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Recent Articles & Updates

Jan 2009

• Perspectives Jan '09 Vol 29 #1 Pg10-  Sentinel Event ALERT: Safely Implementing Health Information and Converging Technologies   [**REF**]  This article is essentially a reprint of Sentinel Event Alert #42 which focuses on the prevention of  'technology-related adverse events.   Although most of the 13 recommendations are pro-active new implementation strategies, a number are specific to the post-implementation phase making this a must read for IT and LDR.  In addition, if like approximately 83% of hospitals in the US, you have an automated dispensing cabinet (ADC), your P&T, RNx, MDx should also download and review a copy of the Institute for Safe Medication Practices (ISMP) Guidance on the Interdisciplinary Safe Use of Automated Dispensing Cabinets (PDF).  This contains an additional 12 guidelines on such issues as ADC location, number, security, stocking procedures, inventory, etc.

• Pt Safety Jan '09 Vol 9 #1 Pg08-  Managing Disruptive Behavior  [**REF**] The concept of disruptive behavior spans beyond the overt behaviors that are familiar items which most hospitals cover in ethics and orientation programs, such as verbal abuse, harassment, condescending or berating behavior, lack of respect or physical abuse.   Disruptive behavior that is identified most in hospital settings consists of more covert interference with communication, team performance, or safe patient care. Some examples are staff who constantly criticize other members of the patient care team, those who incessantly complain without taking any positive action, and those who obviously do not pay attention in meetings.  The article outlines steps for LDR, HR, TxTm, MD, RN and others to take to address disruptive behavior and a side bar that encourages the proactive use of a Code of Conduct.  See also The Doctors Company PowerPoint on Disruptive Behavior by Sue Dill Calloway,RN, MSN, JD submitted by Phillip Ward (Bryce PI Director) and Pam Ward (ADMHMR) with useful references and special relevance for physicians.
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Feb 2009

 
Mar 2009

• Pt. Safety Mar 09 Vol 9 #3 Pg05-  Strategies for Eliminating Catheter-Related Urinary Tract Infection  [**REF**]IC, RN.  Some state hospitals that have long term care or medical units allow the use of urinary catheters.  For such facilities, this article is a good review of the risks involved.  It also notes the fact that CMS will no longer pay for the extra costs associated with catheter-associated urinary tract infections. To guide catheter use, four clear strategies and a decision tree are presented.
  

Apr 2009

• Pt Safety April '09 Vol 9 #4  Pg05-  Preventing Never Events: Pressure Ulcers Although the focus of this topic is on longterm care, state hospital RN, StEd with elderly and/or longer term patients may also find it useful to review the strategies and tips presented.  The chief recommendation is for early identification of at-risk patients.  These would include "those who are older, immobile, incontinent, malnourished, dehydrated… and those who have sensory deficiencies, multiple comorbidities, or circulatory abnormalities such as  diabetes mellitus".  Remember that 'Never Events' are clinical care issues that should never occur. See also CMS IMPROVES PATIENT SAFETY FOR MEDICARE AND MEDICAID BY ADDRESSING NEVER EVENTS    Note: CMS will no longer pay health care organizations for any extra costs associated with Stage III or IV pressure ulcers.  

 May 2009

• Perspectives May 09 Vol 29 #5  Pg02-  5 Sure-Fire Methods: Receiving and Recording Verbal Orders  The requirement for having only qualified staff accept/transcribe verbal or telephone orders given by appropriately authorized persons shifted from standard IM.6.50 (2008) to standard RC.02.03.07 (2009).  Although it did not make the top 10 in our analysis of  state hospital-specific deficiencies for last year (PSQ Analysis 2007-2008) , TJC found 40% of all hospitals were non-compliant at survey time.  This makes the 5 compliance strategies they recommend for RC.02.03.07 worth reviewing byP&T, RN and MD.  There is an encouragement to distinguish between VO and TO and discouragement for use of the former.  Note the possibility of additional staff (e.g., Dieticians) being able to receive/record VO/TO and the requirement for LIP to date, sign AND time such orders.  Remember 48 hours is now the minimum standard unless your state statutes provide more leeway.  

   

June 2009

• Source June 09 Vol 7 #6  Pg06- Tracer Methodology 101: The Fall Reduction Tracer  [••REF••]  Although this is officially a program-specific tracer for home care, JCSC are strongly encouraged to incorporate this as a practice tracer for survey preparation/standard compliance (i.e., NPSG.09.02.01)  and an RN/ PI strategy for the reduction of patient falls.  The article includes a scenario and sample questions that can be adopted to your setting.

July 2009

Aug 2009

Sep 2009

Oct 2009

Nov 2009

Dec 2009

• Source, Dec. '09 Vol 7 #12  Pg01-  Joint Commission Now Giving “Booster Shots” for Standards Compliance First BoosterPak Focuses on Safe Medication Storage [••REF••] Last month in an article on Redesigning (Its) Process(es) with Lean Six Sigma, there was a brief mention of the development of BoosterPaks for problematic standards.  The first BosterPak (BP) became available on 11/19/09 and is a well-designed compliance reference and resource for the Standard MM.03.01.01.  This particular standard has been cited more in more than 30% of TJC hospitals every year since 2005.  In the first half of this year 21% of our members also reported this citation.  Although the article does not provide links, TJC says it sent announcements of the BP to all hospitals.   JCSC, Phrm, P&T, RNx and MDx should at least review the first 22 pages of this 33-page compendium by going to BoosterPaks in the What's New section of your TJC Connect site or downloading BP_MM_03_01.pdf.  The contents include implementation expectations (Pgs 2-11), the survey assessment process (Pg 12), FAQs (Pgs 13-15), key definitions (Pg 16), special issue discussion (e.g., Crash Cart Storage) (Pgs 17-22) and additional references and links.

Reference Articles

• EOC News Jun '08, Vol 11 #6  Pg04-  Preventing Workplace Violence: Tips for Safety in Emergency Department and Psychiatric Hospitals   [**REF**] To address EC.2.10, management of security risks, this article is based on OSHA statistics and guidelines.  It covers factors related to workplace violence in health care; the five main components of a program to prevent workplace violence; getting staff buy-in for the program; and safety tips for staff.  A sidebar provides a summary of tips for recognizing and defusing anger and violence, which involves application of “de-escalation” skills.  FYI: SFT, LDR, RNx.      - by VK    

• Source Sept 08 Vol 6 #9  Pg08- High-Quality Care Using Contracted Staff Complying with Standard LD.04.03.09 : This article does speak to some specific compliance concerns such as the need to properly orient and evaluate (e.g., after 1 week and q 6-months thereafter)  contract staff.  However, its larger focus is on achieving greater value from such staff by fostering a more supportive environment and relationships with them.  It suggests that much of this is done up front through preparatory explanation and clarification of duties with permanent staff.  This is a worthwhile read for HR, RNX and MDx.
  

• Pt. Safety Sept 08 Vol 8 #9  Pg06-   A Nurse Leads Change: Transforming Care at the Bedside : The nursing concept of transforming care at the bedside (TCAB) is explored through a series of questions to Hassmiller, Ph.D., R.N., F.A.A.N., of the Human Capital Team at the Robert Wood Johnson Foundation.  Getting nurses back to the bedside is discussed as a means of empowering them and improving patient care quality and safety.  RNx may find some of the examples and innovations useful food for thought.

• Pt. Safety Sept 08 Vol 8 #9  Pg10-   Educating Patients About Infection Control: Complying with NPSG.13.01.01 : To help comply with the requirements of NPSG.13.01.01, this article briefly discusses hand hygiene, respiratory hygiene, contact precautions and patient education on infection control.  The information and suggestions are basic but worth reviewing and reinforcing with staff by IC, RN, StEd and PtEd.  It also ties in to the speakup campaign.
  

• Source Oct 08 Vol 6 #10  Pg01- Tracer Activities and Patient Flow Standard LD.04.03.11: Measuring and Improving the Patient Care Process: This is TJC's 3rd article (Jan and Aug) this year on Patient Flow/Standard LD.04.0.11.  This one more specifically addresses what surveyors will be looking for and provides a series of tips.  The issue of discharge backups is emphasized.  Patient flow tracers are applicable to state hospitals.  As such, we again encourage you to to identify and evaluate any significant delay trends or patterns of difficulty accessing/providing services.  LDR, MDx and RNx might make the issue more relevant by framing it as a question of timeliness for patient processes such as admission, transfer, discharge, lab result returns, consultation request/response, etc.  See also:
  • RTP Vol2 #3 or Perspectives (2008 March, Vol 28, #3)  Pg10-   New Patient Flow System Tracer for Critical Access Hospitals and Hospitals 
  • RTP Vol2,#08 or  The Source (2008 Aug, Vol 6, #8)  Pg01-  Patient Flow: Keep Patients Safe and Moving Toward Recovery with Leadership Standard LD.04.03.11
  

• Source Oct 08 Vol 6 #10    Pg04- North Memorial Captures Delirium Superimposed on Dementia in Hospitalized Patients: Best-Practice Notes from the Hartford Institute of Geriatric Nursing: If your patient population includes those who are elderly and/or suffer from dementia your RN and MDs might find some of the resources identified in this article useful.  PEARL:  The Hartford Foundation Institute for Geriatric Nursing (HFIGN) has a program called  Nurses Improving Care for Health System Elders (NICHE) that provides best practice and evidence-based approaches/tools for this population (e.g., resources and tools on Geriatric Fall Risk Assessment and Avoiding Restraints In Patients with Dementia)
  

• Pt. Safety Oct 08 Vol 8 #10  Pg01-    Assessing a Patient's Risk for Pressure Ulcers: Compliance Tips for National Patient Safety Goal 14  Although NPSG #14 is not considered 'applicable' to hospitals, those IC, RN and RNx who serve older populations with limited mobility may find this article a useful refresher.  It provides a brief review of maintenance, prevention and risk assessment issues to include some comparison of two risk assessment scales, the Braden Scale (most commonly used and included in the article) and the Norton Scale.  FYI: StEd.  See also the Wound Care Helpline for free info on wound assessment/treatment protocols and related products. 
  

• EOC News Oct 08 Vol 11 #10  Pg01-    The Dangers of Latex  FYI: RN, RNx. Among health care workers, the incidence of latex sensitization is estimated at between 3% and 22%. There are three levels of allergic reaction to latex: #1 Irritant is evidenced by contact dermatitis: #2 Allergic contact dermatitis is evidenced by more severe symptoms of dermatitis and may spread to other body parts.  #3 Latex hypersensitivity is evidenced by hay fever like symptoms, exacerbated by hives and cramps, and potential anaphylactic shock.  A side bar on pg 9 lists a Latex Allergy Checklist for individuals who are allergic to latex.  An important recent finding is that many skin reactions that were attributed to latex in the past are now considered to be due to repeated hand washing and/or the powders on gloves that include corn starch or calcium carbonate. The authors recommend these essential steps for staff related to latex:
  •    Staff members should assume full responsibility for their own health, including any allergic reactions
  •    Determine your own level of sensitivity
  •    Practice careful hand washing
  •    Make sure you are using the right glove for the right reason
  •    Familiarize yourself with alternatives to the use of gloves and other products made of latex, including Nitrile and Guayule, approved by the FDA in April, 2008
  •    Bring any possibility of latex allergy to the attention of hospital management   
  

• The Source Nov 08, Vol 6 #11  Pg01-     Ensuring Accurate Verbal Orders    [**REF**] This is a presentation of 9 basic suggestions for full compliance with RC.02.03.07 as follows:
  • Define the information needed in a verbal order  
  • Designate the location where verbal orders should be recorded
  • Ensure that qualified staff members receive and record verbal orders
  • Set time frames for review and signing of a verbal order
  • Require verbal order recipients to “read back” the order
  • Spell out a drug name and confirm the dose using single digits
  • Ask yourself if the received verbal order makes sense
  • Use preprinted order sheets where possible.
  
  Sometimes familiarity breeds laxity.  Review the above list and note some of the fine points that may not be attended to closely anymore.  For example, has your organization clearly defined what information is REQUIRED in a verbal order?  Do you limit the number of staff who can receive such orders?  Do you require sound alike medications to be spelled out?  RN, MD and StEd should review this article

• The Source Nov 08, Vol 6 #11 Pg04-     Emerging Staff Qualifications and Performance Issues: Human Resources Standard HR.01.02.01: Top Compliance Issue for 2007   [**REF**]  Because HR.01.02.01 is in the Top 10, HR and RN should review this article.  It provides a useful reminder of the relationship of competency to staffing effectiveness and some suggestions for approaching issues of skill mix, task and job analysis.

• The Source Nov 08, Vol 6 #11 Pg06-     Storing Medications Properly: Complying with Standard MM.03.01.01    [**REF**] Medication storage, MM.2.20 (now MM.03.01.01) was also a Top 10 non-compliant standard.  Phrm, RN and P&T should review this article in which TJC lays out the following expectations for compliance and provides additional considerations:
  • Limit the number, doses, and strengths of medications stored (even in an automated dispensing cabinet)
  • Eliminate the use of look-alike drugs whenever possible
  • Empower staff members to report potential storage problems
  • Store adult and pediatric medications in separate locations
  • Monitor the temperature of refrigerators used for storing medications
  • Allow only pharmacy professionals to restock a dispensing cabinet
  • Discourage the storage of sample medications 
  • Remove patient-specific medications from storage as soon as patients are discharged or transferred.
  •Store controlled (scheduled) medications to prevent diversion, in accordance with law and regulations.

• Pt Safety Nov 08, Vol #11 Pg05- Addressing Substance Abuse Among Health Care Professionals   [**REF**] The article defines substance abuse as "misuse or overuse of a substance…by persons unable or unwilling to stop using".   While any healthcare worker  may be affected there are estimates that 8-12% of physicians and perhaps 32% if nurses may have a problem of this nature.  The article reminds us of some of the common signs of the problem to include: Inattentiveness, Lack of concentration, Irritability, Frequent mood swings, Gradual decline in work performance, Frequent absences from work and Elaborate excuses for poor performance or workplace absence.  A more detailed list of signs and behaviors of impairment from the AANA (see below) is included.  There are also recommendations for the content of a comprehensive policy.  MD may find this particularly useful in evaluating compliance with MS.11.01.01 (MS.4.80).  RN may find a useful resource in the American Association of Nurse Anesthetists (AANA) that created "a peer assistance program to provide resources to individuals concerned about their own or a colleague’s substance abuse problem". See also:  Signs and Behaviors of Impaired Colleagues

• Perspectives Dec 08 Vol 28 #12  Pg11-      Update: 2009 Universal Protocol FAQs Now Available Online   FYI: MD, RN.  These may be accessed online in the TJC Universal Protocol FAQs or downloaded in PDF formatPg11-      Update: 2009 Universal Protocol FAQs Now Available Online   FYI: MD, RN.  These may be accessed online in the TJC Universal Protocol FAQs or downloaded in PDF format 

•   Perspectives Sept. '09 Vol 29 #9  Pg09-  Free Help for Meeting Infection-Related NPSG [••REF••]  TJC allotted one year (with quarterly milestones) for the full implementation of HAI-related NPSG 7 by January 1, 2010.  Longer lead times usually suggest a greater effort is needed to comply.  It can also be the basis for greater accountability once the measure is fully in effect.  With that in mind, IC and RN should take advantage a free online education program offered by TJC to support compliance and implementation for NPSG 07.03.01, 07.04.01 and 07.05.01.  Just be aware that the 76-slide webinar with narration by Louise Kuhny, RN, MPH, MBA, CIC and Barbara Soule, RN, MPA, CIC lasts a little over 58 minutes.  You will need to log on to your TJC Connect website to access it.
  • Pt. Safety Sept. '09 Vol 9 #9 Pg01- Helping Patients Stand Tall A Primer on Fall Prevention in Health Care[••REF••] RNx, RN and other clinical LDR should find value in several aspects of this article. It provides useful examples of risks factors and suggests some scales for evaluating them (e.g., Morse Fall ScaleSee also , Hendrich Fall Assessment.  It gives a reference to the VA's tool for fall prevention and mentions some creative approaches to increasing staff awareness of patients at risk.  However, the most useful part of the article may be the pointers it provides on using simple statistics to evaluate and guide your fall prevention program.  It gives easy formulas for establishing fall rates and also encourages looking at the subsequent rate of injuries related to those falls.  SHCC Risk of Falls  
• Perspectives Sept. '09 Vol 29 #9  Pg09-  Free Help for Meeting Infection-Related NPSG [••REF••]  TJC allotted one year (with quarterly milestones) for the full implementation of HAI-related NPSG 7 by January 1, 2010.  Longer lead times usually suggest a greater effort is needed to comply.  It can also be the basis for greater accountability once the measure is fully in effect.  With that in mind, IC and RN should take advantage a free online education program offered by TJC to support compliance and implementation for NPSG 07.03.01, 07.04.01 and 07.05.01.  Just be aware that the 76-slide webinar with narration by Louise Kuhny, RN, MPH, MBA, CIC and Barbara Soule, RN, MPA, CIC lasts a little over 58 minutes.  You will need to log on to your TJC Connect website to access it.
• Pt. Safety Sept. '09 Vol 9 #9 Pg01-  Helping Patients Stand Tall A Primer on Fall Prevention in Health Care [••REF••] RNx, RN and other clinical LDR should find value in several aspects of this article. It provides useful examples of risks factors and suggests some scales for evaluating them (e.g., Morse Fall Scale, Hendrich Fall Assessment.  It gives a reference to the VA's tool for fall prevention and mentions some creative approaches to increasing staff awareness of patients at risk.  However, the most useful part of the article may be the pointers it provides on using simple statistics to evaluate and guide your fall prevention program.  It gives easy formulas for establishing fall rates and also encourages looking at the subsequent rate of injuries related to those falls.  See also SHCC Risk of Falls 

• Source, Dec. '09 Vol 7 #12  Pg01-  Joint Commission Now Giving “Booster Shots” for Standards Compliance First BoosterPak Focuses on Safe Medication Storage [••REF••] Last month in an article on Redesigning (Its) Process(es) with Lean Six Sigma, there was a brief mention of the development of BoosterPaks for problematic standards.  The first BosterPak (BP) became available on 11/19/09 and is a well-designed compliance reference and resource for the Standard MM.03.01.01.  This particular standard has been cited more in more than 30% of TJC hospitals every year since 2005.  In the first half of this year 21% of our members also reported this citation.  Although the article does not provide links, TJC says it sent announcements of the BP to all hospitals.   JCSC, Phrm, P&T, RNx and MDx should at least review the first 22 pages of this 33-page compendium by going to BoosterPaks in the What's New section of your TJC Connect site or downloading BP_MM_03_01.pdf.  The contents include implementation expectations (Pgs 2-11), the survey assessment process (Pg 12), FAQs (Pgs 13-15), key definitions (Pg 16), special issue discussion (e.g., Crash Cart Storage) (Pgs 17-22) and additional references and links.