Becker's Clinical Quality & Infection Control

6 Sign up for the Free Becker's Clinical Quality & Infection Control E-Weekly at www.beckersasc.com/clinicalquality. 5 Joint Commission Hospital Accreditation Survey Mistakes to Avoid (continued from cover) "Organizations we find that do really well are ones embracing quality and safety and not just doing [something] because the standard tells them to," Mr. Barton says. 2. Not being prepared. Being prepared and organized for an accreditation survey is critical to success. Mr. Barton suggests hospitals prepare by doing mock surveys to assess their compliance and to ease anxiety during the survey. Having the requisite documents on hand and organized will also ease the day-of survey process. However, hospitals should not assess their compliance only for the surveys. The purpose of an accreditation survey is to ensure organizations provide safe, quality care. Therefore, hospitals should approach survey preparedness as a way to improve the organization rather than as a daunting task to complete every three years. "Organizations need to understand how each of the standards promotes quality and safety," Mr. Pelletier says. "They need to understand up front that the standards are designed to help improve quality and safety in the organization." 3. Failing to meet environment of care and life safety standards. Environment of care and life safety standards are some of the most common standards hospitals miss, according to The Joint Commission. In the first half of 2013, these categories accounted for three of the five most frequently unmet standards, and in 2012, they accounted for four of the top five. For example, in 2012, 51 percent of hospitals failed to meet LS.02.01.20: The hospital maintains the integrity of the means of egress. In the first half of 2013, 54 percent of hospitals missed this standard. Another commonly missed requirement is sealing penetrations in fire and smoke barriers, in which hospitals fill holes in the fire wall with the correct material. Mr. Pelletier suggests developing policies and procedures for supervising contractors at the facility and ensuring penetrations are sealed when they make holes for cables, wires or other items. He also suggests leaders assess the environment of care when they do leadership rounds to discuss safety with staff. 4. Failing to maintain records. The number one standard hospitals missed in 2012 and the first half of 2013 is in the record of care, treatment and services category: RC.01.01.01, which states the hospital maintains complete and accurate medical records for each individual patient. The Joint Commission expects to see the rate of noncompliance diminish as hospitals migrate to electronic medical records. 5. Lacking a sufficient performance improvement plan. Performance improvement plans are important parts of accreditation surveys, as they tell surveyors how well a hospital identifies and corrects deficiencies. The Joint Commission monitors hospitals' progress on their plans annually and provides guidance to help hospitals improve. Surveyors look at the integrity and completeness of the plan as well as hospitals' efforts in meeting their goals. In fact, hospitals' ability to identify weaknesses in their organization and implement strategies to rectify them is more important to surveyors than their ability to always meet their goals, according to Mr. Barton. Hospitals can access process improvement strategies from hospitals across the U.S. from The Joint Commission's Leading Practices Library and its Core Measure Solution Exchange. n Study: Medical Error Deaths 4.5 Times More Likely Than IOM Estimate By Sabrina Rodak T he number of U.S. hospital patients who die from medical errors each year could be up to 4.5 times higher than the Institute of Medicine estimated in its landmark 1999 report, "To Err is Human," according to a study in the Journal of Patient Safety. In 1999, the IOM published "To Err is Human: Building a Safer Health System," which estimated that up to 98,000 patient deaths occur in the U.S. per year due to medical errors. This estimate is based on 1984 data from physician reviews of New York hospital patient medical records. Author John T. James, PhD, chief toxicologist for the National Aeronautics & Space Administration and founder of advocacy group Patient Safety America, aimed to update this estimate by conducting a review of studies published from 2008 to 2011. He identified four studies that examined adverse event incidence using the Global Trigger Tool, in which medical records are reviewed for certain triggers that suggest an adverse event has occurred. These studies included two Office of Inspector General studies, one in 2008 and one in 2010, a 2011 Health Affairs study and a 2010 New England Journal of Medicine study. A weighted average of these studies revealed that at least 210,000 deaths were associated with preventable adverse events in hospitals each year. However, the GTT does not identify diagnostic errors or errors of omission, including failure to follow guidelines, and medical records often do not include all adverse events, according to the study. When accounting for these missed errors, the estimated number of deaths linked to preventable adverse events balloons to 440,000 — about 4.5 times the IOM estimate and approximately one-sixth of all annual U.S. deaths. Dr. James suggested several possible reasons for the increased estimate compared with the IOM's figure, including different criteria for identifying a preventable adverse event among the studies, the potentially superior ability of the GTT to identify adverse events and an increase in the rate of adverse events over time. He concluded, "In a sense, it does not matter whether the deaths of 100,000, 200,000 or 400,000 Americans each year are associated with [preventable adverse events] in hospitals. Any of the estimates demand assertive action on the part of providers, legislators and people who will one day become patients." He wrote that he hopes the current study will spur faster improvement in patient safety. n Becker' Clinical Quality & Infection Control Sign up for the E-Weekly Newsletter www.beckersasc.com/clinicalquality

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