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Issues & Legislative Committee Report

November 13, 2008

TJC / GPO Oversight Committee

Joint Commission

  1. Beginning Jan. 1, 2009, Laboratory Accreditation by Joint Commission will no longer affect overall hospital accreditation; but will be considered a separate issue.  This is to bring the process in line with current practice when hospital labs are accredited by other agencies, such as CAP or COLA.
  2. The Joint Commission has called for best practices by health care facilities in immunizing health care personnel for influenza.  Per CDC such immunizations have been low despite documented evidence on patient and staff outcomes.  The study will result in a monograph by mid-2009; is sponsored in part by sanofi pasteur; and is in partnership with APICS, CDC and the Society for Healthcare Epidemiology of America (SHEA).
  3. CMMS clarified their position on standing orders at the request of JC by stating that the timing of signed documentation in the patient’s medical record should not impede urgent care.

 

Ethics Pharmaceutical

Big Pharma's Golden Eggs
Shannon Brownlee reviewed the book OUR DAILY MEDS written by Melody Petersen. The book tells the story of the highly profit driven industry may have lost it’s way and diverted to an intensly marketing driven industry. “Their transformation from small chemical manufacturers to marketing machines with sidelines in drug development is owed in large measure to blockbuster drugs. This is the term for any medication that generates more than $1 billion in sales annually. Such drugs as Nexium, Celebrex, Claritin and, of course, Viagra, whose brand names are household words, became blockbusters not because they save lives, or even because they are necessarily more effective than other remedies, but because their manufacturers employ some of the cleverest marketing on the planet.”

One example was with Glaxo’s Zantac. Then customary in the drug business was to put profits back into R&D, but the company decided to invest heavily in marketing its drug. They funded studies intended to show Zantac's superiority then hired “a battalion of sales reps, who flogged the drug relentlessly to doctors.” The company pioneered a ploy now used routinely in pharmaceutical marketing called condition branding. This branding linked its drug to the relief of a common but minor condition, then make consumers and doctors worry that the condition was a sign of a more worrisome disease.

According to the book, the flow of truly innovative drugs has slowed significantly, at least in part because companies that were once science-driven now spend twice as much on marketing existing drugs as they do on developing new ones.

Source: http://www.washingtonpost.com/wp-dyn/content/article/2008/04/03/AR2008040303377_pf.html

Another banning:

The University of Virginia Medical Center and University of Virginia School of Medicine have instituted a comprehensive policy which effectively bans all gifts, meals and promotional items given to employees by vendors and contractors associated with the health system.

The ban, which went into effect October 1, applies to all people who provide patient care or other services within or for the benefit of the health system. R. Edward Howell, Vice President and CEO of UVA Medical Center stated "this policy, in effect, changes the way health care professionals and vendors interact at UVA."

The policies of the two entities have been revised to prohibit all people covered from accepting meals on all University Grounds, gifts of any kind (regardless of value), promotional items (pens, mugs, pads, etc.), or product samples for personal or family use. Vendors can only support educational programs or events through unrestricted gifts to the University of Virginia or the Medical Center. Nominal items expressly for educational purposes are allowed.

All vendors doing business with the two entities are covered under the revised policies, including medical device manufacturers, pharmaceutical companies, construction firms and office supply distributors.

"As one of the nation's leading academic medical centers, we felt it was important to take a strong position to ensure our physicians, nurses, students and staff are free from any potential conflicts of interest. We believe this new policy may serve as a model for healthcare organizations across the nation," explains Steven DeKosky, M.D., Vice President and Dean of the UVA School of Medicine.

John B. Hanks, M.D., president of the Clinical Staff at UVA Medical Center and chief of the Division of Surgery, says the policy should remove any doubts from the minds of patients that vendors might influence decisions over their treatment or care.

"The physicians, nurses and clinical staff of the University of Virginia Health System always put the needs of the patient first and foremost in any clinical decisions we make. While we firmly believe vendors have not held any influence over our clinical decisions, this policy will eliminate any perceived conflicts of interest at UVA," Hanks says. 

Source: http://www.healthsystem.virginia.edu/internet/news/archives08/vendor_policy.cfm

 

Supply Chain Benchmarking

Purchasing Index Submission to the National Health and Hospitals Reform Commission

Oct. 1, 2008    Purchasing Index (PI) provides benchmarking services to the National Health Service (NHS) in the UK since the 1980s. It has also introduced performance benchmarking to the Australian public health jurisdictions in recent years.

PI in their recently released submission to these organizations recommends that the they  consider proposals in the following areas:

For a copy of the full report: http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/152/$FILE/152%20-%20SUBMISSION%20%20-%20Purchasing%20Index%20PL.pdf

 

Quality / Medication Errors / Safety Issues

Quality:

“Clinical standard endorsed to boost reporting, transparency”
Materials Management in Healthcare, September 2008 – Pg. 6

The National Quality Forum (NQF) in August 2008 endorsed 67 clinical standards for cancer care, infectious diseases, perioperative care and care provided by clinicians who are not physicians. The Centers for Medicare & Medicaid Services (CMS) provided the funding. NQF also endorsed standards for surgery and anesthesia, stroke and immunizations.

The standards are voluntary and their goal is improved public reporting and transparency. The new cancer care standards include measures to decrease unnecessary bone scans for prostate cancer and improve patient communication. The infectious disease care standards cover hepatitis B and C as well as HIV/AIDS. For critical care and anesthesiology, standards include perioperative temperature management for surgery patients.

Safety:

“EPA begins investigating disposal of unused drugs”
Materials Management in Healthcare, September 2008, pg 6.

The EPA wants to know if hospitals are disposing of pharmaceutical waste in a matter that threatens water supplies. In August, the EPA began collecting information for a study of disposal practices for unused pharmaceutical products at hospitals and other health care facilities. The EPA has also asked for scientific advice on the potential risk to human health from low levels of pharmaceutical residues in drinking water.

“Top US healthcare organizations announce compendium of strategies to prevent deadly HAIs”

Healthcare Purchasing News, November 2008, pg 6

The Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals was produced by SHEA and the Infectious Diseases Society of American (IDSA), in partnership with the American Hospital Association (AHA), the Association for Professions in Infection Control and Epidemiology Inc (APIC), and the Joint Commission, which accredits more than 15,000 U.S. healthcare organizations. Two sections focus on preventing spread of Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile Infection (CDI). There are four sections that focus on device-and procedure-associated HAIs. Central Line associated bloodstream infection, Ventilator-associated pneumonia, urinary tract infection (the most common HAI 80% attributable to long-term use of urinary catheters, surgical site infection. With patient concern for HAIs growing, it was decided the time was right to review and synthesize current guidelines and develop practical strategies that are easily implemented by healthcare professionals.

 

UPN Issues / Data Standards Issues

GS1 Healthcare US

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 ePedigree 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.

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.

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 completed by year end.