The Joint Commission

Medication Safety Practices

Medication safety remains a critical topic for healthcare providers and consumers. Among the issues being focused on in 2009 by the Joint Commission include anticoagulant errors, the increasing impact of multidrug-resistant organisms, and the appropriate use of antimicrobials, medical reconciliation, and documentation.

The Joint Commission’s National Patient Safety Goal was required to be implemented by January 1, 2009. The focus of this goal is to decrease the likelihood of harm from anticoagulation medications. It requires the standardization of processes for prescribing, dispensing, monitoring, and educating patients on the medications.

Successful implementation of these processes to meet the requirements of the goal is both significant and complex. Medication errors concerning heparin continue to occur, which has prompted the convening of consensus conferences and summits on IV drug delivery and safety. These have been sponsored by the American Society of Health System Pharmacists, the Institute of Safe Medication Practices, and others including representatives from academia, industry, and hospital pharmacy practices.

A clinical case for appropriate and effective use of antimicrobials has resulted from the increased impact of multidrug-resistant organisms. Antibiotic stewardship programs are being implemented to oversee the processes of prescribing and monitoring antimicrobials as part of the greater good of the healthcare community. These stewardship programs have often demonstrated significant reversals in resistance trends as a result.

Another focus of the National Patient Safety Goal is improved medication reconciliation and documented communications, critical to mitigating risk and maintaining safety. Among the changes in 2009 includes the requirement that admission home medication lists include dose, frequency, and route. There must also be documentation that communication has occurred between transferring and receiving units. Upon discharge from the facility, there must be documented evidence that communication of the medication list has been provided to the patient, family, and the next care provider.

Ensuring that each patient receives the correct medications in the right doses at the right times is dependent upon thorough communication. The sharing of every aspect of patient care across all involved disciplines of those working collaboratively would be the ideal to guarantee the patient’s rights to effective, safe, quality care.

The progress of medication-related technology continues at a rapid pace. These technologies significantly change the practices of healthcare practitioners, though they are often challenged with the optimal implementation and use of the tools. The Joint Commission’s 42nd Sentinel Event Alert of December 2008 urges that care be taken when making decisions related to new technology. Understanding the impact the technology will have on patient safety and quality of care relating to the implementation of the new processes must be addressed.

These medication-safety issues, among others, continue to be significant as the focus of the Joint Commission on robust process improvements challenged hospitals in 2009. Medication safety is expected to be impacted as hospitals review and improve their processes to achieve and sustain desired outcomes.

Tags: american society of health system pharmacists, hospital pharmacy, medication errors, medication safety, national patient safety goal, safe medication practices
Posted in Hospital of the Future, Information Technology, Patient Care, Pharmacy, Prescriptions, The Joint Commission

Hospital of the Future: Achievement of Patient-Centered Care

There are many critical issues facing hospitals today. Among these are an increased demand for emergency care, an increased elderly population, more people suffering from chronic conditions, increased costs, and an increased need for access to care. In 2006, a roundtable of healthcare experts joined together to discuss these issues, make recommendations on these findings and trends, and to describe the hospital of the future.

The roundtable’s goal was to examine current healthcare issues such as socioeconomic trends, the physical care environment, technology, patient-centered care values, staffing challenges, and how those issues impact the hospital of the future. Following is a summary of the discussion and conclusion on the topic of achieving of patient-centered care:

It’s About the Patient

As a result of patient safety revelations, there is a a current emphasis and acceptance that the patient is the center of care. Since the patient has the greatest stake in the outcome of treatment and care, that patient should be respected as an equal partner. Family members are also influential in making healthcare decisions, thus becoming the third partner.

These partnerships have significant implications for the safety and quality of patient care. One large study showed that adult patients with chronic or serious conditions who were engaged in a collaborative care model had better control of their blood glucose levels, blood pressure, and serum cholesterol than patients who felt less confident of their doctors or in their own ability to care for themselves.

To further demonstrate the value of patient-centered care, in 2003, the MCG Health System in Augusta, Georgia redesigned its neuroscience intensive care unit to allow patients’ families to stay with them at all times. As a result of the increased insights and observations offered by family members and improved communication, medication errors decreased by 62%, the length of stay was reduced by 50%, and the staff vacancy rate fell from 7.5% to zero.

The Joint Commission’s National Patient Safety Goal 13 has a specific requirement for healthcare providers to encourage patients’ active involvement as a patient-safety strategy. It also requires healthcare staff to identify ways that a patient or family can report safety concerns and encourage them to do so. The foundation for the goal is the idea that when a patient knows what to expect, there is a greater awareness of possible errors and choices. When all aspects of care, treatment, and services are communicated, the patient can be an important source of information about adverse events and hazardous conditions to further engender a culture of safety.

Patients and families are driving momentum for the notion of “nothing about me, without me” with patient advocacy organizations such as Partnership for Patient Safety and PULSE. It is also likely to increase as a result of consumer-directed health plans and health savings accounts that increase consumer responsibility for value-based health care purchasing decisions.

The technology of personal health records (PHRs) that offers patients access to their own health records and increases communication with their healthcare providers will further drive momentum to patient-centered care. A higher level of home care increases the role of “partner” to a 24/7 responsibility.

Barriers to Patient-Centered Care

One of the barriers to patient-centered care is the need for increased patient education even when healthcare providers apparently have less time to spend with them, as in the 10-minute office visit. Health literacy is also an issue, with an estimate that almost half of the U.S. population lacks the skills required to make appropriate health decisions.

 Hospital risk managers can be uneasy with the focus on transparency. However, several studies have shown that a collaborative relationship with open disclosure nurtures, rather than harms, the patient/caregiver relationship.

 Half of all hospitalized patients today suffer from one or more chronic conditions and the prevalence of chronic conditions is expected to rise. More than 75% of adults over age 65 have at least one chronic condition such as diabetes, heart disease, or asthma, and many have multiple conditions. Those with multiple conditions often receive care from multiple providers and take numerous medications. Care is often fragmented, ineffective, and costly due to duplicative services and testing, avoidable hospitalization, and adverse drug events.

Patient-Centered Transformation

The hospital of the future will better meet the needs of all patients–including the underserved, the chronically ill, and the aged who will be filling its beds in greater numbers–with patient-centered care. Process improvement tools such as Six Sigma and Lean can be utilized by hospitals to increase the reliability of delivering patient-centered care.

An example of this transformation can be seen the ThedaCare hospitals of southern Wisconsin. The application of the patient-centered care methods to general medical units has resulted in a reduction of medication errors, a reduced average amount of time patients are hospitalized, and a reduction in fees for certain procedures. Other hospitals such as Virginia Mason Medical Center in Seattle and New York Presbyterian Hospital have used these tools to similar benefit.

Tags: adult patients, collaborative care, healthcare decisions, healthcare experts, medication errors, patient centered care
Posted in Electronic Health Records, Ethics, Hospital of the Future, Information Technology, Nursing, Patient Care, The Joint Commission

The Changing Role of the Hospital Pharmacist

Recruiting has long been a challenge for hospital pharmacies. With considerable competition for pharmacists in the retail industry, where compensation is often higher and more regular hours are offered, i.e., no on-call requirements, hospitals have had a more difficult time attracting and keeping quality personnel. The hospital pharmacist must also be better trained with a broader knowledge base than the retail pharmacist due to the expanded inventory of drugs in use for inpatient care.

New developments in biologics, genomics, robotic preparation, and pharmacy automation require a superior level of technological expertise in the hospital pharmacist. For this reason, the entry-level degree for a pharmacist has been raised to a doctorate (Pharm.D). Completing residency training is also required of many hospital pharmacists. This higher standard is to be lauded, though it has had the side effect of increasing vacancy rates for hospital pharmacists by creating additional educational requirements for the entry of new pharmacy students.

The role of the hospital pharmacist has been changing with greater involvement in direct patient care. In order to combat the high volume of medication errors that occur in hospitals, the role of the pharmacist will become increasingly visible in patient-centered care delivery. With this enhanced patient involvement, hospital pharmacists need additional training and experiential education in hospital settings, with a greater reliance on trained and certified pharmacy technicians for the preparation and delivery of medications.

The physical environment of the pharmacy is facing change as well. With pharmacists increasingly counseling patients on drugs and therapeutic regimens, private space needs to be incorporated to accommodate confidential discussions with patients and families.

With the Joint Commission standards requirement that hospitals must provide pharmacy after-hour services, further stress has been placed on smaller hospitals to maintain pharmacists around the clock. For some, it is not economically feasible to keep a high-salaried pharmacist onsite for only a few requested orders during night-time hours. This issue is being addressed by contracting offsite pharmacists connected to the hospital system who have the ability to approve orders and authorize nursing staff to dispense the medication.

With increased requirements for educational and technological expertise, as well as increased direct patient involvement, the hospital pharmacist is playing an even greater role now as an active member of the healthcare team. The patient-centered model of care is becoming a core philosophy for forward-looking hospitals in which the pharmacist plays an increasingly important part. It is therefore necessary to recruit and retain the best and the brightest for the hospital pharmacy to insure patient safety and quality care around the clock.

Tags: certified pharmacy technicians, hospital pharmacies, hospital pharmacists, patient centered care, pharmacy automation
Posted in Electronic Health Records, Hospital of the Future, Patient Care, Pharmacy, Prescriptions, The Joint Commission

Addressing Medication Errors

Medication errors result in consequences ranging from minor injury to death for thousands of people every year. These errors frequently occur when multiple medications are taken at the same time. They may result from incompatible medications, duplicative therapies, or taking more medications than needed. To prevent such errors, the Joint Commission’s National Patient Safety Goal 8 requires accurate and completely reconciled medications inclusive of all care a patient receives.

The use of multiple medications by a single patient is called polypharmacy, which carries the increased risk of adverse drug events. Patients suffering from several medical conditions, such as diabetes and heart failure, will often require several medications to control the conditions, perhaps eight or nine medications simultaneously. In addition, these patients are often seeing several physicians, further increasing the likelihood of unintended side effects and dangerous consequences.

Clinical pharmacists and the organizations they represent are working to proactively address the adverse consequences of polypharmacy and establish plans, programs, and processes to prevent medication errors. The role of the clinical pharmacist has expanded from dispensing medications and checking for adverse drug interactions to directly addressing a patient’s medication list to identify and resolve potential issues. Technological advances such as computerized physician order entry and automated medication records assist pharmacists, physicians, and nurses to be able to quickly identify and resolve potential drug problems.

In 2007, the Jewish Health Care Foundation created a fellowship designed to assist pharmacists in testing approaches to eliminate the adverse effects of polypharmacy and develop evidence-based interventions across entire institutions. Following are examples of three Pennsylvania-based organizations that are participating in the fellowship program and how they are working to address polypharmacy issues:

University of Pittsburgh School of Pharmacy

At the University of Pittsburgh School of Pharmacy, patients are offered a comprehensive review of their medications in the outpatient clinic. During a 30-60 minute interview with a pharmacist in a private counseling area, the pharmacist reviews the patient’s prescription medications, over-the-counter medications, and herbal supplements. The pharmacist determines if the patient understands why the medications are being taken and how they should be taken. The pharmacist also looks for potential drug interactions, duplicative therapies, and unnecessary medications. The patients identified as requiring additional counseling services, such as nutritional counseling, insulin instruction, or lipid management, are referred for additional comprehensive counseling elsewhere in the hospital.

Patients targeted in this program are patients at high risk for medication errors. These include patients over the age of 65 with more than three chronic conditions and taking more than five medications. The service is available to anyone interested in it, including patients who do not get their prescriptions filled at the facility. They are referred by their physicians, or find the service through advertising or word-of-mouth.

The University of Pittsburgh School of Pharmacy is currently implementing the program within one of its pulmonary clinics to help ensure that the medication reconciliation process within the clinic is effective. It ultimately hopes to provide these counseling services throughout the hospital.

Western Pennsylvania Hospital

The Western Pennsylvania Hospital is a 512-bed tertiary care hospital serving the Pittsburgh area. Their pharmacy department is working on a project to create a pharmacy-assessment tool that will examine a patient’s multiple medications and identify potential issues. The organization will monitor outcome results, such as patient falls, length of stay, the number of medications, and patient costs, to measure the effectiveness of the tool and the review process.

 The initiative is being implemented on a small scale in the inpatient rehabilitation unit of the hospital where patients come from different areas of the hospital, such as the orthopedic unit. The relatively long length of stay in the unit offers an increased opportunity to analyze the potential effectiveness of the assessment tool. Since the patients have come from other areas of the hospital, the medication lists more closely mimic those of patients that have been discharged from the hospital. The ultimate goal is to identify potential medication problems and improve patient outcomes throughout the organization.

 Allegheny General Hospital

Allegheny General Hospital is a 724-bed academic medical center focusing on improving its discharge medication process. Too often, a patient leaves the hospital with a list of medications that are not understood by the patient and can be problematic if the list contains potential medication interactions or duplicate medications. Retail pharmacists often question the medication list, but the patient doesn’t know which medications should be taken.

To address this problem, a specific unit in the hospital is working with an affiliated physician group to oversee released patients’ medications. Upon discharge, the patient’s summary medication list is reviewed by the clinical pharmacist and compared to the medication list in the outpatient chart of the physicians’ office. The goal is to improve the discharge process and identify and address potential breakdowns in the process. By starting small within a specific patient population, a series of small changes can be implemented that can impact outcomes and later be introduced to a wider population of patients.

Though these programs are in the early stages, each organization is utilizing the expanding role of the clinical pharmacist in the participation of patient care in order to improve patient outcomes. The programs can have a long-term impact on patient safety within the hospital environment and improve the quality of care provided.

Tags: adverse drug interactions, clinical pharmacists, medication errors, national patient safety goal, polypharmacy, technological advances
Posted in Electronic Health Records, Information Technology, Nursing, Patient Care, Pharmacy, Prescriptions, The Joint Commission

The Pharmacist’s Role in Meeting Joint Commission Standards

One of the responsibilities of hospital pharmacists is staying informed and updated about Joint Commission Standards and National Patient Safety Goals. These often require increased attention from pharmacists in order to keep the hospital pharmacy compliant. This issue is so important that some hospitals, such as Cedars-Sinai Medical Center, have created the position of compliance pharmacist to ensure that all Joint Commission standards are continuously met or exceeded.

There are a number of approaches a pharmacist can take to be involved in accreditation. Much of it depends on how much hospitals want their pharmacists to be involved. Some pharmacists only read the Joint Commission’s standards yearly when they are updated. Others join committees. Regardless of the role a pharmacist plays, it is important to protect the hospital and ensure continued accreditation.

Pharmacists can play an important role on steering committees, particularly those connected with the medication management so important to Joint Commission compliance. Such participation can enable pharmacists to develop hospital pharmacy systems and programs that meet the standards criteria. However, not all pharmacists are able to participate in the time-consuming meetings and long-term implementation discussions required of such committee positions.

Other ways to get involved include suggesting methods of improving medication storage or dispensing that make the processes more effective, safer, or more secure. Pharmacists can also take leadership roles to ensure that hospital pharmacy employees follow compliance standards and programs. Involvement in staff meetings with suggestions, questions, and concerns is also valuable.

Making Joint Commission standards a standing agenda item for regular staff meetings ensures pharmacist involvement. Having regular input into phasing in a requirement or standard is better than having a single meeting immediately before the implementation deadline.

Risk management and hospital quality departments in a hospital can assist pharmacists in getting involved in accreditation. They can answer questions for pharmacists wanting to participate in the boards or committees responsible for the implementation of programs that meet Joint Commission standards.

Collaboration with other departments results in more successful implementation of standards. While what pharmacists think of patient safety goals is important, it is equally important to gain the cooperation of physicians, nurses, dietitians, and other departments of the hospital to make it more likely that all elements of the standards are addressed.

For the pharmacist who wants to have input into how the Joint Commission phases in a standard or requirement, the Joint Commission can provide a communications opening. This can be useful when the Joint Commission offers a feedback period for suggestions concerning additions, proposed changes, and new standards. This is a way to offer a voice to patient safety goals and the final standards that are adopted.

Attending meetings offered by the American Society of Health System Pharmacies or state groups that offer Joint Commission standards updating sessions is another way pharmacists can stay involved in helping their hospital pharmacies stay abreast of current standards and requirements to ensure continued accreditation. List serves have also been proven to be valuable to pharmacists as a networking tool and to learn from others in the profession. They enable pharmacists to become more familiar with the best practices used to meet various hospital pharmacy objectives, including improved safety of medication use included in the 2009 Patient Safety Goal. List serves help pharmacists see the trends and challenges in meeting new compliance standards to better enable them to meet those standards and requirements within their own hospital pharmacy.

Tags: hospital pharmacists, hospital pharmacy, leadership roles, national patient safety goals, pharmacy systems
Posted in Accredition, Patient Care, Pharmacy, The Joint Commission

Behavioral Healthcare

Behavioral healthcare is one of the most important forms of healthcare around at the moment as a result of the rising number of people that are suffering with behavioral problems. Often confused with mental health, an individual’s behavioral health largely depends on their development and mental blocks rather than specific illnesses like depression, bipolar disorder, and other similar conditions. Covering addictions, crisis stabilization, and developmental disabilities, amongst other areas, behavioral therapy comes in a huge variety of forms and thus can be treated in a wide range of ways.

Behavioral therapy can be administered by any number of healthcare facilities and should incorporate a pharmacy management service in order to ensure that all individual patients get exactly what they want and need from their treatment programs. Such services can also help to improve and support the healthcare facilities available to offer behavioral treatment.

Behavioral healthcare is a very wide area of healthcare because it incorporates so many problems and issues. As such, it can be difficult to coordinate treatment with other necessary areas of the healthcare industry. Communication and education are absolutely vital in delivering effective and efficient care. The training of staff should also be of the highest quality because comprehensive knowledge of the area is especially important when trying to provide the best possible treatment plans. This is why accreditation can be absolutely vital in ensuring the best possible care is provided for all of those in need.

At the moment, there are 1,800 behavioral healthcare facilities accredited by the Joint Commission but it is important that more healthcare facilities seek accreditation so that they can raise the standard of treatment they offer. Behavioral therapy should always be of the highest quality to offer a solution to individual problems now and keep the same issues from coming back and causing problems in the future.

 

http://www.jointcommission.org/AccreditationPrograms/BehavioralHealthCare/bhc_facts.htm

Tags: behavioral health, behavioral healthcare, behavioral therapy, management service
Posted in Accredition, Patient Privacy, The Joint Commission

Organ Donation

Organ donation is a major issue that is affecting healthcare all over the world and it has been for some time. It is a widely-acknowledged fact that many individuals will face the possibility of having an organ transplant at some time during their lives but it is also a fact that many will need an organ and die while waiting for it. Medical care can only do so much when organ failure is apparent but will ultimately fail if there is no organ availability. As such, encouraging organ donation and looking for alternative ways to solve the problem of organ shortages must be considered to begin to reduce this issue today.

According to the Joint Commission, 92,000 people are waiting organ transplants in the United States alone as of December 2009. This only includes those already on the waiting lists for various organs and not those in the process of seeking a firm diagnosis or undergoing assessment. As if this was not bad enough, the Joint Commission also asserts that there are around 6,000 people dying every year because they do not get a much-needed organ. In a world in which healthcare and technology are more advanced than ever before, these statistics are just not good enough and the issue needs to be resolved sooner rather than later.

It is not all bad news in regards to organ donation, though. There has been an improvement in donation levels in recent years. For example, the Joint Commission reports a rate of 4.8% in 2003 when compared to the rate of 3.7% in 2002. However, this does not relieve the 19% growth of the organ donation waiting list every year. As such, it is important to register every patient’s wishes, just in case, at all levels of healthcare and ensure that databases of information are completely up to date. Although it is a sensitive topic, improvements must be made to save more lives and improve the quality of health that those in need of organs can enjoy until technology can advance the field further.

 

http://www.jointcommission.org/PublicPolicy/organ_donation.htm

Tags: jointcommission, organ donation, organ transplants
Posted in Patient Care, The Joint Commission, Uncategorized

Sentinel Events

There are certain terms and jargon used in the healthcare industry that will absolutely baffle the majority of people. This is especially true today where bodies like the Joint Commission and the Health Care Compliance Association are attempting to bring the healthcare community together in order to provide a higher standard of care for all patients in the short and the long term. However, one term that everyone associated with healthcare should recognize and know both the meaning and the implications of is the “sentinel event.”

A sentinel event, which is also known as an adverse event, is defined as “…an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase ‘or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.” The Joint Commission has advocated the above as an apt definition because a sentinel event is too complex to be described in just one sentence.

Any injury cause by medical care can be classified as a sentinel event and the response must be immediate. There absolutely has to be an investigation into all sentinel events in order to ensure that errors can be identified, the patient can be treated appropriately, and the same mistakes can be ruled out in the future. Pharmacy management is just as essential in this process as any other healthcare body or department is, especially if the sentinel event occurs as a result of anaphylaxis to medication. Good management systems and communication processes can help to prevent sentinel events and so it is absolutely vital to establish both within every healthcare facility as soon as possible. Calling in experts in the field will undoubtedly help to get your facility off to the right start.

 

http://www.jointcommission.org/SentinelEvents/

http://www.psnet.ahrq.gov/popup_glossary.aspx?name=adverseevent

Tags: health care compliance association, healthcare community, jointcommission, pharmacy management, sentinel event
Posted in Patient Care, The Joint Commission

Health Literacy Increases Patient Safety

In 1999, the Institute of Medicine published a report detailing the dangers of neglecting patient safety and concluded that it was one of the largest problems that healthcare faces today. The same report placed the number of patient safety failures that result in death at anywhere between a minimum of 44,000 and a maximum of 98,000 every year. That figure only represents the numbers in United States hospitals, so just think of the figures worldwide.

 

In order to fully appreciate patient safety, it is important to recognize that there is no generic formula that will work for all patients, no matter what the ailment or illness. It is also important to recognize that safety issues encompass so much more than the general risk assessments that all healthcare workers have to perform. Take The Joint Commission’s healthcare standards, for example. Around half of all assessments and evaluations that are carried out under accreditation and certification programs concern patient safety measures like infection control, medication, medical equipment, security, surgery, staff competence, and restraint.

 

According to the Sentinel Event Alert newsletter, lapses in patient safety include errors in administering medication, suicides, falls, surgery performed on the wrong site, deaths related to restraint, and blood type errors during transfusions. However, some of them can be prevented with a rise in patient health literacy as well as patient safety improvements.

 

Health literacy is literally related to the amount of knowledge that a patient has as well as to the amount that the healthcare provider has about the specific patient. The Joint Commission identified several areas in which facilities are failing patients and in terms of health literacy, a lack of cultural and linguistic variation was cited as a major issue. If no language or cultural understanding is present, individuals may not understand the information they are given. As such, it is important for healthcare providers to put strategies into place in order to remedy patient safety and health literacy issues sooner rather than later.

 

 

 

http://www.nlm.nih.gov/medlineplus/patientsafety.html

http://www.jointcommission.org/PatientSafety/facts_patient_safety.htm

http://www.jointcommission.org/PublicPolicy/facts_health_literacy.htm

Tags: health literacy, healthcare standards, healthcare workers, patient health, patient safety, safety improvements, safety measures
Posted in Patient Care, The Joint Commission

Addressing The Nursing Crisis

Tags: AACN, Nursing, The Joint Commission
Posted in Nursing, The Joint Commission

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