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Issue 35, September 12, 2019

• What can we do about medical device security?

  The risks range from exposing patients’ sensitive data to outright hijacking of devices, with...

Issue 34, September 5, 2019

• FDA: Use duodenoscopes with disposable parts to prevent infections

  Disposable designs simplify or eliminate the need for reprocessing, which may reduce...

Issue 33, August 22, 2019

• Ensure compliance with EPA rule: Ban all sewering of hazardous waste drugs

  The August 21 ban on the sewering of hazardous waste pharmaceuticals is the first deadline set out...

• Q&A: ISMP President Discusses Medication Safety

  In this interview, Michael R. Cohen, RPH, MS, ScD (hon.), DPS (hon.), FASHP, founder and president...

• MGH Data Breach Affects 9,900 People

  Nearly 10,000 people are being notified by Massachusetts General Hospital that an unauthorized...

Issue 32, August 15, 2019

• 7-Part EMS screening tool boosts early sepsis treatment

  Conducting a sepsis screening during emergency medical service transport to an emergency department...

Issue 31, August 8, 2019

• New sentinel event alert highlights risks of direct oral anticoagulants

  The Joint Commission (TJC) this week issued a new Sentinel Event Alert (SEA #61) warning...

• Leapfrog leader pushes for adoption of expanded medical error policy

  Leapfrog is promoting a nine-point Never Event Policy to help health systems and hospitals address...

Issue 30, August 1, 2019

• Multiple injection safety violations led to NJ outbreak

  Multiple violations of injection safety and infection prevention practices contributed to a 2017...

• CMS unveils sweeping mandates on hospital pricing transparency

  Under the proposed rule hospitals would have to make their 'real, negotiated prices known to...

• Webinar: Preventing Suicides and Eliminating Ligature Risk in 2019

  Presented on: Tuesday, September 10, 2019 1:00-2:30 p.m. Eastern Register at...

Issue 29, July 25, 2019

• The chronic issue of cybersecurity

  Healthcare institutions large and small can be left black and blue by a cyberattack.

• How can we better protect hospital workers from hazardous drugs?

  There are pros and cons to most things in life, and chemotherapy is no different. While it can be...

Issue 28, July 18, 2019

• New decision support tool reduces sepsis mortality by 22.9%

  “The SPOT algorithm surveils 24 hours a day, seven days a week to look for the signs and...

Issue 27, July 11, 2019

• Mold found in Seattle Hospital ORs leads to one death, five infections

  Seattle Children’s hospital said this week one patient died and five others have been...

• Déjà vu all over again: A new ligature resistant FAQ!

  Using the Hospital FAQ page as the baseline, I reckon we’ve got about a dozen FAQs dealing...

Issue 26, July 2, 2019

• NQF calls for quality improvement in Emergency Care

  The National Quality Forum (NQF) recently released a series of recommendations calling for the...

• Incomplete processes, insufficient documentation were top concerns in HFAP surveys

  A new report released by the Healthcare Facilities Accreditation Program (HFAP) says its surveyors...

• HSI returns to regular schedule next week

  Hi everyone, We're sending this edition of Hospital Safety Insider out a day early because of the...

Issue 25, June 27, 2019

• New TJC building and antibiotics requirements for 2020

  Two new requirements from The Joint Commission (TJC) for the Life Safety and Medication Management...

• One size fits all...or one size fits none

  In a world in which the economies of scale don’t always economize, I keep running into...

• Don't Call It A Comeback: The Statement of Conditions breathes again!

  Not a whole lot going on in the July 2019 issue of Perspectives, but it appears that a little more...

Issue 24, June 20, 2019

• Study finds healthcare workers often provide care while ill

  Many healthcare workers may be putting patients at risk by continuing to work when they have...

• Making stock, taking stock: Emergency inventory madness!

  In trolling The Joint Commission’s FAQ page for interesting tidbits to share, I came across...

Issue 23, June 6, 2019

• Language access: Meeting patient needs while increasing compliance and improving outcomes

  The growing LEP population across the nation is creating an increased demand for language access...

• Some FAQing for your reading pleasure

  This week finds us (once again) visiting with our friends from Chicago as they stand astride the...

Issue 22, May 30, 2019

• Crisis communication: 10 tips for hospitals to prepare for a disaster

  Hurricanes, floods, fires, and other natural and manmade incidents can strike anytime, anywhere...

• Dry your eyes: Keeping ahead of the water(s)

  One of the more ubiquitous findings in my travels are those relating to water...

Issue 21, May 23, 2019

• Seattle Hospital shuts down ORs after finding fungus

  Seattle Children’s Hospital shut down four of its 14 operating rooms (OR) this week after...

• Carbon-dating compliance: What happened when?

  First up, in looking back over the last little while of survey activity, I keep looping back...

• Patient Handoffs: Stop Errors and Improve Compliance

  Presented on: Thursday, June 27, 2019 | 1:00–2:30 p.m. Eastern Register at...

Issue 20, May 16, 2019

• Suicide risk NPSG requirements clarified

  Element of performance (EP) 3 requires that the suicide risk assessment include risk factors, which...

Issue 19, May 9, 2019

• CMS proposed rule would strengthen oversight of AOs

  The Centers for Medicare & Medicaid Services unveiled a proposed rulerequiring...

• I got those low-down TJC FAQ blues

  It would be nice to think that perhaps folks are going to be allowed to move on at their own...

Issue 18, May 2, 2019

• Prioritize sepsis assessments in your overcrowded emergency department

  Emergency department crowding leads to a significant increase in door-to-antibiotic time for...

• EOC orientation and ongoing education

  A week or so back, I received an email encouraging me to list what educational competencies are...

Issue 17, April 25, 2019

• In-hospital delirium predicts readmissions

  The development of delirium in the hospital setting impacts about 12.5% of general medical...

• Behavioral health and egress

  In response to last week’s modified Top 10 list (there’s been a request for another...

Issue 16, April 18, 2019

• FDA: Problems Persist With Duodenoscope Reprocessing

  Despite progress made with the reprocessing of duodenoscopes over the last few years, the Food and...

• Steve Mac's top 10 most troublesome EC challenges

  The image that stayed with me was during a scene on a maternity unit in a hospital where I observed...

Issue 15, April 11, 2019

• Multidrug-resistant infections can cost $4,600 per hospital stay

  Infections linked to multidrug-resistant organisms (MDROs) cause a significant cost burden for...

• One of your sprinkler heads is loaded: Can you find it before they do?

  And now, to the recap of the 10 most frequently cited standards during all of 2018 (in hospitals...

Issue 14, April 4, 2019

• Once Again, Safety Issues Top List of Most-Cited TJC Standards

  Hospitals continued to struggle with safety issues in 2018, according to The Joint...

• Wagering on a sewer thing: How are you managing wastes during an emergency?

  Burn, bury, or dump it—apparently there is madness in the method—and your plan needs to...

Issue 13, March 28, 2019

• Joint Commission to publicly report C-sections

  Starting July 2020, The Joint Commission (TJC) will publicly report hospitals that have...

• Immediate Jeopardy: How much do you want to wager?

  Over the last couple of weeks, the folks at the Centers for Medicare & Medicaid Services (we...

Issue 12, March 21, 2019

• Cost of sepsis readmissions exceeds $16,000 per patient

  The annual estimated cost of sepsis readmissions is about half the annual cost of all four of the...

• Keeping an eye on things: Managing behavioral health patients

  Recently, our friends in Chicago added a new FAQ to the canon, this time reflecting on the use of...

Issue 11, March 14, 2019

• SHEA Urges Increased Focus on Preventing Superbugs

  Progress against methicillin-resistant Staphylococcus aureus (MRSA) infections has slowed in...

• It's been a long time: Revisiting an EOC perennial

  Setting the wayback machine for the dark ages of safety (well, 2011 or so), we come to the last...

Issue 10, March 7, 2019

• CMS Memo Emphasizes Revisions on Portable Generators, Emerging Infections

  Review and update your all-hazards risk assessment for emergency preparedness to insure it includes...

Issue 9, February 28, 2019

• Learning from a ransomware attack on your hospital

  It’s breach season. That’s what Ron Pelletier, founding partner of Pondurance, a...

• Waste not, want not: The rest of the CMS Emergency Preparedness picture

  I think it is very clear that hospitals, et al., are going to be able to plot their own course...

Issue 8, February 21, 2019

• Challenges of antibiotic stewardship in the ICU

  Antibiotic stewardship in the intensive care unit setting poses unique challenges to intensivists...

• Workplace Violence Prevention Symposium 2019

  The nation’s leading workplace violence prevention event is back for 2019! Workplace...

• Waste not, want not: The rest of the CMS Emergency Preparedness picture

  Moving on to the rest of the guidance document (it still lives here), I did want to note one last...

Issue 7, February 14, 2019

• Hospital-Acquired Conditions drop 13%

  Hospital-acquired conditions dropped 13% from 2014 to 2017; from 99 per 1,000 acute care...

• CMS isn't done with emergency preparedness

  As we’ve discussed once or twice over the years (decades?!?), emergency preparedness is a...

Issue 6, February 7, 2019

• Webinars on New Hazardous Waste Pharmaceuticals Rule Rescheduled

  The Environmental Protection Agency has rescheduled informational webinars on the upcoming...

• Power Up: When your generator doesn't carry a 30% load

  Particularly for smaller facilities (or, I suppose, big places with multiple generators...

Issue 5, January 31, 2019

• Four Steps to Manage Antibiotics in Acute Care Settings

  A four-phase approach to prescribing and managing antibiotics focuses on critical time points to...

• Power Up: When your generator doesnt carry a 30% load

  Particularly for smaller facilities (or, I suppose, big places with multiple generators...

Issue 4, January 24, 2019

• Why Auditing Catheter Dislodgement is a Patient Safety Must

  Dislodgement of venous access devices such as catheters is widespread and underreported, a survey...

• E to the E to the E to the E: Next step(s) towards a reporting culture

  Thinking that this may have gotten lost in the year-end shuffle, I wanted to take a moment to cover...

Issue 3, January 17, 2019

• Joint Commission: How to improve patient depression screening and treatment

  A new study published in The Joint Commission Journal on Quality and Patient Safety showcases four...

• In security we trust, insecurity we fear: Are you up for a challenge?

  Last week we started noodling on where things might go from a regulatory/accreditation perspective...

Issue 2, January 10, 2019

• CMS’ hospital readmission reductions program’s impact downgraded

  Gains from Medicare's most prominent readmissions reduction initiative have been overstated, recent...

• Manage the environment, manage infection control risks

  In looking back at 2018 (heck, even in looking back to the beginning of 2019—it already seems...

Issue 1, January 3, 2019

• Financial Penalties in Hospital Readmissions Linked to Higher Mortality

  Using financial penalties to reduce hospital readmissions has been linked to a significant rise in...

• More Than 50 Nurses, Staff at NYC Hospital Sickened by Mold

  Mold found in Staten Island University Hospital North’s maternity unit is being blamed for...

• Three Ways to Limit Overprescribing Antibiotics in the Urgent Care Setting

  Antibiotics stewardship at urgent care centers is in the spotlight after the release of a pair of...

• Philo-safety: Improving our practice in 2019

  In case it has not become abundantly clear over the last decade or so of penning this blog, there...

Issue 25, June 13, 2019

• Incomplete processes, insufficient documentation were top concerns in HFAP surveys

  A new report released by the Healthcare Facilities Accreditation Program (HFAP) says its surveyors...

Issue 20, May 16, 2019

• CMS ligature risks codified!

  While I have little doubt that we will yet again revisit the management of ligature risks and...