less directly tied to safety operations, but this has such wide-ranging implications, it can’t possibly hurt to have a little background info). And then for us non C-suiters, a report on the top Technology Hazards in healthcare for 2017 is also on offer, with infection control and prevention being somewhat of a common thread in the hazards, but clinical alarm safety is also represented. The links provided here will take you to access portals where, for a nominal offering of contact information, you can download these reports.

Now, in looking out my window, it appears that winter has finally put in an appearance on the East Coast (though I guess the rains out in California over the past few days is also representative of a winter weather pattern, albeit less snow-covered) and it reminded me of my past days of having (personal and professional) responsibility for (among any number of things) snow removal. Now, to my way of thinking, there is a certain zen that can be experienced when one is combatting the forces of nature one on one (preferably at night) that is probably one of my favorite OCD moments (and believe me, shoveling snow in the middle of the night brings with it a certain inescapable essence of OCD, but I digress). At any rate, one of the more important aspects of the snow removal game is that of ensuring that any and all nearby fire hydrants are well and truly accessible in the event they are needed in an emergency. Just as there is many a slip twixt cup and lip, any delay in accessing firefighting resources can yield catastrophic results, so, as a community service, I give you this information. Particularly in those areas experiencing a little more snow than usual, this might even be worth sharing with the rest of the folks in your organization. I figure if it helps even one person to be a little safer, then it’s worth the effort to spread the news.

And yet another Top 10 list…

Recently, ECRI unveiled its list of the Top 10 Healthcare Technology Hazards (here’s an article discussing this topic). And strangely enough, there is at least a couple that I think you will find oh-so-very familiar. Hopefully, you’re already working on the hazards that fall under your jurisdiction (which will vary from organization to organization), but I think it’s never a bad idea to take a look at what the think tanks are identifying (best believe that your favorite regulatory agency—insert name here—is keeping close tabs on groups like ECRI) and plan accordingly. I’m just going to list the hazards as indicated by ECRI, but if anyone out there in radio land has an interest in more in-depth discussion, please let me know and we can do just that. That said, I think these are pretty straightforward.

1)      Alarm hazards

2)     Infusion pump medication errors

3)     CT radiation exposures in pediatric patients

4)     Data integrity failures in EHRs and other health IT systems

5)     Occupational radiation hazards in hybrid ORs

6)     Inadequate reprocessing of endoscopes and surgical instruments

7)     Neglecting change management for network devices and systems

8)     Risks to pediatric patients from “adult” technologies

9)     Robotic surgery complications due to insufficient training

10)   Retained devices and unretrieved fragments