SDS Accreditation Update
With NPSG compliance problems facilities face now, where do you stack up?
Although the National Patient Safety Goals (NPSGs) have been out for several years, outpatient surgery programs, as well as other health care providers, still struggle to comply.
"I think they're struggling with many of the National Patient Safety Goals, but medication reconciliation was a particular hardship," says Grena Porto, RN, ARM, CPHRM, principal of QRS Healthcare Consulting Inc. in Hockessin, DE, who has worked with The Joint Commission's patient safety advisory group. The universal protocol also continues to pose challenges, she says.
In 2003, when the NPSGs first were rolled out, they were pretty straightforward, Porto recalls. As they have progressed, though, they've "become more complicated, because all the 'low-hanging fruit' is gone. What is left is the hard stuff, like medication reconciliation," she says.
It is becoming increasingly difficult to create a "one-size-fits-all goal," Porto says. Experts say the No. 1 goal usually cited as troublesome for health care facilities is medication reconciliation. In a nod to this, The Joint Commission itself has taken this goal out of play in the accreditation decision and in generating any requirements for improvement for 2009. "Hallelujah!" says Porto. It has been a while in coming, she adds.
In the most recent compliance data posted on The Joint Commission's web site, 22% of hospitals and 22% of ambulatory organization did not comply with this goal in the first half of 2008.
"[E]verywhere I go, they're struggling with it," Porto says, and from her perspective, the compliance issue gets to the very core of the health care industry as it is now: fragmented. "It's because we don't have a real health system. Instead, we have a patchwork of providers, and none of the components speaks to one another or even use the same language," she says.
Porto says this problem is compounded, or perhaps caused, by two things: There is no universal health record, and the manner in which the health care culture has cast the patient, in a very passive, nonproactive role. She thinks patients must be more active in their own health care. "Even then it's a stretch," she says, "because the system is so fragmented."
Medication reconciliation won't work unless the patient "owns" the list, "because they're the only common denominator between all the health care settings and providers that the patient travels through," Porto says. "I think that's an example of a goal that people are really struggling with, and that has failed as a goal just because there is not an infrastructure for it."
Unfortunately, neither patients nor health care in general are yet set up to see the patient as the active participant, Porto says. "When you look at what percentage of patients have all of their updated information, even ask for it or care about it or display any interest in it, it's a real minority," she says.
Following a theoretical patient through the hospital, Porto says, the first problem with med reconciliation occurs upon admission when the patient is asked what medications he or she is on. Often, they might not know the name or dose of the drug. For instance, Porto says, they might just say, "I take a heart pill."
So, she says, you start off with an incomplete list. "The system of multiple, unaffiliated providers who don't communicate means that there's really no way for anyone other than the patient to know what a patient is taking," Porto says. "And then there's the whole issue of patients not being complete or truthful, either intentionally or unintentionally, they leave stuff out. Now you're relying on the memory of the patient, and that's not always so good. It's kind of a huge big mess, no matter how you slice it."
There's a lot of work involved with med reconciliation, and it's a cumbersome process, agrees Kathleen Catalano, RN, JD, director of healthcare transformation support for Perot Systems Corp. in Plano, TX. Catalano suggests providers "literally need to walk through the whole process and look at the handoffs, just like we do with everything to see where the problems are."
Inherent in the medication reconciliation problem is the problem of active handoff communication.
"I think it's hard to find the next provider of care," Catalano says. "We should be making sure we get it to the family, at least, which may seem elementary, but we have to get it to someone," she adds.
Facilities using electronic medical records are having an easier time with med reconciliation, says Darla Farrell, RN, BS, FACHE, CPHQ, who consults with hospitals on accreditation-related compliance and mock surveys and works in the compliance department of Kindred Healthcare in Louisville, KY.
Farrell points to the level of sophistication of the technology that the facility has, "because I'm finding that hospitals that have a higher level of sophistication in their IT departments are finding it much easier to accomplish," she says.
SDS Accreditation Update Programs struggle to label all medications One of the National Patient Safety Goals (NPSGs) that providers struggle with the most is requirement 03.04.01 to label all medications. The latest statistics posted by The Joint Commission, for the first half of 2008, show that 19% of ambulatory organizations and 18% of hospitals failed to comply with this goal. Surveyors have been known to say, "If it hits the table, it needs a label." Syringes shouldn't normally be labeled, then filled, says Ginny McCollum, MSN, RN, an associate director of standards interpretation at The Joint Commission. "They must be filled, and then labeled, unless they are filled immediately" after labeling, she says. "That also goes for basins or poured solutions," McCollum adds. "If they put it down, it must be labeled." Providers might be tempted to label basins a few hours ahead of surgery, says Sophie Duco, RN, associate director of standards interpretation, hospital accreditation, at The Joint Commission. However, the labeling should occur when a medication is transferred from its original packaging to another, she says. "Part of that same standard is ensuring the original packaging remains readily available during the procedure, until its conclusion." |
SDS Accreditation Update Safely storing meds is problem for many Providers continue to struggle with The Joint Commission standard to safely and properly store medications (MM.03.01.01), with 22% of ambulatory organizations and 34% of hospitals being noncompliant in the first half of 2008. Additionally, medication errors are the fourth most common type of sentinel event, with 46 reported in 2008 and 11 already reported in 2009. The standard "can be challenging because often lots of people forget, because the same-day surgery patient is, in general, healthy," says Sophie Duco, RN, associate director of standards interpretation, hospital accreditation, at The Joint Commission. For example, a hospital-affiliated surgery program might be off-site and not have experienced the same type of pharmacy involvement with medications that on-site programs have, she says. "Pharmacy will procure meds, provide policies and procedures, but may not visit those off-site facilities or may not visit them with any frequency," Duco explains. Such situations leave the outpatient surgery managers responsible for ensuring medications are stored appropriately in their area. Ginny McCollum, MSN, RN, an associate director of standards interpretation at The Joint Commission, says that in terms of refrigerated medications, "you should have a mechanism to be able to monitor, not only daily when you're there, but when the organization is closed. There are electronic digital monitoring devices for the medication refrigerator and tissue refrigerator so you know the temperature at all time, she says. "When you come in on Monday, you know was there a blackout, and there was 24 hours of lost temperature," McCollum says. Inexpensive recording thermometers will indicate when a refrigerator temperature is out of range, Duco notes. "The key is that the staff must act upon that finding," she says. Ensure that expired medications, including multidose vials, are removed, she says. "Managers forget to go back and round to make sure no expired meds are available," Duco says. "Lack of daily pharmacy involvement can be lost on staff already busy on patient care paperwork." What happens to meds throughout the day? Ensure that the organization has a policy to safely manage medication that might be gathered up by a particular provider at the beginning of his or her shift, Duco says. For example, in outpatient surgery, an anesthesia provider might gather up medications for all of the day's cases. "The organization has to have a policy in place that addresses safe storage, safe handling, security, and disposition of meds at the end of that person's shift," she points out. The question arises, then, how will anesthesia providers manager their meds through they day? "If they have a lunch break, what do they do with those meds they gathered up?" Duco asks. It is critical not only that a policy be developed, but that the manager ensure the policy is implemented. Also, with controlled substances, there are federal rules and regulations, as well as the facility policy to comply with, Duco says. "Many organizations have gone to [a policy that] you pull meds for one case at a time," she says. One added advantage of such a system is more accurate billing and disposition, Duco adds. Also don't forget the crash carts, says Michon Villanueva, assistant director of accreditation services at for the Accreditation Association for Ambulatory Health Care (AAAHC). "Organizations periodically forget to check their crash card for expired medications," she says. |
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content