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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.

 Oral Anticoagulants Leading Cause of Adverse Drug Events in Older Adults

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.

National Patient Safety Goal 03.05.01 Performance Elements

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.

Reducing the Risk of Patient Harm from Anticoagulation Therapy

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.

The Issue: Wrong Site, Wrong Side, Wrong Patient

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.

Organizational Universal Protocols Are Key to Prevention  

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.

Improving Process Standardization in the OR

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.

MEDHOST Care Notifications

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/”.

Each year The Joint Commission gathers information about emerging patient safety concerns and sets standards and measurable outcomes to help hospitals improve performance and continue to provide high-quality care.

These standards are applicable to all Joint Commission-accredited hospital and behavioral health care organizations.

In this series, we will focus on ways to address the National Patient Safety Goal (NPSG) 15.01.01 which works to identify patient safety risks. This first blog overviews identifying and reducing the risk of patient suicide, which is the NPSG target for 2021.

Identifying and Preventing Patient Suicide Risks

According to a study from The Joint Commission Journal on Quality and Patient Safety, there are approximately 30,000 suicides per year in the United States. It is estimated that 5 to 6 percent of those suicides occur in hospitals. In addition, the overall suicide rate is markedly higher in rural areas as compared to urban areas.

To help hospitals effectively meet the NPSG standard for compliance, an R3 Report by The Joint Commission identifies seven elements of performance (EP) designed to decrease suicide rates in this high-risk group.

Element of Performance 1

For effective prevention of suicides in non-psychiatric units in a general hospital, procedures must be implemented to mitigate suicide risk, such as:

For psychiatric units, removing door hinges, hooks that can be used for hanging, and anchor points are important measures. The rationale is that most common patient areas contain hazards that pose a risk for suicidal patients. By removing the hazard, it minimizes suicide risk.

Element of Performance 2

The second requirement asks healthcare providers to screen all individuals being treated or evaluated for behavioral health conditions with a validated screening tool starting at age 12 and above. The R3 report also states patients being treated for behavioral health problems often have suicidal ideation.

Element of Performance 3

An evidence-based process is required for those patients who have screened positive for suicidal ideation. It is important to complete an in-depth assessment in order to determine how to appropriately treat these patients.

Element of Performance 4

This EP requires the documentation of the patient’s overall level of risk for suicide, as well as a plan to mitigate the risk.

Element of Performance 5

To address care for those at risk, written policies and procedures must be followed.

Staff should be properly trained to identify and assess those at high risk for suicide and follow guidelines for reassessment of the patient. These policies should be guided by an evidence-based practice.

Element of Performance 6

Given that the risk for suicide is very high after discharge from the emergency department or an inpatient psychiatric setting, written policies and procedures for counseling and follow-up care at discharge are critical.

Developing a safety plan with the patient can decrease suicidal behavior. One way to provide additional support is to provide the patient with numbers to crisis call centers.

Elements of Performance 7

Processes for monitoring the implementation and effectiveness of policies and procedures tied to the screening, management, and assessment of at-risk patients are required. Strict adherence to protocols is the only way to ensure there is a high reliability of suicide prevention.

Patient Suicide Risk and COVID-19

COVID-19, and the challenges that communities have faced related to isolation alongside COVID-19-associated morbidity and mortality, have led to an increased number of mental health, substance abuse, and suicidal ideation.

The Centers for Disease Control (CDC) reports that during June 24-30, 2020, 40 percent of adults surveyed reported an increase in mental health symptoms such as anxiety and depression. When compared to a similar 2019 survey in the same timeframe, a significant year-to-year rise in such responses is clear.

In addition, increased substance abuse and elevated suicidal ideation were also reported by younger adults, essential workers, unpaid adult caregivers, and racial/ethnic minorities.

Does Your EDIS Offer Resources for Effective Suicide Screening?

In many cases, high suicide-risk patients present at the emergency room before transitioning to the inpatient setting. The Emergency Nurses Association (ENA) stance as a leading and influential voice on the public policies affecting emergency nursing and suicide screening underscores this point.

On September 29, 2020, the House passed H.R. 4861, the Effective Suicide Screening and Assessment in the Emergency Department Act of 2020. This legislation establishes a competitive grant program to help train up to 40 hospitals with emergency departments to connect patients who are at risk for suicide with treatment and mental health services. This grant can also be used to train emergency department providers, establish policies and procedures, and care coordination for individuals at risk of suicide.

Congruent with the NPSG and ENA, MEDHOST is committed to finding ways to help hospitals and their clinicians quickly identify at-risk patients. By increasing the understanding, knowledge, and preparedness of ED staff and providers over patient suicide risks, patient identification can become more effective, and resources can be readily provided to improve the safety and quality of care for such individuals.

To support emergency departments in these efforts, MEDHOST Emergency Department Information System (EDIS) allows screening tools to be built into the platform per a facility’s needs, along with custom charting options that can be used to help facilities identify patients at risk for suicide.

To learn more about how MEDHOST EDIS can help run your hospital more efficiently with customizable tools, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.

In United States, costs of surgical services account for about one third of all healthcare spending1 with the Operating Room (OR) contributing significantly to these high healthcare costs with its average cost estimated to be $36 per minute.2

Improving OR utilization to lower this average cost is a complex issue that is impacted at multiple points during the perioperative process. Managing OR utilization is key in preventing under-utilization which results in idle time between cases, decreased case count, and lost revenue; and preventing over-utilization that can result in case cancellations, staff fatigue, burn out, and increased staff turnover. 3

Accurate durations for surgical cases are needed to maximize Operating Room utilization and manage costs. It is important to ensure the correct scheduling information is captured at the time of scheduling. One major impact to utilization is reserving the Operating Room for the incorrect length of time. 4 Hospitals struggle with scheduling and prolonged wait times causing provider and patient dissatisfaction, operational inefficiencies, and increased cost. The system complexities can be overwhelming to unbundle, and the multiple improvement efforts may be uncoordinated often result in bottlenecks in other areas.5 Utilizing the physician case average when scheduling will improve accuracy of the time reserved.6 Implementing a digital patient tracking board has also been found to improve patient throughput and identify cases that are running longer then scheduled allowing following cases to be more to other rooms if available.6 Some of the other process improvements that an OR can make are, designing a functional block schedule to address scheduling issues, optimizing the pre-anesthesia time to reduce time in the OR, holding daily multi-disciplinary team meetings to improve efficiencies.7

MEDHOST Perioperative Experience Scheduling provides the ability to schedule cases based on physician procedures averages and identifying equipment conflicts at the time of booking to reduce day of surgery delays. Patient and family tracker boards are available as part of Perioperative Experience. The tracking boards are updated electronically based on clinical documentation to accurately display the flow of the day and identify cases that have exceeding the scheduled time.

 

Want to learn more how MEDHOST solutions can help improve Operating Room utilization, contact us at inquiries@medhost.com or call 1.800.383.6278.

 

References

1 Muñoz, Eric MD, MBA, FACS*; Muñoz, William III BA†; Wise, Leslie MD, FACS‡ National and Surgical Health Care Expenditures, 2005–2025, Annals of Surgery: February 2010 - Volume 251 - Issue 2 - p 195-200 https://doi.org/10.1097/SLA.0b013e3181cbcc9a

2 Childers CP, Maggard-Gibbons M. Understanding Costs of Care in the Operating Room. JAMA Surg. 2018 Apr 18;153(4):e176233. doi: 10.1001/jamasurg.2017.6233. Epub 2018 Apr 18. PMID: 29490366; PMCID: PMC5875376.

3 West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of Resident Fatigue and Distress With Perceived Medical Errors. JAMA. 2009;302(12):1294–1300. https://doi.org/10.1001/jama.2009.1389

4 Jiao, Y., Sharma, A., Ben Abdallah, A., Maddox, T. M., & Kannampallil, T. (2020). Probabilistic forecasting of surgical case duration using machine learning: model development and validation. Journal of the American Medical Informatics Association : JAMIA, 27(12), 1885–1893. https://doi.org/10.1093/jamia/ocaa140

5 ps://nam.edu/wp-content/uploads/2015/06/SchedulingBestPractices.pdf

6 Park, HS., Kim, SH., Bong, MR. et al. Optimization of the Operating Room Scheduling Process for Improving Efficiency in a Tertiary Hospital. J Med Syst 44, 171 (2020). https://doi.org/10.1007/s10916-020-01644-0

7 https://www.beckershospitalreview.com/quality/6-insights-on-boosting-operating-room-efficiency.html

When the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted, one of the key goals was to promote electronic exchange and patient access to data, while also taking into consideration the security and privacy of Protected Health Information (PHI).

The HIPAA Privacy and Security Rules focused on the confidentiality, integrity, and availability of PHI.

In an effort to promote consumer-driven healthcare and encourage competition among HIT vendors, 21st Century Cures Act (Cures Act) further emphasizes the importance of the ease of access and exchange of Electronic Protected Health information (EPHI) for the benefit of both patients and providers.

At first glance, it may seem that HIPAA and the Cures Act are contradictory, as HIPAA was built on the premise of permitting certain disclosures of PHI and the Cures Act actively requiring disclosures of PHI. The Cures Act not only requires disclosures, but it even more explicitly prohibits “Information Blocking” which is defined as conduct that is "likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information."

Intersection: Patient Access and Patient Data Sharing

Patients already had rights to access their data under HIPAA, and the Cures Act has only enhanced this concept by mandating flexibility in how and with whom patients share their EPHI, making the regulations aligned in the concept of patient access and sharing.

Intersection: Patient Consent/Authorization

The Cures Act is focused on the increase and ease of data flow for the benefit of patients and providers, violating the Information Blocking provisions of the Act may place an actor at risk for potential investigations and steep penalties.

However, the Information Blocking provisions should not be interpreted to mean that unvetted and unconstrained access to data is required.

The Cures Act does allow for eight specific exceptions for activities or actions that otherwise might be considered information blocking, one of which is the privacy exception. At least one of several conditions must be met to rely on the privacy exception, and of those conditions, one is that a precondition has not been satisfied. A precondition in this context could mean proper consents and authorization as required by HIPAA or state law. In other words, the permissibility still must be evaluated, and data sharing is not required when it is prohibited under state or federal privacy law.

Intersection: Consideration of Confidentiality, Integrity and Availability of PHI

The Cures Act also has direct parallel to the HIPAA Security Rule in the fact that it specifically identifies a practice that interferes with the exchange of data that directly relates to safeguarding the confidentiality, integrity and availability of ePHI as one of the exceptions to information blocking.

This likely presents little change for Actors (Healthcare Providers, Developers of Certified Health IT, and HIEs/HINs) that are already accustomed to evaluating the security posture of their business associates.

In addition to the intersections between HIPAA and the Cures Act listed above, the U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) released a proposed rule on December 10, 2020 in an effort to modernize HIPAA so it better aligns with the current healthcare landscape. Like the Cures Act, several of the proposed changes focus on speed and ease related to patients’ rights of access, and clarifies and extends provider access for the purposes of care coordination and mental health services.

Things to consider:

In this continuously changing regulatory environment, MEDHOST is committed to help you meet these HIPAA and Cures Act requirements while providing you with solutions that save time and resources, reduce cost, enhance revenue, and create better experiences for the communities you serve.

To learn more contact us at inquiries@medhost.com or call 1.800.383.6278.

Opioid analgesics are FDA-approved prescription medications that can provide pain control for moderate to severe pain when appropriately prescribed; however, inappropriate prescribing can lead to opioid abuse, diversion, and deadly overdoses.1

According to the Centers for Disease Control and Prevention (CDC), the number of drug overdose deaths was four times higher in 2018 than in 1999 despite a recent decrease and, of those 67,367 deaths in 2018, nearly 70 percent involved an opioid and 14 percent involved prescription opioids. As stated by the CDC, “the best ways to prevent opioid overdose deaths are to improve opioid prescribing, reduce exposure to opioids, prevent misuse, and treat opioid use disorder.”2

Benefits of Electronic Prescribing of Controlled Substances

Electronic prescribing of controlled substances (EPCS) allows physicians to transmit controlled substance prescriptions securely to their patient’s pharmacy. The use of EPCS reduces prescription fraud and diversion by removing the risk of prescription forgery and alterations. It also decreases prescribing errors that are often caused by illegible handwriting and use of unapproved abbreviations. And, because the electronic prescription data flows into state prescription drug monitoring program (PDMP) databases, EPCS can help provide physicians with insight into a patient’s controlled substance prescription history, thus helping to identify “doctor shopping” behaviors and opioid overuse.3

Current Usage and Future Requirements

EPCS is now legal in all fifty states, yet it is not widely adopted. Less than 60 percent of all United States prescribers are currently EPCS-enabled, despite having 96 percent of US retail pharmacies capable of receiving electronic controlled substance prescriptions.4 However, individual state and federal regulations will soon change that.

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, passed by Congress in 2018 to help combat the opioid crisis, requires EPCS for all controlled substances prescriptions covered under a Medicare Part D prescription drug plan or Medicare Advantage Prescription Drug (MA-PD) Plan, beginning January 1, 2021.5 Recently, Centers for Medicare & Medicaid Services (CMS) announced that they will delay enforcement until January 1, 2022.6 Despite the delay in enforcement, many states are continuing to pass their own EPCS-required mandates to help address the opioid crisis. Twelve states have already required the use of EPCS prior to December 31, 2020 and an additional 15 states will begin requiring EPCS this year.7

How Your Facility Can Make an Impact in Your Community

MEDHOST EPCS solution is DEA-compliant, Surescripts-certified, and is available in both MEDHOST Emergency Department Information System (EDIS) and MEDHOST Enterprise Electronic Health Records (EHR). To learn more about how MEDHOST can help your facility reduce opioid prescription fraud, improve patient safety, enhance physician workflow, and meet EPCS state and federal requirements, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.

References:

1Preuss, C.V., Kalava, A., & King, K.C. (2020). Prescription of Controlled Substances: Benefits and Risks. StatPearls [Internet]. Retrieved from here.

2Centers for Disease Control and Prevention (CDC).  (2020, March 19). Opioid Overdose. Retrieved from https://www.cdc.gov/drugoverdose/index.html

3The Office of the National Coordinator for Health Information Technology (ONC). (2019, December 18). Health IT Playbook: Opioid Epidemic & Health IT. Retrieved from https://www.healthit.gov/playbook/opioid-epidemic-and-health-it/

4Surescripts. (2020, December). Electronic Prescribing for Controlled Substances. Retrieved from https://surescripts.com/EPCS/

5Center for Medicare & Medicaid Services. (2020). Medicare Program: Electronic Prescribing of Controlled Substances; Request for Information (RFI). Federal Register 85:150 p. 47151-47157. Codified at 42 CFR §423. Retrieved from https://www.govinfo.gov/content/pkg/FR-2020-08-04/pdf/2020-16897.pdf  

6Center for Medicare & Medicaid Services. (2020). Medicare Program; CY 2021 Payment Policies Under the Physician Fee Scheduled and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicaid Promoting Interoperability Program Requirements for Eligible Professionals; Quality Payment Program; Coverage of Opioid Use Disorder Services Furnished by Opioid Treatment Programs; Medicare Enrollment of Opioid Treatment Programs; Electronic Prescribing for Controlled Substances for a Covered Part D Drug; Payment for Office/ Outpatient Evaluation and Management Services; Hospital IQR Program; Establish New Code Categories; Medicare Diabetes Prevention Program (MDPP) Expanded Model Emergency Policy; Coding and Payment for Virtual Check-in Services Interim Final Rule Policy; Coding and Payment for Personal Protective Equipment (PPE) Interim Final Rule Policy; Regulatory Revisions in Response to the Public Health Emergency (PHE) for COVID–19; and Finalization of Certain Provisions from the March 31st, May 8th and September 2nd Interim Final Rules in Response to the PHE for COVID–19. Federal Register 85:248 p. 84472-85377. Codified at 42 CFR §400, 410, 414, 415, 423, 424, and 425. Retrieved from https://www.govinfo.gov/content/pkg/FR-2020-12-28/pdf/2020-26815.pdf

7Imprivata. (n.d). Federal and State Regulations. Retrieved from https://www.imprivata.com/federal-and-state-regulations. Accessed January 3, 2021.

Effective, accurate, and timely communication among team members is an important part of patient care1 and can be negatively impacted by distraction and noise.

The Joint Commission in 2014 found that communication breakdown is the third most identified root cause of for sentinel events.2 The impact of distractions can range from critical patient information not being communicated, prolonged procedures, potential errors in patient care, and surgical site infections.3,5

Distractions can be related to patient care such as alarms, obtaining supplies, and patient care conversations or can be non-patient care related such as personal conversations or internet use. It has also been found that one of the top health technology hazards in 2020 is “alarm, alert, and notification overload”.4 While communicating and documenting patient care is an essential step in proving patient care it has been found that Electronic Health Record (EHR) systems that are labor intensive or do not operate correctly can become distractions.5 Personnel movement in and out of the room to obtain supplies and equipment that is needed for a procedure is also a distraction.5

During the critical phases of care, strategies should be implemented to reduce distractions and ensure patient safety is maintained.6 Critical phases of care include preoperative briefing, time out, anesthesia induction, counting process, and specimen. Preference cards need to be kept up to date to decrease the distraction of and time wasted by staff leaving the Operating Room to obtain supplies.4 The development of standardized checklists for critical phases ensures that all team members are actively involved during critical phases, and a standardized process is followed.7 Providing an effective EHR documentation system that reduces the duplicate documentation and provides quick access to the patient’s health information such as labs, previous documentation, or orders within the Perioperative workflow.

MEDHOST Perioperative Experience provides the ability for preference cards to be updated electronically and to have the changes reflected on all future cases. This ensures that the most accurate information is available for supplies, equipment, instruments, and special instructions so that everything is in place prior to the start of the surgery reducing distractions. Standardized checklists can be built and available within Perioperative Experience to ensure that the required checks and balances are in place to improve patient safety. Clinical documentation is fully integrated with MEDHOST Enterprise to provide continuity of data and ease of access to the patient’s health record. Nurses accessing the patient’s information from Perioperative Experience will only need to log into one system to access items such as patient medical history, labs, past vitals, and orders.

Want to learn more about how MEDHOST solutions can help increase efficiencies and reduce operating room distractions, contact us at inquiries@medhost.com or call 1.800.383.6278.

 

 

References

1 Shambo L, Umadhay T, Pedoto A. Music in the operating room: is it a safety hazard? AANA J. 2015;83(1):43-48.

2 The Joint Commission. Patient safety. Joint Commission Onlinehttps://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/joint-commission-online/jconline_april_29_15pdf. Published April 29, 2015. Accessed December 22, 2020.

3 Yoong W, Khin A, Ramlal N, Loabile B, Forman S. Interruptions and distractions in the gynaecological operating theatre: irritating or dangerous? Ergonomics. 2015;58(8):1314-1319.

4 ECRI. Special Report: Top 10 Health Technology Hazards for 2020: Expert Insights From Health Deviceshttps://www.ecri.org/landing-2020-top-ten-health-technology-hazards [registration required]. Accessed December  22, 2020.

5 AORN. AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Case. Denver, CO: AORN, INC; 2020. https://www.aorn.org/-/media/aorn/guidelines/position-statements/posstat-safety-distractions-and-noise.pdf. Accessed December 22, 2020.

6 Guideline for team communication. In: Guidelines for Perioperative Practice. Denver, CO: AORN,INC; 2020: 1039-1070.

Physician and Pharmacist collaboration can enhance patient care by increasing medication adherence, improving patient outcomes through medication management, and reducing medication errors and adverse drug reactions through collaboration on policy and protocol development. Other ways pharmacists can collaborate with physicians to make a positive impact at their facility include:

Ultimately, this collaboration will increase physician satisfaction and promote success.

Improving Medication Adherence

Patient care can be significantly enhanced by improving medication adherence. Pharmacists can assist the physicians during discharge planning by evaluating the patient’s access to an outpatient pharmacy and out-of-pocket costs, as well as providing patient medication education prior to discharge.1 As the Centers of Disease Control and Prevention (CDC) noted, “When pharmacists are part of the health care team, outcomes related to preventing or managing chronic diseases and adherence to their medications improve.”2

Medication Management

Improved medication management can be achieved with workflows that provide physicians with pharmacist input prior to prescribing in areas such as diabetes, hypertension, opioids, and antimicrobials. For example, pharmacists can assist with opioid management by assessing the patient’s prior opioid use using the state’s Prescription Drug Monitoring Program (PDMP), providing patient education, and through opioid tapering services.3 Pharmacists can manage diabetic patients through collaboration with physicians and improve their patient’s glycemic control through medical history review, monitoring baseline laboratory values, medication adherence, blood glucose monitoring, adjusting medications when needed, and providing individualized diabetes education.4

Policy & Protocol Development

Pharmacists’ involvement in policy and protocol development can promote superior patient outcomes and reduced medication errors and adverse drug reactions while improving physician satisfaction. Pharmacists are medication experts that can contribute to the development and implementation of patient care guidelines and other medication-use policies.1 Pharmacists participating in hospital committees, such as the Pharmacy and Therapeutics (P&T) Committee, have the ability to guide their institution’s use of medications based on comparative studies and cost analysis and then drive that use by making therapeutic substitutions part of hospital policy.

Identifying Opportunities for Improvement

More valuable opportunities for collaboration between physicians and pharmacists at your facility can be identified through analysis of current outcomes where pharmacists could have improved the result with additional information or a different perspective. For example, pharmacists participating in multi-disciplinary teams, such as Antimicrobial Stewardship and Anticoagulation Stewardship teams, can improve quality of patient care.1

In order to be efficient care team members, pharmacists require timely access to hospitalists for consultation and access to the patient’s chart.1 With MEDHOST Enterprise Clinicals, pharmacists can access the patient’s full chart to complete home medication reconciliations, view or place orders, view lab results, view or write clinical notes, and view medication administrations. Additionally, pharmacists have an ability to create a note to communicate consult follow-ups, document rounding notes, or provide medication change recommendations to the physician. To learn more about how MEDHOST Enterprise Clinicals can help your physician-pharmacist collaboration, please reach out to us at inquiries@medhost.com or call 1.800.383.6278.

 

References:

1American Society of Health-System Pharmacists. (2008). ASHP-SHM Joint Statement on Hospitalist-Pharmacist Collaboration. Retrieved from here

 

2CDC. Advancing Team-Based Care Through Collaborative Practice Agreements: A Resource and Implementation Guide for Adding Pharmacists to the Care Team. Retrieved from here.  

 

3D’Arrigo, T. (2018, May 1). Physicians share how they've collaborated best with pharmacists. Pharmacy Today. Retrieved from here.  

 

4Ramser, K. L., Sprabery, L. R., George, C. M., Hamann, G. L., Vallejo, V. A., Dorko, C. S., & Kuhl, D. A. (2008). Physician-Pharmacist Collaboration in the Management of Patients with Diabetes Resistant to Usual Care. Diabetes Spectrum, 21, 209-214. Retrieved from here

An estimated  82 percent of hospitals in the Hospital Readmissions Reduction Program (HRRP) received readmissions penalties1 and readmission costs were higher than initial admission costs for about two-thirds of common diagnoses in 2016.2

Generally, HRRP imposes severe financial penalties for unplanned readmission within a 30-day window. To avoid readmission penalties, healthcare facilities must focus on reducing readmission rates, improving patient outcomes, patient satisfaction, and increasing reimbursement. While readmissions are occasionally unavoidable, it is essential for facilities to focus on reducing those that are preventable.

According to a 2015 study, patients discharged from facilities serving semi-rural areas had a 32 percent greater chance of being readmitted and patients discharged from rural areas had a 42 percent greater chance of being readmitted, than those discharged from facilities in urban areas. The researchers discovered that the increase in readmission rates was driven by lower rates of post-discharge follow up care and utilization of the emergency department for primary care.3

Auerbach et al. (2016) found that approximately one quarter of readmissions are preventable by implementing discharge readiness plans, improving communication between team members, and involving the patient and caregiver in discharge planning.4 Medication reconciliation, clear discharge instructions, and patient education are key areas to consider for effective discharge planning to ensure patients can be safely transitioned to the next level of care.

Medication reconciliation ensures that patients are discharged with the correct medications, dose, time, and instructions. Your EHR should have the ability to complete medication reconciliation prior to the patient’s discharge or transition of care. Medication reconciliation can help reduce the risk of the patient experiencing an adverse drug event following discharge which is a leading preventable readmission reason.5

Ensuring that patients receive and understand the correct discharge communication and documents provides a very high return on time invested. Post-discharge follow-up appointments are critical in successfully managing the patient’s treatment outside of the hospital and reducing readmission or return visits to the emergency department. During the discharge process the patient should be provided with the dates for all follow-up appointments and digital appointment reminders should be utilized when possible.

The patient and their caregiver should have a clear understanding of the follow-up care needed, and information related to who to call and when for questions following discharge. MEDHOST provides the ability to complete discharge documents, education, and follow up instructions customized for the patient. Our solution also improves communication to primary care providers by ensuring the discharge summary is available at the time of the patients discharge. The discharge summary provides relevant information related to medication changes, pending tests or results, and follow up care that is needed.

Additionally, MEDHOST provides the ability to complete and document medication reconciliation before patient’s discharge to help reduce the risk of an adverse drug event following discharge. To increase patient engagement and improve outcomes, patients can securely access their personal health records online through YourCare Community® to review medications, instructions, lab results, receive appointment reminders, and more.

Want to learn more how MEDHOST solutions can help reduce readmission risk, contact us at inquiries@medhost.com or call 1.800.383.6278.

 

 

1 Advisory Board. (2018, September 27). Map: See the 2,599 hospitals that will face readmissions penalties this year. Retrieved from here

2 Statistical Brief #248. Healthcare Cost and Utilization Project (HCUP). February 2019. Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from here.

3 Horwitz, L. I., Wang, Y., Altaf, F. K., Wang, C., Lin, Z., Liu, S., Grady, J., Bernheim, S. M., Desai, N. R., Venkatesh, A. K., & Herrin, J. (2018). Hospital Characteristics Associated With Post discharge Hospital Readmission, Observation, and Emergency Department Utilization. Medical care, 56(4), 281–289. Retrieved from here.  

4 Auerbach, A. D., Kripalani, S., Vasilevskis, E. E., Sehgal, N., Lindenauer, P. K., Metlay, J. P., Fletcher, G., Ruhnke, G. W., Flanders, S. A., Kim, C., Williams, M. V., Thomas, L., Giang, V., Herzig, S. J., Patel, K., Boscardin, W. J., Robinson, E. J., & Schnipper, J. L. (2016). Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients. JAMA internal medicine, 176(4), 484–493. Retrieved from here

5 Jennifer E Prey, Fernanda Polubriaginof, Lisa V Grossman, Ruth Masterson Creber, Demetra Tsapepas, Rimma Perotte, Min Qian, Susan Restaino, Suzanne Bakken, George Hripcsak, Leigh Efird, Joseph Underwood, David K Vawdrey, Engaging hospital patients in the medication reconciliation process using tablet computers, Journal of the American Medical Informatics Association, Volume 25, Issue 11, November 2018, Pages 1460–1469, https://doi.org/10.1093/jamia/ocy115