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In their effort to help hospitals improve performance and consistently provide high quality care, each year The Joint Commission publishes their National Patient Safety Goals (NPSG).
These reports gather information about emerging patient safety concerns and present sets of standards with measurable outcomes applicable to all Joint Commission-accredited hospitals and behavioral health care organizations.
In this series we have touched on goals related to identifying high suicide-risk patients, as well as prevention of wrong site, wrong patient, wrong procedure surgery errors. The third entry of our 2021 NPSG series centers on the reduction of patient safety risks associated with anticoagulant medication use.
As one of the most common medication classes to cause adverse drug events (ADEs), anticoagulants can lead to bleeding events, poor patient outcomes, and increased hospital costs. In this article we provide an overview of the eight required performance elements, along with steps you can take to reduce the risk of patient harm associated with anticoagulation therapy.
Anticoagulant medications are important in preventing and treating blood clots. However, oral anticoagulants, such as warfarin and direct oral anticoagulants (DOACs), are also the most common cause of ADEs in older adults, often leading to ER visits and hospitalizations. In 2017, bleeding events from oral anticoagulants led to over 235,000 emergency room visits.
In a five-year retrospective study conducted by Brigham and Women’s Hospital, they found that 70 percent of ADEs caused by anticoagulants were potentially preventable. Most commonly, the ADEs were due to missed medication doses and incorrect medication directions, such as the wrong drip rate or frequency.
Hospitals can avoid safety issues caused by incorrect anticoagulant dosage and usage by the creation and adherence of protocols designed to identify and communicate the associated risks. The following elements of performance outline eight anticoagulation therapy requirements that apply to all Joint Commission-accredited hospitals and critical access hospitals, as well as ambulatory and nursing care centers.
Element of Performance 1
The first element requires that hospitals use approved protocols and evidence-based practice guidelines to begin and maintain anticoagulation therapy.
Since anticoagulation medications are high-risk medications, organizations will be required to use updated and approved protocols and evidence-based practice guidelines. These guidelines are meant to ensure that the appropriate medication for the indication is selected, as well as the appropriate starting dose and frequency of the medication. Dosing adjustments may be required based on the patient’s age, renal function, liver function, drug-drug interactions, or drug-food interactions. These factors should be addressed in the protocols and practice guidelines.
Element of Performance 2
This element requires that hospitals use approved protocols and evidence-based practice guidelines for anticoagulation reversal and management of anticoagulant-associated bleeding events for each anticoagulant medication.
With bleeding being the most common complication from anticoagulants, having an anticoagulation reversal protocol that uses evidence-based practice guidelines is an integral part of anticoagulation therapy management. These protocols must include which reversal agent should be used based on the anticoagulant medication and the severity of the patient’s bleeding event.
Element of Performance 3
Hospitals are also required to use approved protocols and evidence-based practice guidelines for managing perioperative patients that are on oral anticoagulants. Such guidelines help minimize bleeding risks during surgery.
The perioperative anticoagulant management protocol should:
Element of Performance 4
The fourth element requires that hospitals have a written policy that addresses the need for baseline and ongoing laboratory tests for monitoring and adjusting anticoagulation therapy. Testing ensures that patients are on the correct dose and being monitored appropriately.
Element of Performance 5
Hospitals must establish a process to identify, respond to, and report adverse drug events, including adverse drug event outcomes.
This element also requires that hospitals have a process for:
Element of Performance 6
Providing patients and their families with proper medication education is required when anticoagulant medications are prescribed.
This medication education should include:
Element of Performance 7
The seventh element requires that hospitals only use unit-dose products, prefilled syringes, or premixed infusion bags when available.
This requirement reduces the risk of dosing and medication errors that can occur and increases patient safety by improving the accuracy of the dose administered to the patient.
Element of Performance 8
Hospitals are required to use programmable pumps when heparin is administered through a continuous IV to provide consistent and accurate dosing.
Ensuring patient safety and improving patient outcomes as they relate to all medications, and especially anticoagulation medications, requires constant vigilance. To support hospitals in this task, MEDHOST provides solutions that help reinforce the necessary policies and protocols critical for meeting the eight elements of performance.
Once your facility has anticoagulation policies and protocols in place, you can create orders sets for physicians to use in the Order Management module of MEDHOST Physician Experience. These order sets standardize the ordering process for:
Links to helpful online resources can also be added to order sets via Order Management, providing physicians with direct access to the evidence-based practice guidelines or other references. Some online resources helpful in creating anticoagulation policies and protocols may include:
In addition, contained within pharmacy and nursing workflows, your clinicians can retrieve printable patient education materials. These documents include patient-focused instruction on:
Also, some medications include medication guides that should be given to patients upon the prescribing of those specific medications.
To learn more about how MEDHOST helps support medication processes and helps your facility’s physicians and clinicians ensure proper usage, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.
In part one of our series over the 2021 Hospital National Patient Safety Goals—a yearly report published by The Joint Commission covering emergent patient safety concerns, performance standards, and measurable outcomes—we covered the challenge of identifying high suicide risk patients.
This next entry addresses Universal Protocol (UP) 01.01.01 of the 2021 NPSG, which covers the necessary safeguards for ensuring surgical procedures are performed “on the correct patient and at the correct place on the patient’s body.”
This second entry provides a brief overview of issues that contribute to surgical identification mistakes, as reported by The Joint Commission. We also offer some recommendations on how hospitals can use electronic perioperative health solutions to equip their surgical departments with customizable tools that help standardize and support the entire surgical care workflow, helping prevent wrong site, wrong side, and wrong patient procedures.
According to The Joint Commission there are an estimated 40 to 60 wrong site surgeries each week in the United States. A collaborative project that included The Joint Commission and hospitals found that there is no single cause to surgical identification mistakes. The project did however, identify areas of the perioperative process where small, compounding errors occur most often, and how they contribute to misidentification. The areas requiring most attention in the report were:
In each of these areas the researchers discovered close to 30 main causes, all of which came down to “organizational culture.” Standardized processes must be in place and hardwired into clinician’s workflows to reduce patient medical errors.
To improve standardization in surgical scheduling, pre-op, and operating room processes, The Joint Commission suggests providers adhere to the following Universal Protocols for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™.
Universal Protocol 1 – Conduct a pre-procedure verification process
For effective prevention of wrong patient, procedure, and site, The Joint Commission suggests facilities have pre-procedure processes in place designed to mitigate surgery risks. These processes will vary depending on procedure, but should include these steps:
Universal Protocol 2 – Mark the procedure site
One of the best ways to protect patients about to undergo surgery is to adhere to a consistent site marking procedure. To add clarity and consistency The Joint Commission states providers should:
Universal Protocol 3 – Perform a time-out before procedure
Taking a moment to step back and pause to conduct a final assessment, especially prior to administering anesthesia, allows both team members and patients to place their focus on ensuring accuracy. The Joint Commission suggests that time-outs:
In all listed protocols, The Joint Commission states the consistent use of standardized checklists and processes can significantly decrease surgery misidentification issues.
Every step in the patient’s care journey should be supported by a consistent adherence to standardized clinical workflows.
To help hospitals protect their surgery patients from mistakes that can lead to identification errors, we have made standardization a key feature of our surgical platform—MEDHOST Perioperative Experience. Perioperative Experience gives users the capability to add checklists into the platform per a facility’s needs. These helpful features provide more clarity and structure to the perioperative process, ensuring the right procedures are completed on the right patient, on the right location.
To learn more about how MEDHOST Perioperative Experience can help standardize workflows in your hospital with customizable tools, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.
The deadline for demonstrating the ability to share event-based admission, discharge, and transfer (ADT) patient data with other providers is almost here.
On May 1 the ADT Notification requirement goes into effect, a new part of the CMS Conditions of Participation (CoP) for Interoperability and Patient Access rule. As a quick overview, the requirement states that “hospitals with the technical capabilities to do so must use ‘reasonable efforts’ to send real-time alerts” concerning patient statuses to outside facilities—specifically post-acute care facilities/providers (PACs) and primary care providers (PCPs).
To help you ensure compliance with the ADT Notifications requirements, MEDHOST has added a solution to our platform.
Care Notifications is a MEDHOST service designed to help our hospitals improve their communication with community providers and post-acute settings of care through automated notifications. Care Notifications also help hospitals meet CMS Conditions of Participation requirements for ADT Event Notifications.
Using a highly secure, Direct Messaging standard—a widely adopted and commonly used method for communicating care coordination and transitions of care—the service provides:
To help ensure a seamless implementation, the Care Notifications service has been designed to build onto existing hospital practices. This also helps minimize the effort and resources spent by our customers. Plus, by basing communication on the Direct Messaging standards, hospitals can rest assured that their valuable patient health information remains confidential and secure.
This is a quick and secure solution for real-time ADT data sharing that streamlines the process so you can continue to deliver top quality healthcare and meet CoP compliance.
For more information about the MEDHOST Care Notifications solution, please reach out to your Account Executive or email inquiries@medhost.com.
This modular MEDHOST Enterprise EHR 2019 R1 is ONC 2015 Edition-compliant and have been certified by an ONC-ACB in accordance with the applicable certification criteria adopted by the Secretary of the U.S. Department of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. For a complete review of the EHR certification and accompanying "Cost and Limitations" statements, visit “https://www.medhost.com/about-us/regulatory-and-compliance/”.
Going on 18 years, the nursing profession has exhibited the highest levels of honesty and ethical standards as ranked by Gallup poll.
It is clear that nurses have, and will continue, to play an integral role in promoting care quality across the industry. However, the demand for trained care professionals, especially in the areas of nursing, continues to be a critical issue.
An aging patient population – which includes a retiring nurse demographic – has contributed heavily to continued shortages for care providers. Healthcare initiatives like expanding full-practice authority and redirecting a focus on community-based care have helped address demand. Providers may also want to take a look at how healthcare technologies can play a role in attracting and empowering these essential care providers.
Practicing nurses are constantly dealing with rising job demands and patient volumes. It is critical that nurses have access to supportive resources that allow them to spend less time on-screens and more time at bedsides.
For the gaps human resources can’t fill, nurses often need to rely on technologies that help inform their core evidence-based practices (EBP). The EBPs nurses rely on can change at any time and follow along the lines of:
While each stage is of equal importance, the planning of care is an essential task. A clear plan of care enables nurses to perform their duties with both competence and compassion. A properly built, monitored, and executed plan of care can also help nurses balance outside pressures with the promise of delivering patient-centered care.
Even when patients are fighting the same ailment, they may respond differently to care plans. Because of the fluidity of nursing diagnosis, treatments, and responses, a nursing plan of care can often require a change of course. Managing changes to a patient's care plan requires intuitive systems like an EHR that can effectively facilitate such an at-flight science.
New technologies that create new care workflows are an area where time away from the hospital may pose distinct challenges. However, comprehensive onboarding for both new and previously retired nurses on a properly implemented EHR can be an effective solution when executing a plan of care.
The demands put on a nurse require a high level of mobility and multitasking while maintaining compassion and attentiveness.
Plans of care and the tools used to generate and manage them should function in ways that allow nurses to spend their time in more meaningful ways.
An EHR solution should include these core characteristics to help nurses balance care planning and external pressures with patient-centered care.
The nurses on the MEDHOST team who work as managers, product specialists, trainers, etc. understand the creed: “You never stop being a nurse.” Nursing remains an intricate practice with many moving parts that can often pull nurses away from their core duties, especially during unexpected emergencies or disasters.
When longer shifts and higher patient volumes can take a toll on the mental and physical endurance of nurses, technology can help give them back the time and energy needed to spend towards patients. Healthcare IT should minimize time on screens and maximize time with patients in all situations.
To learn more about how MEDHOST helps hospitals and their clinicians effectively deliver patient-centered care, promote positive outcomes, and increase patient satisfaction, email inquiries@medhost.com or call 1.800.383.6278.
