It was a day of prognostications as America's Health Insurance Plans turned the stage over to former lawmakers and presidential advisers to discuss the future of U.S. healthcare during the group's annual meeting in San Francisco, writes Wall Street Journal blogger Kristen Gerencher. Among the speakers were three people hands-on experience in healthcare policy, including former Sen. John Breaux, former Senate Majority Leader Bill Frist and Former Secretary of Health and Human Services Tommy Thompson. Gerencher also notes that protesters surrounded the conference building behind police barricades erected to allow attendees a space to come and go.
"Hopkins," a follow-up to the acclaimed "Hopkins 24/7" from 2000, takes television viewers inside the Baltimore hospital. Johns Hopkins Hospital officials said after the mostly positive feedback they received following the first documentary they had few reservations about opening their corridors for a second time. Executive producer Terence Wrong, who also produced the first documentary, said he wanted to revisit Hopkins because of changes that had taken place since the first series. More women and international staff members and improved technology were some of the changes that Wrong wanted to explore in the new series.
A foreign company is breaking into the heavily regulated Chinese healthcare system by targeting the elite who are willing to pay premium prices for premium care. Chindex has opened Western-style hospitals and clinics in Beijing, Shanghai and Guangzhou to cater to affluent expatriates and wealthy Chinese. Staffed by foreign doctors and some of China's top physicians, its fees are too high for most Chinese.
More than 100 complaints were made the Maryland Board of Pharmacy last year about patients who received either the wrong medication from a pharmacy or the wrong dosage. Officials say more such cases occur statewide, but just how many is unclear as pharmacies are not required to report them.
Saint Agnes Medical Center in Fresno, CA, has suspended open-heart surgeries after a state report found that the facility was not protecting patients "amid an outbreak of infections" that began last year and continued through May. The hospital now plans to bring in auditors from Michigan-based Trinity Health, its corporate parent; an outside agency will also review Saint Agnes' cardiac-surgery program.
A recent study by the Cincinnati Children's Hospital Medical Center shows that patients receive better care when hospitals employ more nurses. However, shortages in nursing staff is a nationwide issue, and researchers say that mandating certain staff levels could ultimately force facilities to cut back services. This could, in turn, have a negative impact on patient care.
An increasing number of hospitals are using Web-based scheduling systems for their nurses and other shift employees. Statistics show at least 300 hospitals across the country are using them, and hundreds more are likely to start within the next year or two. Hospitals using the systems say one of the biggest benefits of the Internet-scheduling system, both in money saved and quality of service, has been a sharp reduction in the hospitals' use of outside nurses.
The University of Kansas Hospital has implemented an electronic medical records system in its emergency department, giving doctors access to information such as tests and medications patients have received at KU Hospital and at KU Med West. The ER installation marks the latest phase of KU Hospital's three-year implementation of a $50 million electronic medical records system. The hospital already has installed the system in its inpatient rooms and recently expanded the system to its outpatient care facility at KU Med West.
St. Louis-based Missouri Baptist Medical Center has announced it will lay off about 40 employees including administrative workers, members of the management team and other staff. Hospital representatives said an "unanticipated softening of diagnostic testing and elective procedures" was one reason for the cutbacks. Hospital representatives added that as the economy has weakened, some patients may have have delayed receiving care.
CEOs, while they care about patient safety, aren't always involved in the in-the-trenches work that goes on with different patient-safety initiatives. Oh sure, occasionally I'll hear a CEO say he worries about hand-washing and infection control, but usually patient safety is left to the various departments—until something goes wrong.
Except with medication reconciliation.
Med rec is one of the few patient-safety topics that senior leaders mention all the time. At a conference I attended recently, one CEO presenter started his presentation (on an unrelated topic) by asking the room of senior leaders who of them had mastered medication reconciliation. Not one hand went up.
Organizations have struggled to implement a process for reconciling patient medications since The Joint Commission began requiring it in 2004. Four years later, most hospitals have a process in place but few have consistent compliance.
As I've researched and learned about this initiative, I've found that, while every organization approaches med rec differently, there are usually a few commonalities:
1) There's some sort of med rec form used to document the reconciliation.
2) There's a med rec leader who oversees the process.
3) There's a lot of finger-pointing when it comes to noncompliance.
Although medication reconciliation is a hospitalwide initiative at almost every hospital, most organizations isolate oversight and responsibility for the process to one department: nursing, pharmacy, or, occasionally, the medical staff. This sounds good in theory because it makes one person/discipline the medication reconciliation gatekeeper. However, it can also foster blame and reduce accountability. Why, for example, should nursing be responsible for a process that relies on physicians and pharmacists to succeed? How can pharmacy really make sure that the entire nursing staff is properly trained in the med rec process?
Northwestern Memorial Hospital knows the challenges of medication reconciliation first-hand. In 2006, the organization's quality team had done all the recommended steps to meet The Joint Commission's medication reconciliation requirement but their compliance hovered around 40%. That's when they changed their process.
They created a medication reconciliation leadership team that included hospital leaders from all departments (the chief medical officer; the chief of surgery; the chief informatics director; the directors of nursing, pharmacy, and quality; and the president of Northwestern's outpatient areas).
And they restructured their staff training process from one that was done in the "train the trainer" format, separated by discipline, to a multidisciplinary training that included every applicable staff person (nurses, physicians, and pharmacists) all in one room. This ensured that every discipline involved in Northwestern's medication reconciliation process got the exact same message and eliminated the usual blame game that goes along with med rec.
Once leaders were on board, the staff was retrained, and the process was up and running, they took the multidisciplinary approach a step further by looking at compliance data by discipline. This way, Northwestern's quality team can track how groups of nurses, pharmacists, and physicians are doing in terms of compliance, and they can identify any weaknesses without a lot of the unjustified finger-pointing that goes on in a lot of hospitals.
"When we say hospitalwide priority, we don't mean hospitalwide priority for this one physician, we mean hospitalwide priority for physicians, nurses, and pharmacy divisions," said Kristine Gleason, RPh, Northwestern's Clinical Quality Leader, whom I talked with last week.
Today, Northwestern's medication reconciliation compliance ranks above 90%, and the goal for 2008 is to stay above 95%.
If you're one of those senior leaders who is still desperately trying to figure out why your organization can't fully grasp medication reconciliation, you may want to consider a multidisciplinary model like the one at Northwestern. Because, while it's nice to have one med rec leader, it's better to have a whole lot of them.
Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.
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