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Issues & Legislative Committee Report

December 11, 2008

TJC / GPO Oversight Committee

Joint Commission:

  1. There is increasing interest in a new JC competitor for the hospital accreditation business—Det Norske Veritas (DNV Healthcare) is a European risk management and accreditation agency for a wide spectrum of businesses, mostly manufacturing, with an emphasis on ISO 9001 standards.  Exactly how they are a fit for U.S. hospitals remains to be seen, though they reportedly have more of an emphasis on continuous process improvement than the Joint Commission.  Their initial deeming authority from CMS is for four years, beginning September, 26, 2008.

    Previously the only approved accreditors for full hospitals were Joint Commission and the American Osteopathic Association.
  2. In it’s Annual Report on Quality and Safety 2008, released in November, JC lauds the 90% of hospitals that achieved substantial compliance with 2007 goals.  However, in a weak treatment of specific improvements in patient care for heart attacks, pneumonia, and smoking cessation, they admitted the improvements were not about actual patient outcomes, but merely about the hospitals’ declared provision of adequate discharge and after-care instructions.  The report went on to emphasis a fairly wide disparity in results from hospital to hospital, as well as the ongoing need for performance improvement efforts.

GPO Oversight; Year End Perspective

Except for the occasional saber rattling of MDMA (Medical Device Manufacturers Association) on the one hand, and HIGPA (Health Industry Group Purchasing Association) on the other—both using the issue to help justify their existance—there really has been no news this year; or for that matter, since the last Senate Anti-Trust subcommittee review in 2006. 

In its summary paper earlier this year titled “Healthcare Controversy:  Group Purchasing Organizations Encounter Troubled Waters in the ‘Safe Harbor,’ the Knowledge W.P. Carey business group called Senator Kohl’s long silence “an indication that government concern has faded…” (Knowledge@W.P.Carey)

I’d say that unless a signal event occurs to re-energize this issue, we may want to consider dropping it as a regular reportable topic. 

 

Ethics Pharmaceutical

Pharmacy Vendor Gifts/Ethics

Liz Kowaczyk of the Boston Globe reported in a December 10th article that some members of Massachusetts’s Public Health Council may be barred from discussing or voting on sweeping new regulations restricting drug makers' interactions with physicians, because they may have their own conflicts of interest.

The Public Health Department staff is interviewing each of the 15 council members to determine whether they have relationships with pharmaceutical or device manufacturers that should limit their participation in the board's deliberations on the proposed rules.

The regulations written by Public Health Department staff are intended to implement a law passed by the Legislature last summer, which bans companies from providing gifts to physicians, limits when companies can pay for doctors' meals, and requires companies to publicly disclose payments to doctors over $50 for certain types of consulting and speaking. a handful of other states regulate pharmaceutical company marketing to doctors, Massachusetts is the only state in which the rules also will apply to device makers.

The regulations are intended to control costs by reining in unnecessary prescribing of expensive drugs and to make doctors' potential conflicts of interests transparent to the public. There are several practicing physicians on the council. The state Ethics Commission is being consulted to determine what types of relationships with industry would require members to remove themselves from discussions or voting or both.

More information about the proposed Massachusetts rules can be found on the department's website.

Source: http://www.boston.com/news/health/blog/2008/12/members_of_coun.html

 

Supply Chain Benchmarking

Premier Healthcare Alliance Experts to Present at National Events in December

Dec 04, 2008     Leaders from the Premier healthcare alliance will speak around the country in December, sharing insights regarding supply chain efficiency based on the QUEST: High Performing Hospital collaborative.

Joe Pleasant, FHIMSS, senior vice president and chief information officer, will discuss Global Location Number standards at the Healthcare Distribution Management Association roundtable discussion on December 4 in Alexandria, Va.

Carol Davis-Smith, director of Premier Consulting Solutions, will discuss the clinical engineer's role in clinical capital planning and budgeting at the Yankee Alliance Clinical Engineering Committee meeting on December 5 in Worcester, Mass.

QUEST is a voluntary, three-year project with 166 not-for-profit hospitals across 31 states designed to springboard hospitals to new levels of performance. Using benchmarked data from the Premier healthcare alliance's clinical database, Premier and the Institute for Healthcare Improvement identified the main factors that lead to deaths, errors and excessive costs. Using this information, hospitals are able to share best practices and systematically initiate efforts proven to dramatically improve quality and patient outcomes.

QUEST's three-year performance improvement targets are to:

SOURCE: Premier Inc.

 

Quality / Medication Errors / Safety Issues

Medication Errors:

“Self-Dosing Pain Medication Errors Too Common: Study – Review urges tighter controls for intravenous use, standardization of practices” http://health.usnews.com/articles/health/healthday/2008/12/05/self-dosing-pain-medication.html

This article published December 5, 2008, addresses the practice of allowing patients to control their own pain medication intravenously, such as PCA pump. Patients allowed to control their own medication via IV are four times more likely to experience harm than other medication delivery systems. Most mistakes involving intravenous patient-controlled analgesia (PCA) resulted from either human error, equipment issues or communication problems that led to the patient receiving the wrong dosage or drug. PCA errors also tended to be more severe – harming patients and requiring clinical interventions – than other types of medication errors. A five year study uncovered more than 9,500 PCA errors. Patients were harmed in 6.5% of these incidents, compared to 1.5% for general medication errors.  Three recommendations to reduce future PCA errors:

  1. Simplify the equipment –Easier step-by-step instructions could cut down on programming errors.
  2. Use bar codes and keep an electronic medication administration record.
  3. Design and use easy, standardized forms for PCA.

“USP Transitions Medication Error Reporting Programs”  December 4,, 2008
US. Pharmacopeia

USP will transfer its reporting programs, MEDMARX and the Medication Errors Reports (MER) Program to Quantros and the Institute for Safe Medication Practices (ISMP) in order to focus full attention and resources on its core standards-setting activities. USP will use data from these programs to enhance its standards-setting activities to promote patient safety and safe medication use. USP began collecting medication error data in 1991, but has been involved in analyzing such data for more than 30 years. USP found early that information gleaned from error records added a medication safety component to its product standards. USP also played an important role in the drafting and enactment of legislative changes such as the Patient Safety and quality Improvement Act of 2005.

“Improving Quality: How a Hospital Reduced Medication Errors” – http://www.rwjf.org/pr.product.jsp?id=34751&print=true&referer=http%3A//www.rwjf.org

Medication safety was a concern at a hospital in Florence, South Carolina. A patient chart review found 3.5 harmful medication errors for each 1,000 doses administered in the 474 bed hospital. This translates to 35 errors/day – mistakes serious enough to cause some degree of actual harm. The proposed solution involved a plan to automate the medication delivery process, adding safety guards against both prescribing and delivery mistakes.  Numerous technology and process changes were implemented which streamlined the dispensing system – reducing the number of steps and opportunity for error from 17 to 5. One key ingredient was the installation of automated medication storage and dispensing cabinets in all inpatient units. The hospital also instituted an electronic medical record system that includes bar coding to verify the patient receives the correct medicine. At the conclusion of this 5 year project, this hospital found the rate of harmful medication errors had dropped 90% from 3.5 to 0.34/1,000 doses. The automated storage dispensing devices helped cut the average time to get an ordered medication to the patient from 90 to 15 minutes (an 83% reduction).

 

Disaster Preparedness & Pandemic Flu

Implications

Continuing along a trek toward a solution for the pandemic problem that plagues our nations is a challenge to say the least. Doctors, nurses, and ancillary care professionals continue to seek strategic methods for the timely identification and mitigation of illness that can easily turn into a pandemic.

Conclusions

Glezen (2008) describes a scenario that occurred during the 2007 influenza season wherein a 12 year old child ended up dying as a result of what was initially presented as a flu. Upon further investigation, the child was found to have strains of MRSA in her tracheal aspirate and the question asked is “could this death have been prevented”?

Throughout Glezen’s information, the author provides a significant description of why receiving a flu vaccine is critical including the statistical analysis that influenza is the most prominent cause of acute respiratory illness that results in medical consultation each year (p. 2579). The vaccines efficacy ranges between 70 and 90% for school aged children and adults in the workforce. This becomes critical when one realizes that in the event of a large scale influenza pandemic, up to 30% of the nation’s workforce will be affected.

The antiviral remedy is most effective if administered within or 48 hours post onset of symptoms related to an influenza. This becomes problematic when determining which strain of the flu virus is being battled. Orthomyxoviruses are mutable by nature and changes involving these strains occur frequently; timing and severity of symptoms changes often before anything else. This year’s vaccine, to better enable patient’s ability to resist newer strains, contained three new antigens for the more prevalent influenza viruses.

References:

Glezen, W. P. (2008, December). Prevention and treatment of seasonal influenza. New England Journal of Medicine, 359(24), 2579-2585. Retrieved on December 11, 2008, from ProQuest database.

 

UPN Issues / Data Standards Issues

AHRMM's immediate past president Jean Sargent hosted a webcast on the GS1 Standards in NovemberImproving Patient Safety and Supply Chain Efficiency with Data Standards: The Basics of GS1 Standards in Healthcare which was very well attended - nearly 300 people listened in to hear more about the standards and how to get started. GS1 Workgroups are working on the Manufacturer/Distributor toolkits now that the Provider toolkits are in the field. AHRMM is represented on all the workgroups. Additional provider representation is needed on all the workgroups. Anyone interested in learning more and getting involved in the standards movement is encouraged to join GS1 and join a workgroup. Visit HS1 Healthcare US to register. http://www.gs1us.org/GS1HealthcareUS/tabid/162/Default.aspx