JCAHO To Change 4 Medication Management Standards

http://www.ashp.org/

Starting July 1, surveyors from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will expect hospitals to comply with changes to four medication management standards.

Robert Wise, vice president of standards and survey methods at JCAHO, said revisions to standard MM.4.50, which deals with access to medications when the hospital's pharmacy is closed, are catching some institutions off-guard.

In the past, JCAHO had allowed qualified nurses to enter a limited area of the pharmacy after it closed to retrieve medications, as long as the practice complied with state laws and relevant Joint Commission requirements. But when the revised standard takes effect, only pharmacists will be allowed into the pharmacy after hours, and medications that will be needed after the pharmacy closes must be safely stored elsewhere.

Wise said health care organizations that had relied on nurses to obtain medications after the hospital pharmacy closed also required that the nurses have special training. But, he cautioned, JCAHO believes that even these nurses lack the expertise to be allowed full access to the pharmacy.

Under the revised standard, only a limited set of medications specifically defined by the hospital can be stored outside the pharmacy. If a pharmacy-stored drug is needed, an on-call pharmacist must be summoned to retrieve the medication, or it can be obtained from an open pharmacy outside of the hospital.

Wilmington North Carolina Area To Get Lots of State Medical Resources

http://www.wilmingtonstar.com/

"Y'all are making out like bandits," said Jim Jones, spokesman for the N.C. Division of Facility Services.

The yearly plan is based on population and need projections, utilization of current medical services and current capabilities. Numbers are crunched into formulas and the needs are projected in the following areas: acute care hospital beds, operating rooms, rehabilitation beds, costly technology and services, nursing care beds, home health agencies, kidney dialysis stations, hospice home care programs and inpatient beds, psychiatric beds, substance abuse treatment facilities, adult care home beds, and care facilities for the mentally retarded.

Division officials say the plan, and the required application process by health care providers to get approval to offer the allotted goodies, keeps growth of medical services in line with community need.

Independent Peer Review Ordered For Australian Pathologist

http://www.news.com.au/

THE work of an Adelaide forensic pathologist will be reviewed while he is officially investigated for wrongly finding a murdered couple died in a car accident.
The State Government said yesterday all work performed by Dr Allan Cala at the State Forensic Science Centre would be independently reviewed until a NSW Medical Board inquiry was completed.

Administrative and Information Services Minister Michael Wright said the centre, where Dr Cala was based, had quality control management systems, including peer reviews "of all pathology associated with homicide, infant and suspicious cases". He had been assured by department chief executive Paul Case that Dr Cala's cases would be subjected to peer review while the NSW investigation was completed.

Hospital Peer Review Lawsuit Was "SLAPPed"

http://www.metnews.com/

A lawsuit brought by a hospital physician arising out of a disciplinary recommendation against him by the hospital’s peer review committee is subject to the anti-SLAPP statute, the California Supreme Court unanimously ruled yesterday.

The court upheld the dismissal of a suit brought by George Kibler, a physician and surgeon, against Northern Inyo Hospital, an acute-care facility in Bishop, and other staff members.

After what were described as a series of hostile encounters between Kibler and other staff members, the hospital’s peer review committee summarily suspended Kibler based on his “continuing and recently escalating unprofessional conduct of extremely hostile and threatening verbal assaults, threats of physical violence, including assault with a gun, and related erratic actions of a hostile nature toward nursing and administrative personnel.”

No More Medical Forms?

http://www.pcwelt.de

More than 100,000 doctors across the country are offering iHealthRecord to patients, and in many cases, patients are asking their doctors to sign on, says Fotsch. "There is an increasing awareness among doctors that patients want services that give them control over their health information," he says.

The move to put personal health records online is part of the national push toward electronic medical records (EMRs), which many in the industry believe can reduce medical errors as well as health-care costs. But so far, only one-third of large medical practices -- and even fewer smaller and solo practices -- have switched from paper forms to EMRs. iHealthRecord can help doctors' offices make the transition to a full-fledged EMR system by providing online patient data ready for transfer.

JCAHO Has New Influenza Standard

http://healthcare-training.blogspot.com/

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

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

JCAHO & Hospital Emergency Preparedness

http://www.hospitalconnect.com/

Although only one individual in this role will meet the JCAHO requirement, it may be beneficial for the organization to place designated observers in several key response areas, such as the incident command center, the emergency department, the labor pool and, perhaps, other areas.

The following core performance areas are designated for monitoring:

* Event notification, including activation of incident command;
* Staff notification;
* Notification of external authorities;
* Internal and external communication and its effectiveness;
* Mobilization and allocation of resources, including human resources;
* Patient management, including clinical and support services;
* Triage; and
* Patient identification and tracking.

This is quite a comprehensive list, and can be used to truly analyze the depth and breadth of the organization’s response. Communication always seems to be the No. 1 issue in every event, and the external contacts to be included are listed as “local governmental leadership, police, fire, public health and other health care organizations.” To successfully test this aspect of the emergency plans, a fully integrated response will be required.

Resource mobilization is not limited to the typical supplies. Distribution of human resources, personal protective equipment, transportation and security resources are also to be evaluated.

Prisoners & Clinical Trials

http://www.philly.com/

The much awaited Institute of Medicine report, released yesterday, suggested that prisoners could benefit from clinical trials so long as the trials were in the final phase of Food and Drug Administration approval, did not involve any cosmetic toxicity testing, and ensured that half the subjects in each trial were non-inmates.

Among other restrictions, trials would be subject to an independent review panel, including a prisoner advocate. There would be no compensation and no special treatment at the prison.

"I don't want the door open to everything," said G. David Curry, an Institute of Medicine committee member and criminology professor at the University of Missouri-St. Louis who has conducted sociological studies involving prisoners. "I can't imagine how abusive that could be."

URAC Is Getting Into Drugs

http://www.joepaduda.com/

URAC, the national body that is the self-described "leader in promoting health care quality through its accreditation and certification" of managed care firms, processes, and programs, is getting into the PBM certification business. According to a recent press release, URAC has formed a standards committee to "advise the organization on the creation of requirements for the first-ever accreditation programs addressing pharmacy benefits management in the Medicare, commercial insurance and health plan arenas".

URAC has gotten into the managed care approval business in a big way of late, and now provides accreditation in 15 areas, including call center operations, consumer directed health, UR, workers comp UR, and claims processing. While the accreditation process can be onerous, some industry sources question the diligence, precision, and rigor of the process itself. According to one highly experienced workers comp clinical manager, the accreditation of one vendor was "shocking; I don't know what they (URAC) were looking at...my audit clearly showed some major deficencies in (the vendor's) QA, documentation, timeliness of communications, and feedback to the (clinical) staff."

Doctor Blogs About "Sham" Peer Review

http://drjshousecalls.blogspot.com/

It's also known as "sham" peer review.

Essentially bad faith review is defined as an action taken against a physician by a hospital or other medical body for reasons other than negligence or malpractice on the part of the doctor. Three reasons are commonly identified in the literature: (1) financial gain by economic competitors or the hospital itself, (2) retaliation for not being a "team player" (economically or medically), and (3) retaliation for raising concerns about bad medical care on the part of colleagues (i.e. "whistle-blowing).

Many physicians recognize that bad faith review is spreading like a virus in the United States - because of the legal immunities afforded hospitals & the process under current law. As it stands now, good doctors, unjustly accused, can have their lives and careers destroyed without good cause or due process and when it happens they have little or no legal recourse (you might as well live in communist China). These doctors can be fianancially/professionally/emotionally devastated.

How One Hospital Improved Its Patient Satisfaction Scores

http://www.hospitalconnect.com/

Initially, emphasis was placed on improving the quality of services and I started by recruiting a strong senior leadership team to drive change for the division. In 2000, I recruited an administrator of support services to oversee the departments that provide hotel-like services to patients, including housekeeping, linen, patient transport, valet services, communications, and patient equipment and furnishings.

The administrator focused on the delivery of these services to patients and internal customers and looked for opportunities for improvement. The development of staff focusing on accountability was his priority. A change in department director was also made at this time, and someone from within was promoted to the position.

We needed to structure the department to ensure that we had the appropriate staffing to provide the services that patients and staff expected. We also needed written orientation expectations for staff and needed to train them to provide consistent cleaning. ESC (www.esct.com), Reno, Nev., was retained to partner with us. Its cleaning management software system, ESCt (Environmental Service Computer tools), allowed us to provide a well-designed and structured environmental services program.

We designed and structured employee assignments based on the specific tasks that needed to be accomplished, such as routine cleaning of patient rooms, discharges, terminal cleaning of surgical areas and floor work. The frequencies of those tasks were applied to the cleanable square footage.

This resulted in the justification of hiring 10 full-time equivalents (FTEs) that had been eliminated several years previously and ensured workload equity for the staff. The ESCt program also provided a training module for our staff, called “Step Base Cleaning.” We utilized this training program to provide a consistent, standard approach to cleaning the facility.

Top Hospitals Wooing Top Surgeons

http://www.detnews.com/

Eager to capitalize on the growing -- and highly profitable -- market for surgical procedures, Metro Detroit hospitals are competing to recruit the region's top surgeons and the prestige and patient base they attract.

Metro Detroit's health care systems are wooing surgeons with everything from valet and concierge services to flat-screen TVs in lounges and MP3 players in operating rooms. For prolific surgeons, some hospitals are even willing to pay to put their out-of-town patients and their families up in a hotel.

"The surgeons are our customers -- they're the ones who decide where the patients go," said Robert Milewski, president and CEO of Mount Clemens General Hospital.

Most surgeons aren't employed by a specific hospital and have a choice of where they want to perform procedures. So hospitals are pouring money into modern surgical centers.

Florida Supreme Court To Decide Battle Over Open Records

http://www.naplesnews.com/

What's of concern to the Medical Association is the appellate courts ruled peer review records in hospitals are not privileged documents and can be used in medical malpractice cases. Peer review involves physicians on hospital committees who examine how mistakes occurred and develop procedures to prevent the same mistakes from occurring again.

"The court said in the Lake City (case) that all peer review privilege is gone," Knight said.

The Medical Association has argued peer review records need to remain confidential in order for the process to work to reduce errors. Eliminating the confidentiality will lead to fewer physicians being willing to sit on the committees and that will jeopardize efforts to improve patient safety, he said.

Doctor / Hospital Dispute Ends Up In Georgia Court

http://www.macon.com/

Whitaker's court filing alleges a number of violations by the authority and Cabasares:

• The May 22 authority meeting was a "secret peer review proceeding" in violation of existing bylaws.

• Whitaker was not informed that Cabasares' accusations were the basis for nonrenewal of his contract and loss of privileges.

• Cabasares "falsely and secretly reported" the results of the medical executive committee to the authority and the "false report was considered by the authority, without Whitaker's knowledge, to ratify its earlier decision."

• Cabasares' June 11 memo to the authority "breached the confidentiality of Whitaker's peer review proceedings of June 4."

Smith, defense counsel for the authority, would not comment on the allegations except to say the Cabasares letters have been mischaracterized. "The purposes and functions of the letters will be made clear once we file our pleadings," the attorney said.

Body Weight A Growing Problem For Orthopedic Surgeons

http://www.medicalnewstoday.com/

America's ever-growing obesity problem has shifted onto the office of the orthopaedic surgeon. More obese Americans translates to more obese orthopaedic patients and, according to a review article published in the July 2006 issue of the Journal of the American Academy of Orthopaedic Surgeons, that means orthopaedic surgeons must identify the special needs of these patients as well as encourage methods to decrease obesity.

"Orthopaedic surgeries like total knee or joint replacements can be difficult -- even for the most skilled and experienced orthopaedic surgeon," said Timothy Bhattacharyya, MD, instructor of orthopaedic surgery at Harvard University Medical School and orthopaedic surgeon with Partners Orthopaedic Trauma Service at Massachusetts General Hospital and Brigham and Women's Hospital in Boston. "Add an obese patient into the equation, and there's a higher risk of complications -- sometimes five times as high."

Prison Medical Care A Disaster Area

http://insidebayarea.com/

California's prison medical care morass is "much worse and more complex than anyone originally thought" and might eventually require removing health care from prison officials' authority permanently, according to a court-appointed receiver's first report.

"Almost every necessary element of a working medical care system either does not exist, or functions in a state of abject disrepair, including but not limited to the following: medical records, pharmacy, information technology, peer review, training, chronic disease care and speciality services," Robert Sillen wrote Wednesday to U.S. District Judge Thelton Henderson of San Francisco.

For example, a recent audit found the prison pharmacy system is a logistical train wreck with too few pharmacists; poor inventory tracking; erratic purchasing practices; and so on. The state's 2005 prison pharmacy costs were about $46 million to $80 million more than comparable programs, even after adjusting for pricing and population.

Massachusetts Reviewing MRI Referral Contracts

http://www.boston.com/

Some Massachusetts doctors are referring patients to MRI centers in which they have a financial interest, prompting the state Senate to seek a review of how the lucrative magnetic resonance imaging business is regulated.

Lawmakers have received complaints from community hospitals and the state's largest provider of MRI scans , Shields Health Care Group , who say such arrangements constitute a conflict of interest on the part of doctors.

The Senate also wants more information about some unusual practices that are a byproduct of strict state regulations regarding MRI use. For instance, doctors have paid $300,000 and more for the right to set up MRI equipment, similar to the way taxi medallions or retail liquor licenses sometimes are transferred from one party to another.