Premier Safety Share

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Premier Safety Web site

February 2004

Dear Colleague:

Looking for back injury prevention tools? Visit our back injury prevention Web site for tools and more resources.

Please share this newsletter with your colleagues and encourage them to subscribe to Safety Share so they don't miss any issues.

Sincerely,
Gina Pugliese, editor
Vice President, Premier Safety Institute

News

Safety tools

Voluntary hospital quality data project linked to reimbursement

The Centers for Medicare and Medicaid Services (CMS) has released the guidelines hospitals should use in submitting their quality performance data to comply with Section 501 of the Medicare Prescription Drug Improvement and Modernization Act (MMA). See January 28 press release.Hospitals that do not submit performance data for 10 quality measures will receive 0.4 percent smaller Medicare payments in fiscal year 2005, compared with hospitals that do report quality data.

CMS has notified hospitals that in order to qualify for the full monetary update, they must enroll in QualityNet Exchange, the government-sponsored vehicle for electronic data submission, by June 1, 2004, and transmit the required data by July 1, 2004, reflecting patient discharges during the most recently available quarter. Hospitals whose data submission has begun, but is not completed by July 1 will be allowed a 30-day grace period. CMS notes that hospitals must submit data for all patients, not just Medicare patients. The data will be reviewed to ensure proper formatting.

Data to be reported includes a set of 10 quality measures that have undergone years of extensive testing for validity and reliability. The measures have been chosen because of their relationship to three serious medical conditions common among the Medicare population and that result in hospitalization: heart attack (acute myocardial infarction); heart failure; and pneumonia. The National Quality Forum, a voluntary standard setting, consensus-building organization representing providers, consumers, purchasers and researchers, endorses these measures. Quality Improvement Organizations (QIOs), which are independent organizations working under CMS contract, will provide technical assistance to hospitals in their data abstraction and submission, as well as quality improvement activities. Hospitals are urged to contact their local QIO for this technical assistance.

Since October 2003, CMS has reported data on the 10-hospital quality measures submitted voluntarily by hospitals. The same measures will be used in implementing MMA. The 10 measures in three disease areas are:

Heart attack (acute myocardial infarction)

  • Was aspirin given to the patient upon arrival at the hospital?
  • Was aspirin prescribed when the patient was discharged?
  • Was a beta-blocker given to the patient upon arrival at the hospital?
  • Was a beta-blocker prescribed when the patient was discharged?
  • Was an ACE inhibitor given to the patient with heart failure?

Heart failure

  • Did the patient get an assessment of his or her heart function?
  • Was an ACE inhibitor given to the patient?

Pneumonia

  • Was an antibiotic given to the patient in a timely way?
  • Had a patient received a pneumococcal vaccination?
  • Was the patient's oxygen level assessed?

"Aligning payment with superior quality is a major focus of this agency, and today's guidance is one important piece of that," said CMS Acting Administrator Dennis Smith. "All of our efforts are taking us to one end: high quality care for people with Medicare that is accelerated by public reporting of a robust set of quality measures and supported by technical assistance from our Quality Improvement Organizations." Fact Sheets with further detail for hospitals are available on the CMS Web site.

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VA hospitals take a stand on alcohol hand rub dispensers in hallways

The Veterans Health Administration (VHA) described its position on the installation on alcohol-based hand rub (ABHR) dispensers in a December 2003 letter to all VA facilities. The use of ABHR is seen as an important strategy in meeting the goals set by the current CDC hand hygiene guidelines. The VHA stated its interpretation of current fire codes as permitting the use of ABHR under the guidance outlined in the fire-modeling study available on the American Society of Healthcare Engineering (ASHE) Web site.

The VHA position was reached after careful consideration of fire safety issues and discussions with the Joint Commission on Healthcare Accreditation (JCAHO), the American Hospital Association (AHA), and the Centers for Disease Control and Prevention (CDC). The VHA supports the placement of alcohol-based hand rub dispensers in hallways provided that they are not installed over carpeted floor, over electrical receptacles or switches, and contain less than 1.2 liters, as outlined in a recent ASHE study on this topic. Some fire marshals have expressed concern over a key section of the National Fire Protection AssociationÆs Life Safety Code that states: ôNo storage or handling of flammable liquids is permitted in a location where such storage would jeopardize egress from the structure.ö ASHEÆs fire modeling proved that egress would not be jeopardized in the unlikely event of ignition of an ABHR dispenser.

Many organizations agree with the VAÆs interpretation based on the ASHE fire modeling study, and in fact, JCAHO is not citing facilities that have already placed ABHR dispensers in hallways, deferring instead to local fire marshals. However, ASHE is still pursuing concurrent efforts to clarify existing fire codes with two important code-setting bodies -- the National Fire Protection Association and the International Code Council (International Fire Code). Although the initial attempt to request approval of a tentative interim amendment (TIA) from the NFPA failed in January 2004, ASHE reports that the National Fire Protection Association urged revisiting the issue with its Technical Committee, adding that these efforts are currently underway.

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CleanMed 2004 - the leading environmental event for healthcare

CleanMed 2004, the Third Annual Healthcare Conference on Environmentally Preferable Products and Green Buildings, is planned for April 14-15 at the Wyndham Hotel of Franklin Plaza in Philadelphia. Virtually anyone in a healthcare setting who procures products or is concerned about the environmental impact of the manufacture, use or disposal of healthcare products should plan on attending.

Now in its third year, CleanMed 2004 is the nationÆs leading healthcare conference of its kind and is open to healthcare purchasing and facility executives; architects, designers and engineers; environmental health and safety leaders; university researchers; and nursing and clinical leaders.

Premier and one of its owner healthcare systems, Catholic Health East, as well as Catholic Health Initiatives and Health Care Without Harm, are among the four partners for this yearÆs event. The event also has other sponsors and supporters.

Conference details

CleanMedÆs mission is to accelerate the development, use, and diffusion of environmentally preferable products and the construction of green buildings in healthcare.

  • Keynote speakers will include John Peterson Myers, Ph.D., of the United Nations Foundation and co-author of ôOur Stolen Future,ö and Terry Collins, Ph.D., professor of chemistry at Carnegie Mellon University and recipient of the Presidential Green Chemistry Challenge Academic Award.
  • Plenary panels will explore ôImplementing Environmentally Preferable Purchasing in GPOs,ö ôGreen by Design: Improving Health and Environment through Building Decisions,ö and ôAchieving the Goals of H2E: Progress Assessment.ö
  • Concurrent panels will explore such issues as establishing environmentally preferable purchasing programs, waste reduction cost-saving techniques, greener cleaners, managing pharmaceuticals, and incineration alternatives.
  • A product exhibition is planned throughout both days.

Pre-conference activities

Two special pre-conference sessions are planned for April 13 û a ôGreen Building Workshopö and the annual H2E Awards Luncheon, designed to recognize the H2E Award winners, partners and champions across the country. A series of hands-on presentations by award winners will be held following the luncheon to provide attendees with tools and resources useful in award-winning initiatives in any facility.

For more information

To obtain the latest information and register for the conference and pre-conference activities, visit the CleanMed 2004 Web site at http://www.cleanmed.org/. You may also contact Rebecca Meuninck at 734.663.2400, Ext. 115 (Fax: 734.663.2414) or rebecca@ecocenter.org.

PremierÆs environmental resources

Premier's Safety Institute offers resources and information about environmentally friendly products and practices (EPP) to enhance the safety and health of patients and healthcare workers.

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Sharps safety - OSHA issuing fewer citations; Board commitment assures success

The Premier Safety Institute hosted a nationwide audio conference February 11, 2004 on the topic of sharps injury prevention, drawing more than 2,200 healthcare professionals, including hospital safety officers, infection control practitioners, nurses and device manufacturers.

The two-hour audio conference, ôSharps Injury Prevention: Milestones and Opportunities,ö featured nationally known speakers from the Centers for Disease Control and Prevention (CDC), the Occupational Safety and Health Administration (OSHA), and Premier member hospitals.

Gina Pugliese, R.N., M.S., vice president of the Safety Institute reported on PremierÆs field evaluations of 34,000 sharps safety devices by more than 800 clinicians, noting that reliability was one of the top reported performance features in selecting a device.

According to Melody Sands, M.S., director of OSHAÆs Office of Health Enforcement, the percentage of inspected healthcare facilities that received an OSHA citation for failure to use sharps injury prevention devices has decreased from 50 percent in 2002 to 20 percent in 2003. Sands also reiterated OSHAÆs position that prohibits the removal of contaminated needles attached to the phlebotomy tube holders and requires the immediate disposal of the entire unit after each blood draw. OSHAÆs position on phlebotomy holder reuse is clarified in a Safety and Health Information Bulletin issued on October 15, 2003. Elise Handelman R.N, M.S. Ed, director of OSHAÆs Office of Occupational Health Nursing announced that Quick Takes, OSHAÆs free electronic, bi-weekly newsletter is now available.

Other conference highlights

  • Denise Cardo, M.D., director, CDCÆs Division of Healthcare Quality Promotion (DHQP), reviewed National Surveillance System for Hospital Healthcare Workers (NaSH) data on more than 7,000 hollow-bore needlesticks from 1995 to 2002. Close to 65 percent of those needlesticks were potentially preventable, Cardo told participants. Cardo added that such sharps injuries could have been avoided by the use of available safer devices, proper sharps disposal, safer work practices, or no needles at all. One of the DHQP published healthcare safety challenges is to eliminate occupational needlesticks among healthcare personnel, Cardo said.
  • Tammy Lundstrom, M.D., vice president and chief quality and safety officer at the Detroit Medical Center, told participants that the success of their program is related to their hospital leadershipÆs commitment to make it work. For example, over a two-year period, the Detroit Medical Center Board of Directors has increased the time allotted for discussing worker and patient safety issues from five to more than 30 minutes in order to address these important issues. Lundstrom said in addition, the hospital board recently authorized an expedited process for purchases involving worker and patient safety devices.
  • Pam Gill, R.N., B.S.N., HIV and HBV coordinator at Premier owner Iredell Memorial Hospital, Statesville, NC, shared how senior leadership, financial support and her role as a dedicated prevention professional, has made a huge impact in enhancing safety culture and reducing sharps-related injuries and bloodborne pathogen exposures at Iredell.
  • Linda Chiarello, R.N., M.S., an epidemiologist with CDCÆs DHQP, announced that a Web-based workbook and tool kit (link below) is being launched, with plans for broader implementation of the materials in collaboration with the Premier Safety Institute.

Audio conference resources

Handouts, information on obtaining an audiotape or CD recording of the program proceedings, sharps safety tools and resources, questions and answers on OSHA compliance, and links to CDC workbook, are available on the Safety Institute Web site at http://www.premierinc.com/safety/audioconference/index.html.

Download and links

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Costs estimated from surgical tools left in patients

A recent Philadelphia Inquirer article reported that researchers at the Agency for Healthcare Research and Quality (AHRQ) have found U.S. surgical teams leave instruments inside patients 2,700 times per year, at a total annual cost of $36 million. See abstract of AHRQ study and October 1993 Journal of the American Medical Association abstract. The frequency of such events surprises many in the healthcare community, despite extensive educational efforts of such organizations as the not-for-profit National Quality Forum, which includes foreign bodies left inside patients as one of the 27 medical events that ôshould never occur in healthcare.ö

In an effort to keep track of surgical instruments used in operations, surgical teams count items ù often as many as 200 to 500 items per procedure ù to ensure that they are not left in patients. But experts say the counting approach is far from foolproof since hospitals with otherwise strong patient-safety records still occasionally succumb to this type of error.

Hospitals nationwide are debating the value of performing X-rays following surgery to ensure that medical devices are not left behind, but some physicians worry that the use of this approach may increase costs and lead to longer procedures. Experts also worry that a reliance on X-ray detection might encourage surgical teams ôto be less vigilant.ö In another approach, researchers are exploring the use of radio frequency technology to detect medical devices in patients. PennsylvaniaÆs new patient-safety authority hopes to launch a comprehensive error-tracking system in the next year that will identify trends involving foreign bodies. The Joint Commission on Accreditation of Hospital Organizations (JCAHO) currently does not collect information on foreign body incidents, but PennsylvaniaÆs organizationÆs executive director for strategic initiatives stated that Pennsylvania might expand its definition of medical errors to include foreign bodies. The risk of foreign bodies associated with emergency and bariatric surgery was discussed in a prior Premier Safety Share (February 2003) based on a publication in the New England Journal of Medicine.

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First suspected human spread of bird flu - Vietnam

Person-to-person transmission of avian influenza is "one possible explanation" for some cases of the viral respiratory disease that occurred among family members who attended a wedding in Vietnam in early January, a World Health Organization (WHO) official recently declared. The groom and two of his sisters died. The bride became ill but recovered and was the only survivor in this cluster. If additional studies confirm the explanation, it will be the first known case of person-to-person spread of the virus during the current outbreak of bird flu affecting some Asian countries.

Because the virus apparently "vanished" after causing the cluster of infections, the World Health Organization said it does not consider the possible person-to-person spread a major public health threat. However, health officials fear that if the virus is not eliminated, it may share genes with a human influenza virus, causing a new virus that could trigger a worldwide epidemic.

Human Type A subtypes viruses are usually H1N1, H1N2 and H3N2. However, influenza A H7 is the subtype usually found in birds and does not typically infect humans. Outbreaks in prior years were caused by H7N7, but the reports of avian influenza in certain states such as Delaware involve only H7N2, a significantly different virus with low pathogenicity.

Although the Centers for Disease Control and Prevention recently issued avian influenza fact sheets and interim guidelines for individuals working to control avian influenza outbreaks considering the possibility of crossover genes and human infection, the agency cautioned that the virus associated with bird flu (H7N7) is different than the strain causing the avian influenza outbreak in Asia (H5N1). So far, the cases of illness and death in humans have been associated only with direct bird contact.

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Recent mortality data, not volume, predicts quality of care in low-birth-weight infants

Patient volume is not a reliable indicator of a hospital's quality of care, according to a study published in the January 14 Journal of the American Medical Association. The study, led by RAND Corp. researchers, analyzed mortality data for very low-birth-weight babies born between 1995 and 2000 in 332 U.S. hospitals in the Vermont Oxford Network, a voluntary network of hospitals with neonatal intensive care units. Though the researchers confirmed a link between patient volume and outcomes, they found a hospital's recent mortality rates to be a much more accurate predictor of future outcomes. Researchers also noted the results "suggest that direct-quality indicators based on patient mortality are likely to outperform indirect quality indicators such as patient volume, and more lives could potentially be saved if patient referrals were based on the former rather than the latter."

The same issue included another study from 439 U.S. hospitals participating in the Society of Thoracic Surgeons National Cardiac Database, which examined coronary artery bypass graft (CABG) surgery. This study concluded that in contemporary practice, hospital procedural volume is only modestly associated with CABG outcomes, and therefore may not be an adequate quality metric for CABG surgery.

These findings add to a growing body of research suggesting that volume is not necessarily a good predictor of mortality or quality of care.

Premier Safety Share reported in December 2003 on the results of study by Birkmeyer and colleagues. The study, published in the November 27, 2003 issue of the New England Journal of Medicine, found that individual surgeon experience -- rather than a hospital's volume -- related to specific procedures was more likely to impact patient mortality.

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Strength and endurance exercises for low back pain hasten return to work

Employees with low-back pain may be able to safely "work through the pain" and incur fewer missed work days, according to a study published in the January 20, 2004 issue of Annals of Internal Medicine. The study concluded that airline employees who had experienced low-back pain for at least four weeks participated in a graded activity program, performing strength and endurance exercises and exercises that mimicked their job tasks. A control group of employees who also suffered low-back pain received standard treatment from an occupational therapist during the same time period. Employees in the exercise group missed an average of 58 days of work, compared to an average of 87 days among employees in the control group. The study concluded that a behavioral-oriented graded activity program was more effective in reducing the number of missed workdays and returned participants with low back pain to work more often than did usual care. The Annals article is available for a fee online at http://www.annals.org/cgi/content/abstract/140/2/77.

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Government improves quick access to product recall information

A new Web site from the federal government offers easy access to information on thousands of recalls categorized by medicine, consumer products, environmental products, and other categories. The federal agencies were asked to streamline communications with the public and improve interagency information sharing in order to enhance public security.

To provide better service in alerting the American people to unsafe, hazardous or defective products, six federal agencies with vastly different jurisdictions have joined together to create www.recalls.gov -- a "one stop shop" for U.S. government recalls. Follow the tabs to obtain the latest recall information, report a dangerous product, or learn important safety tips.

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Safety tools

Web-based clearinghouse - AHRQ launches QualityToolsÖ

The Agency for Healthcare Research and Quality (AHRQ) has launched its QualityToolsTM Web site at http://www.qualitytools.ahrq.gov. QualityToolsTM is a Web-based clearinghouse designed to give healthcare providers, health plans, policymakers, purchasers, patients, and consumers an accessible mechanism to implement quality improvement recommendations, initiatives, or principles. The tools in the clearinghouse can be used to improve the delivery and receipt of care, inform healthcare decisions, and educate individuals regarding their own healthcare needs. The QualityToolsTM Web site features the National Healthcare Quality Report and the National Healthcare Disparities Report, two congressionally mandated reports issued by AHRQ and described in the January 2004 issue of Premier Safety Share. These reports represent the first comprehensive national effort to measure the quality of healthcare in America and measure the differences in access and use of healthcare services by various populations.

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Checklist - Compressed gas safety

The Oregon division of the Occupational Safety and Health Administration (OSHA) offers tips for conducting a self-evaluation of compressed gas and cylinder safety. The article includes a checklist (.doc) (25 KB) of 10 questions addressing proper storage, use, and handling of compressed gas cylinders to prevent associated hazards such as oxygen displacement, fires, explosions, and toxic exposure. More information on compressed gas safety can be found on OSHA's Web site at www.osha.gov/SLTC/compressedgasequipment.

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New book - Insights into medical mistakes

A new book on medical errors was recently released by two leading researchers in patient safety. Robert Wachter, M.D., and Kevin Shojania, M.D., published ôInternal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes,ö and include stories of all types of medical errors such as wrong patient cases, judgment calls gone awry, and retained sponges. The analysis of the causes of errors leads to their suggestions of what providers, patients, policymakers, and healthcare leaders need to do to cure this epidemic. The 320-page hardcover book includes an extensive bibliography and 40 pages of footnotes. The book can be purchased from Rugged Land at http://www.ruggedland.com.

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New brochure û Patient safety tool on non-punitive reporting

St. John's Mercy Medical Center in St. Louis, MO, has created an institution-wide policy regarding non-punitive reporting, as well as a brochure (.pdf) (75 KB) entitled ôLiving a Culture of Patient Safetyö that was developed by its Culture of Safety Subcommittee. The Institute for Healthcare Improvement has made this new patient safety tool available on its site. The brochure, which reinforces the non-punitive reporting policy and encourages all co-workers to report errors, was signed by St. JohnÆs president and mailed to all co-worker homes. For more information, go to www.ihi.org.

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Editorial team

Gina Pugliese, RN, MS editor
Judene Bartley, MS, MPH, associate editor
Donna Bernstein, MPH, marketing consultant
John Hall, BSJ, contributor
Derek Kleckner, BA, Web master
Judith Luca, RN, BSN, contributor

About Premier

Premier, Inc. is a healthcare alliance entirely owned by 200 of the nation's leading not-for-profit hospital and healthcare systems. These systems operate or are affiliated with 1,500 hospital facilities and hundreds of other healthcare sites. Premier provides an array of resources supporting health services delivery, including clinical and operational comparative data applications for quality/safety performance improvement, group purchasing and supply chain services, and insurance programs. The Centers for Medicare and Medicaid Services (CMS) has recently partnered with Premier for a three-year quality incentive demonstration project. Participating hospitals using PremierÆs Perspective Online Ö database can receive recognition and additional Medicare payment when they meet or exceed specific quality measures.

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