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2012 Reading Tips Newsletter – August (Vol 06 #08)

State & Psychiatric Hospital Compliance Collaborative’s Reading Tips Newsletter (RTN) August 2012, Volume 6, Issue 8
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  • Fresh SPHCC
    • Guests & Visitors – Refurbishment of the SPHCC website is just about ready for your access. Change over to the new homepage is expected on 8/31/12. Just go to www.SPHCC.net as usual and you will be taken to a familiar but fresh SPHCC. See you there!
    • Current Members – Later this month, we will begin contacting each member directly. As part of the transition we will be updating your Custom Support Page (CSP). Your new CSP will serve as an individualized and more user-friendly homepage on our refreshed site. New features and the extension of your membership will be explained.
  • AnchorCompliance Blog: Because the revised CMS Conditions of Participation include attention to nursing care planning, surveyors may look more closely for evidence of documentation. Are you ready? Do you know the 3 historical pitfalls to look out for? Join the discussion.



••Additional Updates in:


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Recommended Readings, Tips & Pearls


PR: AnchorAnchorClarifications and Expectations: Managing Corridor Clutter—Part 1 [REF:EOC, RN, SFT.] Perspectives April 2012, Pg 1, Vol 32, # 8

LS.02.01.20 is one of the most frequently cited standards for psychiatric hospitals. In that context, this article which addresses one aspect of this standard, is worth reviewing. The fundamental issue here is that “aisles, corridors and ramps required for exit access in a hospital…not be less than 8 feet in clear and unobstructed width…” Storing and/or parking items in hallways can violate this principle and defeat fire safety. Items (e.g., mobile workstations) left in a corridor and not used in the last 30 minutes would be considered stored and not in use1. One possible exception is a crash cart that could reasonably be considered ‘in use’ or ready for use at all times. Items that project into hallways more than 6 inches are also non-compliant. However, wall-mounted computer touch screens or writing surfaces that self-retract to less than 6 inches when not in use can be acceptable2. Even the storage of patients in corridors (e.g., on gurneys) for more than 30 minutes would not be permitted by the Life Safety Code. [PEARL] On the other hand, the article points out that the dead-end area of corridors that is beyond the exit and patient doors could be used for equipment storage (e.g., mobile workstation) if it is less than 50 square feet and properly sprinkled (See NFPA 101-2000, Paragraph, Exception 1 or 6. ) ***Note: the ’30-minute definition was established by CMS and is not in the Life Safety Code. For more details on 1 & 2 above see S&C-10-18-LSC: Revision of S&C-04-41 dated August 12, 2004, “Corridor Width & Corridor Mounted Computer Touch Screens in Health Care Facilities—Clarification Effective Immediately,” dated May 14, 2010


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TS: AnchorAnchorBenchmark: The Joint Commission Gives a Shot in the Arm to Health Care Personnel Influenza Vaccination Rates [REF: BHC, IC, PI] The Source Jan 2012, Pg 1, Vol 10, # 8

Influenza is a serious illness that on average, leads to more than 200,000 hospitalizations and 36,000 deaths each year. The transmission of influenza within health care facilities (by patients AND staff) is also a serious concern. According to the US Department of Health & Human Services (HHS), vaccination is the single most effective preventive measure available against influenza. To help address this concern, IC.02.04.01 requires organizations to offer vaccinations to staff, including licensed independent practitioners. Despite such facts and requirements, vaccination rates among health care personnel (HCP) remain relatively low (i.e., < 60% as compared to the 90% benchmark established for 2020 by the Healthy People 2020 initiative. In this context, TJC recently extended applicability to all its accreditation programs (including BHC) and made other revisions to IC.02.04.01 EPs 1-4, 7 and 9 that became effective 7/1/12. The article provides a useful list of required accomplishments on page 15 that will facilitate compliance with the revisions. It also gives detailed advice for calculating vaccination rates as will be required by EP6 effective 7/1/13. To that end, “The Joint Commission also recommends using the specifications in Section 2a1 of NQF’s Measure Submission and Evaluation Worksheet 5.0 as the standardized methodology to calculate influenza vaccination rates for licensed independent practitioners and staff (available at http://www.qualityforum.org /WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=68275).”
Tip 1: Use the suggested worksheet. Review and evaluate your organization’s compliance with the revised standard against the 9 required accomplishments listed in the article on page 15.
Tip 2: For more details, see our RTN review of Joint Commission Revises Influenza Vaccination Standard: Applicability Extending to All Accreditation Programs in 2012 and the R3 Report on Influenza Vaccination (released 5/30/12)


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EC: AnchorTo Lock or Not to Lock? Guidelines for door locking in health care occupancies [PEARL: SFT] E C News Feb 2012, Pg 9 Vol 15, # 8

The need to have unobstructed egress and doors that open for fire safety versus the need to lock them to provide security and/or privacy sometimes conflict. Security alone has not always been considered a sufficient reason for locking doors. Psychiatric wards and areas housing patients that are prone to wandering (e.g., dementia) have generally been accepted as having a clinical need justification that has made the locking of doors permissible. The 2012 edition of NFPA 101 has expanded the locking criteria to address security needs in addition to clinical need for door locking. Although CMS does not yet recognize the 2012 LSC, TJC does address locking in the Basic Building Information (BBI) in its Statement of Conditions (SOC). As such, it may still be worthwhile for our facilities to be reminded of some of the basic requirements for allowable door locking such as:
• staff carry keys at all times (vs. have a set hanging at the nurses station), are available and well trained in the fire safety plan
• the hospital safety plan identifies staff that are to carry keys
• the hospital safety plan defines procedures and staff priorities for fire safety egress
Beyond this, one TIP mentioned in the article is to ensure that all locked doors are keyed the same. [PEARL] There is also a summary table of door locking options and allowable locking devices/circumstances with references to the related NFPA 101 2000 Edition exceptions on page 11. Finally, the article warns that a failure to address the essential issues in your Fire Safety Plan and to have appropriate rationale for locked doors in patient areas could result in an Evidence of Standards Compliance follow-up.


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[Index] [Blog] Perspectives [PR] – (August, Vol 32, # 8)

Pg01 AnchorJoint Commission Center for Transforming Healthcare Releases Targeted Solutions Tool for Hand-Off Communications FYI: RNx, RN. TJC’s Targeted Solutions Tool for Hand-off Communication was released on 6/27/12. It is designed to help caregivers prevent communication related errors when information is passed among caregivers. As with previous TSTs, this one is also an application that walks an organization through a series of steps designed to identify opportunities for performance improvement and provide guidance toward proven solutions most relevant to an organizations particular needs. More specifically the Hand-off TST should help:
• Evaluate the current hand-off processes
• Use a validated measurement system to determine need for improvement
• Identify areas of needed focus
• data collection (customizable forms)
The Hand-off TST has identified a number of specific causes for ineffective hand-offs along with solutions described in the mnemonic for SHARE:
• Standardize critical content. – e.g.,SBAR
● Hardwire within your system – e.g., using standardized forms
● Allow opportunity to ask questions – i.e., between senders and receivers of the info
● Reinforce quality and measurement – e.g., evaluating hand-off compliance and holding staff accountable
● Educate and coach – i.e., hand-off related teaching and training



[Index] [Blog] The Source [TS] (August Vol 9 # 8)

Pg10 AnchorCMS: Regulatory Changes Affect Deemed Status Organizations [REF: GB, IC, IM, JCSC, LDR, MDx, RNx] As previously reported, on 7/16/12, a revision of Conditions of Participation (CoPs) to allow hospitals more flexibility became effective. A 1-page summary of these revisions is provided in a table on page 11 of this article. For more details, see our RTN review of CMS-3244-F provided in a special expansion of the CMS section of our June newsletter.


[Index] [Blog] Environment of Care News [EC] (August Vol 15 #8)


Pg05 AnchorTClarifications and Expectations: Corridor Clutter Trashed, Part 1 What to put in a corridor and when without violating the Life Safety Code® FYI: JCSC, Last month we noted that the same article in the Clarifications & Expectations series (featuring George Mills) was presented in Perspectives and EOC News. TJC has done it again. There is a slight change in the title (from Managing Corridor Clutter—Part 1 to Corridor Clutter Trashed, Part 1), a subtitle has been added (What to put in a corridor and when without violating the Life Safety Code®) and a new 2-sentence introduction. Otherwise, it is the same article with almost exactly the same content and section headings. Refer to our review of the article in Perspectives above.

Pg08 AnchorTraditional Equivalencies CMS permits use of certain sections of the 2012 Life Safety Code®[Ftxt] FYI: EOC, LDR, SFT, This is the same article published under the same title 2 months ago in Perspectives. Click on [Ftxt] above for a full text download. For more details and a download of S&C12-21-LSC referenced in the article, see our June 2012 RTN review of Traditional Equivalencies: CMS Permits Use of Certain Sections of 2012 LSC Perspectives (June, Vol 32, # 6) pg7 Life Safety Code®.


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Quarterly Provider Updates

Mid-Quarter Instructions

Spotlight/What’s New

  • Survey and Cert Letter 12-36 [PDF, 87KB]: (6/15/12) Revised Hospital Conditions of Participation (CoPs) – Governing. The revised regulation at 42 CFR 482.12 requiring inclusion of one or more members of the medical staff on a hospital’s governing body has raised numerous questions and concerns. Consequently, CMS is reviewing this issue and will reconsider it in future rulemaking. Effective 7/16/12, CMS is instructing all surveyors (AOS, DNV and TJC) not to interpret on their own the requirement concerning medical staff membership on the governing body, and to not issue citations related to this specific provision.
  • Survey and Cert Letter 12-35 [PDF, 124KB] (6/15/12) Safe Use of Single Dose/Single Use Medications to Prevent Healthcare-associated Infections. Under certain conditions, it is permissible to repackage single-dose vials or single use vials (collectively referred to in this memorandum as “SDVs”) into smaller doses, each intended for a single patient…


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Joint Commission Online(JCO) & Website


SPHCC Library Additions & Full Text Articles

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ALL: Everybody, CHP: Chaplain, C&P: Credentialing & Privileging, E&M: Engineering & Maint, EOC: Environment of Care, FB: Finance/Business, FdDt: Food services/Dietary, GB: Gov Body, HR: Human Resources/Personnel, HST: Human Service Tech/Aid, IC: Infection Control, IM: Info Mgt/Med Records, IT: Info Technology, JCSC: Jt Com Survey Coordinator, LDR: Leadership/Mgt, MEC: Med Exec Committee, MD: Medical Staff, ofco: Officer and/or Committee, PI:Performance/Quality Improvement com/dept, PPR: PPR team mbrs/ldrs, P&T: Phrm & Therapeutics Com, Phrm: Pharmacy,PSY: Psychology, PtAd: Patient Advocate, PtEd: Patient Education, RHB: Rehab/Activity Therapy, RN: Nursing, SFT: Safety,StEd: staff ed & training dept, SW: Social Work, TxTm: Treatment Team, UrUm: Utilization Review/Management,X: Exec, Dir or Chief (e.g., MDx = Medical Director)
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