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Hospitals face growing financial challenges, ratings agencies say

Fri, 27 Jan 2012 15:59:00 GMT

Not-for-profit hospitals in the US face increasing financial pressures, two top credit rating agencies reported n January. Moody’s Investors Service reports that the outlook for hospitals looks negative for 2012, and Standard & Poor’s Rating Service says that “an increasingly difficult operating environment” will adversely impact hospital credit quality and ratings.

Among the challenges identified by Standard & Poor’s are tighter revenues, weaker payer mixes, lingering impact from the recession and health reform.

The Moody’s report can be found here; Standard & Poor’s can be found here (password required).

Point of Care Coordinator of the Year seeks nominees

Fri, 27 Jan 2012 15:52:00 GMT

The American Association of Clinical Chemistry Clinical Point of Care Testing (CPOCT) Division is accepting nominations for their 2012 Point of Care Coordinator of the Year Award.

Nominations are due March 15. For more information on how to nominate a colleague, visit here.

Two new accreditation decision rules approved

Fri, 06 Jan 2012 14:59:00 GMT

Effective January 1, 2012, two new accreditation decision rules have been approved by The Joint Commission for the Contingent Accreditation decision category. Both require the organization in question to resolve its Contingency Status within one year.

The first of these new rules applies to an organization has completed its first Joint Commission survey for deemed status and receives a Requirement for Improvement (RFI) related to a condition level finding. The second is for an organization undergoing its first Joint Commission survey and demonstrates systemic patterns or trends of noncompliance with the accrediting body’s standards.

A third decision rule has been moved to the Contingent Accreditation decision category, when possible fraud or abuse has been identified within an organization. There has been some slight changes to the language of this decision rule.

For full details on these changes, visit The Joint Commission’s website.

From the AHAP Blog: Joint Commission releases latest Survey Activity Guide

Fri, 06 Jan 2012 14:56:00 GMT

The AHAP Blog reports that The Joint Commission has released the 2012 Survey Activity Guide. This annual publication, made available directly through The Joint Commission’s website, is intended to help hospitals prepare for their on-site survey.

The guide also includes a list of activities during an on-site, suggested participants, objectives, and a general overview of the session.

For more information on the 2012 Survey Activity Guide, visit The Joint Commission’s website.

Greeley Reflections

Mon, 06 Sep 2010 17:20:00 GMT

Medication Management and pharmacist first-dose review

Part 7 of 7

Performance review and improvement

A good way to test your process is by incorporating ongoing tracers, along with retrospective record review, for each of your medication administration sites to identify issues or vulnerabilities related to the first review of medication orders. At a minimum, orders written and processed at various hours of the day and on weekends should be reviewed. The hospital is required to evaluate the effectiveness of its medication management system anyway so this can be incorporated into the process. Review the monthly manual override lists for trends on units and in the organization. This way you will be able to identify breakdowns in your process and will allow you to target specific interventions to the problematic areas.

Greeley Reflections

Mon, 30 Aug 2010 17:18:00 GMT

Medication Management and pharmacist first-dose review

Part 6 of 7

Provide 24/7 accountability

Even when a pharmacy is not open 24/7 a “qualified” individual must perform a review prior to dispensing and, even then, a pharmacist must be on-call so that expertise is available. A retrospective review of orders must then be completed as soon as a pharmacist is available. There is also the expectation that any discrepancies be resolved prior to dispensing the medications.

The practice of allowing nursing staff to review new medications and administer a drug without pharmacy review first still exists in some hospitals. However, ASHP recommends that hospitals have a policy and procedure in place which allows for after-hours emergency access to medications only post authorization from the on-call pharmacist. Your process should be routinely evaluated to determine what the accessed off hours drugs were, the amounts withdrawn and what their intended use was to determine if any changes are needed. For example, this evaluation might lead to additions to the stock medications supply for approved protocol initiation such as for DVT.

Greeley Reflections

Mon, 23 Aug 2010 17:15:00 GMT

Medication Management and pharmacist first-dose review

Part 5 of 7

Evaluate care sites

There are care delivery areas in which medications are not typically needed urgently or are not LIP-controlled environments where it doesn’t make sense to bypass the pharmacist review requirement in the first place. Consider removing those medications not determined to be reasonably needed urgently from these sites to reduce the amount of unwarranted manual overrides. This would require pharmacy to release the medications only after a pharmacist’s initial evaluation.

Greeley Reflections

Mon, 16 Aug 2010 17:12:00 GMT

Medication Management and pharmacist first-dose review

Part 4 of 7

Meeting the requirements continued

Pharmacist Access to Patient Information

In order to provide the best recommendations, pharmacists need ongoing access to patient information. Pharmacist review is only as encompassing as the availability of patient-specific information.. Consider access to other valuable data such as:

Histories and physicals, laboratory results and other documents located in the medical record
Information needed for prospective therapeutic medication monitoring such as for maintaining patient profiles.

Automated medication systems

Although useful in increasing efficiency and accuracy, automated medication dispensing systems should be set up with a built-in first-dose profile requirement for pharmacists’ review prior to staff being able to administer medications except in urgent situations. This permits a pharmacist to intercede ahead of time, if necessary.

Greeley Reflections

Mon, 09 Aug 2010 17:07:00 GMT

Medication Management and pharmacist first-dose review

Part 3 of 7

Meeting the requirements

Your goal should be to develop processes that do incorporate pharmacy review of all medications prior to administration except in an emergency situation, physician controlled area, or where established, approved guidelines exist. Approved situations might include the implementation of a stroke protocol, the recovery of a patient in the PACU or in outpatient radiology where pre-procedural screening criteria exist. Of course, even though a first-dose review is not required in these circumstances, pharmacy should be consulted if there are questions or potential issues related to the medications that are being planned or administered.

Greeley Reflections

Mon, 02 Aug 2010 17:02:00 GMT

Medication Management and pharmacist first-dose review

Part 2 of 7

The Hospital Requirements

In the standards for medication management, The Joint Commission requires that prior to dispensing, a pharmacist reviews all newly ordered medications except in areas controlled by a Licensed Independent Practitioner (LIP) (e.g. Emergency Department) or in an urgent situation in which a delay would adversely affect the patient. It also requires that medications be dispensed in accordance with professional standards of practice.

CMS’s Interpretive Guidelines (§482.25(b) requires a pharmacist review of medications prior to dispensing except in emergencies as well. CMS also requires that guidelines, protocols, policies and procedures be developed for the appropriate control and distribution of medications. Aside from federal and state law, CMS is very clear that pharmacy services must be in implemented utilizing standards and guidelines promoted by professional organizations such as the FDA, NIH and the American Society of Heath-System Pharmacists (ASHP) and that these principles be maintained in the process you implement. Although ASHP Guidelines recommend that medications be reviewed by a pharmacist before patient administration, they also allow for exceptions when an established procedure exists for medications used in specific treatment circumstances. So if a standardized, approved process is implemented, setting or circumstance-specific exclusions to the pharmacy first-dose review can occur.

Greeley Reflections

Mon, 26 Jul 2010 19:12:00 GMT

Part 1 of 7

Medication Management and pharmacist first-dose review

Patients want and expect that every safeguard is in place when receiving health care services. The challenge is how to make this happen with the complexities of the system in which health care is delivered as safe medication practices lies within the purview of multiple individuals. A 2006 study by the Institute of Medicine showed that there is approximately one medication error per day totaling 1.5 million per year and it is noted that miscommunication between physicians, pharmacists and nurses is a common cause. The requirements of both CMS and The Joint Commission address the critical processes of a safe and effective medication management system and both have been proponents of utilizing pharmacists’ expertise and involvement in the ordering of medications.

Healthcare systems with more than one hospital can opt for concurrent survey

Mon, 26 Jul 2010 18:19:00 GMT

Those healthcare systems with more than one hospital or other accredited body organized as a single system can now opt for a concurrent survey, The Joint Commission said on an official statement on its website. The concurrent survey option is available to those organizations within any Joint Commission accreditation program.

The concurrent survey brings value to the accreditation of health systems by:

Looking at how the system develops and implements systemwide policies, procedures and functions
Sharing leading practices from one site in the system that could be adopted at other sites within the system (for example, the process of ongoing professional practice evaluation for medical staff)
Identifying opportunities for standardization across the system
Identifying potential solutions for implementing complex standards and National Patient Safety Goals
Increasing communication and collaboration among organizations within the system regarding quality and safety issues

To read more on the story, click here.

HHS announces final rule on meaningful use

Mon, 26 Jul 2010 18:16:00 GMT

The Department of Health and Human Services (HHS) announced its Final Rule on Meaningful Use, according to an official statement on its website. The rule, intended to spell out exactly what will constitute healthcare parties’ appropriate use of electronic health records, has been anticipated since the proposed rule was released in January. HHS Secretary Kathleen Sebelius, National Coordinator for Health Information Technology David Blumenthal, and newly named CMS Administrator Don Berwick were on hand to make the announcement.

The Final Rule stipulates that those entities that are considered meaningful users in 2011 and 2012 will receive incentive payments. Based on comments concerning the proposed rule, HHS decreased the number of objectives that hospitals and physicians must meet. They have also divided the objectives into two sets: a core set, of which all must be met, and a menu set, of which five out of ten must be met.

The Meaningful Use requirements are a stipulation of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009. The act provides funding for the adoption of electronic health records.

To read more on the story, click here.

New survey reveals catheter-related bloodstream infections are still an issue

Mon, 19 Jul 2010 21:40:00 GMT

A recent survey conducted by the Association for Professionals in Infection Control and Epidemiology reveals that catheter-related bloodstream infections (CRBSIs) are still a problem, according to the Wall Street Journal Blog. Two thousand and seventy-five respondents—mostly infection prevention specialists—participated in the survey.

The results from the survey revealed:

40% of respondents said their facility had been “actively focused" on efforts to reduce central line, dialysis line, and port-related infections for five or more years
48% of survey respondents reported that CRBSIs are at least somewhat of a problem at the facility where they work
12% said CRBSI infections are not a problem at all

Additional findings in the survey, can be found by clicking here.

To read more on the story, click here.

Joint Commission focuses on safe injection practices

Mon, 19 Jul 2010 21:37:00 GMT

All hospitals receiving Joint Commission accreditation will now have to pay special attention to safe injection practices, according to an official statement on The Joint Commission's website. The Joint Commission will be paying close attention to make sure care providers follow standard precautions for disease-free injections, as many organizations fail to follow correct practices, even though some believe to conduct safe injection practices.

All Joint Commission accredited organizations (ambulatory, behavioral healthcare, critical access hospital, home care, hospital, laboratory, long term care, and office-based surgery programs) are required to follow relevant scientific guidelines for infection prevention per IC.01.05.01 Element of Performance 1 (EP), and safe injection practices are a key component of standard precautions required per IC.02.01.01 EP 2.

To read more on the story, click here.

Greeley Reflections

Mon, 19 Jul 2010 21:29:00 GMT

It’s Time to dust off staffing effectiveness: Implementation Date July 1, 2010

Part 5 of 5

On July 1, 2010, the Joint Commission resumed surveying for the new version of Staffing Effectiveness. So, what does that mean to health care organizations? Keep it simple and address the needs of your organization.

Step #4: During review, develop a concise, written report of the results of any analysis when staffing effectiveness/adequacy was a potential or contributing factor in an adverse outcome.

Keep this process clean and clear.
Review your reporting structure and think about imbedding a column that simply indicates a yes/no or check mark that staffing effectiveness was a factor. This simply and clearly highlights the staffing effectiveness issue to the organizational leaders.

Joint Commission looks to refine, improve tracer methodology

Mon, 12 Jul 2010 14:43:00 GMT

The Joint Commission is looking to refine and improve its tracer methodology, according to an official statement on its website. The Joint Commission hopes to integrate patient care tracers and patient system tracers to thoroughly evaluate selected high risk or problem-prone processes.

The refinements will focus on seven areas:

Cleaning, disinfection and sterilization of medical equipment, devices and supplies
Patient flow
Contracted clinical services
Diagnostic radiation services
Therapeutic radiation services
Clinical information systems
Ongoing Professional Practice Evaluation/Focused Professional Practice Evaluation (OPPE/FPPE)

To read more on the story, click here.

Berwick appointed to head CMS

Mon, 12 Jul 2010 14:37:00 GMT

President Barrack Obama has appointed Donald Berwick, MD, president and co-founder of the Institute for Healthcare Improvement, as the Centers for Medicare and Medicaid Services (CMS) administrator. Berwick, who was nominated for the position back in March, was supposed to have gone through a Senate confirmation hearing. However, President Obama has decided to use his executive power to bypass the Senate hearing and appoint Berwick.

There was expected to be some debate over Berwick’s ability to serve, mainly based on his previous expressions of admiration for the British National Health Service, as well as some fear of his thoughts on rationing. However, many in the healthcare industry will see his appointment as a huge win. Berwick has been a patient safety and quality improvement advocate for years, and his leadership will be greatly valued at the CMS.

To read more on the story, click here.

Greeley Reflections

Mon, 12 Jul 2010 13:41:00 GMT

It’s Time to dust off staffing effectiveness: Implementation Date July 1, 2010

Part 4 of 5

Step #3: Keep your leaders informed related to actions required/taken when staffing issues have been identified as an issue. Consider defining a time line for reporting. Do you inform leadership at the time staffing effectiveness is being considered as a contributing factor, during the review process, or wait until the determination has been made that staffing effectiveness contributed to the adverse outcome? By defining the process, you are developing a consistent and reasonable way to manage the expectation.