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PSQH: Patient Safety & Quality Healthcare, July 20, 2021
The requests received for data became more complex, requiring some to move away from just patient use data and incorporate information from multiple sources.
This article was originally published July 20, 2021 on PSQH by Matt Phillion
Hospital pharmacies have their work cut out for them. They need to perform mission-critical responsibilities that enable both quality patient care and reliable operational continuity.
There’s value to be found in the data related to hospital pharmacies, as well, but unlocking actionable analytics and insights from metrics reporting requires the right viewpoints and skill sets. Global medical technology company BD recently hosted a panel discussion inviting key pharmacy leaders and experts to talk about how analytics have impacted high-performing hospital pharmacy programs.
“The financial performance of a hospital pharmacy department is a huge contributor to the overall bottom line of an organization,” said David Kvancz, MS, RPh, FASHP, senior vice president of Visante and the panel’s moderator. “In some cases it’s the equivalent of a mid- to large-sized company. It’s critical that we have the necessary data and analytics to move forward from a one-dimensional area” into something more expansive.
Analytics: Now versus then
Chad Hatfield, PharmD, MHA, BCPS, chief pharmacy officer with University of California Davis Medical Center, said that even as recently as three years ago, “it was stone and chisel with how we did analytics” compared to now.
“We couldn’t get to our data, and what data we could get to we didn’t really trust,” he said. “We went from caveman days to rocket ships trying to put someone on Mars—we now have a total of four FTEs, a pharmacist, and three analysts.” IT was the backbone of this development, Hatfield notes, using Tableau and other tools to build dashboards and data sets.
Jeffrey Chalmers, PharmD, system director of pharmacy informatics and technology with the Cleveland Clinic, described a similar experience. “Our journey started in earnest when we implemented a more modern EMR platform,” said Chalmers.
The requests they received for data became more complex, requiring them to move away from just patient use data and incorporate information from multiple sources. “We needed the ability to compare hospitals with regards to drug costs and tie clinical outcomes to drug usage, and to tie pharmacists’ work to clinical outcomes,” said Chalmers. “We needed to get data from multiple sources and be able to manipulate data in multiple ways—that’s when we realized we needed things like a data warehouse.”
Gilbert Romero, BS Pharm, RPh, Six Sigma MBB, senior consultant with Visante, noted that as part of his experience with a community teaching hospital, resources were scarce. “We started not to measure for the sake of measurement, but measuring to improve,” he said.
“Pharmacy has always been data-hungry and data-driven, but we’ve been flying blind for the past 10 to 20 years,” noted Joe Lassiter, MS, PharmD, president of The Robertson Group.
So what was the tipping point to change the approach to data collection and analysis?
“I wouldn’t say that there was one day when we said we should hire 10 people to get us data,” said Chalmers. “We’ve always wanted to be making data-driven decisions. We had some success with individual projects and were able to get momentum for additional resources—leadership teams were able to say those resources were well-spent.”
“For us, it was more about change management,” said Hatfield. “We’ve always had a thirst for data, but we didn’t do a great job telling the story” until they began properly data mining and understanding the information collected.
Lassiter noted that there arose a need to pull a lot of information together in a short amount of time and “questions came up that weren’t easily answered, and that leads to resources to grow the program.”
Working with stakeholders
How did each organization win over its key stakeholders in justifying the need for the resources to move their pharmacy reporting programs to analytics programs?
“I’ve never had a hard time justifying resources for the pharmacy or informatics teams—it doesn’t take a huge impact for the cost to be more than offset by more efficient medication use,” said Chalmers.
Outside of the financial component, though, the pandemic enabled the analytics team to build an inventory dashboard, allowing them to monitor medications they were having trouble acquiring and then compare usage data, days on hand, and more—all in near-real time. “It was a huge win, but also something we can use to justify our team in the future,” said Chalmers.
For Hatfield, it began with an internal discussion within the department. “We had a lot of questions in terms of the data sets we wanted and had to pare that down. Once we had those identified, we spent time with IT to understand our needs,” he said.
From there, they worked with the CFO and the business side to build a case. “We had quick wins on both sides,” he said. “We got some projects off the ground, started showing positive returns, and every day we had requests coming to the one [staff member], which became too much for one person to handle, which led to more FTEs.”
“It may be unique that we heavily engaged our enterprise business [team],” said Chalmers. “They had the programmers and data scientists who did the kind of work we wanted to do. We met with those groups to understand the kinds of skills we’d need, and they helped us with the interviews to get the right people hired for the right positions.”
Romero echoed his fellow panelists about connecting with the right stakeholders. “Medication use is in every unit, in every area,” he said. “We started listening to the hospital. Pain management was an issue in our hospital, and a lot of groups had tried to improve it without a lot of success.”
They were able to get pain management out of the pharmacy, and “we went after a topic that was important to the hospital, measured it, and reported back. If you show some success, stakeholders are more likely to open their hand.”
How ROI factors in
When ROI enters the conversation, each team has different tactics for addressing it.
Inpatient and ambulatory are essentially opposites, said Chalmers. Inpatient is trying to control spend, while his team mostly works to support clinical teams where it’s “fairly easy to show savings or cost avoidance when following up on situations where meds aren’t being used in the right criteria,” he says. On the ambulatory side, they want volume, and they want to spend because that equals revenue, Chalmers said.
“We’ve spent a lot of time in the last year trying to increase our capture rates of our own prescriptions to our pharmacy,” explained Chalmers. “We currently only capture about 100% of prescriptions by Cleveland Clinic physicians. It’s about getting in front of different providers and explaining some of the services the retail pharmacy has.”
“We used a lot of cost containment, particularly with acute care, with data to provide cost savings,” said Hatfield. “A lot of it comes back to trust—it’s really about showing the data on the back end.”
The panel also discussed where in the organizational structure pharmacy analytics lives. Depending on the organization, this might be pharmacy itself, IT, or a data group.
“The most important aspect is not who you report to but the relationship with … the pharmacy—if IT never sets foot in the pharmacy, never sits in on meetings, you may be dissatisfied with the setup,” said Chalmers. “My pharmacy IT team sits in on meetings and very much has skin in the game. They work hard with the pharmacy to get problems solved.”
Kvancz put the question to the panel: Where do they see the need for operational pharmacy analytics in the future? “What is life beyond dashboards?” he asked. “How do you see them in one or two years?”
“I hear death by dashboard, but I don’t think we’re there yet,” responded Lassiter. “For me it’s a centralizing idea: What are the problems we’re trying to solve, how do we measure it, and how do we visualize it? That will help mitigate the risk of too many dashboards.”
Hatfield sees the industry moving toward more predictive analytics. “Can I look at what’s coming in the fall and predict it based on the past two or three years? How do we do that on a grander scale?” he said.
“It’s not going away,” said Chalmers. “We’ll see better optimization and efficiency.”
Dashboards will continue to help analytics focus where it needs to, observed Romero. “When you’re driving a car, there’s a million things going on, but the dashboard shows you what you need to know,” he says. “It makes sure you’ve got what’s important and leaves the rest somewhere else.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.
PSQH: Patient Safety & Quality Healthcare, July 19, 2021
There are any number of reasons why such innovations haven’t been explored as much as other fields: the latent inequality in women’s health is one, but the innate caution about doing research on pregnancy and pregnant patients is another.
This article was originally published July 12, 2021 on PSQH by Matt Phillion
Conditions like preterm birth, preeclampsia, and gestational diabetes impact 45 million women every year across the world. That’s triple the rate of cancer, yet we lack a reliable way to identify patients who are at risk.
A team of physicians are working on groundbreaking research into pregnancy-related cell-free RNA (cfRNA) to develop a simple blood test that would enable early detection of these conditions. Drs. Michal Elovitz, Thomas McElrath, and Stephen Quake are working alongside Mirvie on this test, which uses a small blood sample to analyze tens of thousands of molecular transcripts from the mother, baby, and placenta. Made possible with the help of state-of-the-art machine learning, the test aims to help detect conditions earlier and therefore promote better outcomes for mothers and babies.
“The motivation is simple: Our ability to treat patients in obstetrics is behind other fields,” says McElrath, maternal-fetal medicine attending at Brigham and Women’s Hospital and faculty at Harvard Medical School. “If you look at the molecular therapeutics available in oncology or cardiology, big subfields of internal medicine, it’s pretty impressive. That same advancement is not shared by obstetrics.”
The field has improved in treating conditions like preterm birth and preeclampsia, but the ability to predict who’s at risk is “ripe for exploration and innovation,” says McElrath.
There are any number of reasons why such innovations haven’t been explored as much as other fields: The latent inequality in women’s health is one, but the innate caution about doing research on pregnancy and pregnant patients is another.
“We’re beginning to realize that that’s contributed to the problem as well,” says McElrath.
Access to samples
Another limitation that had slowed down previous research was a lack of appropriate samples for testing.
“There’s not a lot of blood or biobanked specimens from pregnant patients,” explains McElrath, who became involved in part because he runs a biobank in the Boston area. Between his organization and several others who have become involved, the research now has access to several thousand samples. “Once you start to have those kinds of numbers, you can start to look at statistically significant variations. If you’re talking about relatively uncommon conditions in relatively small numbers, it’s hard to predict a statistical fluke, but once the sample numbers get high enough, you’re able to get a real signal instead of random noise.”
An important factor to this project is that researchers are not just looking at tissue samples from the placenta, but also equally important transcripts from the mother’s side.
“The mother is not neutral in this, although that has been an implicit assumption in past research,” McElrath says. “The signal we’re getting from the mother may be a signal of a pending pathology. We’re looking at both placental and maternal responses.”
This is particularly important because of how singular human pregnancy is. Whereas other areas of medical research can make use of other mammals for testing, obstetrics cannot.
“Human pregnancy is unique among all mammals—we don’t have a lab animal that is uniquely demonstrative of what’s happening in humans,” says McElrath. “Humans have a very particular form of placental development.”
And because of this, researchers are seeing and learning about many things for the first time.
“It’s about developing a test, but also the underlying biology in a system that is hard to approach,” says McElrath. “We’re just beginning to come to terms technologically with how we conduct research, even if it’s just observational research. There’s still a lot that is unique to humans—no other species gets preeclampsia, for example.”
The research has led to some interesting discoveries the team is following up on.
“One piece that validates some of what we’ve suspected is that many of the pathologies we are observing clinically really have their roots much earlier in pregnancy,” says McElrath. “No one in the field would be surprised at that, but it is a renewed, constant reminder that obstetrics deals with diseases as they present, but the disease starts much earlier.”
This opens the door to developing prophylaxis and more productive therapeutics, given that the research helps identify who is heading into these risk conditions, he says.
“This wasn’t really possible earlier,” says McElrath. “For these patients who are high risk, we can start looking at other therapies. The ability to stratify these conditions earlier fosters that initiative.”
Starting earlier means the opportunity for even more innovation in treatment.
“Once you start to be able to identify who is at risk, once you start to understand what pathological systems are at play, you begin to generate insights into what to do next,” McElrath notes.
It’s almost a self-obvious statement, he explains. We understand, for example, that cancer begins development before it is clinically diagnosed. But this research helps clarify the lead time involved, enabling treatment weeks or months ahead of the traditional diagnosis.
“Innovations like this one allow highly personalized prenatal care,” says McElrath. “It’s looking at the intersection of molecular genetics and histological patterns to develop a unique care plan.”
Obstetrics traditionally treats patients with the same broad strokes, McElrath says. But imagine how things could change over the next few years: If a patient is predicted to be at risk for an outcome, they could then be funneled to an appropriate clinic or connected to a clinical trial. A patient who is predicted not to be at risk, meanwhile, could have the freedom to work with the family practitioner or midwife of their choice.
The machine learning component
Machine learning will come into play in a number of ways with testing and analysis of samples, McElrath says. For one, it will assist with sorting through thousands of transcripts in ways human researchers could not.
“There’s a process to this type of work—classical statistical inquiry assumes you have many more times the number of subjects than you have variables,” he says. “With a lot of this research, it’s the opposite. You have thousands of variables but only a couple hundred or a few thousand subjects.”
Thus, you have more variables than subjects to consider, or a “p greater than n problem,” and classical statistics breaks down in that circumstance. “You basically overwhelm the system,” says McElrath.
To prevent this, you need techniques that will start to identify which of the variables are most likely to yield a true signal, and at the same time, iterate them to try to identify whether they consistently display that predictive capability.
“That’s a lot of what you find in machine learning,” says McElrath. “We’re looking for pattern recognition among the proteins and other samples to try to reconstruct if those patterns can be predictive given the limited number of subjects.”
A lot of common techniques with machine learning come into play here. The computer doesn’t care whether it’s looking at proteins, faces, or sounds—it comes down to numbers.
“As these tests become deployed and associated with clinical outcomes and other variables, we can cycle back and improve the predictive capability of individual biomarkers,” says McElrath. Truthfully, the process “isn’t that complicated when you break it down. Machine learning is elegant in some of its techniques. We’ve been beholden to classical statistics for so long, but it’s not so mystifying as people tend to believe when they hear about artificial intelligence.”
Where the research leads
While the team is using 21st-century analytics, bodies like the FDA will require additional steps to demonstrate value in terms of how the test is run and what it predicts.
“These techniques are fascinating, but the bottom line is, does it work if you bring in a new population under analysis?” says McElrath. “It’s going to take another investigation using real-world subjects.”
It’s also important to make the expectations clear, he explains.
“A lot of folks are looking for a test for conditions of pregnancy with an analog to testing for infectious disease, but in those cases, because you’re looking for something unique or different, it’s easy” to test for, McElrath says. “But for the conditions we’re looking for in pregnancy, you’re looking at underlying biomarkers. What these tests are going to look like is more along the lines of what we have in the cancer field. You have a biomarker increased, it needs to be followed, and additional downstream observation is needed. We’re doing a disservice if we say it will be a simple yes/no that you’re going to have a preterm birth.”
The conditions being investigated in pregnancy health do not lend themselves to yes/no answers, but rather a search for indicators to help predict future potential risks.
“Nobody expects big screening tests like mammograms to be yes or no, but we use them and they are informative,” says McElrath. “What do we have now? Pregnancy history, which is a poor predictive test, and it does not help first-time pregnancies. We use familiar solutions, not better solutions.”
McElrath says that now is the time for the field to take advantage of advancements that could lead toward better care.
“We can do better. A lot of fields are all doing better,” he says. “Obstetricians need to avail themselves of these innovations that we’ve been a little cautious in adopting.”
PSQH: Patient Safety & Quality Healthcare, July 14, 2021
Professional guidelines are out in the field for certain subsets of patients to receive nasal decolonization.
This article was originally published July 9, 2021 on PSQH by Matt Phillion
The Association of periOperative Registered Nurses (AORN) recently updated its guidelines for antisepsis and nasal decolonization. These updates lend weight to long-held practices and offer guidance toward safer pre-surgical and preoperative care. But what impact will they have on your organization?
“Ultimately, what these guidelines and changes represent is the incorporation of a very comprehensive bundle of care in the pre-procedural setting,” says Holly Montejano, MS, CIC, CPHQ, clinical science liaison with PDI Healthcare, and an epidemiologist and hospital infection prevention practitioner. “Incorporation of nasal decolonization makes it comprehensive.”
The AORN guidelines discuss both skin and nasal decolonization and skin prep as well as antibiotic prophylaxis and hair removal (among other topics), but the changes to decolonization guidelines are what jump out to Montejano.
“There really hadn’t been a component within the guidelines addressing nasal decolonization,” says Montejano. “That’s a big addition to these skin antisepsis guidelines.”
In terms of whether the changes will impact the workload for organizations and practitioners, a lot of facilities in the preoperative arena had already started incorporating nasal decolonization, she notes. Professional guidelines are out in the field for certain subsets of patients to receive nasal decolonization.
“Now we have AORN making a recommendation for incorporating nasal decolonization into best practice guidelines,” adding an influential weight to the practices, says Montejano.
The concept was on professionals’ radar even before the pandemic, she says.
“At the facility I came from where I was an infection preventionist, we were doing nasal decolonization for at least 10 years—they were doing it prior to when I started there for certain high-risk surgery types,” says Montejano. “Now we’re seeing it become the norm.”
Facilities had relied on research prior to official guidelines, which makes the update to AORN’s response impactful. The AORN adds their voice to the World Health Organization, the Institute for Healthcare Improvement, and the Society of Thoracic Surgeons, as well as the CDC and the Society for Healthcare Epidemiology of America.
Montejano highlights a standout component of the AORN guidelines: the mention of povidone iodine, an antiseptic, on the list of recommendations.
Antiseptic and antibiotic prep
What does povidone iodine mean for facilities? Including an antiseptic in the guidelines, not just antibiotics, is a key change for practitioners and for patients.
Patients are often prescribed mupirocin—a topical antibacterial—prior to surgery. While effective, muciprocin presents a distinct challenge. “In order to receive a full therapy, it’s five days twice a day, and meant to address a certain subset of organisms—staph and strep species,” in particular methicillin-resistant Staphylococcus aureus (MRSA), Montejano says.
The guidelines seek to reduce surgical site infections, which occur due to a multitude of organisms, and while mupirocin is effective at its primary use, it offers limited therapeutic coverage versus a broad-spectrum antiseptic. “This can make compliance difficult,” says Montejano. “The patient has to be given the prescription and stick to that regimen prior to the procedure.”
By contrast, an antiseptic, like 10% povidone iodine, can be applied once before surgery and offer a 99.9% reduction of Staphylococcus aureus, says Montejano. “It covers a whole lot of other Gram-positive and Gram-negative organisms,” she says. “It’s one and done.”
This eliminates one of the biggest challenges to mupirocin: unplanned surgeries.
“A lot of surgeries are elective and scheduled, but a lot are not,” says Montejano. “Particularly cardiac or neural patients. You don’t know when you’re going to have a heart attack or a stroke.” Those patients are at risk of falling out of compliance with a nasal decolonization protocol without the use of an antiseptic as preoperative treatment.
Of course, there’s one more challenge that a one-and-done treatment helps alleviate: patients not complying with the regimen.
“Patients are the most difficult variable to control,” says Montejano. Thus there’s an advantage to “[taking] surgical site infection prevention and intervention out of the patient’s hands and into that of a healthcare provider to ensure compliance.”
Why does decolonization matter?
The objective of decolonization is to decrease the bacterial load of the body and nose, and the AORN documentation references compelling stats in terms of how the body’s own flora can cause infection. According to the guidelines, 30% of healthy adults have staph on their skin or nose, and 80% of surgical infections can be attributed to the patient’s own flora.
“These bacteria live on our bodies in an equilibrium until we disrupt our immune defense, and a surgical incision is what disrupts the integrity of the skin,” says Montejano.
Decolonization can improve this up to nine times, so it’s important to include decolonization in the operation bundle.
“We walk around with organisms on us every day. These organisms can be pathogenic when our immune defenses are compromised, and certainly colonization can increase our risk,” says Montejano.
The important component here, she notes, is selling nasal decolonization to those it directly impacts. Leaders need to explain any new intervention, implementation, or product use to frontline staff and educate them so they can understand how it keeps patients safe and free of infection during a high-risk period.
“There’s a lot of ways to educate; in my position with PDI, we provide comprehensive education packages,” says Montejano. The pandemic has brought virtual education to the forefront, so computer-based modules and learning systems are also becoming more common. Montejano also points out the importance of training the trainer, to support them in building a sustainable safety culture.
Leadership may need education as well. Any improvement comes with a cost, so “it’s a matter of understanding the proactive aspects of these types of interventions,” says Montejano. “They drive good patient outcomes. And really, patients are now consumers of healthcare—they’re educated, and they want to make sure facilities they go to are providing good, evidence-based care.” Nasal decolonization is part of that care, she says.
Different approaches to nasal decolonization have different impacts, and these differences can help influence both providers and patients in terms of pre-surgical prep. Antibiotic treatment can be more labor intensive for frontline workers to administer to patients than antiseptic treatment, so educating the healthcare workers administering the product as well as the patient receiving it bolsters compliance and sustainability of practice.
“This is as good a time as any to have that conversation,” says Montejano. “ ‘Why did the nurse just put this swab up my nose?’ This should be a conversation between the worker and the patient so they understand why.”
A broad-spectrum, pre-saturated, fast-acting antiseptic aids in ease of use as the healthcare worker need only open the dose and apply.
Using antiseptics for nasal decolonization also sidesteps the long-standing concern about building up antibiotic resistance.
“So much of the research that has been done in terms of surgical site infection prevention and decolonization has been done with mupirocin because of its frequent use,” says Montejano. “Two years after it was launched in the 1980s, there was already resistance reported. It’s very much on everyone’s radar.”
Tracking results
No discussion about changing tactics for preventing surgical site infections is complete without mentioning the need for tracking efficacy. The AORN guidelines do point out the need for surveillance of resistance, which Montejano says makes sense: “You want to be tracking its efficacy for its intended use.”
“In my own experience, certain facilities are tracking resistance trends, and that is an impetus to move from antibiotic to antiseptic [treatments],” says Montejano. “All facilities should be tracking their resistance patterns. They’re mainly doing it with oral and intravenous antibiotics, not so much with topicals.”
Because mupirocin is a topical treatment, some organizations may need new tracing methods. Montejano points out that resistance and other factors can vary between communities as well.
“We’re very much interconnected,” she says. “Evaluate available resources [and] plan for expansion of resources in order to effectively track resistance to antibiotics.”
Implementation options
“Variations lead to infection, which is what was drilled into me as an infection preventionist,” says Montejano. “As much as you can, standardize the care.”
Whether adopting universal or horizontal approaches, Montejano recommends taking the antiseptic piece of the new guidelines to offer broad-spectrum coverage that doesn’t have resistance concerns.
“It’s nice because an organization can now choose how,” she says. “An antiseptic fits into both types of strategies, whether you’re using a universal or more targeted approach. You can use it in either strategy.”
The AORN document is impressively comprehensive in its guidance and background, Montejano says.
“It’s nice to see these guidelines incorporated—it may be a changing of the guard in terms of the best chemistry,” she says. “At the end of the day, we’re talking about human lives. We need to be critical in assessing the literature out there to ensure interventions used in direct patient care are safe and effective.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.
PSQH: Patient Safety & Quality Healthcare, July 13, 2021
When COVID-19 hit, it heightened public awareness of safety protocols, causing healthcare facilities to be more acutely aware of the need to consistently enforce protocols for verifying who was in a building at a given time.
This article was originally published July 12, 2021 on PSQH by Jennifer Williams, RN, MBA, PhD, JD.
The pandemic drove healthcare providers and vendors to take an even closer look at facility entrances: who enters a facility, how they come in, and how they leave. On a typical, pre-pandemic day, vendors would plan a visit, verify their identity, enter the facility, and receive a compliant badge—often via a credentialing kiosk. Until registration was complete and all requirements fulfilled, vendor representatives weren’t authorized to do business with the hospital. However, enforcement was sometimes inconsistent across facilities, departments, vendor entities, and representatives.
Then, COVID-19 hit and heightened public awareness of safety protocols. Healthcare facilities were acutely aware of the need to consistently enforce protocols for verifying who was in a building at a given time. In response, mobile COVID-19 health screening apps became part of the procedure, integrating with credentialing kiosks to provide healthcare facilities with a consistent approach to creating safer spaces for patients, providers, visitors, and vendors.
This shift has elevated credentialing and badging to a strategic imperative: one that is on the C-suite’s radar and is fast becoming part of hospitals’ standard operating procedures post-COVID-19.
The pandemic has forever changed access to healthcare facilities
Compliance obligations have long required healthcare providers to screen and verify vendors before they enter a facility. Providers are also responsible for managing the physical and personal security of patients, staff, and individuals, according to Joint Commission standard EC.02.01.01.
The pandemic underscored the importance of enforcing these protocols. Along with the imperative of knowing who is in a facility at any time, providers must ensure there aren’t any unregistered or noncompliant badges on-site.
As pandemic-initiated technologies emerged and existing technologies found new uses, healthcare facilities adopted technology solutions to provide an additional layer of safety and security. These solutions include touchless health screening apps, temperature assessment devices, and geolocation technologies.
Health screening apps powered by quick response (QR) codes make it easy for anybody entering a building to use their smartphone to quickly check in and privately answer symptom-related questions. Along with streamlining the check-in process through a touchless solution, the QR-coded approach also allows a facility to verify a person’s identity more accurately. Temperature assessments offer a way to validate the self-reported answers to the health screening questions on the check-in app. Geolocation data, meanwhile, complements the other two solution types. Combining these technologies, it is possible to verify that everyone who has participated in the check-in is on-site, is at a determinable location, and has undergone the necessary health screening upon arrival.
These solutions provide a comprehensive, qualified record of who has been in a facility while offering the assurance that everybody on-site meets standard health and safety requirements. However, modern technologies often operate in silos. For healthcare facilities to provide optimal safety and security, they must integrate these technologies with an existing credentialing solution.
The hidden costs of an outdated credentialing system
As we ease into a post-pandemic world, today’s healthcare facilities require a modern, digital credentialing system, ideally one with sufficient credentialing rigor that is further supported by an integrated mobile health screening app. Without this powerful combination, healthcare providers may face unnecessary risk and vendors may experience delayed or denied access to a building.
Delayed delivery, especially regarding time-sensitive products or urgent supplies, can have a significant ripple effect on many people in the facility—including patients. It also puts the provider-vendor relationship at risk.
In contrast, a modern credentialing system helps providers reduce administrative costs through streamlined processes. It also results in more effective vendor management while offering unique insights to improve patient and staff safety and security. These insights can help providers manage whom they do business with and work efficiently with business associates.
The post-pandemic benefits of an integrated credentialing mobile app and badging kiosk solution
As facilities integrate their credentialing mobile app and badging kiosk solutions, they’re seeing additional, long-term benefits beyond the pandemic. One example is limiting the spread of infection by tailoring the health screening questions to check for symptoms beyond COVID-19. This is significant when one realizes that, according to the CDC, healthcare-associated infections impact an estimated 2 million patients annually, costing U.S. hospitals between $28 billion and $45 billion each year.
Also, by streamlining the visitor and vendor monitoring process, hospital staff can better focus on patient care. From a vendor relationship perspective, a streamlined process fosters trusted connections between providers and vendors. And from a facilities management point of view, it establishes a foundation for compliance and future infection control protocols.
First impressions are lasting impressions. When a vendor, visitor, patient, or staff member approaches a healthcare facility, they expect ease of entry and safety. Yet the pandemic made us all think differently about our face-to-face interactions, adding health screenings to the already rigorous credentialing process. By having greater visibility into the way people enter hospital facilities, a health system strengthens its commitment to patient safety and empowers vendor representatives to better serve the organization.
At first, these additional steps may have seemed temporary or a further encumbrance because they created even more data records. But those records are essential in the event of an emergency; for example, they can help a hospital conduct contact tracing in the event of a disease outbreak. Over time, the technology designed to support these pandemic-initiated protocols has evolved. Today, facilities are realizing these technologies speed up the credentialing process without compromising safety or security. In return, a facility can enjoy a stronger reputation and better relationships with vendors, staff, patients, and visitors.
Jennifer Williams, RN, MBA, PhD, JD, is director of market development & education at GHX.
PSQH: Patient Safety & Quality Healthcare, July 13, 2021
Patients get better care when family has access to answers.
This article was originally published July 9, 2021 on PSQH by Megan Headley
Family caregivers have long played a critical role in keeping elderly adults and individuals with chronic conditions out of the hospital, even if these unpaid caregivers haven’t always been able to get the support they need. Now, that may be beginning to change.
President Biden’s American Jobs Plan is seeking $400 billion to expand access to at-home and community-based care services and support for individuals on Medicaid. It’s one of many ways that healthcare professionals are recognizing the important role of family caregivers at a time when their services are more in demand than ever.
Caregivers help lower healthcare costs
By 2030, all baby boomers will be age 65 or older, increasing the already strong need for elderly care. In a 2020 report, Caregiving in the U.S., AARP and the National Alliance for Caregiving identified that nearly one in five people (19%) are providing unpaid care to an adult with health or functional needs. In the wake of the COVID-19 pandemic, when staying at home meant reducing risk of infection, the value of at-home caregivers became even more evident.
While much of this value is the result of the costly nature of care, which keeps many family members from calling in paid support, there is also clear value to health systems in supporting at-home care by family members. A 2019 study in Gerontologist mapped out the costs of care for older adults with and without caregivers and determined that, by and large, having a family caregiver reduces utilization of healthcare services and decreases the risk of institutionalization.
A 2017 study in the Journal of the American Geriatrics Society determined that integrating informal, unpaid caregivers into the discharge process can reduce readmission rates by 25% over 90 days. “While integrating informal caregivers into the patient discharge process may require additional efforts to identify and educate a patient’s family member, it is likely to pay dividends through improved patient outcomes and helping providers avoid economic penalties for patient readmissions,” commented A. Everette James, JD, MBA, director of the University of Pittsburgh’s Health Policy Institute and senior author of the study, in a statement.
“As people live longer with more complex issues, and COVID clearly demonstrated this, we depend upon families to be able to cope with the needs of family members with health problems,” says Claudia Fine, chief professional officer at eFamilyCare, a digital platform that connects family members with care advisors. However, as Fine has determined through eFamilyCare, simply involving family caregivers in appointments isn’t enough. Caregivers also need access to education and their own support system if they are to effectively help manage patient care.
New strategies for supporting caregivers
While a number of organizations seek to connect family caregivers with resources and emotional support, the eFamilyCare app aims to ensure that family caregivers have access to patient care information in real time. Through the app, family members are assigned a dedicated care worker, typically a social worker or nurse. Family members can message back and forth with their care worker whenever needed. “We’re not providing care, but we are providing advice and direction about how to access and use needed information, skills, and care, which leaves the family member supported,” Fine says.
Fine notes that the ability to access information can be a major roadblock for many family caregivers. While telehealth appointments are in some ways making primary care providers and specialists more accessible, it can still be difficult to get rapid direction to healthcare problems without seeking emergency care.
“Accessing and navigating the social services system, the government system, and the healthcare system can be a challenge,” Fine says. “I think that resources exist, but people don’t always get to them. Sometimes they don’t know about them. Sometimes they just need encouragement to get to them.”
This is the area eFamilyCare seeks to address. Through the high-touch, high-tech app, eFamilyCare’s advisors coach family caregivers using the Institute for Healthcare Improvement’s 4M framework for care, which drives down healthcare costs through its four-pronged approach to quality patient care: aligning actions in accordance with what matters to the patient; helping manage medications; improving mobility; and managing changes in mentation.
“We have learned that caregivers want the support,” Fine says. “Even if the family caregiver is not actively involved with the care advisor every week, it’s very important to have that touch place and that sense of history.”
Encouraging family to speak up
Providing family caregivers with their own care advisor can also help arm these critical members of the care team with confidence to speak up about issues during doctor’s appointments. Research has indicated a strong trend toward silence from family caregivers when it comes to speaking up to clinicians about patient problems. In a 2018 article in BMJ Quality and Safety, for example, Sigall K. Bell, MD, director of patient safety and quality initiatives for the Raskin Fellow in Medical Education at Beth Israel Deaconess Medical Center, found that more than half of the surveyed family members of ICU patients reported hesitance to speak up about possible clinician mistakes, mismatched care goals, or confusing or conflicting information.
Empowering family caregivers with their own resources and care advisors may be the next step toward driving better care outcomes.
PSQH: Patient Safety & Quality Healthcare, July 12, 2021
Healthcare plans for the underserved markets, which include patients using Medicaid, Medicare Dual Advantage, or a healthcare exchange, offer limited options under the current pharmacy setup.
This article was originally published July 9, 2021 on PSQH by Matt Phillion
Medication non-adherence costs us a half-trillion dollars per year. Sixteen percent of U.S. healthcare spending goes toward unnecessary costs associated with patients not taking their medications. But when you take a step back, it’s easy to see that the root issue is “not a genetic problem, it’s a ZIP code problem,” notes Jason Rose, CEO of AdhereHealth. The industry needs to focus on the right tools to help guide these patients toward better adherence for higher-quality outcomes and improved healthcare spending.
“When you dig deeper into who’s at highest risk, predominantly you’ll see the focus on underserved communities,” says Rose. “Patients who live in pharmacy deserts, food deserts, who have lower health literacy, who aren’t able to pay for the drugs—all the social determinants of health that cause these issues.”
Zooming out to a broader context, Rose notes, the pharmacy process today is very much reactive. The doctor sees the patient, diagnoses them with a medical condition, and prescribes the meds—but after that, the doctor may never know whether the patient has filled that prescription or whether they’re taking it adherently.
“The providers don’t have the data to understand the current adherence level, or if they took the prescribed drug at all,” says Rose.
Healthcare plans for the underserved markets, which include patients using Medicaid, Medicare Advantage dual eligibles, or a healthcare exchange, offer limited options under the current pharmacy setup; there is also limited technology focusing on which patients are best served by which type of pharmacy.
“Digital pharmacies really focus on ensuring good connectivity with the patient—Amazon PillPack is king of the hill in terms of digital pharmacy today—but Amazon PillPack and pretty much all the other digital pharmacies are not focusing on Medicaid and Duals,” says Rose. “They may not even have [the] licensure to dispense to a Medicaid population.”
This situation presents two major problems: high-risk populations may not be getting their meds, and healthcare lacks technology that focuses on these populations’ additional needs, like food, water, shelter, and transportation.
AdhereHealth is working with health plan providers to address this challenge with AdherePack™.
“The health plans have timely access to medical diagnoses, eligibility for benefits, and also know what medications their members filled and how often they’ve filled them,” says Rose. “They have all the data, and it comes through in a timely manner. Within a day or two it’s adjudicated, and it’s a robust data set.”
What the plans don’t do, however, is broad-based analytics: identifying a patient who was diagnosed with a particular condition but never filled their prescription, for example. For better medication adherence, healthcare providers need to know which patients with certain diagnoses have started their medications; which patients are taking them adherently; and whether patients are stopping a medication appropriately when they receive a replacement medication or have a similar change in their drug regimen.
“The lack of analytical firepower to diagnose those areas for medication adherence is one of the causes of unnecessary costs,” says Rose.
Room for improvement
AdhereHealth identifies those issues and provides a list of patients to the healthcare plan management team. “It’s a very dynamic situation for each patient,” says Rose. “Our analytics identify which patients are high risk and high cost.”
The analysis identifies patients who would benefit from some kind of compliance packaging: patients on eight or more drugs; patients who change their medications with some frequency; and patients who work with multiple providers, multiple pharmacies, or multiple caregivers. All of these subsets can struggle with medication adherence.
“It’s a challenging environment for anyone, let alone the underserved market, to get all the drugs they’re supposed to take, and to obtain those drugs on a single day rather than an entire month of refills,” says Rose. “Compliance packaging can help them self-manage their drugs.”
Rather than have various prescriptions called in over the course of a month, requiring multiple trips to one or more pharmacies, matching patients with a delivery service that meets their needs can significantly help with compliance.
“I can have a private courier come to my doorstep with all the drugs I need for an entire month,” says Rose. “The patient can get on a routine, with dosage packaging, all of which overcomes many social determinants of health that most pharmacies never touch.”
The patient is enrolled, through a caregiver or some other method, and they receive four one-week sets of medications in blister packages or dosage strips. “It’s very similar to the Amazon PillPack, but the difference is it is for the underserved market,” says Rose.
Technology’s role
Pharmacies may try to assist underserved patients with many social determinants of health, but may not have the technology or data they need on a daily basis to effectively do so.
“For example, an organization focusing on Medicaid or Duals might send a specialist to do an inventory of the patient’s cabinet—which can be intrusive, and delays care,” says Rose. “And this inventory may or may not be the full list of medications that they should be taking.”
With the help of AdhereHealth, because the analytics are connected with the payer’s data, the organization will have the most up-to-date diagnoses and the meds the patient should be on, without sending a clinician to the patient’s home.
“We’re talking with the patients with a perspective of understanding them more deeply,” says Rose. “Understanding their ZIP codes, their pharmacy desert, we can talk with them to make sure they’re getting what they need and anchor all those drugs to a single data source.”
This enables reaching out to providers and caregivers for medication synchronization to avoid multiple, unconnected refills.
“This is really important stuff,” says Rose. “For example, a blind or disabled patient may not even be able to get to their mailbox, so having a private courier to their door is a big deal. Or if you have a mail-order prescription but may not have enough money for copays for 90 days.”
There’s also a lot of time and energy involved in medication adherence, he notes. Patients might be taking as many as 20 pills a day, and their caregivers do the brunt of the prep work, making multiple trips to the pharmacy every week and measuring out doses.
“When we talk with patients, we use motivational interviewing. What’s their world like?” says Rose. “Tell us about the medications you’re on, the diagnoses you’ve been prescribed medications for. Do you take these medications adherently? And they say, ‘Yeah, most of the time.’ But they might be splitting pills because they can’t afford the copay.”
The potential for error is high, too; a patient moved to a different statin may not know to stop taking the old one, for example. “Studies show 40% of readmissions are caused by medication adherence issues,” says Rose. “And it comes down to three areas: a new diagnosis but never filled the drug; if they did, were they adherent; and did they stop when they were supposed to.”
While the technology helps on the provider and pharmacy side, the idea behind AdhereHealth’s work is to focus on technology-enabled clinical workflows rather than force technology onto patients. “It’s not an app that sits on someone’s phone,” says Rose. “It’s on the back end, on fulfillment, making sure the right drugs go to the right patients.”
AdhereHealth touches about 30 million patients per year and stresses the importance of addressing these underserved patient needs. “It’s a major gap. I saw recently that there are 80 million Medicaid patients nationwide, and enrollment is at its highest ever,” says Rose.
Underserved groups of all kinds will need more help maintaining their health now and in the future. “As they grow older, as they experience new needs especially post-pandemic, there will be patients who will have issues with making ends meet to pay for their medications,” says Rose.
All of this builds into a growing trend in the healthcare industry to help patients get the care they need at home, reducing the need for assisted living or institutional, long-term care settings and hospital visits.
“The more we can make this transition—telepharmacy, telehealth, remote devices in the home—the better. The missing piece of that is, how do you get the right pharmacy for those patients to be treated at home?” says Rose. “And if you don’t have the underserved market covered, that’s a major gap. Fifty percent of Americans don’t take their chronic long-term therapy medications as prescribed … you’ve got all this high-tech equipment, but what about the drugs that are supposed to be taken easily, self-managed in a precise way?”
Patient experience, regardless of where a given patient is on the spectrum of social determinants of care, should continue to be a growing focus.
“My point of view is you have to look at things both qualitatively and quantitatively,” says Rose. “Obviously, it makes sense to improve patient health and experience, but these aren’t just stats. It’s someone you know who is hospitalized or worse because they weren’t adherent to their medications. It’s critically important for quality of life.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.
PSQH: Patient Safety & Quality Healthcare, July 7, 2021
HFAP, a brand of the Accreditation Commission for Health Care recently collected data to help healthcare professionals expand their knowledge of the risks, triggers, and variations of stroke, with findings that took a year of pandemic challenges into account.
This article was originally published July 7, 2021 on PSQH
By Matt Phillion
While COVID-19 took over much of the healthcare world’s attention for the past year, programs addressing other conditions continued to work hard to keep patients safe—addressing both existing challenges and new ones brought on by the pandemic.
HFAP, a brand of the Accreditation Commission for Health Care (ACHC), issued its annual benchmarking report on stroke programs recently, which demonstrated COVID-19’s impact on these programs. HFAP collected data to help healthcare professionals expand their knowledge of the risks, triggers, and variations of stroke, with findings that took a year of pandemic challenges into account.
“What we’re doing in our annual performance report is metrics—we ask hospitals to submit their compliance with performance metrics for nationally recognized standards for stroke care,” says Carol Roesch, certification advisor for HFAP. “We take their performance and compare it against peers at the four levels of HFAP stroke certification—Stroke Ready, Primary Stroke, Thrombectomy, and Comprehensive Stroke—which allows them to compare their metrics with hospitals certified at the same level.” The report also includes a hospital size component for additional comparison opportunities.
“Our goal in doing this is to support improvement in individual stroke centers, so they can say, ‘Look, we’re doing great in this benchmark or falling behind in another,’ and what can we learn from that,” says Roesch.
COVID-19 had a major effect on this year’s results, as challenges arose due to factors that impacted healthcare across the board. “It’s been a crazy year,” says Roesch. “Anecdotally, I’ve observed that it was harder to maintain benchmarks for a number of reasons.”
COVID-19’s effect on staffing was one of them. Because facilities were running shorthanded, many stroke coordinators, even full-time ones, were called back to the staff nurse level. The reasons for those staff shortages should be no surprise for anyone following the pandemic’s impact: Many nurses couldn’t work for any number of reasons or had to care for their families; staff were afraid to come to work due to COVID-19 or were sick themselves; and of course, many facilities saw patient surges, requiring more staff on the floor to provide care.
“There was something else we observed—hospitals had to struggle more or push harder on some benchmarks that were time-limited,” says Roesch. “Delays were built in because hospitals were full, and also because of additional screening of patients. They had to screen for COVID before those patients would go in for the first test, and those things added time.”
Also anecdotally, the report authors observed that bed shortages in some units made meeting time-related stroke benchmarks harder; patients who needed to be transferred to a higher level of care, for example, might run into a lack of beds in those units. Yet through creativity, organizations found ways to overcome their challenges.
“It’s interesting how creative hospitals were in how they faced these dilemmas,” says Roesch. “Turning a recovery room into a COVID unit—we even heard reports of turning a gift shop into a COVID unit.”
And to meet staffing shortages, hospitals turned to cross-training, such as training surgical staff to the med floor.
Stroke programs faced the same lack of PPE as other healthcare sectors, and used similar creativity to make the resources at hand work.
“The shortages in PPE were something I never thought I’d see in my career,” says Roesch. “Hospitals have been so adaptive. It’s amazing, with almost daily updating of policies at times, and getting the word out to staff for reeducation and safety.”
Fear of going to the hospital
Healthcare in general saw fewer patients venturing into the hospital during the height of the pandemic. While the report doesn’t drill down into hard numbers, anecdotally HFAP observed that, as in other areas of healthcare, there was a noticeable decrease in non-COVID-19 stroke patients going to the hospital.
“They attribute it to a fear of catching COVID by coming into the hospital,” says Roesch. “The worry for the future is, what becomes of those patients who had strokes at home and didn’t come to the hospital?”
No one should brush aside stroke symptoms, which makes this population’s hesitancy to seek care even more worrying.
“You absolutely need to get to the ED as soon as possible,” says Roesch. “If you think about a heart attack versus a stroke, a heart attack has chest pain and the patient realizes: ‘I’ve got to go to the hospital.’ But a stroke may involve weakness on the left side, and the patient may write it off as, ‘Maybe it’ll go away. Dizziness, headache—do I have time to go to the ED for that?’ ”
Stroke care professionals have long pushed for a better understanding of the signs of stroke, working to educate patients about taking symptoms seriously.
“Even during non-COVID times, that’s part of the education we do every year,” says Roesch. “For stroke centers, it’s a requirement: telling the community to call 911 if they have any symptoms, and knowing that getting to the hospital is imperative. We want to make sure we can get the right treatment to them, or if they need an intervention, a thrombectomy, there’s a limited time on that as well.”
Statistically, the field observed an increase in the number of strokes among COVID-19 patients as well.
“There’s a lot of reasons for that,” says Roesch. “COVID patients have an increased risk of developing clots, inflammation, and hypercoagulation, which makes a COVID-positive patient a higher risk.”
The benchmarking report did not observe that any one type of stroke center struggled with or succeeded against pandemic challenges more than other types, though any given center’s success was impacted by how its geographic area was doing with COVID-19.
“I did see that regionally, if COVID was red hot in a community, the hospitals, regardless of stroke center level, were more impacted than others,” says Roesch. “They were still trying to provide the same level of care, the same modalities, but now with all the additional patients and testing.”
Add to this the challenge of family members not being able to stay with the patient, and organizations saw new difficulties for assessing incoming patients.
“What if a patient comes in with stroke and they can’t talk? How do you find out their last known-well data? COVID brought a lot of complicating factors,” says Roesch.
Best practices observed
HFAP hosts quarterly teleconferences for stroke centers to share best practices and ideas for improvement. This year, some of those sessions included discussion about improving times for stroke patients.
“Some presenters discussed ways to get a stroke patient to a CT scan as quickly as possible, for example,” says Roesch. “Time from door to CT is so important. One suggestion that came up: Let’s not even take the patient to a room in the ED. Do a quick triage while they’re on the EMS cart, get a physician and nurse bedside. Make sure [the patient’s] airway, breathing, and circulation are OK, and get them to the CT right now.”
Looking forward, Roesch brings up the impact of COVID-19 on stroke risks. “I think it’s part of the disease process with COVID. When they are that sick—everything going on in their bodies, the inflammation, the hypercoagulability—[it] made them so much more susceptible. It’s not just respiratory. It attacks the whole body,” says Roesch.
Many of the COVID-19 patients who also had strokes were younger, and patients who have experienced a stroke are more likely to have one in the future.
“That’s one takeaway: There’s a population of younger stroke patients who are at a higher risk because they’ve had one,” she says. “There’s always a need for education, and that’s something that is stressed at the time to the patient—if they’ve had a stroke, that puts them at a higher risk for another.”
Despite the pandemic’s unprecedented challenges, the report shows that stroke centers across the country worked hard to keep pace.
“They’ve done an exceptional job to meet the benchmarks,” says Roesch. “I know they’ve struggled because of all the things we’ve discussed. But still, when hospitals are reporting, I’ve seen very little change—very little decrease, in some cases no decrease—in meeting their performance measures in the benchmarking report.”
That success shows how important stroke center quality is to those who work there.
“That quality is shining through, which is part of why we do this benchmarking report,” says Roesch. “It’s a driver of quality, and then they can share that with their colleagues.”
PSQH: Patient Safety & Quality Healthcare, June 23, 2021
UVC light inactivates viruses and other airborne pathogens, improving indoor safety.
This article was originally published June 22, 2021 on PSQH by Del Williams
Although LED light fixtures normally emit non-harmful visible light with a 400–700 nm wavelength, lower-frequency UV light LEDs can effectively kill such pathogens. UVC, a very powerful UV light wavelength of 180–280 nm, is viricidal, bactericidal, and fungicidal since it passes through the outer wall of the pathogen and causes damage at the molecular level. The destruction ultimately leads to inactivation of the pathogen, making the cells unable to reproduce.
UVC is known to disinfect air, water, and nonporous surfaces and has been used for decades to reduce the spread of tuberculosis, influenza, and Legionnaires’ disease. According to the CDC, UVC is the only recognized technology for effective germicidal treatment against airborne pathogens.
The CDC has also determined that the integration of in-room UVC sources in conjunction with buildingwide HVAC systems has great promise, particularly given the growing knowledge of the dangers of airborne viruses. Best of all, these stand-alone UVC fixtures can be used continuously throughout the day, in occupied rooms, even when the HVAC system is off.
“In indoor settings, one of the best ways to combat airborne viruses is to continuously recycle individual room air while safely treating it with UVC radiation,” says Michael Fischer, president of Energy Harness Corporation, a Florida-based designer and manufacturer of LED lighting for a variety of commercial settings. “Unlike traditional wide-spectrum fluorescent or mercury vapor UV tubes, LEDs can produce UVC by controlling the specific wavelengths of light emitted. In addition, they don’t contain extremely toxic substances like arsenic or mercury that are inherent in the traditional UV tubes.”
Prior to the pandemic, Energy Harness responded to the demand for hydroponic “grow” lighting and designed LED lights with color spectrums (including UV) to mimic sunlight. When the COVID-19 pandemic began, Fischer says his team quickly realized the potential effectiveness of UVC technology to deactivate viruses and used the technology to design a fixture to combat the airborne organisms. However, achieving this requires technology that can safely deliver the proper UVC dosage in a specific combination of three main factors.
“Ultimately, germicidal efficacy of ultraviolet light is based on dosage, distance, and wavelength,” explains Fischer. “Dosage is a function of UVC power multiplied by exposure time. Distance is the proximity of the pathogen to the UVC source. And wavelength is the nanometer range of the ultraviolet light.”
According to Fischer, to eradicate pathogens effectively, the UVC wavelength should be in the germicidal range, with a peak of approximately 268 nm. The intensity must be high enough to irradiate the space, and the duration must be long enough to affect the organism. He spells out the equation as (Wavelength Intensity * Duration) = Dosage Delivered.
After significant R&D, the LED manufacturer developed a ceiling-mounted UVC system called Active Airflow that circulates room air many times per hour into an enclosed chamber, where UVC disinfection occurs.
Due to its unique patent-pending design, the unit allows for an exceptionally long exposure time. The internal germicidal chambers are filled with hundreds of high-powered LEDs arranged in close proximity to the airborne pathogens as they move through the fixture. With the intensity, the distance, and the time measured, Energy Harness can effectively “control” the UVC dosage. In addition, the LEDs in the unit irradiate in the most effective germicidal range (with a 260–280 nm wavelength).
When the Active Airflow LED fixture was tested by Intertek Laboratories (ETL), a nationally recognized testing laboratory, it was shown to be 99.9% effective in eliminating airborne pathogens. Further laboratory testing directly on the SARS-CoV-2 virus revealed that the LED technology in the Active Airflow fixture inactivated 99.998% of the virus—within one second. A virus reduction rate of 99.999% is the maximum sensitivity that the testing mechanism could measure.
Because the unit houses the UVC LEDs internally, it does not produce any visible light in the room it disinfects. With the unit mounted in the ceiling, the people occupying the space are completely shielded from the UVC. Each LED fixture can typically disinfect a 256-square-foot area, depending on average occupancy, occupant activity level, etc., and multiple units can be deployed in larger rooms, according to Fischer.
When installed in standard ceiling grids, the pathogen-inactivating UVC LED fixture can be used continuously through the day in occupied rooms, which enables constant airborne disinfection of the air throughout the area.
The unit is UL and CSA certified by ETL and is manufactured in an EPA-registered facility in Florida. It has also been certified by ETL to produce no harmful ozone and is registered with the California Air Resources Board.
To help mitigate the spread of viruses, Union Health, an integrated health system in Indiana, installed 48 of the Active Airflow UVC LED light fixtures last year at its facilities, primarily at entry points, waiting areas, and testing areas. This year Union Health is installing a second round of fixtures.
“We are looking for different ways to protect our patients, our visitors, and our staff. So, after in-depth research, we were happy to move forward with the purchase and the installation of these devices,” said Mike Mullins, system director of facilities at Union Health System, in a TV interview last year.
Although this UVC LED fixture works independently from the HVAC system, it still uses active air handling to draw room air into the unit. The standalone approach of the disinfection system could make it simpler for most facilities to install. The unit is designed to fit into a grid ceiling much like a troffer luminaire and takes up the same space as a single 2- by 4-foot ceiling tile. In addition, although the primary focus of the Active Airflow UVC LED fixture is on safety and the continuous disinfection of airborne viruses, aesthetically pleasing architectural designs are also being developed to complement a variety of interiors.
As healthcare facilities are seeking to make their indoor areas safer while occupants are still in the room, the installation of fixtures that can continuously kill airborne pathogens will be vital to aid safe operation.
Del Williams is a technical writer who lives in Torrance, California.
PSQH: Patient Safety & Quality Healthcare, June 22, 2021
A recent PSQH Poll found that among healthcare organizations' biggest concerns, almost half said their top risk is workforce retention.
This article was originally published June 21, 2021 on PSQH by Jay Kumar.
As part of Healthcare Risk Management Week, PSQH reached out to our readers with a few questions about how healthcare organizations are dealing with managing risks.
The Quick Poll had a total of 81 respondents.
Biggest risks facing healthcare organizations
Asked which are the top risks facing their organizations, 47% of respondents said their biggest concern was workforce retention. Other top concerns were COVID-19, regulatory compliance, cybersecurity and ransomware, caregiver burnout, and medical errors.
Frequency of risk assessments
Asked how often their organization conducts a risk assessment, 59% of respondents said annually. Another 19% said they conducted assessments only when needed, while 8.8% said they conduct assessments only when needed. Nine percent said they conduct risk assessments twice a year, and others wrote in quarterly, when requested by a client, and every three years.
Risk management technology
When asked what types of technology they use to monitor risks, nearly 48% of respondents said they use data analytics. Another 30% use risk management software, and only a single respondent each said they used AI or robotic process automation, although a few wrote in that they use a combination of AI and software.
Concern over organizational risk management
When asked about the level of concern regarding their organization’s ability to assess and manage risks, 58% of respondents said they were somewhat concerned. Another 33% indicated they were very concerned, while 10% were not concerned.
PSQH: Patient Safety & Quality Healthcare, June 17, 2021
Regulators are continuing to insist on the wearing of masks in healthcare facilities.
This article was originally published June 17, 2021 on PSQH by A.J. Plunkett.
As COVID-19 case numbers start to drop nationwide, there’s a tendency to want to ease up on the precautions taken over the last 15 months. But regulators are continuing to insist on the wearing of masks in healthcare facilities.
The top three reasons to continue to require patients, staff, visitors, and vendors to wear masks:
CMS encourages you to—the federal agency has said hospitals and other providers should follow CDC guidelines, which as of mid-June continued to be to require masks.
CMS “requests” that you do—a hospital in west Texas eased up its mask requirements as the state opened up earlier in June and, according to a news report, then reinstated its policy “at the request of Centers for Medicare & Medicaid Services during an on-site visit.”
CMS will cite you if you don’t, especially if you have mask requirements in your current hospital policy.
Cases in point:
Another hospital in Texas with a CDC-based COVD-19 policy that staff should “Wear a mask in all patient-care areas, hallways, and public areas…,” was cited in March under Tag A-0749, Infection Control Officer Responsibilities, according to a CMS inspection report. CMS inspectors walking through the hallway at the facility saw a staffer “at the nursing station not wearing a mask,” and “waiting in the hallway to meet with hospital administration Personnel #6 and Personnel #7 were seen walking in the hallway not wearing a mask,” and during the opening conference “Personnel #1 did not wear a face mask while within 6 feet of the surveyor in his office.”
A critical access hospital in Minnesota with a policy stating that were to be “screened for symptoms consistent with COVID-19 and must pass the screening to be allowed to visit” and that “visitors must wear a mask and visitor badge at all times in the facility” was cited by CMS surveyors in February for not insuring that a screener was on duty at all times to enforce screening and providing badges.
Finally, a third hospital in Texas was cited in early February for failing “to take measures to contain and/or prevent the transmission of a highly suspected contagious Coronavirus (COVID-19). Also, the facility failed to follow their own policy,” according to the inspection report. Observations included that of nine staff members at the Emergency Department nursing station, with surveyors reporting that “three staff members were not wearing masks. One staff member was observed drinking from a coffee cup with her mask pulled down under the chin. The observation of this issue with no mask went on during the 20-minute tour of the emergency room.” In another observation, surveyors said, of six staff members caring for a patient in the trauma room of the emergency room, one of the staff members was only wearing a surgical mask with no N-95 mask.”
And if you needed another reason, don’t forget the COVID-19 variants that continue to cause concern. According to the CDC’s online page on variants, updated as of June 15, 2021, there are multiple variants, with six identified as “notable.”
Experts have said one, known as the Delta variant, could create a new patient surge. The World Health Organization said June 16 that the variant was in 80 countries worldwide and responsible for 10% of the new cases. And it is continuing to mutate.