healthcare-training

POST-STORM PROTECTION FROM MOLD

2007-06-08T09:53:00.000-04:00

Days of constant rain may trigger a problem in your very own home. Mold growth originates from roof leaks or faulty plumbing. To prevent mold from starting and spreading, the moisture in your home must be controlled.

WeatherREADY offers helpful ideas on how to control and remove growth from your walls, roof, and the like.

• To remove mold growth from hard surfaces use commercial products, soap and water, or a bleach solution of no more than 1 cup of bleach in 1 gallon of water. Use a stiff brush on rough surface materials such as concrete. If you choose to use bleach to remove mold: Never mix bleach with ammonia or other household cleaners. Mixing bleach with ammonia or other cleaning products will produce dangerous, toxic fumes.
• Open windows and doors to provide fresh air.
• Wear non-porous gloves and protective eye wear.
• If the area to be cleaned is more than 10 square feet, consult the U.S. Environmental Protection Agency (EPA) guide titled Mold Remediation in Schools and Commercial Buildings (go to http://www.epa.gov/mold/mold_remediation.html)
• Always follow the manufacturer's instructions when using bleach or any other cleaning product.
• If you plan to be inside the building for a while or you plan to clean up mold, you should buy an N95 mask at your local home supply store and wear it while in the building. Make certain that you follow instructions on the package for fitting the mask tightly to your face. If you go back into the building for a short time and are not cleaning up mold, you do not need to wear an N95 mask.

Preventing hospital bed fires in nursing homes

2006-09-14T10:46:00.000-04:00

The Food and Drug Administration reported that it had received 95 reports from 1993 to 2003 of fires involving electrically powered hospital beds, with 75 percent associated with failed motor starting capacitors and overheated motors.Awareness of fire risks and precautions related to electrically operated beds is important to protect nursing home residents and staff against the risk of injury or death and to prevent significant property damage.

Here are some safety tips from Nursing Homes Magazine to prevent fires caused by hospital beds:

* When plugging in a bed, visually inspect the bed’s power cord for damage from, among other possibilities, use, age, crushing, pinching, shearing, cutting, cleaning solutions, bed movement, human and equipment traffic, and furniture placement
* After inspection, connect the power cord directly into a wall-mounted outlet that is in good working order and capable of accommodating a heavy-duty or hospital-grade plug.
* Do not cover the bed’s power cord with a rug or carpet. Doing so may impede normal air flow which, in turn, can lead to greater heat buildup.
* Test the bed to ensure that it moves freely to its full limit. Confirm that the bed’s vertical motion does not interfere with the bed’s power cord or plug.
* Examine the bed’s hand and panel controls, including patient lockout features, to ensure that the bed is working properly and can move freely without damaging any cords.
* Check bed-occupancy monitors and all other equipment in the resident’s room that has plug-in power supplies for indications of overheating or physical damage.

Maintaining electric power during a disaster

2006-09-11T09:34:00.000-04:00

JCAHO recently issued a Sentinel Event Alert that recommends specific steps healthcare organizations can take to maintain electrical power supply during a natural disaster.

According to the Alert, compliance with minimum National Fire Protection Association codes is not enough to assure the safety of patients and their care during an emergency situation. Many health care organizations did not have sufficient power to ventilate facilities in the aftermath of Hurricane Katrina and patient evacuations were delayed because of the unavailability of electricity-dependent elevators to transport patients.

To reduce risks to patients created by power failures, JCAHO’s Alert recommends steps that health care organizations take:

· Match the critical equipment and systems needed in an extended emergency against the equipment and systems actually on the emergency power system.
· Inventory emergency power systems and the loads they serve.
· Provide training for and test those who operate and maintain the emergency power supply system.
· Ensure that generator fuel is available and usable.
· Assure that the organization management and clinical leaders know how long emergency power will be available and what locations within the facility will and will not have emergency power in the event of an electrical outage.
· Establish contingency plans for doctors and other caregivers to follow during losses of electrical power.

In addition to the Alert, the Joint Commission is adding a new requirement in 2007 that organizations test emergency generators at least once every 36 months for a minimum of four continuous hours. Facilities already must test their generators 12 times a year for 30 minutes. If a test fails, the organization must immediately implement stop-gap measures until a permanent fix can be put into place.

Doctors-in-training commit medical errors

2006-09-07T14:54:00.000-04:00

About one-third of American doctors-in-training report making at least one major error during the recent past, a new survey in the Journal of the American Medical Association reports.

Thirty-four percent of respondents reported making at least one major medical error during the period under study; 43 percent of residents completing at least one year of training reported errors.

Of the participants, 20 percent reported one error, 6 percent reported two errors, and 8 percent reported three or more errors during the study period. An average of 14.7 percent of participants said they had made an error in the past three months.

The errors were generally attributed to personal distress and burnout. “Historically, there has been an attitude that training to be a doctor is stressful,” Dr. Tait Shanafelt, professor of medicine at the Mayo Clinic and author of the study said. “What we are starting to explore is that there may be consequences to the distress, that it may actually influence the care they provide.”This is a challenging problem,” Dr. Shanafelt said. “There appear to be both personal and professional factors that contribute to distress, so any possible solutions are going to need to both address all the potential sources of distress and set up a support system to address stress as it develops.”

New bird flu drugs on the horizon

2006-09-05T09:24:00.000-04:00

With instances of resistance to Tamiflu, the only drug effective against the H5N1 bird flu virus, reported, there is an urgent need to develop new drugs that can be used to treat infection.

The Voice of America reports that British doctors have peered inside a key protein on the surface of the virus, obtaining structural information that chemists could use to design new drugs to block it. The new drugs would avoid the resistance that some influenza viruses have already acquired to Tamiflu.

Researchers used advanced X-ray technology to provide an "atomic picture" of the atoms that comprise one of the two surface proteins in the H5N1 virus.

Neuraminidase – the “N” in H5N1 – is the protein in bird flu that allows the virus to spread to other cells in the body. Drugs currently used to treat bird flu are based on other neuraminidase models that are not specific to H5N1.

By identifying H5N1’s unique blueprint, researchers may one day be able to use drugs that home in on the strain that has killed 139 people in the past three years.

The problem is that the new drugs are five years away, but it could potentially be shortened as countries accelerate their pandemic preparedness plans.

Home care patient rights

2006-09-01T12:53:00.000-04:00

Federal law requires that all individuals receiving home care services be informed of their rights as a patient. The National Association for Home Care has developed a model patient bill of rights based on the patient rights currently enforced by law.

Home care patients have the right to:

* be fully informed of all his or her rights and responsibilities by the home care agency
* choose care providers
* appropriate and professional care in accordance with physician orders
* receive a timely response from the agency to his or her request for service * be admitted for service only if the agency has the ability to provide safe, professional care at the level of intensity needed
* receive reasonable continuity of care
* receive information necessary to give informed consent prior to the start of any treatment or procedure
* be advised of any change in the plan of care, before the change is made
refuse treatment within the confines of the law and to be informed of the consequences of his or her action
* have health care providers comply with advance directives in accordance with state law requirements
* be informed within reasonable time of anticipated termination of service or plans for transfer to another agency
* be fully informed of agency policies and charges for services, including eligibility for third-party reimbursements

Medication errors impact children’s chemotherapy

2006-08-28T09:17:00.000-04:00

Ten percent of children with a once-deadly childhood cancer do not get the correct chemotherapy regime because of medication errors, new research contends.

According to the report in the Aug. 14 online edition of Cancer, 9.9 percent of the oral chemotherapy medications were prescribed or given incorrectly to children with acute lymphoblastic leukemia (ALL).

Medical errors in the United States cause up to 98,000 hospital deaths per year and are thought to be common among outpatients. But they have not been well studied, particularly in children.

Dr. James A. Taylor, a professor of pediatrics at the University of Washington and Children's Hospital and Regional Medical Center, conducted a study that found errors in 10 percent of the medications administered. Of the 17 errors in 69 children, 12 were the result of how the medications were administered and five were caused by prescribing errors -- incorrect dosages.

One of the ways of eliminating error is using electronic prescribing systems, said Dr. Lydia Gonzalez-Ryan, clinical director of the Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta. "There needs to be standardized practices," she added. "We need to get into preprinted orders that set up quality control."

Physical aggression among nursing home residents is cause for concern

2006-08-24T15:19:00.000-04:00

About 88,000 (6.8 percent) of U.S. nursing home residents are physically aggressive every week – hitting, shoving, scratching or sexually abusing others, according to a recent study by the Archives of Internal Medicine, Medicalnewstoday.com reported. This aggression can inflict physical and psychological harm on staff and other residents. Verbal aggression, when residents threaten, scream or curse at others, also can cause difficulties.

"Physical or verbal aggression among nursing home residents with cognitive impairment may be a major cause of distress among staff and other residents injured by the aggressor, as well as to the aggressor," the study concludes. "We found that aggressive behavior among residents was associated with depression, delusions and hallucinations, and that physical aggression was also associated with constipation.

All of these factors may be amenable to intervention and, in addition to reducing the morbidity associated with these entities themselves, effective treatment may reduce the risk of violence in nursing homes."

Nursing home evacuation fails during hurricanes

2006-08-21T09:53:00.000-04:00

Nursing homes in hurricane states had rampant deficiencies in their evacuation procedures, which harmed patients during Hurricane Katrina and other recent storms, according to a Department of Health and Human Services report released last week, The New York Times reported.

The problems that occurred included unavailable buses that required patients to be transported in borrowed vehicles that lacked air conditioning or broke down along the way. Food and water had to be rationed and medications, oxygen canisters and incontinence supplies were left behind. Staffing was inadequate and residents suffered pressure soars and urinary tract infections from the travel conditions.

Some nursing homes had no instructions on how much food and water to take, no method for assigning staff to the trips, no procedures for transporting medications and no plans for how and when to return. They could not get help from local officials because there were no formal partnerships.

The study recommends that 25 “core elements” of emergency preparedness be included in plans for the nation’s 16,125 nursing homes that receive Medicare or Medicaid money. But the government also plays a role, with advocates saying the federal government must be more explicit about the components of an acceptable plan, not just mandate one.

Training program promotes safe lifting

2006-08-17T11:57:00.000-04:00

Healthcare organizations that have experienced a lot of patient lifting injuries should take a cue from the Alamance Regional Medical Center in Burlington, NC and start a training program for staff, according to Safeliftingportal.com.

The center’s Safe Patient Handling and Movement program has succeeded in eliminating lifting injuries. The program includes a two hour class that is mandatory for all clinical staff, with extra time devoted to practice – staff members take turns lifting each other so there is clear understanding of the procedure.

The program began after the center experienced a number of employee back injuries and shoulder pain that led to increased workers compensation costs. After implementing the program, the costs decreased, saving the center money. Patient injuries decreased, too, which is even more important.

“Since implementation, we’ve had no lifting or moving injuries,” said Mary Jane Brown, an employee health nurse. “Plus, our employees aren’t exhausted from lifting patients all day.”

Avian influenza update shows continued threat and medication deficiencies

2006-08-14T10:16:00.000-04:00

A recent report from the Centers for Disease Control and Prevention notes that the avian influenza A (H5N1) epizootic (animal outbreak) in Asia and parts of Europe, the Near East, and Africa is not expected to diminish significantly in the short term. It is likely that H5N1 infection among birds has become endemic in certain areas and that human infections resulting from direct contact with infected poultry and/or wild birds will continue to occur.

So far, the spread of H5N1 virus from person-to-person has been rare, limited and unsustained. No evidence for genetic reassortment between human and avian influenza A virus genes has been found; however, this epizootic continues to pose an important public health threat.

There is little pre-existing natural immunity to H5N1 infection in the human population. If these H5N1 viruses gain the ability for efficient and sustained transmission among humans, an influenza pandemic could result, with potentially high rates of illness and death.

In addition, genetic sequencing of influenza A (H5N1) viruses from human cases in Vietnam and Thailand shows resistance to the antiviral medications amantadine and rimantadine, two of the medications commonly used for treatment of influenza. This would leave two remaining antiviral medications (oseltamivir and zanamivir) that should still be effective against currently circulating strains of H5N1 virus. Efforts to produce vaccine candidates that would be effective against avian influenza A (H5N1) viruses are under way. However, it will likely require many months before such vaccines could be mass produced and made widely available.

Preventing patient falls in nursing homes

2006-08-11T09:53:00.000-04:00

1.5 million seniors live in U.S. nursing homes and 75 percent of them fall annually. About 1,800 fatal falls occur every year and up to 20 percent cause serious injuries. Falls result in decreased physical functioning and disability and fear of falls leads to depression and social isolation.

How can nursing homes prevent falls?

The Centers for Disease Control and Prevention offers these fall prevention guidelines:

* physical conditioning and rehabilitation using prescribed exercises to improve strength and endurance
* environmental assessments and modifications to improve mobility and safety, such as installing grab bars, lowering bed heights and installing handrails in hallways
* review of prescribed medications to assess their risks and minimize use
* provide patients with hip pads to prevent hip fractures if falls occur
* technological devices such as alarm systems that are activated when patients try to move unassisted

Your staff must understand the proper assessment tools and protective strategies they can take to prevent patient falls.

Psychiatric service test announced by JCAHO

2006-08-09T09:44:00.000-04:00

The Joint Commission on Accreditation of Healthcare Organizations recently announced an initiative to test and implement an initial set of core performance measures for hospital-based, inpatient psychiatric services.

The five candidate measures in the set address the following dimensions of in-patient psychiatric care:

* Assessment of potential risks, previous trauma, co-existence of substance abuse and patient strengths
* Restraint use
* Seclusion use
* Patient discharge on multiple antipsychotic medications
* Provision of discharge assessment and aftercare recommendations to responsible community health providers upon discharge

Psychiatric hospitals are now being sought to voluntarily test the measures for a one-year period beginning on January 1, 2007. More than 550 psychiatric hospitals accredited by the Joint Commission are eligible to participate in the test. Participating organizations will be able to substitute the reporting of test measure data for current performance data reporting requirements. Test data from individual hospitals will not be publicly reported.

The Joint Commission will use the measure testing experience to make appropriate refinements to the measures, with a final set of measures becoming available to psychiatric hospitals in the fall of 2008 to meet Joint Commission performance measurement requirements.

Psychiatric hospitals wishing to participate in the testing of the candidate measures should contact Frank Zibrat, associate director, ORYX Implementation, Accreditation Operations, at 630-792-5992 or fzibrat@jcaho.org.

Certification program for inpatient diabetes care launched

2006-08-03T09:35:00.000-04:00

JCAHO and the American Diabetes Association are collaborating on a new certification program for inpatient diabetes care that will be the nation’s first diabetes certification program.

The Advanced Inpatient Diabetes Care Certification Program will certify organizations through an on-site review of their compliance with national standards and the management of diabetes patients through clinical guidelines. The review will include an assessment of performance measurement and improvement activities. In addition, organizations will be assessed regarding the qualifications and competencies of practitioners; processes established to encourage patient self-management; demonstrated leadership support for the program; and use of clinical information systems to monitor patient care management.

More than 14 million Americans have been diagnosed with diabetes, with one out of every 10 health care dollars now being spent on diabetes and its complications. This includes more than $40 billion for inpatient hospital care. Effective management of glucose levels of diagnosed diabetic patients can help reduce the risk of further complications and adverse outcomes.

“The collaboration between the ADA and Joint Commission will help standardize the care provided for all diabetic patients in all inpatient departments in a hospital,” says Jean Range, M.S., R.N., C.P.H.Q., executive director, Disease-Specific Care Certification, Joint Commission. “This will lead to a better quality of life for diabetic patients and position certified organizations for success in pay-for-performance programs.”

Patient safety in Illinois

2006-07-31T10:17:00.000-04:00

Every year, JCAHO establishes new patient safety goals that healthcare organizations must follow to maintain accreditation. But now individual states are taking action. Gov. Rod R. Blagojevich of Illinois recently issued a package of reforms to reduce the number of medical errors and improve patient safety, including:

* Proposing that all providers use e-prescribing by 2011 to reduce the risk of medication errors
* Creating a new Division of Patient Safety within the Illinois Department of Public Health (IDPH) to specifically focus on reducing medical mistakes and improving patient safety
* Directing the new Division of Patient Safety to develop standardized medication practices to reduce adverse drug effects
* Directing the Department of Financial and Professional Regulation (IDFPR) to complete an on-line physician database so patients can learn more about their doctors
* Directing IDPH to expand its nursing home database to help seniors and their families learn more about each facility

“These are just some of the steps we can take to cut down on medical errors and help keep patients safe,” Gov. Blagojevich said. “If we’re successful, our patient safety plan will save money because it will reduce the costs that come with treating medical errors. But far more importantly, it will save lives. It means peace of mind, and better care, for all of us.”

Microsoft to offer healthcare software

2006-07-27T09:48:00.000-04:00

Microsoft plans to offer healthcare software that is designed to retrieve and quickly display patient information from many sources, The New York Times reported yesterday.

The software will replace other programs that compile patient information, but can’t share the data. Many hospitals and clinics have different kinds of patient information in electronic form, but their different computer systems and software cannot share the data, which is the problem Microsoft’s new system addresses.

Microsoft is buying a software system called Azyxxi that will do the job. The software was first used at the Washington Hospital Center, where patients are treated faster because of it. “We weren’t doctor-poor or bed-poor,” Dr. Craig Fried, who designed the software, said. “We were information-poor.” Patients had been waiting because doctors were unable to find patient records and treatment history.

Microsoft hopes to meet the needs of doctors and hospitals, who hope to save money and improve care by handling patient records and tracking treatments electronically. It will be competing with other established suppliers of clinical information technology systems, including Cerner, Epic, G.E. and Ecylpsis.

High medication errors lead to call for electronic prescribing

2006-07-24T09:22:00.000-04:00

Medication errors harm at least 1.5 million people every year and lead to $3.5 billion in additional medical costs, according to a report from the Institute of Medicine released on July 20.

The report calls for a series of steps to improve interaction between patients and healthcare organizations, including electronically written prescriptions by 2010.

The report found that 400,000 preventable drug-related injuries occur each year in hospitals, 800,000 in long term care settings and 530,000 among Medicare recipients in outpatient clinics.

The study finds that paper-based prescribing is associated with high error rates, so it promotes electronic prescribing, which eliminates hand writing errors and automatically alerts prescribers to possible interactions, allergies and other problems. It says that by 2008 all healthcare providers should make plans to write prescriptions electronically and by 2010 they should write them and pharmacies should be able to receive them.

Avoiding needlestick injuries

2006-07-20T10:35:00.000-04:00

According to the American Nurses Association, health care workers (HCWs) suffer between 600,000 and one million injuries from conventional needles and sharps annually. These exposures can lead to hepatitis B, hepatitis C and Human Immunodeficiency Virus (HIV), the virus that causes AIDS.

At least 1,000 HCWs are estimated to contract serious infections annually from needlestick and sharps injuries, with nurses sustaining the overwhelming majority of these exposures.

Over 80 percent of needlestick injuries are preventable with the use of safer needle devices, but less than 15 percent of U.S. hospitals use them. The safer needles cost .28 cents more per needle, but the expense is minimal compared with the approximate $1 million for a needlestick that results in a serious infection.

The CDC reports that many of these injuries can be prevented by using safer devices, such as needleless IV systems and blunted, retracted or shielded needles. Healthcare employees should use:

* a safe needle device or needleless system for withdrawal of body fluids
* use needleless systems or needles with engineered sharps protection for other procedures requiring needle devices
* use non-needle sharps that include engineered sharps protection such as certain surgical equipment
* use safe handling techniques

Hand washing

2006-07-17T13:33:00.000-04:00

Since the early 19th century, hand washing has been known to be the most effective method for halting the spread of disease, yet the compliance rate for health care workers is unacceptably low – from 14% to less than 50%, according to an American Nurses Assoication report published in the American Journal of Nursing.

Lack of hand hygiene promotion and administrative sanctions for non-compliance are the main reasons for the low figures. Organizations should actively campaign to have health care workers follow these hand washing procedures:

* wash when hands are visibly soiled, when gloves are removed, before direct contact with a patient and after contact with a patient’s skin or bodily fluids
* the correct method for handwashing is to wet the hands, apply soap and rub vigorously for 15 seconds, covering all surfaces of the hands and fingers
* hand gels can be used for disinfection by applying the recommended amount in one palm and rubbing the hands together, covering all surfaces of hands and fingers until the hands are dry
* an adverse effect of handwashing is skin irritation; healthcare workers should be provided with lotions that minimize skin irritation
HH

Coordinating disaster preparation

2006-07-13T10:38:00.000-04:00

A new JCAHO study finds that community-based preparation for and response to disasters will require more effective communication and planning among hospitals, public health agencies and community first responders—such as fire, police and emergency medical services.

The study—“Integrating Hospitals into Community Emergency Preparedness Planning” is the first large-scale national assessment of how closely hospitals and their communities are collaborating on natural or other disasters. Recent natural disasters and terrorist attacks have underscored the need for health care facilities to integrate their activities with community-based emergency preparedness efforts.

The study found that most acute care hospitals are involved in community-wide drills, analyze threats and vulnerabilities with community first responders, and are in communities that have plans for mobilizing necessary supplies, equipment, and decontamination facilities that would be required in an emergency. However, the Joint Commission study recommends drills and exercises that more truly simulate the stresses created by emergency conditions that persist over time.

Other study recommendations include the creation of health care organization coalitions that can accurately determine the adequacy of community resources to meet identified potential needs. The study finally identifies the need for national benchmarks for objectively measuring and gauging continuous improvement in emergency preparedness planning efforts.

“This study provides important new information about the current state of linkages between hospitals and their communities, and makes clear that neither can afford to work independently in the face of major emergencies,” says Jerod M. Loeb, Ph.D., executive vice president, Division of Research, Joint Commission.

To view the complete study, go to http://www.annals.org/cgi/content/full/144/11/799.

JCAHO institutes new influenza vaccine standard

2006-07-11T15:27:00.000-04:00

JCAHO has instituted an infection control standard that requires accredited organizations to offer influenza vaccinations to staff. The standard takes effect Jan. 1, 2007 for the Critical Access Hospital, Hospital and Long Term Care accreditation programs.

The Joint Commission developed the standard in response to recommendations by the Centers for Disease Control and Prevention making the reduction of influenza transmission from health care professionals to patients a top priority. Studies show that influenza causes 36,000 deaths and over 200,000 hospitalizations in the U.S. annually, with healthcare-associated transmission documented among many patient populations in a variety of clinical settings. Infections have been linked to unvaccinated health care workers, with fewer than 40 percent of healthcare workers immunized each year.

The new Joint Commission standard requires organizations to:

- Establish an annual influenza vaccination program that includes at least staff and licensed independent practitioners

- Provide access to influenza vaccinations on-site

- Educate staff and licensed independent practitioners about flu vaccination, non-vaccine control measures (such as the use of appropriate precautions)and diagnosis, transmission and potential impact of influenza

- Annually evaluate vaccination rates and reasons for non-participation in the organization’s immunization program

Pause for the cause

2006-07-05T16:32:00.000-04:00

WakeMed in Raleigh, NC has developed an innovative way to prevent medical errors before surgery – Pause for the cause.

This mandatory patient safety checklist is completed prior to surgery to prevent wrong site surgery, make sure surgeons have the right patient, the right procedure, the right equipment and the right side of the body. “It brings the whole team together so that it’s the last check,” says Sharon McNamara, WakeMed’s director of surgical services.

The checklist includes the following procedures:* correct patient, using two identifiers
* correct procedure, according to consent
* correct physicians, according to consent
* correct sites are properly marked
* correct patient position verified
* correct special equipment, supplies or implants available
* correct information documented in patient records

Falls legislation proposed in Congress

2006-06-29T09:08:00.000-04:00

The Keeping Seniors Safe from Falls Act was introduced in Congress earlier this month. The act, sponsored by Rep. Ralph M. Hall (R- TX) and Rep. Frank Pallone (D-NJ), seeks to create a national public education and awareness campaign that informs healthcare professionals about how to reduce falls, which are the leading cause of death among seniors, affecting one-third of adults over 65 each year.

The bill will expand research and provide demonstration projects to develop better ways to prevent falls and improve the treatment and rehabilitation of fall victims.

“The type of education on elderly falls provided through this bill will help inform health professionals about how to reduce these avoidable and frequently disabling injuries,” Rep. Pallone said. The bill is supported by the National Council on the Aging, the Home Safety Council and the National Safety Council.

100,000 Lives campaign reduces deaths from medical errors

2006-06-26T10:16:00.000-04:00

A campaign to reduce medical errors in hospitals has saved the lives of an estimated 122,300 patients at about 3,100 hospitals nationwide, according to data released June 14, at the conclusion of the Institute for Healthcare Improvement’s 100,000 Lives campaign, which began in December, 2004.

The campaign, sponsored by the IHI, supported by JCAHO, with more than 3,000 participating hospitals, focused on making six kinds of changes in patient care:

* deploy rapid response teams at the first sign of patient decline
* deliver reliable care for acute myocardial infarction to prevent deaths from heart attacks
* prevent adverse drug events by implementing medication reconciliation
* prevent central line infections
* prevent surgical site infections by delivering correct perioperative care
* prevent pneumonia

“The campaign has exceeded our highest expectations,” said Dr. Donald Berwick, president/ceo of the IHI. “The hospitals have not only prevented unnecessary deaths, but they’ve proven that it’s possible for the health care community to come together voluntarily to rapidly make significant changes in patient care.”

JCAHO announces 2007 Patient Safety Goals

2006-06-19T09:27:00.000-04:00

JCAHO announced its 2007 National Patient Safety Goals last week, which apply to nearly 15,000 accredited and certified healthcare organizations.

Major changes in the 2007 goals include extension of a requirement that accredited organizations define and communicate the means for patients and their families to report concerns about safety, across all Joint Commission accreditation and certification programs.

A new requirement specifies that behavioral health care organizations, as well as psychiatric hospitals identify patients at risk for suicide. This requirement is part of the Goal: “The organization identifies safety risks inherent in its patient populations.” For home care organizations, a corresponding requirement under this goal stipulates that these organizations are to identify risks associated with long-term oxygen therapy such as home fires.

New language in one of the two requirements under the existing medication reconciliation goal stipulates that a complete list of current medications be provided to patient on discharge from care.

“The 2007 National Patient Safety Goals target critical areas where patient safety can be improved through specific actions in health care organizations,” says Dennis S. O’Leary, M.D., president, Joint Commission. “Organizations that truly integrate these requirements into their daily operations will realize major opportunities to improve patient safety.”

Infection control for long term care

2006-06-09T08:53:00.000-04:00

Nosocomial infections are the major source of morbidity and mortality in long term care facilities, with an estimated 1.5 million infections occurring annually in the U.S., according to Nursing Homes magazine.

Senior care facilities have a legal and moral obligation to minimize the risk of infections to their residents and staff, but many facilities lack experienced infection control personnel and procedures.

Facilities must have a program that detects, prevents, controls and reports infections, which address such areas as food handling, laundry, waste disposal, employee health, pest control, visitation and safety.

Two of the most important components of an infection control plan are employee and resident health programs. An active employee health program prevents employees from spreading infections to patients and prevents employees from contracting infections at work. A resident health program covers issues such as resident hygiene, skin care, TB screening and immunization for pneumococcal pneumonia and influenza.

For more information, see http://www.nursinghomesmagazine.com/Current_Issue.htm?CD=983&ID=5082

Preventing hospital bed entrapment

2006-06-05T09:23:00.000-04:00

In an effort to combat hospital bed entrapment, which has killed 413 patients since 1985, the FDA recently released guidelines to help healthcare organizations create safer sleeping environments for patients.

Elderly patients in hospitals and nursing homes, especially those who are frail, confused, or have uncontrollable body movement, are most vulnerable to entrapments, which have occurred in a variety of patient care settings, including hospitals, nursing homes and long-term care facilities.

The guidelines identify special issues associated with hospital bed systems and suggestions for how healthcare facilities can assess existing beds. They characterize the body parts at risk for entrapment, the locations of hospital bed openings that are potential entrapment areas and the recommended test methods for assessing gaps in hospital bed systems.

“This guidance will assist healthcare facilities in making better informed decisions to ensure a safe sleeping environment,” said Larry Kessler, director of the FDA’s Center for Devices and Radiological Health. “While not all patients are at risk for entrapment and not all beds pose a risk, this guidance will ensure that entrapment risks with current hospital bed systems are identified.”

Avoiding exposure to BBPs

2006-06-01T09:23:00.000-04:00

More than 8 million healthcare workers in the U.S. risk exposure to bloodborne pathogens from needlesticks injuries and cuts from sharps.

Advance for Nurses magazine reports that six devices cause most of the injuries: disposable syringes (26 percent); suture needles (17 percent); winged steel needles (12 percent); scalpel blades (7 percent); IV catheter stylets (5 percent); and phlebotomy needles (3 percent).

Workers can avoid exposure with a combination of strategies that includes safer work practices, personal protective equipment, safety devices designed to prevent injury and contact with blood and management’s commitment to a culture of safety.

Organizations can select the best sharps safety devices and safely dispose of them to prevent injury. A culture of safety involves a commitment to remove hazards from the workplace and reporting all hazards in an effort to keep every employee safe.

Error reporting

2006-05-30T09:56:00.000-04:00

Hospitals’ attempts to improve safety culture and increase error reporting often focus on hospital-wide formal error reporting processes. But a recent study by Medical Care assessed how the safety culture of individual hospital departments affected the reporting of treatment errors, Safety Share reports.

A questionnaire used in three hospitals among three medical departments – internal medicine, surgery and intensive reveals they were more willing to report treatment errors when they were instructed on safety procedures as they relate to their work and working conditions. They felt more secure in reporting errors when they perceived that safety training information was readily available.

There were also variations within departments. Internal medicine and surgery were more likely to report errors than those in intensive care because they more readily perceived the suitability of safety procedures to their culture.

The authors conclude that hospitals must realize the importance of employee perceptions regarding safety procedures and that these perceptions can vary significantly among departments, which influences the way they report medical errors.

Paramedic exposure to BBPs

2006-05-26T09:35:00.000-04:00

A study of paramedics that estimates the national incidence rate of on-the-job blood exposure suggests they are at high risk for contracting HIV and hepatitis B and C from bloodborne pathogens.

The study, by the Constella Group, featured a mail survey sent to certified paramedics in the U.S. to determine the frequency of exposure and the routes of exposure, including accidental needlestick, contact with "non-intact skin" (i.e. cuts, lesions), contact with mucous membranes (i.e. eyes, nose, and mouth), patient bites, or cuts from other sharp objects containing patient blood, such as broken glass.

"Our study indicates that more than 20 percent of paramedics are exposed to patient blood at least once a year," according to Dr. Jack Leiss, chief epidemiologist at Constella. "Just as many of those exposures occur through contact with mucous membranes as through needlesticks. While the primary focus of prevention efforts has been on needlesticks, our study indicates that exposures to the eyes, nose and mouth may be equally important."

The study suggests that paramedics continue to be at substantial risk for blood exposure and that more attention should be given to reducing blood exposures through mucus membranes.

JCAHO/OSHA compliance

2006-05-22T09:31:00.000-04:00

Safety and health managers in healthcare face a challenge when it comes to administering JCAHO and OSHA standards, according to Business & Legal Reports. They must address the requirements of both entities. Joseph McFadden, president of McFadden and Associates, safety and health consultants in Denver, Colorado, offers helpful tips on the standards:

* JCAHO standards are for healthcare facilities only. OSHA covers many industries.
* JCAHO does not issue monetary fines. OSHA does.
* A non-compliant review by JCAHO may lead to non-accreditation. Failure to comply with OSHA standards leads to citations which many include monetary fines.
* JCAHO may perform unannounced inspections, but not always. OSHA inspections are usually unannounced.
* JCAHO requires written follow-up reports. OSHA requires a written plan of action.
* JCAHO requires written policies and procedures. OSHA may require written safety and health plans and procedures.
* JCAHO covers patients, visitors and staff safety. OSHA covers employee safety only.
* JCAHO requires staff training. OSHA requires employee training.
* JCAHO follows OSHA’s bloodborne pathogens standard. OSHA enforces the bloodborne pathogens standard.

Violence training

2006-05-18T09:52:00.000-04:00

TRAINING to help healthcare staff deal with violence at work is making a difference -- but only where it has a solid grounding in day-to-day situations, according to research reported by Scotsman.com.

Work-related violence is one of the most serious occupational hazards facing the healthcare sector, with nearly 12 per cent of staff experiencing physical violence from patients or their relatives and nearly 26 per cent experiencing bullying, harassment or abuse.

Violence management training offered to staff -- for example, de-escalation, breakaway moves, control and restraint -- has often been a key element of strategies to prevent or manage the problem.

The University of Nottingham research found that practical training being given to nurses, doctors and other health professionals is generally yielding "positive, but limited, short-term benefits" in dealing with the rising tide of aggression and violence they face in the workplace.

The researchers concluded that to achieve effective standards, training has to blend with other preventative systems and procedures that are already in place in an organization. It is important that training does not just focus on promoting individual skills and knowledge.

Keeping long-term care facilities clean

2006-05-16T09:10:00.000-04:00

Maintaining the cleanliness of long-term care settings maintains regulatory compliance and decreases infections. Nursing Homes magazine offers these tips for keeping the facilities clean:

* Change cleaning solutions frequently to decrease the opportunity of spreading contaminants.
* Make a point of cleaning special areas, such as the handles of canes, the handle grips of the walker, the arms of the wheelchair, the arm rests of the bedside commode.
* In the resident room, make sure to clean bedside phones, remote control devices, lamp switches, call cord activation devices and electric bed controls
* In the dining area, clean the arms of chairs, cloth napkins and tablecloths and make sure staff members clean their hands after touching residents.
* activity and therapy staff have their own cleaning concerns – how to keep balls, scissors and other equipment used in daily activities clean.
* maintenance staff can inspect the building for larger areas that may need cleaning, such as floors, handrails, doors, walls and other building surfaces.
Everyone in the facility should take pride in maintaining building cleanliness.

Patient safety shortcomings

2006-05-12T09:20:00.000-04:00

While patient safety systems have improved, current systems are not close to meeting certain recommendations, according to a study in the Journal of the American Medical Association, Hospitals & Health Networks magazine reports.

The researchers examined seven areas of patient safety: computerized physician order entry systems; computerized test results and assessments of adverse events; specific patient safety policies; use of data in patient safety programs; drug storage, administration and safety procedures; manner of handling adverse/error reporting; prevention policies and root-cause analysis.

Among the findings:

* While 74 percent of hospitals reported full implementation of a written patient safety plan, nine percent reported no plan.

* While a substantial percentage of hospitals have medication safety systems, only three percent reported full implementation of CPOE for medications.

The report recommends hospitals review the seven patient safety areas, assess their progress in implementing each of them, and report that progress to the community.

HIPAA privacy compliance training

2006-05-08T09:28:00.000-04:00

Your organization may have finished implementing its new Privacy policies, but it can’t be fully compliant until it has instituted an ongoing enterprise-wide training program.

The HIPAA Privacy Rule stipulates that all members of the enterprise receive training that is appropriate to their organizational roles. This includes employees, volunteers and trainees.

While some members of the staff should receive the specialized training that applies to their jobs, everyone should receive training on the following topics, according to the Phoenix Health Systems HIPAAdvisory:* Principles and objectives of HIPAA Privacy
* Background – what is protected health information?
* Need for privacy of PHI
* Overview of HIPAA privacy regulations
* Individual’s rights regarding: privacy, control of uses and disclosures of PHI, access and accounting of records
* New organizational privacy policies and procedures
* Cooperating with investigations or audits
* How to report a violation
* Organization’s commitment to patient privacy integration

JCAHO to perform unannounced surveys

2006-05-01T15:18:00.000-04:00

JCAHO is rolling out a new process for conducing on-site accreditation surveys and certification reviews on an unannounced basis, which applies to the more than 15,000 healthcare organizations it accredits.

“Making on-site evaluations less predictable and more focused on potential performance issues is intended to satisfy both public demand for greater organizational accountability and organizational demand for greater value in undergoing these outside evaluations,” Dr. Dennis S. O’Leary, JCAHO president said.

The decision to institute unannounced surveys was driven in large part by healthcare organization leaders who feel their organizations are always performing at a high level. The unannounced surveys also relieve the organizations from the costs incurred in the past in preparing for the evaluations.

From 2006 to 2008, the unannounced surveys will occur in the year in which the organization is due for its next survey. Subsequent unannounced surveys will occur during an interval of 18 to 39 months after the previous unannounced survey.

Safe lifting and movement of nursing home residents

2006-05-01T09:11:00.000-04:00

With 211,000 occupational injuries suffered by caregivers in 2003 and increases expected due to the rapidly expanding elderly population in the U.S., a call is being made for safer methods of lifting and moving nursing home residents.

A National Institute for Occupational Safety and Health report urges the use of lifting equipment, which is safer for the caregiver and more comfortable for the resident. It asserts that nursing homes should provide sufficient training on lift usage so staff develops competency. The training should focus on how to use the equipment for residents with a range of disabilities.

The use of lifting equipment prevents resident falls and the back and shoulder injuries caregivers experience when moving patients manually. Employers benefit from improved resident safety, reduced staff injuries, lower workers’ compensation costs and improved retention of caregivers.

Midwest mumps outbreak

2006-04-27T09:05:00.000-04:00

In the largest mumps outbreak in the U.S. in more than 20 years, almost 1,000 people have contracted the disease in the Midwest since last December, according to a Center for Disease Control announcement that was reported in The New York Times.

No one has died from the disease, but 20 have been hospitalized.

The epidemic began in Iowa, where 815 suspected cases have been reported and it has spread to seven other states.

About half the cases in Iowa involve college students, most of whom have been vaccinated. The vaccine for measles, mumps and rubella has an 80 percent efficacy rate for those inoculated with one dose and 90 percent for two doses. Dr. Julie Gerberding of the CDC attributes the outbreak to victims who have only received one dose “coupled with people who have received the vaccine but are susceptible anyway, living in crowded conditions like college dormitories and setting up a cascade of transmission that’s going to take awhile to curtail.”

The CDC is providing an additional 50,000 doses of the vaccine and the Iowa Public Health Department is trying to contain the outbreak through public education and inoculation.

Transporting residents safely

2006-04-17T09:59:00.000-04:00

Every year residents of nursing homes are injured by accidents that occur during transport, often within sight of the facility. Most of these accidents could be avoided if simple precautions are followed.

Nursinghomes Long Term Care Management magazine offers the following guidelines that protect facilities and residents:

* implement a drug testing program and motor vehicle registration checks for employees responsible for transporting residents
* equip vehicles with emergency communication devices, such as two-way radios or cell phones
* develop a preventive maintenance schedule for each vehicle
* provide an appropriate number of staff to meet the needs of patients while en route
* check equipment for proper working conditions before loading passengers
* park the vehicle so wheel chair lifts can be lowered to a flat area, away from traffic
* move the wheelchair completely on the platform during loading, with passenger’s hand and arms on lap
* set wheelchair brakes and fasten safety restraints before raising the lift to level of entry in van
* always fasten restraints according to manufacturer’s directions when transferring a wheelchair into the vehicle
* start the vehicle only after all passengers are properly seated
* provide a certified driver training course and offer annual refresher courses

Eliminating tubing and catheter misconnections

2006-04-10T09:05:00.000-04:00

JCAHO issued an alert last week urging health care organizations to pay special attention to how tubes and catheters are connected to patients.

Reports to the commission and other organizations show that tubing and catheter misconnection errors occur frequently and lead to fatalities.

Important warning signs of a possible misconnection include having to force-fit tubes together or having to use an adaptor.

To reduce the risk of errors relating to tube misconnections, JCAHO recommends that health care organizations:

* Avoid purchasing non-intravenous equipment with tubing connectors that permit connection with IV connectors
* Conduct tests on new tubing and catheters to identify potential for misconnections
* Always trace a tube or catheter from the patient to the point or origin before connecting a new device or infusion
* Route tubes and catheters having different purposes in different, standardized directions
* Emphasize the risk of tubing misconnections in clinician orientation and training programs

Patient lifting injuries

2006-04-07T08:37:00.000-04:00

More than half of nurses and radiology technicians report they suffered job-related chronic back pain or on-the-job injuries resulting from lifting, moving or repositioning patients.

The survey, conducted by Peter D. Hart Research Associates and released by AFT Healthcare, found that 56 percent of nurses and X-ray techs suffered from lifting-related injuries, chronic back pain or both. Nearly half the nurses and a third of the X-ray techs said they were considering leaving their profession because of injuries or chronic pain.

The study calls for the passage of laws requiring hospitals to buy equipment such as portable hoists to protect workers and patients. Some hospitals have invested in the equipment, but most don’t use it. “Construction workers use cranes, package delivery personnel use dollies, yet most healthcare workers are on their own and getting hurt,” says Candice Owlie, chair of AFT Healthcare. “This is affecting patient care and the profession.”

Human factor of medication errors

2006-04-03T10:04:00.000-04:00

Greater than 40 percent of the medication errors that occur in U.S. healthcare facilities are linked to the “human factor,” Mary Bylone, nursing administrator at AtlantiCare Regional Medical Center in Pomona, NJ told Advance for Nurses magazine.

“Issues surrounding lack of knowledge, deviation from policy, miscalculation of dosage or rate, drug preparation error, transcription error, fatigue and computer entry errors are all examples involving the human factor of medication administration,” she said.

“It’s easy to blame these mistakes on equipment, packaging and flawed systems. It’s been hard, on the other hand, to accept that we are at the root of many of the preventable incidents.”

Healthcare facilities are making a greater effort today to eliminate human errors, in an effort to comply with JCAHO regulations and improve patient safety. But Bylone believes nurses and other healthcare professionals must make more of an effort to prevent errors. “The next time you make your way to the bedside with medication to administer, be sure to give it safely – and make sure your human factor is up to date and safe,” she said.

OSHA tackles Avian flu

2006-03-30T10:10:00.000-05:00

OSHA has released a document, “Guidance for Protecting Workers Against Avian Flu,” that offers tips for different kinds of workers to protect themselves from infection.

Farm workers who may come in contact with infected poultry should wash their hands frequently and be provided with the appropriate PPE, including protective clothing, gloves, goggles, boots and respirators. They should also receive antiviral drugs daily during the time they are in contact with infected poultry.

Food handlers should avoid contact with eggs from infected poultry and should cook chicken to reach an internal temperature of 180°F.

Airline flight crews who could come in contact with infected people should wash hands frequently, wear disposable gloves and follow CDC guidelines for the handling of sick passengers.

There are also tips for lab and medical workers who may be involved in the research or treatment of Avian flu.

“All employees with potential occupational exposure should be trained on all the hazards associated with exposure to influenza A (H5N1) and the protocols in place in their facility to isolate and report cases or reduce exposures,” the report concludes.

Social worker safety

2006-03-23T09:30:00.000-05:00

The death of a South Texas social worker last week has sparked renewed interest in promoting safety among social workers, who deal with work related violence, including physical assault, verbal assault, harassment and the threat of assault from the people they are investigating.

The family of Sally Blackwell, the social worker who was killed, said she had received threats in her position as a program director who oversaw case workers, according to The New York Times.

A survey released last week by the National Association of Social Workers found that 55 percent of 5,000 licensed social workers said they faced safety issues on the job. Another survey found that 19 percent had been victims of violence on the job and 63 percent had been threatened.

The NASW asserts that agencies should develop safety plans to protect social workers. The plan should include:* how to recognize signs of agitation
* what to do at first signs of agitation
* code words and phrases to signal for help without increasing the client’s agitation
* format for ongoing assessment of a client’s level of dangerousness
* format for intervention including: when and how to attempt de-escalation; when and how to use non-violent self defense; when and how to call security and police; when and how to evacuate building

Preparing for bird flu

2006-03-20T13:11:00.000-05:00

Preparations for a possible influenza sparked by the deadly H5N1 strain of avian bird flu have stepped us as federal officials ordered additional stocks of antiviral drugs and launched a new effort to develop a vaccine that could be effective against the mutating virus.

The U.S. Department of Health and Human Services has order another 1.75 million treatment courses of the antiviral drug zanamivir, known by the trade name Relenze, and 12.4 million treatment courses of oseltamivir, known as Tamiflu. The drugs will be added to the 5.5 treatment courses already purchased for delivery to states if an influenza epidemic occurs.

The department has also authorized the National Institutes of Health and the U.S. Centers for Disease Control and Prevention to begin working on a second prepandemic flu baccine based on the mutating H5N1 virus. The current stockpile of prepandemic vaccine is based on an earlier version of the virus and could be less effective at inducing immunity.

Preparing for the Hurricane season

2006-03-10T08:41:00.000-05:00

With less than 90 days until the beginning of the 2006 hurricane season, leaders in long term care in Southern states gathered recently to share their experiences from the 2004 and 2005 seasons, looking at how the care of frail, elderly and disabled residents in nursing homes and assisted living facilities along the Gulf Coast was affected by either evacuation or staying in place.

“Hurricane Katrina made everyone take notice,” said LuMarie Polivka-West, a senior director at the Florida Health Care Association. “But we’re moving beyond sharing lessons learned to partnering with our colleagues in formulating mutual assistance plans, developing better training materials and crafting regional response strategies for the future.”

Members of the summit shared their insights with government agencies about what it means to prepare for physical disasters while attending to the medical needs of very ill, very old and very fragile patients and residents. Several at the summit agreed that volunteer and non-governmental organizations (NGOs) should be better integrated into the federal response. The government should engage NGOs in its planning process and provide them with necessary support as part of a joint response.

Communication skills

2006-03-06T10:55:00.000-05:00

The Fountains, a nursing home in Tucson, AZ instituted a staff training program called “Keep a Friend,” that motivated staff to adapt their communications styles to build relationships with others, according to Nursing Homes magazine.

The workshop helps staff members communicate more effectively with residents and their family, as well as colleagues.

“Associates learn the importance of active listening, engaging in conversation, correct tone voice, body language, empathy and eye contact,” says June Hussy, The Fountains vice president of public relations. “When practiced and incorporated into daily interactions, these skills help to improve teamwork and overall service and care, which in turn improve associate, resident and family satisfaction.”

Improving surgery

2006-02-27T15:29:00.000-05:00

Hospitals perform more than 42 million inpatient surgeries each year, but complications often follow which can kill or harm patients and lead to extended stays, according to Hospitals & Health Networks magazine.

A group of medical associations has teamed up to form Surgical Care Improvement Project to use evidence-based practices to target four of the most common surgical complications: blood clots, heart attacks, surgical site infections and ventilator-associated pneumonia. The goal is to reduce their incidence by 25 percent by 2010.

Under the program, hospitals are provided evidence-based measures and clinical practice guidelines to support changes that will improve surgical outcomes. For instance, guidelines for the reduction of cardiac events, which occur to 2-5 percent of patients undergoing non-cardiac surgery, outline the appropriate use of beta blockers and how to identify patients who are at risk.

“SCIP will save lives, reduce harm and result in effective and efficient care delivery,” says Nancy Foster, the American Hospital Association’s vice president of quality and patient safety.

JCAHO’s new accreditation program

2006-02-23T09:18:00.000-05:00

Today’s blog features comments from Dr. Walter Ettinger, president of UMass Memorial Medical Center that appeared in Advance for Health Information Executives magazine:

“JCAHO’s new accreditation program rolled out this year and UMass Memorial was one of the first hospitals to undergo the new periodic performance review. Two specific changes in the review were clear: the use of the tracer methodology and the focus on the National Patient Safety Goals.

Under the tracer methodology, specific patients are selected by the surveyors and tracked within the organization to assess quality and safety of care. Surveyors evaluate the care delivered by each department as well as how departments work together as a whole. In addition, the tracer methodology puts the survey spotlight on staff members.

We also realized that with emphasis on National Patient Safety Goals, we would have to sharpen our focus on safety. From the self-assessment, we knew that surveyors would be investigating procedures such as the frequency of handwashing, patient identification before administering medication or drawing blood and use of improper abbreviations when writing medication orders.

In our view, the new survey process would require some major changes in staff behavior and our organization would be on the receiving end of a thorough, comprehensive JCAHO review. We had to prepare.”

Thank you, Dr. Ettinger!

Eliminating medication reconciliation errors

2006-02-21T11:29:00.000-05:00

JCAHO recently released a new alert that urges intensified attention to the accuracy of medications given to patients as they transition from one care setting to another, or one practioner to another.

According to the alert, medication reconciliation should occur whenever a patient moves from one location to another in a healthcare facility; or from one healthcare facility to another or to home; and/or when there is a change in the caregivers responsible for the patient.

Last year, United States Pharmacopeia received more than 2,000 voluntary reports of medication reconciliation errors and an Institute of Medication report estimates more than 7,000 deaths per year in hospitals due to medication errors. Most of the medical errors resulting in death were due to a breakdown in communication, and approximately half would have been avoided through effective medication reconciliation.

To reduce the risk of reconciliation errors, JCAHO advises organizations to:

* put the list of medications in a highly visible place with information about dosages and schedules
* reconcile medications at each interface of care
* communicate a complete list of patient medications to the next service provider
* provide patients with a complete list of medications they will take after being discharged, with instructions on how long to take them

Staff sexual abuse of nursing home residents

2006-02-16T10:56:00.000-05:00

Cases of staff sexual abuse of nursing home patients are uncommon, but when they occur lives are destroyed, facilities’ reputations are tarnished and costly lawsuits are brought, according to Nursing Homes magazine.

Preventing sexual abuse starts with criminal background checks of prospective employees. Once a prospective hire passes the background check, a thorough interview should follow, in which the candidate is asked to respond to different scenarios to gauge how he or she would handle stressful situations. Once they’ve been hired, new employees should be taught how to handle abuse and report it anonymously.

The federal government requires nursing homes to report all allegations of abuse to state survey agencies. Beyond the notifications, nursing homes should:

* safeguard the resident and provide the medical and psychological care needed
* separate the alleged perpetrator from residents during the investigation
* immediately notify the family in a face-to-face meeting
* notify police
* consider bringing in outside counsel to help conduct the investigation

Diabetes prevention

2006-02-14T12:01:00.000-05:00

Although most nursing facility patients who suffer from diabetes are diagnosed before they enter the facilities, the risk of diabetes increases with age, so long term care practitioners must look at practical methods of screening patients and implementing treatment that will prevent new cases.

A comprehensive program for diabetes prevention, prepared by Provider magazine, includes: * screening patients for hyperglycemia, which signals a pre-diabetes condition, during annual physical exam
* evaluating high risk patients via lab tests for levels of blood glucose, glycated hemoglobin, fructosamine and insulin
* assessing general nutrition, with prevention-oriented diets for high risk patients
* implementing weight loss program for overweight patients
* encouraging patients to maintain a healthy weight and diet
* promoting regular exercise programs

Diabetes prevention programs promote the health of your patients and save money by limiting patient hospital visits.

Combative behavior

2006-02-09T09:23:00.000-05:00

Due to dementia and other psychological problems, nursing home residents are frequently combative, shouting, kicking and striking out at others, most often nurses, who are the victims 90 percent of the time.

When staff anticipates and de-escalates violent episodes, combative behavior can be managed.

The basic techniques for de-escalation, according to Nursing Homes magazine, are:

* active listening and effective verbal responding – good communication with residents can defuse violent behavior
* redirection – Staff redirects resident attention to other subjects
* stance – by standing about 18” apart from residents, staff can move a resident without losing balance. Positioning to the side instead of in front of a resident, they can avoid being struck
* tincture of time – allow resident time and space to let the outburst dissipate
* don’t jump to conclusions – listen carefully to resident concerns before acting
* controlling the environment – move other residents out of the way, remove objects residents could use to hurt others, block routes residents use to leave the facility
* teamwork – staff members must work together to handle combative behavior

Resident abuse

2006-02-06T09:17:00.000-05:00

Everyone knows about the laws that protect residents in long term care facilities from abuse. But LTC employees are protected by laws, too, from abuse by residents.

When an employee at an Iowa LTC facility sued for damages after losing her job for slapping a resident who had sexually abused her, awareness grew about employee rights.

Nursing Homes magazine suggests facilities take these actions to protect their employees from resident abuse:

* Create a policy prohibiting hostile environment in the workplace by residents – sexual harassment policies already on the books should be rewritten to apply to residents, with multiple avenues for complaint procedures employees can pursue
* Provide training on handling resident abuse – train employees to handle sexual harassment by residents and train managers to respond to employee harassment complaints
* Readjust supervisor attitudes toward resident abuse – managers must not believe that resident abuse is “part of the job” -- they must understand that resident behavior can constitute sexual harassment and be actionable under the Civil Rights Act of 1964 and other laws

Fire ants

2006-02-02T11:37:00.000-05:00

Last year, one of the nation’s largest healthcare companies settled for $1.8 million with the family of a resident who died after fire ants swarmed his bed.

Fire ant infestation is a problem in long-term care facilities that recurs despite frequent treatments. Older residents are the most vulnerable to attacks because they can’t move quickly.

The following strategies can be used to prevent fire ant attacks:

* seal any cracks, holes and entry points in the exterior masonry
* trim vegetation at least 18” away from the building structure
* keep the roof, gutters and downspouts free of debris
* repair any leaks and other excess moisture sources
* clean up food debris in common areas
* monitor landscape garden beds for fire ant mounds
* spray pesticides or apply pesticidal baits

Ongoing monitoring and the use of chemical pesticides are the one-two punch you can use to safeguard your property from fire ants and protect residents.

Fire ants

2006-02-02T11:36:00.000-05:00

Hospital wastes

2006-01-30T09:56:00.000-05:00

Toxic hospital wastes can cause health and environmental hazards, with syringes, intravenous needles, blood, body fluids, human tissues, dressings, drainage bags and disposable items creating pollution. Even bandages, gauze and cotton dumped outside can be a hazard.

Hospitals should be aware of these kinds of waste, according to Managing Infection Control magazine:

* Municipal waste: solid waste generated from healthcare facilities
* Hospital waste: all kinds of waste generated within a hospital, including biological and non-biological.
* Medical waste: Wastes from patient treatment, diagnosis or immunization.
* Infectious waste: Wastes that can cause infectious disease, including bloodborne pathogens.
* Hazardous waste: Solid and liquid wastes that can cause serious injury, including radioactive, toxic or explosive materials.

Hospitals should develop a waste control plan that covers all kinds of waste in an effort to protect patients, staff and the general public

Methamphetamine abuse straining hospital emergency rooms

2006-01-26T11:35:00.000-05:00

A sharp increase in the number of people arriving in emergency rooms with methamphetamine-related problems is straining local hospital treatment facilities across the country, The New York Times reported.

Seventy-three percent of the 200 county and regional hospitals polled in a survey said there has been an increase in emergency room visits for methamphetamine-related problems recently. Fifty-six percent of hospitals said their costs had risen because of the growing abuse of the drug.

Users frequently develop rapid heartbeat, increased blood pressure and fevers that can reach 105 degrees. And because the drug's neurological side effects frequently include aggressive behavior and paranoia, the hospitals say they deal with many victims of fights or beatings.

"It has really rocked us," said Patrick Fleming, director of the Salt Lake County Division of Substance Abuse Services in Utah. "People are staying in treatment slots longer, so I can't spin those beds to someone else. My waiting lists are mounting like crazy."

Though a relatively small number of total emergency room visits are for illicit drugs, the hospitals said methamphetamine was by far the leading drug problem. Forty-seven percent of hospitals said methamphetamine caused more emergency room visits than any other drug, while 16 percent cited marijuana, 15 percent cocaine and 1 percent heroin.

Investigators overlook problems in nursing homes

2006-01-23T11:26:00.000-05:00

Investigators from the Government Accountability Office have found that state inspectors often overlook serious violations in the nation’s nursing homes, according to a report in The New York Times.

State employees who inspect the homes, working under contract to the federal government, pervasively understated “serious deficiencies that cause actual harm or immediate jeopardy to patients,” according to the GAO. The harm includes severe weight loss, multiple falls resulting in broken bones and other injuries and pressure soars. The deficiencies also include fire safety violations, with concerns about cost delaying the installation of automatic sprinkler systems that leave more than 20 percent of homes without adequate fire protection.

Nursing homes must meet federal standards to receive Medicaid and Medicare. They spend $67 billion per year on nursing home care, but Medicare plans to begin linking payment to the quality of care nursing homes provide and will test a “pay for performance” system this year, according to Dr. Mark B. McClellan, a Medicare official.

Federal employees visit about five percent of the nation’s 17,000 nursing homes each year to validate findings of state inspectors. Serious problems not detected by the state inspectors were found in 28 percent of the visits from 2002 to 2004, up from 22 percent in 2000 to 2001.

Sponge, Sharp and Instrument Counts

2006-01-16T09:40:00.000-05:00

The practice of sponge, sharp and instrument counts can lessen the potential for injury to patients as a result of a retained foreign body and promote optimal perioperative patient outcomes.

The Association of periOperative Registered Nurses recommends these practices should be followed:

* sponges should be counted on all procedures in which a sponge could possibly be retained
* sharps and other miscellaneous items should be counted on all procedures
* instruments should be counted for all procedures in which an instrument could be retained

The counts should be performed: before the procedure to establish a baseline, before closure of a cavity, before a wound closure begins, at skin closure or end of procedure and at the time of permanent relief of either the scrub person or the circulating nurse.

Bed Rail Safety

2006-01-12T10:19:00.000-05:00

Since 1990, the FDA has received 102 reports of head and body entrapments involving hospital bed rails, including 68 deaths. Patients can be caught, trapped, entangled or strangled, with deaths caused by entrapment of the head, neck or thorax.

You can protect frail, elderly or confused patients from bed rail injuries by following these guidelines:* Evaluate bed rails to insure the dividers are not large enough for a patient to insert his head or thorax.

* Split or quarter side rails can be risky for individuals because they can get caught in the space between the top and bottom rails. Nurses must determine the need for upper and lower rails in the context of resident assessment.
* Any time a new mattress is purchased for an old bed there should be no more than a 2-inch clearance between the rails and mattress. If the distance is greater, the mattress should not be used.
* Bed rails should not be used as a substitute for patient protective restraints.

Treating wounds

2006-01-09T09:25:00.000-05:00

Approximately five million patients a year suffer from chronic wounds and the number will increase as our population ages. But if basic procedures are followed, many wounds can be prevented.

It is vital to understand the cause of the wound and the patient’s overall status before treating the wound. Here are some questions to help in assessment:

* What caused the wound?* What is the location of the wound?
* What kind of tissue is in the wound bed?* Is the wound draining?
* Is the patient incontinent?
* Is pain a factor?

After a patient is assessed and the above questions are answered, appropriate treatment will include:

* Wound dressings – occlusive, non-occlusive, absorbtive, debriding, etc.
* Sharp debridement – performed by a physical therapist or physician
* Nutritional support – vitamin, mineral or protein supplements may be needed to support wound healing
* Incontinence care – frequent and generous applications of barrier creams can prevent breakdown from incontinence
* Electrical stimulation – radio frequency, ultrasound, whirlpool and hyperbaric oxygen therapy

Wandering prevention

2006-01-04T08:29:00.000-05:00

Wandering of dementia patients “is a complex challenge,” Bettye Rose Connell, a research scientist at the Atlanta VA Medical Center told Nursing Homes magazine. “There’s no one size fits all solution for it.”
Nursing homes rely on alarms and electromagnetic door locking systems and design their environments with open layouts to prevent wandering, but staff practices are another important strategy that can be used.

Connell says staff can plan activities that redirect residents away from the areas around the exit doors. “It’s good to stage activities away from exits that hold residents’ attention – such as the smell of baking bread or the sound of period music,” she says. “The person who is wandering might follow her nose to the fragrant smell of something baking in the oven, or she might follow her ears to the sounds of swing music wafting down the hall.”“Wandering is not something you can simply foist off on technology and facility design,” she says. “Staff and programming play important roles in wandering prevent

New Options for Hospital Fire Safety

2005-12-28T10:25:00.000-05:00

To fight the five fires a day and more than 8,000 per year that occur in our nation’s health care facilities, a number of new fire fighting techniques are in use, according to a recent article in the Occupational Health & Safety magazine (YEAR).

Clean agent portable fire extinguishers are being seen as an alternative to fire blankets and the Halon 1211 extinguisher in patient care areas. “Our research shows that fire blankets are not completely successful in smothering an oxygen fire,” says Ron Long, director of facilities services at Banner Good Samaritan Medical Center in Phoenix. “You don’t want to use an ABC extinguisher with a patient that has an open incision, and sterile water concerns me because of all the electrical equipment that may be attached to a patient. Therefore, the clean agent fire extinguishers are truly the best way to handle fires in a hospital setting.”

Hospitals that phase out the use of Halon 1211 must train all employees to use the new equipment. “We are hands on and train every department in our facility,” Long says. “Our goal is to make sure everyone is trained and everyone is safe.”

Hand hygiene

2005-12-22T10:27:00.000-05:00

Improved adherence to hand hygiene reduces outbreaks in healthcare facilities, transmission of antimicrobial resistant organisms and overall infection rates.

Your employees can practice proper hand hygiene by:* Washing hands regularly with soap and water

* Disinfecting hands using alcohol-based hand rubs by applying product to the palm of one hand, rubbing hands together and covering all surfaces of hands and fingers until hands are dry
* the use of gloves does not diminish the need for hand hygiene
* not wearing artificial nails and keeping natural nails less than one-quarter of an inch long

Healthcare organizations should consider the smell, consistency and color of hand hygiene products before purchasing. They should also develop a system for measuring adherence to hand hygiene recommendations, such as periodic monitoring.

Sexual harassment of nurses by patients

2005-12-20T15:21:00.000-05:00

When nurses provide compassionate care for patients, they sometimes ask for more. Sexual harassment of nurses by patients is a growing problem, which runs the gamut from offensive jokes and sexual comments to inappropriate touching and sexual assaults.

The harassment creates a professional tension for nurses, who must walk a fine line between their professional responsibilities to the patient and protecting themselves. Meanwhile, medical institutions have legal requirements to care for patients that can limit their response to patient harassment of nurses.

A survey that examined how nurses respond to being sexually harassed by patients found that they often crack jokes or sternly reject the patient’s conduct, but few have been trained on how they can respond.

Nurses should be protected by their organization's sexual harassment policy. If harassment occurs, they can also:

* refuse to care for the patient
* ask for assistance from a second nurse
* report the behavior to a supervisor who can speak with the patient
* in extreme situations, institutions may be able to send the patient to another facility

Healthcare violence

2005-12-15T10:50:00.000-05:00

Violence is a severe problem in healthcare facilities with more assaults occurring in health and social services than any other industry. In a recent 10 year period there were 106 health care related deaths from violence. Psychiatric units and emergency departments are the leading areas for violence, but no department is immune.

Eliminating violence from healthcare facilities is a responsibility each facility and its employees share.

The facilities can:

* provide information on the hazards associated with units and jobs
* train supervisors on methods to reduce security hazards
* supervise the movement and care of risky patients and monitor high risk patients
* control access to high risk areas, including emergency rooms, psychiatric units, intensive care units and pharmacies
* ensure employee safety by prohibiting them from working alone and providing escorts as appropriate

Employees can:

* know the security procedures of their facilities
* not leave scalpels or needles near patients
* obtain patient history of violence
* report every violent incident to administration and security

Pain management standards

2005-12-13T09:00:00.000-05:00

All accredited healthcare organizations have been required to comply with JCAHO’s pain management standards since 2001, but many have struggled to comply.

The standards recognize the rights of patients to assess and manage pain and implore health care organizations to assure staff competency in pain assessment and management.

Here are the eight steps you can take to comply with the standards:

1. Develop an interdisciplinary work group that focuses on pain management.
2. Analyze current pain management practices to determine how you can improve.
3. Articulate and implement a standard of practice – who assesses pain, how do they do it, when do they do it.
4. Establish accountability for pain management.
5. Provide clinicians with information about pharmacologic interventions to help them write and implement orders.
6. Provide patients a quick response to their reports of pain.
7. Provide education of staff – programs for nurses are especially helpful.
8. Use patient surveys and performance measurements to continually evaluate and improve the quality of pain management.

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Making the Patient Safety Act work

2005-12-08T12:13:00.000-05:00

The Patient Safety and Quality Improvement Act, signed into law by President Bush this year, could revolutionize the American healthcare industry by creating an anonymous nationwide database of medical errors to help healthcare workers provide better patient care by sharing information about errors.

The act comes with a protection privilege that shields organizations from liability when they report errors. When a facility files a report with a patient safety organization (PSO), it can’t be used against the organization by a plaintiff or accrediting body, so it is safe from liability.

“When physicians can report errors in a voluntary and confidential manner, everyone benefits,” one expert said.

The next major step is regulating the creation of the PSOs, which will analyze the error information and provide it to healthcare organizations. The Agency for Healthcare Research and Quality will establish the PSO regulations later this year.

TB screening prevents workplace infection

2005-12-06T08:52:00.000-05:00

Employers with workers from countries with high tuberculosis prevalence should utilize pre-hire TB screening, according to a recently published report.

A study by the Journal of Occupational and Environmental Medicine concluded that TB transmission largely occurs among workers from countries with high TB prevalence and close proximity with those workers can result in transmission to workers from countries with low prevalence.

“The growing proportion of immigrant workers in the American workforce may be creating new situations for the emergence of TB in the workplace,” the study said. Language barriers, lack of health care access and inadequate understanding of the importance of treatment exacerbate the problem.

The report urged employers to consider pre-employment screening for immigrant workers from high TB prevalence countries in Central and South America.

Selecting medical gloves

2005-12-01T13:22:00.000-05:00

Medical gloves are essential personal protective equipment for healthcare workers, because they provide protection from bloodborne pathogens and other infectious, chemical and radioactive hazards. Latex gloves were the traditional choice, but alternatives have been developed because of the health risks associated with latex.

* The most important point for selecting medical gloves is to determine what kind of protection is needed and then make sure the gloves provide it.

* The health effects associated with the gloves must be considered next. There are health risks associated with latex gloves (allergies), powdered gloves (granulomas and adhesions in surgical patients) and vinyl gloves (incineration can release dioxin in the air). Gloves must provide protection without risking the health of workers or patients.

* The gloves must fit properly. Tight gloves cause chafing of the skin and poor fitting gloves make it difficult to perform manual tasks such as gripping or manipulating medical devices.

* Feedback from glove wearers can help you determine if the gloves you’ve selected are right. Check for fit, comfort, resistance to leaking and tearing, skin irritation and the ability to perform job tasks.

Avoiding the bird flu pandemic

2005-11-30T16:33:00.000-05:00

The risk of an avian influenza bird flu pandemic in the U.S. is so high now that Pres. Bush pledged $7.1 billion in emergency funding to stockpile vaccines that can treat it and create new vaccines the virus isn’t resistant to.

Two antiviral medicines, Tamiflu and Relenza, may be useful treatments for H5V1, the avian influenza virus strain, but it is generally resistant to two other antiviral medications, amantadine and rimantadine. A worldwide effort to create new vaccines is underway, but it is hampered because it is unknown exactly what form the deadly virus would take.

The H5V1 virus, which began affecting Asian poultry in 2003, rarely affects people, but close contact with infected poultry can cause human infection and there have been isolated reports of human to human transmission. To date, 130 human cases have been reported in five Asian countries, with 67 fatalities.

The reported symptoms of avian influenza have ranged from typical influenza-like symptoms (fever, cough, sore throat) to eye infections, acute respiratory diseases, viral pneumonia and other life threatening illnesses.

At this time, it is uncertain whether the currently circulating H5N1 virus will lead to a global pandemic, but if the virus adapts to allow easy human to human transmission, a pandemic could occur. Three bird related flu pandemics have hit the U.S. in the past century, with 500,000 dying in 1918 during the most severe outbreak.

People can reduce the risk of catching or spreading avian influenza by:
* covering nose and mouth when coughing or sneezing
* disposing of dirty tissues promptly
* avoiding large crowds
* maintaining good basic hygiene, including washing hands frequently to reduce the spread of virus; wash hands before and after handling food

Protecting patient rights

2005-11-22T09:15:00.000-05:00

The Patient’s Bills of Rights, adopted by the U.S. health care industry in 1998, provides patients with the fundamental right to receive considerate healthcare that safeguards their dignity and respect. When healthcare workers follow it, they provide quality care that benefits their patients and enhances the reputation of their organization.

* The right to respectful treatment – provide prompt and courteous care
* The right to privacy and confidentiality – HIPAA’s new Security Rule requires administrative, physical and technical safeguards to guarantee the confidentiality of all electronic PHI
* The right to be in communication – patients have the right to communicate with anyone outside the facility unless their safety is in jeopardy
* The right to make informed decisions – patients have the right to a full diagnosis of proposed treatments that are easily understood
* The right to participate in all aspects of healthcare – patients have the right to make decisions about their care and must be informed of the medical consequences of their actions.
* The right to an advance directive – patients have the right to a living will, healthcare proxy or durable power of attorney, so they can state their wishes about receiving care in case they become incapacitated
* The right to impartial access to care – patients must be given impartial access to care, regardless of race, national origin, religion, age, creed, sex or sources of payment

Your employees should be aware of these important patient rights and honor them as they care for patients.

Managing Dementia Related Behaviors

2005-11-16T15:25:00.000-05:00

Dementia related behaviors, common in nursing home residents, can be a severe burden to the staff. Effectively managing them improves functionality and the quality of life for patients and staff.

The first step is to understand the DRB you are dealing with and why it occurs. The behavior, which can involve kicking, hitting, biting and scratching at specific times, can be caused by intrinsic and extrinsic factors, from physical and psychological diseases to environmental factors like light and heat.

Treating DRB involves early intervention and distracting and redirecting a person from the behavior while maintaining the resident’s dignity and respect.

Medication is frequently required, although medication for the treatment of DRB is FDA approved. Nursing homes follow state guidelines for psychotherapeutic medications, including antipsychotics, antidepressants and mood stabilizers. In many cases, pain medication should be the first tried and beta blockers, estrogens and cognitive enhancement drugs have also been tried.

Educate your staff to make sure they understand the behavior and drug management techniques that can be used to treat DRB.

NEW! Safety Orientation training program

2005-10-19T15:21:00.000-04:00

Safety Orientation For Healthcare: Preparation Meets Opportunity

Every day on the job your employees face potential hazards. But if they are prepared, they can prevent injury at work. Help your staff prevent injuries that may be encountered on the job. Learn More...

healthcare training

2005-10-19T14:41:00.000-04:00

Welcome to the Healthcare Training blog, brought to you by Coastal HealthTrain, a division of Coastal Training Technologies Corp.

Coastal HealthTrain is the leading supplier of non-clinical training videos, CD-ROMs, web-based courses and handbooks for healthcare professionals. We offer training in the following topic areas:

· Ambulatory Care

· Behavioral Healthcare

· Home Health

· Hospitals/General Healthcare
- Compliance
- Customer Service
- Diversity
- Emergency Preparedness
- Employee Retention
- Employee Safety Orientation
- Ergonomics
- Facilities/Plant Management
- Fire Safety
- Group Development
- Hazard Communication
- HIPAA Privacy Rules
- Infection Control
- Management
- Motor Vehicle Safety
- OSHA/JCAHO Tools
- Patient Care
- Patient Safety
- Sexual Harassment
- Stress
- Substance Abuse
- Violence Prevention

· Long-Term Care

Check back weekly for news, info and more!