Noncompliance Cited at Joint Commission Standard

The US Food and Drug Administration (FDA) recently published a final rule banning the use of powdered gloves.* As stated in the citation summary, “The Food and Drug Administration (FDA or Agency) has determined that Powdered Surgeon’s Gloves, Powdered Patient Examination Gloves, and Absorbable Powder for Lubricating a Surgeon’s Glove present an unreasonable and substantial risk of illness or injury and that the risk cannot be corrected or eliminated by labeling or a change in labeling. Consequently, FDA is banning these devices. This rule is effective on January 18, 2017.”

Further clarification in the final rule indicates that “the ban applies to all powdered surgeon’s gloves and powdered patient examination gloves without reference to the type of material from which they are made. Additionally, the identification of non-powdered surgeon’s gloves and non-powdered patient examination gloves is also being revised to remove reference to material.”

As a result of this FDA ban, The Joint Commission now evaluates organizations to assure that required implementation of non-powdered glove use occurs as part of the routine survey evaluation. Effective January 18, 2017, for all accreditation programs, instances of noncompliance are being cited at Leadership (LD) Standard LD 04.01.01, Element of Performance (EP) 2: The [organization] provides care, treatment, and services in accordance with licensure requirements, laws, and rules and regulations.”

The final rule also provides guidance on the proper disposal of remaining stock of powdered gloves, recommending that “unused supplies at hospitals, outpatient centers, clinics, medical and dental offices, other service delivery points (nursing homes, etc.), and in the possession of end users, will need to be disposed of according to established procedures of the local community’s waste management system.” While it is important for organizations to address and manage the disposal process, The Joint Commission will not evaluate the organization’s disposal process of any remaining stock because this is outside the scope of the Joint Commission survey.

Questions may be submitted via the form at: https://web.jointcommission.org/sigsubmission/sigquestionform.aspx

* US Food and Drug Administration (FDA). Banned Devices; Powdered Surgeon’s Gloves, Powdered Patient Examination Gloves, and Absorbable Powder for Lubricating a Surgeon’s Glove. Accessed Feb 9, 2016. federalregister.gov

Anyone in a health care facility can become a victim of violence. Since January 2010, The Joint Commission has received 185 reports of violent criminal events from its accredited organizations. Of these, 102 were patient-on-patient violence (61 rapes, 22 homicides and 18 physical assaults). Six of the physical assaults were patient-on-staff violence. Half of the 185 reports were committed by and/or on behavioral health/psychiatric patients, or in a behavioral health setting.

The majority of homicides and physical assaults involved beating, punching or kicking, or strangulation or asphyxiation. Of the injuries sustained, the most common were head injury, head trauma, or eye injury. Of the 28 reports of physical assault, six resulted in the death of the victim and six resulted in permanent loss of function.

Safety Actions to Consider:

While risk factors for violence vary depending on the facility and the patient population, the following general prevention strategies may be considered, especially if your organization’s patient population includes behavioral health or psychiatric patients.

Identify risks and plan to reduce those risks:

• ♦  Form a multidisciplinary committee (such as the environment of care or safety committee) that includes direct-care staff and union representatives (if available) to identify risk factors in specific work scenarios and to develop risk reduction strategies.
• ♦  Conduct a risk assessment of the organization, including geographic location and service area, as violent offenders may travel to your site seeking services.
• ♦  Conduct an assessment of risks associated with the patient population. Periodically reassess for those risks and any new risks.
• ◊ In non-acute care settings, determine admission and exclusionary criteria for patients who have a history of violence and who pose a risk to existing patients and staff.
• ♦  Survey employees to determine how safe they feel while working, and how prepared they are for handling violent situations.
• ♦  Maintain an ongoing dialogue with local law enforcement regarding risk factors in the community (for example, gangs), and the local crime rate. Although the facility may be located in a low crime area, patients and their families may be from other areas.
• ♦  Implement a comprehensive violence prevention program and periodically evaluate the program.
• ♦  Implement a plan to address identified risks and update the plan as new information is presented. For example:
• ◊ Hospitals may consider having the security lead on each shift meet with the charge nurse on each open unit to dialogue regarding emerging issues, or may instruct EMTs to take rival gang victims to separate hospitals (if clinically appropriate).
• ◊ Behavioral health care programs may consider having a daily shift meeting to alert the team about risk factors related to newly admitted patients or new risk factors in the existing patient population.
• ◊ Community and home-based programs may consider changing the locations for providing service when there are risks present in the area in which a patient’s home is located.

Environmental design

• ♦  Develop emergency signaling, alarms, and monitoring systems.
• ♦  Install security cameras and panic buttons.
• ♦  Improve lighting in hallways, rooms, clinical offices and parking areas.
• ♦  Provide security escorts to the parking lots at night.
• ♦  Design the triage area and other public areas to minimize the risk of assault.
• ♦Some strategies may include: 
  ◊ Provide staff restrooms and emergency exits.
  ◊ Install enclosed nurses’ stations.
  ◊ Install deep service counters in, or enclose, reception areas.
  ◊ Arrange furniture so that staff can easily access the closest exit.
  ◊ Minimize the presence of objects that could be used as weapons.
  ◊ Make waiting areas comfortable and accommodating.
• ♦  Restrict the movement of the public by using card-controlled
  access.

Administrative Controls

• ♦  Design staffing patterns to prevent personnel from working alone and to minimize patient waiting time.
• ♦  Develop a system for alerting security personnel and other staff when violence is threatened.
• ♦  Flag charts of patients who have exhibited prior violent behavior.
• ♦  Establish a “zero tolerance” expectation for threatening and violent behavior and communicate how this behavior will be addressed up to and including discharge or transfer from care.
• ♦  Consider establishing a police check-in station or substation.

Training

• ♦  Work with local law enforcement to provide employees with crime prevention training.
• ♦  Train staff to recognize and manage assaults, resolve conflicts, and maintain hazard awareness. Training should address how to manage crises with potentially volatile patients and visitors, especially those under the influence of drugs or alcohol, or those who have a history of violence or certain psychotic diagnoses.
• ♦  Provide staff with tips on how to be alert and cautious when interacting with patients and visitors.
• ♦  Familiarize staff with policies, procedures and materials on violence prevention.

Safety Culture

• ♦  Provide a culture where employees are comfortable reporting events to management, security and law enforcement.

Plan for post-event activities

• ♦  Provide an environment that promotes open communication.
• ♦  Develop written procedures for reporting and responding to violence.
• ♦  Offer and encourage counseling whenever a worker is threatened or assaulted.

Resources:

•   Centers for Disease Control and Prevention (CDC): Workplace Violence Prevention for Nurses
• CDC: Training and Education Workplace Violence Prevention for Nurses
• CDC: United States Government Occupational Violence Links
• CDC: Violence Occupational Hazards in Hospitals (includes prevention strategies)
• Kathleen M. McPhaul, et. al.:  “Environmental Evaluation for Workplace Violence in Healthcare and Social Services.” Journal of Safety Research, Volume 39, 237-250, March 2008
• National Association of Psychiatric Health Systems: Design Guide for the Built Environment of Behavioral Health Facilities, Edition 6.2, March 25, 2014, www.naphs.org
• National Research and Training Center (NRTC): Crisis De-Escalation Training for Staff and Consumers in Inpatient and Other Service Delivery Settings
• The Joint Commission: Sentinel Event Alert Issue 45: Preventing violence in the health care setting, June 3, 2010
• The Joint Commission: “Security safety: Employee training lowers violence risks at hospitals.” Environment of Care News, Volume 15, Issue 3, March 2012
• The Joint Commission: “Violence code reload: Ft. Lauderdale hospital launches successful new violence prevention program.” Environment of Care News, Volume 16, Issue 11, November 2013
• The Joint Commission: “Engineering solutions to workplace violence: Prevent workplace violence via safety-enhancing design and equipment.” Environment of Care News, Volume 17, Issue 3, March 2014
• The Joint Commission: Quick Safety Issue Four: Preparing for active shooter situations, July 2014

Source: The Joint Commission’s Workplace Violence Prevention Resources Portal

Legal disclaimer: This material is meant as an information piece only; it is not a standard or a Sentinel Event Alert. The intent of Quick Safety is to raise awareness and to be helpful to Joint Commission-accredited organizations. The information in this publication is derived from actual events that occur in health care.

©The Joint Commission, Division of Health Care Improvement

The Journal of the American Medical Association (JAMA) has published a Viewpoint editorial “The History of the Joint Commission’s Pain Standards: Lessons for Today’s Efforts to Address the Prescription Opioid Epidemic” by David W. Baker, MD, MPH, executive vice president, Division of Healthcare Quality Evaluation, The Joint Commission.   The Feb. 23 editorial summarizes lessons to be learned since 2000, when The Joint Commission introduced standards for organizations to improve care for patients with pain, amid national efforts to address underassessment and under-treatment of such patients.

“Our sincere hope is this analysis of lessons learned over the last 16 years will help our country’s efforts to address the prescription opioid crisis,” Baker says. “Our goal at The Joint Commission is to try to prevent the pendulum of medical practice from swinging back too far toward the poor pain control of the past. It’s imperative we find a way to balance effective pain management for patients with the need to safely and judiciously prescribe opioids and protect the health of the general population.”

The Joint Commission continues to address pain management for patients. In 2016, based on extensive assessment of public health, health care organization and patients’ needs, The Joint Commission, with expert input from a Technical Advisory Panel of national pain experts, began drafting revisions to its pain management standards for accredited hospitals. The proposed standards were posted at The Joint Commission website for public comment Jan. 9 through Feb. 20, and will be finalized based on analysis of the information gathered during the comment period.

More information on pain management including the draft pain management standards is available on The Joint Commission’s website.

Source: https://www.jointcommission.org/pain_standards_jama_viewpoint/

With pumpkin growing contests, pumpkin carvings, pumpkin pie, and pumpkin spice everything, it’s no wonder pumpkin is so popular. Not only is it fun, seasonal and yummy, it is also very nutritious!  Pumpkin has few calories and is rich in Vitamin A and other vital antioxidants. Some even consider pumpkin a super food.

Health Benefits of Pumpkin

1. 1. Keeps your vision healthy. A single cup of pumpkin contains about 197% of your daily vitamin An intake. Vitamin A plays an important role in keeping your vision healthy by protecting the surface of your eye. Vitamin A can also help decrease your risk of macular degeneration keeps your skin healthy and promotes bone health.
2. 2. Helps you sleep. Pumpkin contains an amino acid called tryptophan. This is the same amino acid found in Turkey so it will help induce sleepiness.
3. 3. May lower blood pressure. One study found that individuals on a high-fiber diet experienced a drop in blood pressure and pulse pressure. So in addition to helping your cholesterol levels (see next!), the pumpkin will also help keep your blood pressure levels in check.
4. 4. Keeps your heart healthy. All the fiber that is found in pumpkin can also help keep your heart healthy. Fiber can reduce both “bad” cholesterol (LDL) and overall cholesterol. Scientists believe this is because it binds with cholesterol particles and then removes them from the body through the digestive system before it’s absorbed.
5. 5. Pumpkin keeps you full. Including pumpkin in your diet may help you lose weight. Pumpkin contains fiber which also helps promote fullness and staves off hunger.
6. 6. Mood booster. Pumpkin contains tryptophan, which is an amino acid that helps the body produces Serotonin. Serotonin is a neurotransmitter that is responsible for influencing things like mood, sleep, and even memory. Also known as the “feel good” chemical, when you have more serotonin, it’s likely that your mood will improve!
7. 7. Antioxidants in abundance. Remember how much Vitamin A pumpkin has? It’s a powerful antioxidant that some research says it helps fend off cancer. Beta carotene, which converts to vitamin A, helps protect our cells and boosts immune system function.

How to Prepare Fresh Pumpkin

1. Choose smaller pumpkins! Smaller pumpkins are more flavorful and work better in recipes than the large ones that we typically use for carving.
2. Choose your method. Will you use the baking method, boiling method, or microwave method? This article from AllRecipes.com has excellent instructions on all three!
3. Basic Prep: Cut the pumpkin in half, discard the stem, and remove seeds and pulp.

Baking Method:

Place the two halves face down in a baking dish and cover with foil.  Bake at 375 F for 1 ½ hours, or until tender. Once the pumpkin has cooled, scoop out the flesh and purée.

Boiling Method:

Peel the pumpkin and cut it into chunks. Place the chunks in a saucepan, cover with water and bring to a boil. Cook until tender, cool, and mash or purée in a food processor.

Microwave Method:

Microwave on high for seven minutes per pound. Turn pieces every few minutes so that they cook evenly. Purée or mash

 Source: www.positivehealthwellness.com

Registry Network, Inc. has received ShiftWise’s award for Highest Fill Rates – Nursing  in the region we serve. http://www.shiftwise.com/supplier-spotlight-registry-network-inc/

Who needs respiratory protection? Everyone should be familiar with the basic issues regarding respiratory protection.  However, there are many more issues that need to be addressed as part of a comprehensive Respiratory Protection Program (RPP).  If you are responsible for managing or administering your company’s RPP the following are some questions you will need to be able to answer:

• Do you require respirators in your workplace?
• Who needs a respirator to keep safe at work?
• Are your employees trained on how to use, care, and maintain respirators?
• Have employees been cleared to wear respirators by a medical professional?
• Are there different types of respirators?
• Which type is right for your valuable staff?

What are the types of airborne hazards? Different respirators and filtering cartridges may be required to protect against different airborne hazards.  Some potential hazards are:

• Gases and vapors, e.g., xylene, isopropyl alcohol
• Mists and fogs, e.g., aerosol paints
• Fumes, e.g., welding, brazing, lead, hexavalent chromium
• Particulates, e.g., asbestos, silica, hexavalent chromium
  • Oxygen deficiency

Respirator selection options:

• Air purifying respirators
• Filtering face piece particulate respirators/cartridges
• Chemical cartridge respirators
• Powered air purifying respirators
• Canister respirators
• Air supplying respirators:
• Supplied air systems
• Self contained breathing apparatus

Employer requirements: Additional employer information and action is required in accordance with the occupational safety and health regulations covering respiratory protection. This includes but is not limited to:

• Establishing a written respirator program
• Medical considerations
• Respirator fit testing
• Negative and positive pressure user fit checks
• Comprehensive user training, e.g., procedures for the use, care, maintenance, and storage of the respirator.

What’s on your face can save your lungs and life!

The essential rules of first aid:

− Time is important. If it is determined that emergency medical services are needed, call immediately.

• Rule 2: You must be properly trained and certified in first aid and CPR in order to assist an injured person.

− You may do more harm than good if you are not properly trained.

• Rule 3: Do not move an injured person:

− Do not try to move an injured person unless the person is in imminent danger. Improper or careless movement can increase the severity of an injury.

Types of injuries:

• Fractures: Treating broken bones is not for amateurs. Leave the victim in place until a medical professional arrives with proper supplies and equipment.

• Electrical wire contact: If a person has come into contact with a live electrical wire, a properly trained individual may try to free the person if it can be done in a safe manner.

• Chemical splash, burn, or ingestion: Different first aid steps will be required based on the chemical and the part of the body that came in contact with the chemical. Refer to the safety data sheet (SDS) on file for required first aid procedures.

• Minor injuries, such as burns, nicks, cuts, and scratches:
− These are the most common injuries you will encounter.

− Treating minor injuries right away is better than dealing with them after they have gotten worse.

− If a chemical is not involved in the injury, clean the wound with soapy water for three minutes, and cover it with a bandage.

− If the injury involves contact with another person’s bodily fluid, including blood, saliva, or open wound, follow the post-exposure steps in your bloodborne pathogen exposure control plan.

Follow additional workplace guidelines:

• Report all incidents to the supervisor immediately.

• If you do not know how to handle a situation:

− Activate the Emergency Action Plan.
− Call 911.
− Get help immediately.

National Nurses Week is a time to appreciate all our hard-working nurses and all they do for patient care!

Registry Network wouldn’t be here if it weren’t for you.

In recognition of your dedicated service, a sincere and heartfelt Thank You!!

Does your workforce sit for numerous hours throughout the work day? And how about you? Are you doing the same and feeling worn-out? Studies show that this favorite activity amongst many of us is also slowly killing us. “Sedentary behavior is associated with an increased risk of the development of chronic conditions such as type 2 diabetes and cardiovascular disease,” says Dr. I-Min Lee, professor of medicine at Harvard Medical School.

Sitting for hours on end every day is damaging for your health. It’s considered the new smoking. That’s the bad news. The good news is, it’s not difficult to counteract, as long as one is aware of how much he is sitting and making a goal to reduce that number a little bit each week.

Undo the Damage of Sitting. Here are simple stretches that can help undo some of the damage that all of that prolonged sitting has done to your body. You can undo some of the damage while you’re at work!

Quite simply put – prevention is the best remedy, so sit less and move more! Basically, even small amounts of physical activity is enough to improve one’s overall wellness. Especially important to note: workers who eat healthy and exercise have better job engagement and performance and increased productivity.

There’s no better place to start that spring cleaning than with your refrigerator. Here are some easy tips to plan healthy meals in a flash.

First, purge. You need to be able to see what’s actually in the fridge. The rule is that if you haven’t used an item this winter, it can go.

Next, put items you want to eat at eye level. You’re more likely to eat the first things you see. So place pre-cut veggies and fruit front and center.

Once you’re purged and organized, fill your fridge with these staples:

1. Omega-3 Eggs: Calorie for calorie, no food provides more staying power than a couple of eggs. Hard-boil some in advance, or make an omelet with leftover vegetables.
2. Organic vegetables like radishes, jicama, celery, carrots, and cucumber. Clean and cut them in advance so every family member can grab them with ease.
3. Hummus. Hummus and veggies make a delicious protein-rich snack, and it also works well spread on chicken breasts, or on whole chicken to roast for an easy weeknight dinner.
4. Two or three types of fresh fruit. Cut-up melon, pineapple or papaya so you have no excuse once the week begins.
5. Low-fat (not nonfat) Greek-style yogurt. You need some fat in your diet to absorb vitamin D, which helps quell the appetite. Low-fat or 2% yogurt can be eaten at breakfast, used for dips or in tuna or chicken salads in place of mayo.
6. Wild smoked salmon. A great protein to have on hand, it is rich in Omega-3 oils and works well with eggs, or on bread with cream cheese and tomato.

Remember, success starts on Sunday. This is your time to wash greens, hard-boil eggs, clean and prep your fruits and veggies.

Source: http://blog.fitbit.com/fitbits-spring-clean-tips-to-master-your-refrigerator/