Quality & Patient Safety

Quality & Patient Safety Headlines

  • High hospital C-section rates will be published online in 2020

    Next year, patients and potential parents will have one more metric by which to judge your hospital. Starting July 2020, The Joint Commission (TJC) will publicly report hospitals that have consistently high C-section rates on its Quality Check website.
    Hospital rankings will be based on TJC’s perinatal care (PC) Cesarean Birth measure PC-02. Hospitals accredited by TJC are already required to report that data to the accreditor, but this will be the first time it’ll be visible to the public.
    TJC will only track the number of C-sections done on nulliparous, term, singleton, vertex (NTSV) births—procedures performed on first-time mothers carrying a single baby that has its head facing down at the onset of labor.

  • Q&A: Legal marijuana use in hospitals

    While still illegal federally, there are currently 33 states that have legalized marijuana for medical use. At the moment, the laws on this topic are very dependent on where your facility is located, and you should take the time to look up your state laws.

    This Q&A is meant to clear up some of the broader questions around medical cannabis in healthcare—for patients as well as healthcare employees.

    This Q&A has been lightly edited for clarity.

    Benjamin Caplan, MD,
    is the founder of the CED Clinic and a spokesman for Doctors for Cannabis Regulation, the only national physicians’ association dedicated to the effective regulation of cannabis in the United States. 

    Q: If a patient has a valid medical marijuana recommendation, is he or she allowed to bring it to the hospital? Say if they’re going to be there for an extended period of time or overnight?
    That’s a policy question for hospitals. There are places in the United States where it’s legal to bring [medical cannabis] to a hospital, although they would not be administering it. But it’s different region to region.
    I think there’s a legal question and an ethical question. State laws are telling medical patients that they are allowed to have a choice to use this particular medicine. Hospital policies are quite different, and for good reason. In order for doctors to best manage illnesses carefully, and to the best of our abilities, we must know as much as we can [about] what a patient is taking. But it’s very common for patients to sneak cannabis in back rooms or under the radar, which is really unfortunate for everyone. I think the hospital perspective should be embracing what patients find helpful.
    To have cases where patients are having seizures in a hospital and they can’t get the medicine that they want (and find helpful) as an outpatient is a real cultural disconnect for the medical establishment. I think the solution is for people to not sneak around; the solution is for hospitals to open their arms to patients who find a medication helpful. 

  • Talk down: Joint Commission on de-escalation

    At 10 p.m. on May 20, 2018, a patient was transported by the fire department to Loretto Hospital in Chicago and put into a wheelchair in the emergency department. It was a Friday night, and the patient had been brought in for alcohol abuse.

    About an hour later, the patient and a patient care technician (PCT) got into a heated verbal altercation. The patient then got up from his wheelchair and walked toward the PCT. Another staffer tried to stand between the two, but the PCT pushed the patient “very hard.” The patient fell and hit his head on the front of his hospital bed, “causing a deep laceration to the head.”

    CMS later cited the facility for violating the patient’s right to be free from abuse and harassment.

    This case study is one of many similar incidents that can be found on HospitalInspections.org. Put yourself in the shoes of the participants: If you were the PCT in this situation, what would you have done? What if you were the staffer who tried to stop the fight—what would you have done to get the other two to calm down? If your employees had been involved, what do you think they would have done?

  • Depression screening and treatment

    Depression is the leading cause of disability worldwide, and 16.2 million Americans experienced a major depressive episode in 2016. It’s also closely tied to suicidal ideation—a major concern of The Joint Commission and CMS. But despite clear guidelines saying providers should screen for depression and provide follow-up and treatment, it’s the fourth least-reported measure on the Medicaid Adult Core Set. And only seven states report depression screening and follow-up data.

    In the January edition of The Joint Commission Journal on Quality and Patient Safety, a study named “Not Missing the Opportunity: Improving Depression Screening and Follow-Up in a Multicultural Community” was published by Ann M. Schaeffer, DNP, CNM, and Diana Jolles, PhD, CNM, at the Harrisonburg Community Health Center (HCHC) in Virginia. Set in a diverse city in Virginia, researchers showcased ways to overcome cultural and language barriers to depression treatment. The study looked at methods to improve the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach for depression. Originally developed for identifying and treating substance abuse disorders, SBIRT has been successfully applied to other chronic health conditions and has demonstrated improved outcomes for depression.

  • Examine your dialysis space to ensure room to separate infectious patients

    Hemodialysis is one of four areas The Joint Commission (TJC) says it’s increasing focus on during surveys. With this in mind, ensure that your hospital’s hemodialysis patients remain in clear view of staff while undergoing the procedure. In addition, make sure there’s enough space to separate patients with respiratory illnesses, fevers, fecal incontinence, or other infectious conditions.

    That includes a way to care for dialysis patients with hepatitis B completely separate from non–hep B dialysis patients—using a curtain for separation is not enough, warns Kathleen Good, MSN, RN, a former surveyor with TJC and now an associate of Patton Healthcare Consulting, which is based in Naperville, Illinois.

    In a November 7 blog post, Andrew Bland, MD, MBA, MSAP, FAAP, FACP, medical director of TJC’s Division of Healthcare Quality Evaluation, wrote that among other infection control practices for hemodialysis, surveyors will be observing water and dialysate testing, medication storage, preparation and administration, and “patient placement in full view of staff during dialysis treatment.”

    What this means, says Good, is that patients must be observable at all times for their safety. In particular, staff must be able to see “dialysis lines where they are connected to the bovine graft, AV fistula, intrajugular catheter, or Permacath™,” she says. Staff must also be able to hear and see the dialysis machines as patients are undergoing dialysis.

  • Suicide Prevention National Patient Safety Goal updated

    The Joint Commission (TJC) announced revisions to its suicide prevention National Patient Safety Goal (NPSG) November 27. NPSG 15.01.01 now has seven elements of performance (EP), up from three. All the changes are listed in R3 Report 18 and will take effect July 1, 2019. The update applies to all TJC-accredited hospitals and behavioral healthcare organizations.

    The report says the new EPs aim to improve quality and safety of care for patients treated for behavioral health conditions and who are identified as high-risk for suicide. TJC officials say the revised requirements are based on more than a year of research, review, and analysis with multiple panels convened by TJC and representing provider organizations, suicide prevention experts, behavioral facility design experts, and other key stakeholders.

    “The science of suicide prevention has really advanced over the past few years, including better tools for screening, assessment of suicidal ideation, identification of environmental hazards in health care facilities, and methods to prevent suicide after discharge,” said David W. Baker, MD, MPH, FACP, executive vice president of TJC’s Division of Health Care Quality Evaluation, in a release. “We had not updated the NPSG since its original release in 2007. This revised version and the accompanying resource compendium will more robustly support health care organizations in preventing suicide among patients in their care.”