But placing cost above HCW choice could
Buying needle safety devices based on group purchasing organization (GPO) contracts isn’t likely to earn you an Occupational Safety and Health Administration (OSHA) citation, but making cost a priority over health care worker preference could.
GPOs have been under scrutiny in a series of articles in The New York Times that have questioned special fees and other contractual arrangements with manufacturers that could limit product choice. They allow hospitals to save money by pooling their buying power and negotiating contracts with suppliers.
Brand choice would not concern OSHA inspectors as long as health care workers favored the device selected and were able to evaluate various technologies, OSHA compliance officials told Hospital Employee Health.
"If they’re buying good devices [through the GPO], that’s OK," says Melody Sands, MS, director of OSHA’s office of health compliance assistance. "If they’re saying they can’t buy safety devices, that’s a problem. All we’re looking at is: Is the employee protected?’ We don’t care [about the brand] as long as the device works for them."
There is no requirement for hospitals to consider a certain number of safety technologies, Sands notes. But each year, the exposure control plan must show that frontline health care workers were involved in the selection and that new technologies were considered.
The selection process should allow different hospital units to make their own choices, recognizing that the patient populations and procedures create different needs, notes Amber Hogan, MPH, an industrial hygienist in OSHA’s office of compliance assistance.
OSHA has received phone calls from employees who say their employers chose a device based on cost that was not favored by the staff. However, none became a formal complaint, Hogan says. "It would worry us if an employer would only consider a device because of cost," she says.
Consider all choices in selection
Choice has become an integral aspect of device selection. With a fast-growing market of needle safety devices, hospitals now have an unprecedented number of options in various product categories. Needle safety experts say it’s important to keep that breadth of choice available to health care workers.
June M. Fisher, MD, director of the TDICT Project at the Trauma Foundation of San Francisco General Hospital and an expert on device evaluation, advises hospitals to screen all available devices before selecting items for further consideration.
Device evaluation committees "shouldn’t be restricted [in the initial screening] by their materials management," says Fisher. "You should know all the technology that’s out there when you have your review."
Various product evaluation forms are available on-line, including at the TDICT site (www.tdict.org) and Premier, one of the nation’s largest GPOs (www.premierinc.com/safety).
GPOs have made adjustments based on the federal Needlestick Safety and Prevention Act, which mandated the use of safety devices. Hospitals may purchase devices "off-contract." Some GPOs also have broadened their product base.
"The law requires frontline workers to choose the devices that are most appropriate for their particular work setting," says Gina Pugliese, RN, MS, vice president of the Premier Safety Institute in Chicago.
"The group purchasing contracts are only a place to start to look for cost-effective choices." she says. "The law says you have to pick what the frontline workers want."
Pugliese notes that Premier, one of the nation’s largest GPOs, has contracts with 16 different sharps safety companies. "We have almost every IV catheter company on the market under contract," she says. "We think it’s important that hospitals have the opportunity to try out all kinds of technology."
In 2001, Retractable Technologies Inc. of Little Elm, TX, filed an antitrust lawsuit against the GPO Novation, Becton Dickinson, Premier Inc., and Tyco International, another device maker, asserting that the large manufacturers and buying groups conspired to create monopolies in the safety device market. All have denied the claims. In July, an article in The New York Times revealed $1 million in "special marketing fees" paid by Becton Dickinson to Novation as part of its exclusive contract. In a release, BD said the fees were paid to "offset Novation’s anticipated losses, resulting from the fact that Novation was switching suppliers." Novation called the fees "an element of the financial value that suppliers offer to members as part of their bids."
Be alert to state laws
Hospitals may need to look beyond OSHA to determine how they select devices. Twenty-one states have passed laws regarding needle safety devices. Some of those laws contain requirements that are even tougher than federal OSHA and may impact the issue of device selection. For example, in Georgia, hospitals with public employees must use "the most effective available needleless systems and sharps with engineered sharps injury protection." Minnesota’s law requires hospitals to "document consideration and implementation of appropriate commercially available and effective engineering controls."
New Jersey, home of the BD corporate headquarters, requires licensed health care facilities to use only sharps and needle devices with integrated safety features that have been approved by the Food and Drug Administration. The law provides for a waiver if no appropriate device is available.
The involvement of licensing as a mechanism for ensuring compliance makes the New Jersey law one of the strictest in the nation.
[Editor’s note: For more information on complying with OSHA mandates on needle safety devices, sign up for our upcoming audio conference, Sharps Safety Compliance: How to Avoid OSHA Citations and Costly Fines, scheduled for Wednesday, Oct. 23 from 2:30 to 3:30 p.m., ET. To register, call (800) 688-2421 and mention effort code 62761. The facility fee is $299, which includes free CE and CME for your entire staff, program handouts and additional reading, a convenient 48-hour replay, and a conference CD.]
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