Archive for June, 2010
Joint Commission revises a few National Patient Safety Goals
In last week’s publication of Joint Commission Online, The Joint Commission announced it was revising a few National Patient Safety Goals (NPSG) related to clinical practice. The revisions were made to better reflect current evidence-based practice, according to The Joint Commission, which also said that when the NPSGs were originally created, they reflected the best practice at that time. There are no new requirements included.
The affected NPSGs include:
- NPSG.03.05.01 element of performance (EP) 6: Related to anticoagulant therapy-required lab-tests.
- NPSG.07.04.01 EP 11: Related to central line-associated bloodstream infections, specifically antiseptics for skin preparation.
- NPSG.07.05.01 EP 7: Related to surgical site infections, specifically administration of antimicrobial agents for prophylaxis.
- NPSG.07.05.01 EP 8: Also related to surgical site infections, specifically hair removal.
To find the exact revisions, click here for last week’s Joint Commission Online
“Boston Med” debuts, showcases challenges faced by hospital staff
There’s been a lot going on this week: HHS’ request that hospitals not wait to implement the proposed Final Rule regarding patient visitation rights, as well as the Accreditation Council for Graduate Medical Education (ACGME)’s announcement of proposed resident duty hours. Both of these announcements affect patient safety in some way or another, and I will post on those next week.
However, where I like to make Friday posts a little less news-focused and more fun when possible, I’d like to talk about “Boston Med,” a new series that premiered last night on ABC. The show focuses on real doctors, residents, staff, and patients at three of Boston’s teaching hospitals: Brigham and Women’s Hospital, Massachusetts General Hospital, and Children’s Hospital Boston. It’s filmed in documentary-style.
The first episode focused on two lung transplant patients and the physicians involved, as well as the process that transplant patients must go through to receive a viable organ. Another theme revolved around a resident in the emergency department and some of the personal issues she was struggling with during her grueling and demanding training period. A third theme focused on a police officer patient who had been shot in the line of duty, and the trials and tribulations he faced on his road to recovery–which included surgery on his jaw.
I thought the show portrayed well the emotions that run through hospital staff as they perform their jobs each day as well as the emotions of patients and their families who may or may not be used to the healthcare system. I’d like the show to focus a little more on the support staff in future episodes, as viewers really only got a taste for the lives of they physicians and residents from the first episode. However, with seven more installments, I have faith that the series will deliver.
Did any blog readers see the episode? What were your thoughts? If you work in a hospital, did this strike you as familiar?
Med rec implementation postponed again–what is your organization’s process?
Earlier this month The Joint Commission announced that it again would be pushing back the implementation date for changes to the medication reconciliation process, formerly National Patient Safety Goal (NPSG) 8 and proposed as NPSG.03.07.01 during the field review process. In its June 2 Joint Commission Online the accreditor said that through the field review process it became apparent that although organizations think that getting a handle on medication reconciliation is important for patient safety, they do not think it is fair to comply with a NPSG or standard that holds them responsible for matters out of their control. These “matters” might include collecting an accurate list of a patient’s medication from patients who do not know all of the medications they are taking. Or communicating to the patient’s next provider of care the patient’s medication list at the time of discharge–often the next provider of care is not known.
The field has been complaining about the actual NPSG concerning med rec since its institution years ago because of its impracticality. Now The Joint Commission is saying that the newest form of requirement may come in the general standards, and not the NPSGs, and it will not be ready for implementation until July 2011 at the earliest.
I’d like to hear from you readers about how you’ve been handling medication reconciliation in the absence of any clear cut regulations from The Joint Commission. Of course there are general best practices out there, and that is likely what many of you are following. What are those? How has your hospital been reconciling patients’ medications?
Patient discharge planning receiving more attention
Discharge planning has been an often neglected time in a patient’s hospital stay, which is likely one of the main reasons 20% of patients return to the hospital within 30 days, reports The New York Times. Several new programs have taken root to reverse this trend and ensure that patient care at discharge is a focal point to prevent patients from returning to the hospital.
Two of these programs, Project BOOST (Better Outcomes for Older adults through Safe Transitions) and Care Transitions Intervention, are leading the way. Project BOOST is a creation of the Society for Hospital Medicine and provides interested hospitals with a toolkit of standardized forms to streamline the discharge process. Care Transitions Intervention is out of the University of Colorado Denver’s School of Medicine, with funding from the John A. Hartford Foundation and the Robert Wood Johnson Foundation.
I wrote about the Care Transition Intervention program a couple of years ago in Briefings on Patient Safety. At that time, this project was a newer take on how to manage the handoff process for patients being discharged from the hospital. It also gave rise to the notion of a “transitions coach,” a similar concept to that of the “patient navigator” I posted about last week.
Has your facility taken part in any program that focuses on patient discharge as a means of preventing rehospitalization?
Robots to carry out daily hospital tasks
Although this headline may make you think you accidentally checked The Onion’s homepage, this is actually a true story out of Scotland. The BBC is reporting that Forth Valley Royal Hospital in Larbert, Stirlingshire, Scotland is going to be deploying a group of robots to carry out everyday tasks like delivering meal trays, cleaning the operating rooms, and dispensing medications. The hospital will make room for the robots by way of an underground corridor, which is how they’ll travel throughout the facility.
Infection prevention is one of the benefits to using robots for many tasks that various hospital workers currently carry out. The robots are equipped with sensors and computers to alert them if anyone or thing is in their paths, and will stop moving. They can also open doors.
If you’re interested in learning more about the robots, click here for the BBC article.
Today is National Time Out Day!
Today, June 16th, is National Time Out Day–is your hospital marking the day with any sort of special fair or event? I thought I’d share this page of resources from the Association of periOperative Registered Nurses (AORN), a group that is leading the effort in promoting not only the day, but the sentiment of National Time Out Day year-round.
AORN is asking healthcare providers to make a “Time Out Commitment”, designed to “increase awareness of and compliance to taking a time for every patient, every time before the start of a surgical procedure.” The program will provide educational tools to increase awareness about wrong-site,-person, and -procedure surgery. You can find more about the Commitment here.
Don’t forget to check out the collection of Time Out videos that AORN has put together, at the bottom of its resources page! These videos are from hospitals around the country, showing off how they perform a time out prior to surgery.
Patient navigators a growing field in healthcare
Patient navigators may be coming soon to your hospital—if your hospital doesn’t already use them. Patient navigators are staff members whose jobs consist of helping patients find their way through the confusing world of medical tests, procedures, inpatient stays, and discharges, reports The Philadelphia Inquirer. Programs across the country are sprouting up, and although not every one uses the term “navigator,” the intent is the same: Help sick, anxious patients better understand and utilize the healthcare system.
Many cancer centers are employing patient navigators, reports the Inquirer, because cancer care is so unique. However, some hospitals also use navigators more in the disease management role, for patients with chronic diseases like diabetes. The idea is not a new one—case managers have been helping patients in this role for years, but now more facilities are embracing the role as healthcare remains a complex system.
To read more about patient navigators, click here to find the full Philadelphia Inquirer story.
Has your hospital employed patient navigators? Have you found that they help increase patient safety and patient satisfaction?
HHS, AHRQ announce patient safety and medical liability grants
The Department of Health and Human Services (HHS) and the Agency for Healthcare Research and Quality (AHRQ) announced last Friday, June 11, that they had awarded $23 million in grants in the name of a patient safety and medical liability initiative, as well as $2 million for final contract evaluation. The grants are the product of an announcement on patient safety that President Barack Obama made in September 2009 to a joint session of Congress.
The initiative includes grant money for both demonstration and planning grants in the realm of patient safety and medical malpractice, as well as funding to review existing reforms of the medical liability system.
The demonstration grants, which were awarded in allotments of up to $3 million and total $19.7 million, were given for projects that will be implementing and evaluating evidence-based patient safety and medical malpractice projects. To view the full list of recipients of demonstration grants, click here.
The planning grants, which were awarded in allotments of up to $300,000 and total $3.5 million, allow recipients to do some detailed planning around patient safety and medical liability reform. To view the full list of recipients of planning grants, click here.
President Obama originally said that the initiative should award grants to programs that trial models for:
- Focusing on patient safety by reducing preventable injuries
- Encouraging better communication between doctors and patients
- Compensating patients quickly and fairly for medical injuries, but also discouraging frivolous lawsuits
- Reducing liability premiums
To find more about the initiative, visit www.ahrq.gov/qual/liability/
An illustration of patient-centered care
The Boston Globe has a column today about a patient’s positive experience with the healthcare system, and it struck me as one I wanted to share with Patient Safety Monitor Blog readers. The patient was going in for hip surgery and although she had her share of ups and downs (a headache as the result of spinal anesthesia, an allergic reaction to morphine) she felt that she had been taken good care of throughout the process, including a case manager calling once the operation was scheduled simply to be sure the patient’s home was set up in a way that would be conducive to her needs after surgery. Many caring healthcare professionals helped her through the stages of surgery and she valued the attention given by her care team.
I don’t want to take away from the column’s account, so you can read the full version here.
Sometimes its easy to focus on the negative–the never events, near misses, communication problems, etc.–in the realm of patient safety. I liked that this account focused on the positive, which is something that I think anyone who works in healthcare needs to be reminded of from time to time.
Safety in the surgical environment
Briefings on Patient Safety recently launched a new column that explores patient safety from the perspective of a newcomer to the field. Columnist Catherine Hinz, MHA, is the patient safety lead at HealthEast Care System in St. Paul, MN. Previously, Hinz worked for seven years as an ED health unit coordinator, completed a patient safety internship with the Agency for Healthcare Research and Quality, and finished a residency with The Studer Group.
The Patient Safety Monitor blog will be featuring excerpts of Catherine’s columns on the blog, beginning with the most recent, about finding the fun in patient safety:
One of the first things I did when I started in this role was observe surgical cases. The surgical environment fascinates me for many reasons. In patient safety, the operating room (OR) is often one of the most high-profile areas for an adverse event, such as a wrong-site surgery or retained foreign object. Surgery can change the course of a patient’s disease, condition, and healing process in a matter of hours. The unique team dynamics in surgery consist of an incredible amount of interdependence, differing education levels, hierarchy, and minimal interaction with the patient. Lastly, on a personal level, I have undergone two knee surgeries but remembered very little about the process, although it’s one in which I’m interested. I was excited to see the teams in action.
I originally intended to observe surgical cases for the purpose of paying close attention to our timeout process. Month after month, our audits neared 100% correct completion rates. This rate of success, while not impossible, left questions in my mind about our technique and auditing practices. I likened it to a hand hygiene rate of 100%; it sounds fantastic, but in some ways unbelievable. It was a golden opportunity for me to enter the OR suites and observe, because not many people knew who I was or my position in patient safety. In fact, a lot of teams assumed I was a nursing student (an entirely different and equally intriguing issue).
I quickly tried to learn everything I would need to know about being in the OR suite. I reviewed sterile technique and spoke with our surgical educators about what to expect. I was extremely nervous the first time I entered the OR suite. Staying against the wall (and attempting not to touch anything), I stood with my clipboard, ready to take notes. I was in awe of the amount of skill, talent, and expertise with which our teams completed procedures. It was humbling to watch and wonder about the marvels of healthcare—our methods, our devices, and our pharmaceuticals.
As I watched through my patient safety and human factors lens, I also witnessed opportunities that left our teams and patients susceptible to risk. Some of the breakdowns in communication, readiness of imaging and equipment, and power hierarchies opened the door to innovation and improvement efforts. After a series of weeks observing multiple cases in different facilities, we put a plan together for the year called “All 4 Safe Surgery.” Our four initiatives were:
- A newly revised timeout process utilizing human factors engineering
- An introduction of checklists
- An introduction of briefings
- Collaborative work with the Minnesota Hospital Association for retained foreign objects, called Safe Account
To read Catherine’s full column on safety in the OR, see the July issue of Briefings on Patient Safety (a part of your Patient Safety Monitor subscription for those blog readers out there who are also subscribers.)
