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Patient Safety Monitor Journal answers your most important patient safety questions and offers field-tested compliance strategies to ensure your patient safety efforts measure up to The Joint Commission.

  • Gutting HAIs: Ambitious goals for 2020

    The Department of Health and Human Services (HHS) has given hospitals aggressive goals on HAI reduction. By 2020, the department wants CAUTI rates to be cut 50% in acute care hospitals, long-term care facilities, and ambulatory surgical centers.

    Sue Dill Calloway, RN, Esq., AD, BA, BSN, MSN, JD, CPHRM, CCMSCP, president of Patient Safety and Healthcare Consulting and Education, says the HHS goals are pretty ambitious, particularly considering some of their previous results.

    The first step, Calloway says, is for hospitals to commit to HAI prevention training. That requires special emphasis on educating staff working on the frontlines of care.

    “When my sister was in [the hospital], I saw [staff] do some really bad dressing changes,” she says. “I saw them not washing their hands. When my sister had a wound infection, they didn’t culture it or notify the infection preventionist. They took an off-label saline flush and put it on there. And there was a fresh patient coming from postop into that room.”

    HAI training requires many different competencies, she says, including hand hygiene, proper antibiotic usage, and the correct way of handling IVs and catheters. While conducting this kind of training may sound like a drain on resources, she points to a number of free toolkits and resources that organizations can take advantage of. Two key providers of free HAI prevention guidance and training are the Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare Improvement (IHI). The CDC website offers several worksheets, checklists, and free webinars on HAI reduction and antimicrobial stewardship. Meanwhile, the IHI has several HAI reduction toolkits and how-to guides covering hand washing, CAUTIs, SSI, CLABSI, and MRSA. 

    The main issue with these resources, she says, is that most people aren’t aware that they exist.

    “The CDC in April 2011 put out this amazing document on reducing infections and found a lot of hospitals didn’t even use it,” says Calloway. “It was a great resource that tells you how to put a peripheral line, mid-line, central line. It told you how often to change the dressing, how often to change the tubing. But I did a number of web-based programs—none of them were well attended—and we would ask people, ‘Do you know this document? Do you use this document?’ They would say, ‘No.’ ”

    She says this lack of awareness of HAI resources has even come to the attention of CMS, who even mentioned in its list of proposed changes that many outpatient facilities were unaware that there was a CDC infection control checklist for them.

  • Study: Recounting the cost of CAUTIs

    You probably know that CMS doesn’t reimburse for hospital-acquired infections (HAI), including catheter-associated urinary tract infections (CAUTI), the most common healthcare-associated condition in the U.S.

    What you may not know is that CAUTIs cost hospitals far more than most think. While most say the average cost of treating a CAUTI is $1,000, that figure is likely too low. In some cases, it’s 10 times too low.

    That’s according to a new study published in the American Journal of Infection Control. The study was written by Christopher S. Hollenbeak, PhD, professor of surgery and public health sciences at Pennsylvania State University, and Amber L. Schilling, PharmD, MEd, research analyst at the Penn State College of Medicine.

    The pair systematically reviewed patient-level cost data, focusing on studies conducted in the United States between 2000 and 2017.

    “We can conclude that the prevailing notion of a CAUTI costing approximately $1,000 is an underestimate and an oversimplification of its true economic burden,” Hollenbeak and Schilling wrote. “Many factors can increase the attributable cost well above $1,000.”

    This means it’s time to reexamine how you prioritize catheter infections.

    The money
    Both the Department of Health and Human Services (HHS) and The Joint Commission want a crackdown on HAIs.

    HHS has set aggressive goals on HAI reduction. By 2020 the department wants CAUTI rates to be cut 50% in acute care hospitals, long-term care facilities, and ambulatory surgical centers. The Joint Commission made several changes to its CAUTI National Patient Safety Goal in 2016 as well. The changes went into effect on January 2017, and surveyors are still hunting for noncompliance.

    Meanwhile, CMS has long used the threat of out-of-pocket expenses to get hospitals to reduce HAIs. But according to Hollenbeak and Schilling’s study, without a clear sense for how much CAUTIs cost, hospitals may not be responding appropriately to that financial incentive.

     

  • Case study: Hospitalwide huddles curb catheter infections at Saint Anthony

    This February, Saint Anthony Hospital in Chicago won the Illinois Health and Hospital Association’s (IHA) “Innovation Challenge: Partners in Progress Award.” In just two years, the facility cut its hospital-acquired infection (HAI) rate by 90% and saved itself $498,000. 

    How did the facility make such tremendous strides in infection control? Short answer: daily interdisciplinary safety huddles (DISH).

    While most hospitals conduct safety huddles, what makes DISH different is that participation is hospitalwide. Representatives from all departments (security, nursing, emergency services, infection control, etc.) meet every morning for a 15-minute daily briefing.

    Alfredo Mena Lora, MD, is the medical director of infection control (IC) at Saint Anthony. DISH is just one aspect of their HAI reduction program, he says, but it’s a unique part of it.

    “We know that huddles have been proven to improve outcomes and reduce certain variables, whether it’s in surgery or catheter placement,” he says. “But a hospitalwide huddle is what I think is novel.”

    At DISH, nurse managers report on which patients have indwelling catheters (urinary or central venous). Then it’s decided which patients still need their catheters. If not, the device is expected to be removed within 24 hours. The reason this matters is because the longer a patient has a catheter, the more likely he or she is to develop an infection.

    After one year of DISH meetings, Lora became curious. He felt the meeting was making a difference—after all, he saw the catheters being removed. But he wanted to prove it.

    “Everything we do, every small quality improvement initiative, as the IC person here I always try to study it to see if there are empirical ways to assess the before and after,” he says. “I knew the meeting was being effective; my objective was to look at the before and after.”

    In the summer of 2016, he made a chart of his findings and submitted it to the IHA’s innovations competition. While he’s glad to be recognized, he says winning the award wasn’t the point.

    “Our goal wasn’t to win any specific award, but rather our day-to-day quality improvement objectives here in the hospital,” he says.

    Setup
    For an improvement program, DISH is pretty simple and cheap to set up. Saint Anthony started doing DISH meetings in late 2014. While it took a few months to get rolling, Lora says they saw results almost immediately.

    They tracked their progress by tracking their device usage rate (DUR). While the definition of HAIs have changed over time, DUR has remained a constant variable for measuring the effects of medical intervention.

    “When we reviewed this retrospective, we saw a downtrend after we were assessing the needs of catheters on a daily basis and forcing their removal,” he says. “I do think it promotes quick removal and is pretty cost-efficient and easy to do.”

    There are always small challenges in trying a new improvement project, he says. But DISH is very sustainable and it helps correct any kind of challenges they have.

    Right now, he’s working on a way to better assess why certain catheters remain. For example, was there a rise in the DUR because there were more sick patients? Because a new physician didn’t know the catheter policies? Or something else?

    “Because I’m the infection control physician here, I know why some catheters remain—because some patients are sick and so forth,” he says. “As part of optimizing DISH, I’m looking for better ways to obtain that data moving forward and report it at DISH in a more efficient way.”

  • Update: Pentax issues recall for duodenoscopes

    Check your inventory of the duodenoscopes in your hospital as well as any off-campus clinics or ambulatory care centers, now that the FDA has issued yet another urgent infection control recall for the medical instruments that are notoriously difficult to clean.

  • Call me, beep me: When physicians text

    As SMS technology has developed, providers have taken to texting patient health information (PHI). They send pictures of X-rays and rashes. They ask opinions and advice on patient cases. They message the on-call physicians that they are needed, ASAP.

    In medicine, there are a lot of cost, coordination, and time benefits to a secure SMS. That’s why so many were upset when a miscommunication almost forced them to stop.

    An article by the Health Care Compliance Association (HCCA) in December reported that CMS had sent emails saying that “texting is not permitted.”

    What CMS meant to say was “texting medical orders is forbidden; secure texting of PHI is fine.” But as the emails were written, many thought they meant “all texting of PHI is forbidden, period.” And healthcare organizations weren’t happy. 

    “Secure texting is an integral part of a community platform for organizations,” one manager told the HCCA. “If you pull secure texting out of that pathway, you have disrupted a huge chain of communications that will have a broader effect.”

    CMS later explained that it wasn’t placing a blanket ban on texting as a whole. Care team members can text PHI over a secure messaging app, the agency said. They just can’t text medical orders.

    “CMS recognizes that the use of texting as a means of communication with other members of the healthcare team has become an essential and valuable means of communication among the team members,” wrote David R. Wright, director of CMS’ Survey and Certification Group. “In order to be compliant with the [Conditions of Participation (CoP)] or [Conditions for Coverage (CfC)], all providers must utilize and maintain systems/platforms that are secure, encrypted, and minimize the risks to patient privacy and confidentiality as per HIPAA regulations and the CoPs or CfCs.

    “It is expected that providers/organizations will implement procedures/processes that routinely assess the security and integrity of the texting systems/platforms that are being utilized, in order to avoid negative outcomes that could compromise the care of patients,” Wright added.

    While texting PHI is allowed, there are caveats: namely, the types of SMS you use and how you enforce compliance.

    Making a texting policy
    Frank Ruelas, MBA, a facility compliance professional at St. Joseph’s Hospital and Medical Center Dignity Health in Phoenix, says texting is a case where practice is far outpacing policy and procedures. Providers will text each other no matter what, even in hospitals where it’s prohibited.

    “To think that physicians are not texting to other members of the healthcare team is borderline silly,” says Ruelas. “For example, if one walks down the halls of a hospital and spots a physician, he or she probably has their face pointed to their portable device and are either reading or texting. To think none of this involves patient-related matters just doesn’t seem reasonable.”
     

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