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Issues & Legislative Committee

August 13, 2009

JCAHO / GPO Oversight Committee

Joint Commission Offers Seasonal Flu Immunization Strategies
 In an effort to help healthcare organizations improve the rate of healthcare worker influenza vaccinations, the Joint Commission has released a Monograph, “Providing a Safer Environment for Health Care Personnel and Patients Through Influenza Vaccination: Strategies from Research and Practice.”  

This monograph is the result of a 10-month collaboration between the JCAHO,  APIC, CDC,SHEA and NFID.   It includes information about the influenza vaccine, barriers to successful programs and strategies for overcoming them along with examples of successful initiatives organizations have used to improve vaccination rates.

The monograph incorporates evidence-based guidelines and published literature to highlight practical strategies and the tools submitted by healthcare organizations.  Electronic copies are available at www.jointcommission.org at no charge.

The CDC says that vaccination rates remain low despite documented benefits.  In 2007 the JCAHO implemented a new standard in hospitals and long-term care facilities requiring that influenza vaccinations be offered to staff and practitioners.
Source: ICT (Infection Control Today)  August 2009

Quality / Medication Errors / Safety Issues

Safety:

“CHCA Patient Safety Alert June 2009 – Pressure Ulcers”

Numerous reports have been made to the CHCA serious event database over the last year regarding pressure ulcers. Prior to 2007, no such events had been reported. These events demonstrate the difficulty in preventing pressure ulcers in especially fragile patients for whom position changes are medically contraindicated. The data also suggests that pressure ulcers may be more likely when a larger than normal pediatric patient is involved, implicating the problem of adult care issues in the pediatric setting.

Two of the cases reported to CHCA involved lack of proper equipment which may have contributed to the development of pressure ulcers. One case, a morbidly obese comatose patient with hyperglycemia, pancreatitis, diarrhea, and refractory hypertension was not initially placed on an air bed as she needed a larger bed and one was not immediately available. A large sacral wound was discovered prior to the arrival of the air bed. The patient’s skin breakdown was felt to be due to complications of her care and overall complexity.

The second case involved a patient that had been in traction for two spinal fusion surgeries. The patient came back from surgery with areas behind ankles and knees wrapped in dry gauze (instead of sequential compression stockings being utilized) Two days later, the PICU nurse un wrapped the patient’s legs and found areas of skin breakdown. The wounds had already developed so the wound nurse was not able to stage them.

“CHCA Patient Safety Alert July 2009 – Never Events Revisited”

Over the last year, ten Never Events have been reported to the CHCA serious event database. This number is the lowest number reported during one year since the database’s inception. Of the ten events reported this year, none resulted in permanent injury or death. The vents types were: retained objects after surgery (3), wrong site surgery (2), wrong surgery (1) and pressure ulcers (4). This information suggests that facilities can reduce Never Events by focusing on these areas.

“ISMP Medication Safety Alert”
July 30, 2009
Vol. 14, Issue 15

“Will Color-Tinted IV tubing help?”

Color has often been used effectively to capture attention or differentiate items, but its use in healthcare as a patient safety strategy has frequently fallen short of achieving its intended results. Over ruse of color-coding, overreliance on color to identify items rather than enhance or differentiate them, lack of standard colors to ensure meaning, use of too many colors to be distinguishable and memorable and assigning a single color to multiple items that are different but within the same general category, have exhausted many of the potentially positive attributes of using color to improve patient safety. Healthcare, for the most part, has not standardized the meaning of certain colors. This allows companies to product different products using the same color-tinted IV tubing – a situation that can lead to harmful mix-ups. We cannot rely on color as a safety feature until everyone agrees on its meaning and appropriate utilization.

FDA Reviews / Government Updates

The Congressional recess started and ends with no Health Care Reform legislation signed into law.
What the President will say on Wed 9/9/09 to the joint session of Congress is not public.  I will upload a copy of the speech when available.

Summary from the Wall Street Journal: 
Two overarching problems:
Convincing those who already have healthcare insurance that there’s something in Reform for them
COST!: the Congressional Budget Office estimates costs @ 1.6 Trillion over the next Ten (10) years                               

Summary from the New York Times:
Two gargantuan tasks:
            Expanding coverage
            Reigning in spiraling costs
Areas of agreement include: no insurance rules to exclude anyone.  All insurers to offer a minimum package benefits; federal subsidies for modest income people; health insurance exchanges; reward high quality care (outcomes) not volume (piece work).

Areas of disagreement include: employer mandates; a publicly run health plan.
Employer and business groups are advocating change in 2009 due to soaring costs. This was not the case in 1993-94.

Electronic Health Record (EHR):
Two Fed Gov’t Departments - DOD and the Dept of Veterans Affairs (DVA) have independently developed EHRs!  (AHLTA & VISTA respectively)
They don’t talk to each other!  The ultimate goal is to create a record for individuals the first day they join the military and maintain it though the individual’s lifetime.  No mention of private sector use post military.     http://veterans.house.gov/hearings

HealthCare Finance News:  Aug 2009
White House Secures AHA’s Backing
There is a “framework” for reimbursement concessions for hospitals  to avoid spending $155 billion in Medicare and Medicaid over the next ten years.  Besides AHA, Catholic Health Assoc and the Federation of American Hospitals said they support proposals to set restrictions on physician self-referrals to hospitals where they have an ownership interest and simplify red tape.

From Materials Management in HealthCare  Sept 09
America’s nurses believe they spend too much time on supply chain activities fearing that it would not be done correctly otherwise! 
Examples include: searching for supplies; putting away supplies; managing expiration dates nod lot #s;
Materials Managers should: Educate all staff about the supply chain; create a strategic plan for shared accountability; reallocate teams to align activities to skills; outsource as appropriate.

Senators Probe GPOs:
Senators have asked the seven largest GPOs to provide data on: how they are paid; what service they provide besides picking brands and negotiating prices; how their revenues are impacted when their hospitals buy outside the GPO contracts.

Pricing Forecast -- Cloudy:
After a volatile period, supply chain prices are stabilizing but continued economic pressures and possible health reform promise ot influence pricing.

Cost of Confidentiality (ECRI) / Transparency (AHRMM President Jay Kirkpatrick)
Hospitals have little or no access to data on what other hospital pay for the same devices. The major categories for physician personal preference items are cardiology and orthopedics.
AHRMM believes that transparency would expose waste, greed and inefficiency cutting prices 20-50%!

Rules for OR Reps
Currently each Medical center has its own rules and policies.  The effort for national standards has been moving slowly.  Many private sector firms offering software and policies have sprung up.

Joint Commission bows out of vendor credentialing debate.
JCHAO announced that it is not in the business of developing standards of competence for healthcare industry sales reps.  (Journal of Healthcare Contracting July/Aug pg 6

FDA:
The recalls start once again with Peanuts.  Drugs include 2 million bottles of Listerine, as well as 20 pages of Smith and Nephew Bone healing systems serial numbers.
http://www.fda.gov/Safety/Recalls/EnforcementReports/ucm180348.htm

Supply Chain Standards – GS1/HSCSC

There was a GS1 track at the AHRMM conference at the end of July which was well-received and well-attended.

Continue Healthcare Provider Awareness

  • Web Seminars: The Basics of GS1 Standards in Healthcare – Jean Sargent
  • Distribute Tool Kit CDs at August speaking engagements/meetings/events
  • Mayo Clinic / Cardinal Health GLN Implementation White Paper – AHRMM Newsletter
  • Seton Family Hospitals / BD Success Story – AHRMM Newsletter
  • GLN GPO Roster Pilot – Finalizing to launch in August/September

Healthcare Provider C-Suite Brochure