AHRMM Issues & Legislative Committee

January 12, 2009

Emergency Preparedness / Surge Capacity / Pandemic Flu

Disaster Preparedness & Surge Capacity – Their Associated Costs

Statement – How do we set the conditions for successful responses to Disaster Preparedness when the unknown factor or “Surge Capacity” looms over clinical/facility readiness like a specter of death?

Implications – Human capacity, logistics capabilities, when & where will disaster strike?  Each element addresses a different facet of readiness and potential shortfalls in response that we need to review and make radical recommendations in order to respond to our community needs and still be able to operate with economic capital and certainty.

Conclusions – Coordination begins with your customer.  Determine how they will operate during a crisis, disaster or surge of patients by asking the following: what will they focus on? Critical care? crisis management?A number of conclusions can be seen from news and reports submitted in this recap of the last year, 2008.

FY08 Recap of this past year – Issues and Resolutions to Disaster Preparedness & Surge Capacity

• Jan 08 - Mass Distribution; Problems with Management and Contents of the Strategic National Stockpile (SNS); Extremely Limited Surge Capacity for Emergencies – Trust for America’s Health website at http://healthyamericans.org/bioterrorism-and-public-health-preparedness
• Feb 08 – Reported on results from the 2nd National Emergency Management Summit, held in Washington DC.  A notable presentation addresses ‘identifying triggers/metrics within the system that would allow managers to shift to a “Crisis Standard of Care” without changing the actual standard of care’.  Website for the National Emergency Management Summit is http://www.emergencymanagementsummit.com
• Mar 08 – No Report submitted;
• Apr 08 – No Report submitted;
• May 08 – No report submitted; “Critical care panel tackles disaster preparation, surge capacity, rationing”, as reported by Lisa Schnirring and Robert Roos  Staff Writers for CIDRAP News; article located at http://www.cidrap.umn.edu/cidrap/content/influenza/biz-plan/news/may1308chest.html; Articles speaking specifically to the panel’s recommendations can be found in the May issue of CHEST found at http://www.chestjournal.org/content/133/5_suppl;
• Jun 08 – No report submitted;
• Jul 08 – No report submitted; AHRQ Public Health Preparedness – Hospital Surge Model Version 1.2; The AHRQ Hospital Surge Model estimates the resources needed in your hospital(s) to treat casualties resulting from specific biological, chemical, nuclear, or radiological scenarios.  For the selected scenario, the model estimates the number of casualties and the required hospital resources to treat the casualties.  For a brief description and hyperlinks go to http://www.ahrq.gov/prep/hospsurgemodel/description; the actual online model is accessible at http://hospitalsurgemodel.ahrq.gov. 
• Aug 08 – No report submitted;
• Sep 08 – No report submitted; New AHRQ Tool Helps Hospitals Evaluate Disaster Drills, read about it at  http://www.ahrq.gov/news/press/pr2008/drillelempr.htm; the actual tool is available online at http://www.ahrq.gov/prep/drillelements  Press Release Date: August 20, 2008
• Oct 08 – No report submitted;
• Nov 08 – No report submitted; AHRQ Webcast on Surge Logistics “Lessons Learned from the Field of Emergency Preparedness” Website is at http://www.ahrq.gov/prep/fieldemprep
• Dec 08 – No report submitted.

Quality / Medication Errors / Safety Issues

Healthcare Errors:

“Joint Commission Alert: Prevent technology-related healthcare errors”

Healthcare Purchasing News – www.hpnonline.com, January 2009 pg. 6

Technology is often called the “cure” for healthcare, but a new Joint Commission Sentinel Event Alert warns that implementation of technology and related devices is not a guarantee for success and may actually jeopardize the quality and safety of patient care.

This alert urges greater attention to understanding when a technology may or may not be applicable, choosing the right technology, understanding the impact of the technology on quality and safety of patient care and attempting to quickly fix technology when it becomes counterproductive.  This Alert makes it clear that the overall safety and effectiveness of technology in healthcare ultimately depend on the users (humans) and that any form of technology can have a negative impact on the quality and safety of care If it is designed or implemented improperly or is misinterpreted.

There is very little data on the number of errors directly caused by the increasing combined use of health information and devices. In addition, the Joint Commission urges healthcare organizations to use its Information Management accreditation standards to improve patient safety while using technology.

The Alert notes that the implementation of technology can threaten care and patient safety when: Clinicians and other staff are not included in the planning process; Providers do not considers the impact of technology on care processes, workflow and safety; Technology is not fixed when it becomes counterproductive and technology is not updated.

To reduce the risk of errors related to health information and technology, the Sentinel Event Alert recommends that healthcare organizations take a series of 13 specific steps. The full report is available at www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_42.htm.

Safety:

“Joint Commission monograph to offer promising strategies for immunizing healthcare personnel”

Healthcare Purchasing News – www.hpnonline.com, December 2008, pg 6

In an effort to help improve the rate of healthcare worker influences immunization, the Joint Commission will product a new monograph that includes examples of successful strategies and tools that have been used to improve immunization rates.  The free, educations, monograph, planned for publication in mid-2009, will include: Information about the impact and prevalence of the acquisition and transmission of influenza in the healthcare workplace; An overview of barriers to successful influenza immunization programs and strategies for overcoming them; and a compilation of promising practices and effective strategies for implementing healthcare personnel influenza immunization programs.

Healthcare organizations are encouraged to submit examples of immunization programs that have successfully increased immunization rates among healthcare personnel. Submissions can be made online at: www.jointcommission.org/PatientSafety/InfectionControl.

Supply Chain Standards – GS1/HSCSC

AHRMM continues to support the GS1 standards in healthcare supply chain and has representation on all of the workgroups including the Global Location Number (GLN) Work Group, the Global Trade Item Number (GTIN) Work Group, the Global Data Synchronization (GDSN) Work Group, the Traceability Work Group, the Adoption and Implementation Team, and the GS1 Healthcare US Leadership Team. GS1 Healthcare US held a Work Group Forum in October. During that meeting, an announcement was made regarding adopting universal data standards and eliminating custom account numbers by 2010 (GLN) and custom product numbers by 2012 (GTIN). The plan involves the adoption of the GLN for standardized account/location identification and the GTIN® for standardized product identification by all healthcare providers and suppliers. This industry-wide initiative to adopt GS1 standards for account/location and product identification will help to ensure that the correct products are delivered to correct locations at the correct time – creating a safer, more efficient, and less expensive supply chain. The next meeting is scheduled for March.

A free webinar titled "Improving Patient Safety and Supply Chain Efficiency with Data Standards: The Basics of GS1 Standards in Healthcare" and presented by Jean Sargent was held in November and focused on how the GS1 standards will help improve supply chain efficiency while improving patient safety. It was a how-to session providing an overview of GS1 standards, the benefits to be gained, and the new Healthcare Provider Tool Kit to help providers get started. Due to the enormous success of the webinar, it was offered again January 29, 2009.

A video being created by GS1 with input from AHRMM staff to promote awareness of the issues of standardization in the healthcare supply chain is in final production and will be available by the end of the first quarter.