Author Archive for: Matt Vensel

New IAHSS guideline aims to help healthcare facilities respond to workplace violence

March 20th, 2018 Email This Post Print This Post

Looking to reduce the likelihood of workplace violence in healthcare, the International Association for Healthcare Security & Safety Foundation (IAHSS) released a new Threat Management guideline earlier this month stating that “healthcare facilities should establish a process and multidisciplinary team to identify, assess, validate, mitigate, and respond to threats of violence or other behaviors of concern.”

The multidisciplinary threat management team should, says IAHSS, identify threats and determine their seriousness and severity. Additionally, IAHSS recommends the team develop intervention plans that protect potential victims and address problems that precipitate threats, document the threat assessment process with privacy and confidentiality in mind, and conduct a review after addressing each threat.

The IAHSS guideline suggests the development of a threat management program “that is informed by data and research in this area.” To do so, IAHSS says that healthcare facilities should designate individuals who are responsible for, amongst other things, educating staff and promoting the reporting of threats; assessing all reports of concerning behavior; implementing timely response plans; and advocating for victims and offering support and counseling if needed.

IAHSS says all healthcare staff should get education —  based on their job function and potential risk — about identifying concerning behavior, reporting protocols, activating an emergency response, and documenting threats and incidents.

The new Threat Management guideline was initially developed by the IAHSS Council on Guidelines and incorporated feedback from IAHSS membership, the Emergency Nurses Association, and the American Hospital Association, according to a press release announcing the guideline.

“Implementing the intent of this guideline will be one of the least expensive and effective steps an organization can take to reduce the likelihood of violence,” Tom Smith, chair of the IAHSS Council on Guidelines, said in a statement. “The Threat Management Guideline establishes a framework for healthcare organizations to proactively identify and manage threats of violence. Input from our colleagues at the AHA and ENA helped us enhance the quality and value of the final product.”

The issuing of the guideline comes several months after a report by IAHSS, entitled “Mitigating the Risk of Workplace Violence in Health Care Settings,” encouraged healthcare facilities to take immediate steps to mitigate violent incidents.

Make us even better with your feedback… and maybe win $50 off any HCPro product

March 6th, 2018 Email This Post Print This Post

Feedback from safety professionals is essential to us at HCPro as we strive to develop products that help healthcare organizations like yours stay up to date and in compliance, keeping your workers safe. Please take just a few minutes to share your thoughts with us regarding ongoing and new challenges faced by you and your safety colleagues in 2018.

In gratitude for your participation in our survey, you have a chance to win $50 off any product in the HCPro Marketplace. Simply click on the link below to begin the survey. If the click-through does not work, please cut and paste the URL below into the address bar of your browser.

Here’s the link to the survey:

All your answers are confidential and anonymous. If you have questions related to this survey, please contact me at The deadline to fill out the survey is March 30, 2018.

TJC: Unintended retention of foreign body, falls most common sentinel events in 2017

March 1st, 2018 Email This Post Print This Post

The Joint Commission (TJC) on Wednesday released an updated list of its sentinel event statistics for 2017, and you’ll find some familiar medical miscues at the top.

TJC reviewed 805 reports of sentinel events, which it defines as unexpected events that result in death or serious physical or psychological harm to patients. That’s down slightly from a year ago, when they decreased from 934 in 2015 to 824.

The most frequently reported sentinel event was again the unintended retention of a foreign body (116), edging out falls (114). Rounding out the five most common were wrong patient, site, or procedure (95), suicide (89), or delay in treatment (66).

To view the latest sentinel event info, here’s a link to TJC’s quarterly reports.

New HHS fact sheet gives guidance for handling long-term patient surge

February 27th, 2018 Email This Post Print This Post

One of the deadliest flu seasons in recent memory has prompted the Department of Health & Human Services (HHS) to release a fact sheet that gives guidance on handling an influx of patients flocking to healthcare facilities for treatment of the flu and other seasonal illnesses.

While the latest briefing from the CDC suggests that this flu season has peaked, the fact sheet provides useful information healthcare facility emergency planners should consider when developing plans to deal with a similar surge of sick patients in the future. Note that this fact sheet states “these considerations are different than those of planning to handle surge from a no-notice, short duration event” like the recent mass shootings in Orlando, Las Vegas, and Parkland, Florida.

The HHS fact sheet states that “all hospitals must have an emergency operations plan” to deal with a long-term surge. Among the strategies it recommends are expanding normal clinic hours to limit the number of clinic patients coming to the ED, rescheduling elective procedures to free up beds, and setting up “surge sites” such as tents or mobile units located next to the ED.

It also recommends preventive steps that could minimize the surge during a severe flu season, including the use of telehealth, telephone prescribing, virtual information, community paramedicine programs, and risk communications and creating media campaigns encouraging vaccinations, handwashing, and other infection control practices.

The HHS fact sheet states that “there is little an individual hospital or health system can do to prevent patient surge from seasonal illness, but a region or healthcare coalition, in partnership with public health, can use coordinated strategies to help provide situational awareness to support patient surge management throughout the community.”

To download the fact sheet from the HHS website, click right here.

Our expert answers a couple of reader questions related to waste disposal

February 19th, 2018 Email This Post Print This Post

When you’ve got healthcare safety or standards questions, we’ve got answers. More specifically, we’ve got a stable of industry experts who are only an email away and are willing and able to give you the guidance you are seeking.

This time, we turned to Dan Scungio, MT(ASCP), SLS, the laboratory safety officer for Sentara Healthcare in Virginia, to answer a pair of waste disposal questions recently posed by our readers. Scungio, aka “Dan, the Lab Safety Man,” writes a monthly column for our monthly Medical Environment Update newsletter.

Question No. 1, from a blog commenter named Sarah Winters: “I am the nursing supervisor for a school district. At the end of every year, the nurses at the schools close and seal their full sharps boxes and transport them in their vehicles to [our] central office, where I then take them to EMS for disposal. A safety/health inspector has told us this is unsafe and violates the OSHA standard. I cannot find how that violates any OSHA regulation. Suggestions? Resources? Thanks.”

Answer from Dan, the Lab Safety Man: “OSHA does not directly regulate the transport of hazardous waste, but the U.S. Department of Transportation does. The DOT states that if you are not in the business of transporting hazardous materials, the process of sharps transport for the schools falls under the DOT’s Materials of Trade exemption. That means it is acceptable to transport used sharps in your private vehicle provided they are packaged in containers constructed of a rigid material that is resistant to punctures and securely closed to prevent leaks. That said, individual state regulations may supersede federal DOT rules, so it is important to know what the transport laws are in your specific state.”

Question No. 2, submitted anonymously via email: “Can we dispose of irrigation fluid from the anterior chamber of the eye in the regular garbage if not visibly contaminated with blood and is self-contained in a sealed bag?”

Answer from Dan, the Lab Safety Man: “Eye irrigation fluid may not be considered an infectious waste if it does not contain blood, but it is probably not a good idea to place it into the regular (non-hazardous) waste stream. It is important to consider those who handle the trash after it leaves your site. If there is breakage of a sealed container or bag that creates an exposure, that would create a scenario that will raise questions for the person exposed and a situation that should be avoided.”

Got a question you’d like answered? Shoot us a note at

How would Trump’s proposed 2019 budget affect OSHA? Barab weighs in

February 15th, 2018 Email This Post Print This Post

Jordan Barab, the former OSHA official under Barack Obama who still champions worker safety on his personal blog, has gone through the 2019 budget proposal that the Trump Administration unveiled earlier this week, the one that aims to slash by $18 billion the budget for the Department of Health and Human Services.

While OSHA’s overall budget is not among the ones President Trump is proposing to cut, Barab is still concerned, writing that, like last year, Trump “once again proposes to slash or eliminate important safety and health programs and agencies.”

Per Barab, if approved, the 2019 budget proposal would eliminate the Susan Harwood Training Grant Program and the Chemical Safety Board. However, given how Congress reacted to proposed cuts of those programs last time around — as Barab put it, they “had about as much lift as a Butterball Turkey when the administration floated these ideas” in his 2018 budget — he isn’t too worried it will actually happen.

“There’s a saying that there’s no education from the second kick of a mule. With a little lobbying and common sense, we can only hope that the Trump administration will get to witness that phenomenon” with these proposed cuts, Barab wrote.

Additionally, the 2019 budget proposal looks to eliminate two advisory committees dealing with whistleblower protections and federal employee safety and health, Barab wrote. They would be the Federal Advisory Council on Occupational Safety and Health and the Whistleblower Protections Advisory Committee.

As far as OSHA’s overall budget is concerned, Barab said it would, if approved, remain “mostly level,” with a $5.1 million increase from 2017 in enforcement and a $3 million increase in compliance assistance, mostly, Barab wrote, “to add Compliance Assistance Specialists who had been cut in previous years due to budget limitations” plus “eight staff to work exclusively on the Voluntary Protection Programs.”

OSHA, in its budget justification, says it has set a goal of 30,840 inspections for 2019, which is 5% less than the 2017 fiscal year, the most recent data available.

OSHA says it plans to focus on “the highest-impact and most complex inspections at the highest-risk workplaces.” One would think that list includes healthcare facilities. But in a recent article of our Medical Environment Update newsletter, Barab and industry safety experts expressed concern about how the loss of dozens of OSHA inspectors under Trump might affect healthcare workers.

We’ll circle back on this in greater detail, with original reporting on how it could affect you, in the event these cuts actually get pushed through this fall.

Group sues Trump administration, OSHA for failing to share 300A summary reports

February 14th, 2018 Email This Post Print This Post

One advocacy group is suing the Trump administration, claiming the Department of Labor (DOL) and OSHA are illegally withholding records about workplace injuries and illnesses, our colleagues over at OSHA Compliance Advisor wrote this week.

In each of the final three months of 2017, advocacy group Public Citizen submitted Freedom of Information Act (FOIA) requests for records submitted by employers under OSHA’s electronic injury and illness recordkeeping rule. The group says it intended to use the info to conduct research on job safety and health. Public Citizen claims its October and November requests were inappropriately denied.

That recordkeeping rule, finalized in May 2016, required employers with 250 or more employees and employers in some high-risk industries that have 20 or more workers to electronically submit their 2016 300A summary report to OSHA by December 31, 2017. OSHA was then supposed to make the data public to encourage employers to prevent injuries and illnesses and to advance research into workplace safety.

OSHA issued a response explaining why Public Citizen’s FOIA request was denied.

That response, via our colleagues writing for OSHA Compliance Advisor: “As stated in the preamble to the Improve Tracking of Workplace Injuries and Illnesses final rule (see 81 FR 29624), OSHA plans to use the establishment-specific data for enforcement targeting purposes. Disclosure of the data before and while it is being used to select establishments for inspection would in turn disclose OSHA’s techniques for law enforcement investigations. Thus, OSHA has determined the data submitted under the electronic reporting requirements are exempt from disclosure while they are being used for enforcement targeting purposes.”

Public Citizen appealed, arguing that the records are not exempt from FOIA because they were not compiled for law enforcement purposes, and that OSHA in its final rule in 2016 stated that it would publicly disclose these records to encourage workplace safety. The advocacy organization’s suit asks the court to find that failure to provide the records is unlawful and to order the DOL and OSHA to provide them.

Trump’s proposed budget would slash HHS

February 12th, 2018 Email This Post Print This Post

The budget for the 2019 fiscal year proposed today by the Trump Administration would slash by $18 billion the budget for the Department of Health and Human Services (HHS). If approved, that represents a 21% decrease from its 2017 budget.

According to The Hill, all but three HHS agencies are subject to budget cuts, the exceptions being the National Institutes of Health, the FDA, and the Indian Health Service. (Those three would receive modest bumps to their budgets in 2019.)

Per The Hill, CDC faces a $1 billion budget cut, the Substance Abuse and Mental Health Services Administration funding would decrease by $688 million, and the Administration for Children and Families would lose $4 billion — about 1/5 of its budget.

Furthermore, President Trump’s budget proposes cutting $1.7 trillion in funding for HHS programs, including Medicare, over the next decade, per USA Today, which said Trump also encouraged Congress (again) to repeal the Affordable Care Act.

“The president’s budget makes investments and reforms that are vital to making our Health and Human Services programs work for Americans and to sustaining them for future generations,” said new HHS Secretary Alex Azar, slated to testify about the budget in front of three congressional committees this week, in a statement.

Pentax duodenoscopes voluntarily recalled for design and labeling updates

February 7th, 2018 Email This Post Print This Post

The FDA announced today that it has cleared the updated design and labeling for Pentax ED-3490TK duodenoscopes and that the scopes will be recalled so the manufacturer can make design changes meant to reduce leakage of patient fluids — thus limiting the spread of infection — and update product operations manuals.

In 2015, the FDA issued a safety warning against Pentax and two other duodenoscope companies. The warning stated that a design flaw prevented the scopes, which are designed to be used on multiple patients, from being cleaned properly, creating an infection risk. Duodenoscopes are flexible, lighted tubes that threaded through the mouth, throat and stomach into the top of the small intestine (duodenum).

A subsequent Senate investigation revealed that dirty scopes were the direct cause of 25 infection outbreaks, sickening dozens of patients and leading to the death to at least 21 people. The FDA bore some of the blame for deciding to not alert the public to the threat until after its 17-month investigation into the matter.

After the manufacturers revised their reprocessing instructions, the FDA in 2016 deemed the duodenoscopes safe for healthcare facilities to use again.

The FDA stated in today’s news release that since then it has been working with the manufacturers to “modify and validate their reprocessing instructions to further enhance the safety margin of their devices,” and “show with a high degree of assurance that their reprocessing instructions, when followed correctly, effectively clean and disinfect the duodenoscopes.”

Specifically, the FDA asked that Pentax reduce the potential for leakage of patient fluids into ED-3490TK’s closed elevator channel and under the distal cap.

Now that Pentax has done this, the FDA recommends that facilities acknowledge their Urgent Medical Device Correction and Removal notification disclaimer icon and identify affected products, return the field correction response form, and indicate if they do not have any affected duodenoscopes or operations manuals, and remove and dispose of older operations manuals once the new ones are received.

For more information on today’s news, check out the FDA’s official release here.

Flu activity is ‘still high and widespread,’ claiming lives and costing employers

February 5th, 2018 Email This Post Print This Post

This deadly flu season rages on with, as of Friday, 53 children nationwide having died from the flu. Hospitalization rates are the highest they have been since CDC started tracking that in 2010. And there still may be several more weeks remaining in this flu season, the top CDC official warned late last week.

In a Friday briefing, Anne Schuchat, MD, acting director of CDC, said, “Unfortunately, our latest tracking data indicate flu activity is still high and widespread.”

Schuchat, who is leading CDC’s flu-fighting efforts after the resignation of Brenda Fitzgerald, said it is still not too late to get a flu vaccine. She recommends citizens to do so if they haven’t already despite the resistance of Influenza A H3N2 viruses.

Schuchat also encourages everyone to wash their hands and properly cover mouths when coughing or sneezing. One Florida nurse shared the same sentiment, albeit with a little more sass, in a recent video that went viral over the weekend.

While the loss of life is the main concern for CDC, Schuchat this morning pointed out on Twitter that the flu leads to billions of dollars in lost productivity each year.

(Pink, however, stiff-armed the flu to sing the national anthem at the Super Bowl.)

Schuchat’s tweet included a link to a website encouraging employers to protect their workforce. There, CDC data shows how vaccinations cut down on flu-related illnesses and medical visits–and, in turn, lost productivity for employers.

Mandatory vaccinations are a hot topic in healthcare. CDC has advocated for years that all healthcare workers get vaccinated annually. A couple of weeks ago, we wrote in this space about some things that healthcare leaders should ponder when considering making flu shots mandatory at their hospital or clinic.

Establishing a mandatory flu vaccine policy before the end of this deadly flu season is probably unrealistic at this point given the hoops that must be jumped through to make that happen. But perhaps this can get the ball rolling for next year.

High-reliability healthcare, ‘preoccupation with failure’ and a valuable workshop

February 1st, 2018 Email This Post Print This Post

Gary L. Sculli, MSN, ATP, brings a unique perspective to safety in healthcare. In addition to being a registered nurse for more than three decades, he has served as an officer in the United States Air Force Nurse Corps and for many years worked as a pilot for a major U.S. airline.

Three years ago, Sculli shared some of his experiences and many of the insights gained during a diverse career in an HCPro book, “Building a High-Reliability Organization: A Toolkit for Success,” which was coauthored by Douglas E. Paull, MD, MS, FACS, FCCP, CHSE. Below is a book excerpt from a chapter on failure, in which the authors urged healthcare leaders, in the pursuit of high reliability, to embrace the concept of “preoccupation with failure.”

At the core, much of patient safety is dealing with uncertainties and unexpected events, the cardiac arrest being a prime example. In moments like these, not only do organizations rely on the technical expertise of staff and best practice guidelines, but also benefit from teams that are flexible, can adapt, and in essence, are resilient. Organizations themselves must be resilient to deal effectively with the changing face of healthcare.

Let’s examine a disaster from forest firefighting history—the Mann Gulch Fire in 1949. Young firefighters parachuted into Mann Gulch, near Helena, Montana, to combat what they believed was a rather routine forest fire. They were led by foreman Wag Dodge. But when the fire jumped from the south to the north side of the gulch, the firefighters were trapped and isolated from their escape route to the Missouri River. There were two possible routes for survival; either join Wag Dodge in his newly devised “circle of fire” or run to the top of the north ridge. This was the first time the circle of fire had been utilized during forest firefighting. Essentially, Dodge lit the grasslands on fire depriving the oncoming fire of any fuel to spread, thus protecting anyone within the circle. Whether due to a lack of trust, leadership, or communication, none of the other firefighters joined Dodge within the circle, despite his efforts to encourage them to do so. In addition, the young firefighters would not drop their heavy backpacks, slowing their ascent to the top of the north ridge. Thirteen firefighters died with their backpacks on and within sight of safety in the circle of fire or beyond the ridge. Dodge survived because he was able to pivot and adjust to rapidly changing and unexpected conditions.   

Several authors have discussed resilience, flexibility, innovation, and adaptability as attributes of successful organizations, including those in healthcare. Healthcare organizations must be able to learn from their mistakes. They must be able to face reality, “drop their old tools,” and accept the fact that the landscape can and will change suddenly and that unexpected events will occur. They must also accept that the best solutions to navigate the unexpected may be found in high-reliability industries. When viewed in this manner, leaders are not afraid to actively demand, even when faced with obstacles, such things as perpetual team training, mass standardization, briefings and handoffs, situational awareness support, just culture, staffing increases, and other patient safety initiatives. Leaders model open-mindedness and embrace innovation when unforeseen or novel situations arise. They talk with and listen to staff at the frontline when it comes to identifying and solving systemic challenges and failures. In many ways, current healthcare leaders are in a position similar to Wag Dodge. They must be resilient, prepared to build a circle of fire, and change course in order to solve unexpected and complex problems.

This spring, Sculli is again partnering with HCPro to give healthcare leaders the needed tools and guidance to create a culture of high reliability and safety within their organizations.

On April 16, Sculli will lead an intensive one-day workshop at Renaissance Orlando at SeaWorld® in Orlando, Florida. For more information on this upcoming HCPro workshop — which targets healthcare safety professionals, CEOs, COOs, VPMAs, risk managers, and quality/performance improvement professionals — please check out the event page at

CDC Director Brenda Fitzgerald resigns

January 31st, 2018 Email This Post Print This Post

Just two days after Alex Azar was sworn in as the new head of the Department of Health and Human Services (HHS), Azar accepted the resignation of his CDC director.

Brenda Fitzgerald resigned this morning, a day after POLITICO reported that she bought shares in a tobacco company not long after taking the job — a serious conflict of interest considering that as CDC director she was tasked with reducing tobacco use.

She also bought stock in Merck & Co., Bayer, and Humana, per the POLITICO report.

From the official HHS statement: “Dr. Fitzgerald owns certain complex financial interests that have imposed a broad recusal limiting her ability to complete all of her duties as the CDC Director. Due to the nature of these financial interests, Dr. Fitzgerald could not divest from them in a definitive time period. After advising Secretary Azar of both the status of the financial interests and the scope of her recusal, Dr. Fitzgerald tendered, and the Secretary accepted, her resignation. The Secretary thanks Dr. Brenda Fitzgerald for her service and wishes her the best in all her endeavors.”

Dr. Anne Schuchat will serve as CDC’s active director, according to the agency’s website, while a permanent replacement is sought.

Fitzgerald’s departure comes as CDC combats one of the most severe flu seasons in recent memory, with dozens of deaths across the country.

It also means more changes at HHS, which figures to be under the scrutiny of President Donald Trump. When swearing in Azur on Monday, Trump vowed that his new HHS secretary was “going to get those prescription drug prices way down.” Azur and Fitzgerald’s eventual replacement must also take on the opioid crisis — a topic Trump touched upon again during last night’s State of the Union address.

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