|
THE WEEK OF SEPTEMBER 26, 2022 | |
WELCOME TO THE PULSE!
Your Editor developed The PULSE based on comments and suggestions from the membership and with your input in mind.
For it to reach its full potential, your contributions to content are needed.
Please send your questions and comments to the Editor, specific to these recurring columns:
- SURVEY SNIPPETS
- WHAT’S ON YOUR MIND
- WE HEAR YOU
|
SURVEY SNIPPETS
Shared information from our member centers about their surveys
(Please share with us your experiences, questions and comments. No names or centers will be printed; everything is anonymous.) E-mail to: jshanton@jssurgctr.com.
| | | |
|
One of the simplest tools you can use in preparation for the life safety portion of a survey starts with your eyes and some simple safety housekeeping. When visiting my clients' centers I immediately start looking for the lowhanging fruit items. What might those be you ask? Let me explain. Before I even park the car, I look at the landscaping; is it well kept and a safe distance from the building? | | |
|
Is the fire department connection (FDC) on the outside of the building clear, labeled, and accessible? Is there good fire department access for apparatus? Are the center's name and operating hours, along with a no smoking sign, visible and clear. Next I move to the inside. Ae the fire extinguishers mounted correctly, fully-charged with up to date annual and monthly inspection tags? Are the exit and emergency lights working, especially exit lights which should be illuminated at all times? How about the fire alarm control panel? Is it in a trouble condition, easily observable by a yellow light on the panel display? Now to the doors throughout the center; are they wedged open, thwarting their ability to stop the spread of smoke and fire, not to mention the maintenance of appropriate air pressures and flows? Are the paths of egress and exit doors being kept clear?
In most cases I can view everything listed above and have a good idea of the center's safety culture before saying good morning. Keeping the surface in order not only gives a good impression, but it may make for an all-around better life safety survey experience.
Anthony Riehl, CFI, CESI
Healthcare Life Safety Consultants, Inc.
anthony@hlsconsultantsllc.com
Something from my last survey: You must have a policy on the recall of food products and sign up for FDA monthly e-mails.
AAAHC v41 Ch 6. K.3: If a patient has had 3 or more visits/admissions, or if a clinical record is complex and lengthy, a summary of past and current diagnoses or problems, including past procedures, must be present in the record to facilitate the continuity of care.
This is pretty straight forward, yet it is a common citation on surveys. It is a standard for both regular and CMS surveys, so prepare for it. If you use EMC, starting with the first visit, set up the system to track the patient’s visits and make sure that the information is in a prominent location in the EMR.
If you use a paper record, create a tracker that contains the patient’s label, the date of each visit, and a short summary of past and current diagnoses or problems, including past procedures. Place this on the front of the chart or make it the first sheet of the record. Consider printing it on bright paper so that everyone sees it. When preparing for a survey, use the surveyor worksheets at the back of the accreditation handbook to check your clinical records to ensure that everything is there.
This tool is designed to ensure continuity of care, but many times, centers seem unaware of the standard. It only becomes an issue when patient visits are numerous. I recently did a survey in a pain center and patients were often seen more than 20 times! They did not have a diagnostic summary. If you do not have this process in place, create it now so that everyone will be familiar with the process.
Ann Geier- MS,RN,CNOR(E ), CASC
Ambulatory Healthcare Strategies
ageier@ah-strategies.com
Tissue Certificates are something off the beaten path. You are required to have Tissue Certificates and produce evidence of regulatory compliance in order to maintain accreditation. With oneSource you can search and display Tissue Certificates, including FDA registrations, state registrations and licenses, and accreditations from the AATB & EBAA. Tissue suppliers are required to have a certificate and meet standards that provide a safe supply of donated tissue. You need to make sure that you remain compliant during an accreditation survey and tissue tracer reviews.
Katie Rudolphi
oneSource
katie.rudolphi@onesourcedocs.com
| |
THE PHARMACY CABINET
Stay current with the latest Pharmacy news
| | | |
|
|
How many times may individual single-dose or single-use vials be entered for a single patient?
The safest practice is to enter a single-dose or single-use vial only once so as to prevent inadvertent contamination of the vial and infection transmission. Single-dose or single-use vials should be used for a single patient and a single case/procedure/injection. Therefore, they should require only a single entry into the vial.
| | |
|
In certain situations, healthcare personnel may believe that drawing the entire contents of the vial into a single syringe will not allow for safe and accurate titration of dosage (e.g., pediatric dosing during a surgical procedure). In these circumstances, healthcare personnel must consider the risk of repeated entry into a single-dose or single-use vial for that single patient/procedure.
If the single-dose or single-use vial will be entered more than once for a single patient as part of a single procedure, it should be with a new needle and new syringe, and the vial must be discarded at the end of the procedure and not stored for future use.
Amit Gupta RPh, Pharm. D, CCP
Consultant Pharmacist
amit@amitguptaconsulting.com
|
WHAT'S ON YOUR MIND?
Questions from our members
(Please forward any questions you may have, about anything!) E-mail to: jshanton@jssurgctr.com
| | | |
|
Q: I was trying to find the guidelines for pediatric surgical cases in an ASC. Specifically, guidelines regarding PALS certification for staff, PALS crash cart, if security measures are needed, if PACU had to be 1:1, etc. N.J.A.C. TITLE 8 CHAPTER 43A states that staff must be PALS certified if there are pediatric patients but doesn’t define the pediatric patient. Some protocols define a pediatric patient by age and/or weight/size. | | |
|
If performing surgery in an ASC in NJ, would a 16 or 17 y/o be considered a pediatric patient?
A: It is based on facility P&P. For instance, an ASC can have a 12-year old bigger than some adults.
The rules in 8:43 A15.3 (d) require: ‘The facility shall have written policies and procedures regarding emergency kits and, if required, emergency carts which are appropriate to the patient population served by the facility and approved by the medical director. The policies and procedures shall be reviewed annually, revised as needed and implemented.
NJDOH
Q: Our center is now doing Ophthalmology; however, we have trays over 10 years old for other subspecialties done here previously. Are we required to keep trays that we no longer use, and do we need to notify DOH if we do get rid of them?
A: There is no regulation that you have to notify DOH. You should try to sell them!
Q: Is there a time limit to Anesthesia Time, the time the patient is under anesthesia in an ASC?
A: Best answered this way. If there was, it would be determined by the length of the procedure performed, but there is nothing in NJ regs about this or CMS for that matter.
"There used to be a time limit for the surgery & recovery time, but that has been gone for some time now. If the procedure is on the CMS approved list, CMS has already evaluated the case, i.e.: long ortho cases or spine cases.
Ann Geier, MS, RN, CNOR( E), CASC
Ambulatory Healthcare Strategies
Q: Is requiring a surgeon to have privileges at a local hospital a state, federal, TJC or Governing Board rule?
A: While CMS has issued more recent instruction, in New Jersey what applies is 8:43A-3.6(a)(6): At least one member of the medical staff has to have admitting privileges at a hospital.
NJDOH
Q: Getting pushback from anesthesia about boosters, they say the local hospital has on their website: ‘booster shots are not currently mandatory, CDC strongly recommends’.
Does staff still have to comply?
A: Yes!
You are an ASC so it does not matter at all what hospitals are doing; they have separate regulations.
As an ASC, you abide by the Governor’s EOs 290 & 294, which specify that employees must ‘up to date,’ which is defined as fully vaccinated and have one booster.
| | | |
|
|
Threats to the healthcare industry have increased dramatically each year, along with the sophistication of cyber-attacks. Industry and government alike have recognized the dawning of this new era. For each gain delivered by automation, interoperability, and data analytics, the vulnerability to malicious cyberattacks increases, as well.
| | |
|
To thwart these attacks before they occur, it is essential for healthcare organizations to establish, implement, and maintain current and effective cybersecurity practices.
There are numerous organizations, either government-run or a collaboration by the government organization and the private sector, that have come together to assist healthcare companies. The goal of the Health Sector Council and this publication is to foster awareness, provide best practices, and move towards mitigating the most impactful cybersecurity threats.
Health Industry Cybersecurity Practices: Managing Threats and Protecting Patients
Dawn Meglino
Anatomy
DMeglino@ANATOMYIT.COM
|
DOLLARS AND SENSE
Advice to help your center’s bottom line
| | | |
|
- How well is your ASC performing concerning denials and appeals?
To answer that question, conduct an audit. It should examine everything from your denial rate, to the speed a denial is acted upon, to your appeals success rate. As you work to implement changes, make sure to benchmark results and acknowledge success.
| | |
|
Your technology should help you perform a more accurate and complete audit and allow you to effectively track your performance.
Kathryn Boylan
SIS First
kboylan@sisfirst.com
- Since it's football season, I’m going to use a football analogy for you! I’ve heard doctors sometimes say "Why do we need a collection agency, We can just do it on our own." That’s the same as saying ‘Why doesn’t Tom Brady kick field goals, he has legs". Your collection agency is your field goal kicker; we’re the specialists that you bring in when required. It might not be the touchdown that you wanted, but you’re still getting three points.
Jonasz Knapik
Savit
jonaszknapik@gmail.com
- Many ASCs do not pursue collections for cases with outstanding balances greater than 90 days. Why? Successfully collecting on these cases often requires labor intensive work. It can be easier to ignore them and focus on easier collections. The problem with this approach is that you give up on potential cash that can likely be captured. You may also miss opportunities to identify and address the factors contributing to ongoing payment delays. That’s why closely monitoring and working older cases should be kept as a priority. To help, trend the key performance metrics for this area and perform at least monthly audits of the bucket.
Karena McKenzie
Surgical Notes
Karena.mckenzie@surgicalnotes.com
- Many things cause staff burnout, but helping your employees by implementing software is one thing you can do to prevent it. Increase staff efficiency by automating purchasing, invoicing, and supply chain processes. This cuts time spent handling supply chain-related tasks from days to hours, so your employees can get back to more pressing priorities.
Kayla Johnson
Hybrent
kayla.johnson@procurementpartners.com
- Quiet quitting: The not-so-silent phenomenon sweeping the workplace
Lately, you may have heard the buzzword "quit quitting." But what exactly is it if it’s not actually about leaving a job? An outgrowth of The Great Resignation, it’s a trend gaining traction on social media in which working professionals share their alternative to quitting their job outright.
Quiet quitting, the phenomenon of “I’m not quitting my job, but I’m not giving 120% either,” is a slippery slope when it’s related to disengagement or is revenge for perceived wrongdoings. As these employees advance through the stages of tolerate, avoid and eliminate, their lack of discretionary effort and growing negativity can have real impact on your company and other team members.
To re-engage these employees, attend to your own passion and excitement for your work; create a trusting, inspiring and safe atmosphere that offers plenty of opportunities for recognition, growth and autonomy; and emphasize what is most important to your team according to their unique needs and personalities. Want to learn more about how to overcome quiet quitting?
Jeanne Roman
jeanne.roman@insperity.com
973-822-4618
|
KEEP IT CLEAN
Infection Control tips from the professionals
| | | |
|
- Assure all manufacturer instructions for use (IFU) are readily available, organized, and followed to the letter. This includes all packaging materials, tip protectors, holders, brushes, equipment used for reprocessing and the instruments that are being reprocessed.
| | |
|
Keep the manufacturer IFU, the facility policies/procedures and the current AAMI ST79 all readily available in both the soiled and clean work areas. This provides easy reference as needed.
Make sure technicians have read the IFU and that they are following all of the steps recommended for cleaning, packaging and sterilization. Most IFU will include a manual cleaning process and an automated process, but some devices can only be cleaned manually. If an IFU does not include all of the required information, the manufacturer should be asked to provide these details. Ideally, the ASC’s designated infection prevention and control professional should also review the IFU and perform periodic audits to assure the IFU are being followed.
If the IFU for instruments that are processed together in the same set or cycle do not match, they must be reconciled. For example, if one manufacturer recommends use of a NON-ENZYMATIC detergent and another recommends use of an ENZYMATIC detergent, it is best to consult with each manufacturer to determine which type of detergent will be used. Many ophthalmic device manufacturers now recommend either NO detergent or only NON-ENZYMATIC detergent to prevent TASS. If conflicting IFU cannot be reconciled, some devices will need to be processed separately.
Sterilization parameters for different manufacturers or devices may also conflict with one another, and it can be helpful to list all the manufacturers and devices routinely processed, along with their sterilization parameters on a reference sheet that is posted in the sterile processing area. Of course, they should be laminated and properly secured, to facilitate cleanliness in the environment.
Renee Fusco- RN, CIC, CSPDT
Advanced Infection Control Concepts
Rfusco-aicc@comcast.net
- Water quality can have a dramatic impact on medical devices. It can cause damage by causing pitting and corrosion of surgical instruments. It can also cause a reduction in cleaning efficacy, and these problems can all interfere with disinfection/sterilization. A common problem is ‘staining.' Unless the discoloration can be rubbed off (such as a spot), it is a stain. Most staining leads to corrosion of the surface of the instrument. Once this happens the surface is no longer intact leading to cleaning, disinfection and/or sterilization failures. You should have your water quality tested at least twice a year (AAMI TIR-34), especially in the spring and fall when changes in the tap water usually occur from your local water source.
Nancy Chobin, RN, AAS, ACSP, CSPM, CFER
Sterile Processing University
nancy@spdceus.com
| |
|
Assembly Majority Leader Lou Greenwald said he’s considering a legislative package this fall regarding workforce development for the health care industry, a move that comes as both health care providers and workers say they are reaching crisis levels of staffing.
“It’s early on,” Greenwald (D-Camden) told POLITICO. “Coming out of the pandemic, we saw a lot of people retire or choose other careers. At the same time, we have a very marketable, young, well-educated workforce coming out of the number one public education system in the country that are choosing health care. I think it's an opportunity to take advantage of it.”
The pandemic exacerbated staffing shortages and burnout within the health care industry, with solutions being a top priority for health care lobbyists in Trenton. The New Jersey Hospital Association, which represents the state’s acute-care hospitals, released a survey in February: 70 percent of the state’s hospitals that found vacancy rates for registered nurses jumped from 8.2 percent in 2020 to 13.4 percent in 2021.
Greenwald suggested the bill package would be expansive across different areas of the health care industry, but declined to offer specifics, saying that it was still in its early phases. He said he is also “looking at a couple of areas” for workforce development efforts, such as education.
“Certainly nursing, hospitals, doctors, primary care would all be a part of that,” he said. “But mental health, behavioral health sciences, services, as well as nursing staff at long-term care facilities have all [been] raised [to] a level where there’s opportunity.”
Greenwald said he was looking to introduce something this fall, although on Thursday he proposed the introduction of several health care workforce bills regarding student loan redemption programs and behavioral health. The text of the bills are not out yet.
Here are two of his packages that could affect ASCs:
A4617 would require DOLWD to identify and recruit unemployed individuals for employment in healthcare facilities
A4619 codifies and extends authorization for certain out-of-state heath care providers and recent graduates of health care training programs to practice in New Jersey
Also, out there, held in Assembly AFI last Thursday was A1255. The Senate version already passed out of Senate Commerce. It states that if prior authorization and utilization review are required, the entity must make certain disclosures on its website and in writing. If prior authorization is required, a determination must be made within 2 business days and disclosed to both the subscriber and the provider.
NURSE STAFFING BILL(S)
The Nurse Staffing bill that has been around for years was re-introduced by Senator Vitale in the Senate and Assemblywoman Jimenez in the Assembly.
| |
RELIGIOUS EXEMPTIONS IN JEOPARDY? | |
With new vaccines available, religious exemptions may be more difficult to obtain. | |
|
ASCs NEED TO BUILD STRONG BRANDS
Please read this article from one of our vendor members, INFINIA.
IN THE ERA OF DIGITAL HEALTH-LED DECENTRALIZATION, ASCs NEED
TO BUILD STRONG BANDS
By Ron Cappello and Lizzie Kupersmith
9/14/22
We always overestimate the change that will occur in the next two years
and underestimate the change that will occur in the next ten. Don't let
yourself be lulled into inaction.
- Bill Gates
This observation was made 20+ years ago, and still resonates today;
especially given the growing importance of ASCs in the delivery of
affordable, quality care.
Over the past ten years, digitization has accelerated exponentially due to
innovative government policies, changes in consumer preference, an influx
of venture capital and private equity, a growing number of digital health
entrepreneurs, and countless other factors, including the COVID-19
pandemic.
As a result, a myriad of technology-led disruptive innovators has entered
the market, and it’s these innovations that are leading the way in the
decentralization of healthcare delivery.
Whether an Ambulatory Surgery Center, Urgent Care Center, or the
emerging sector of Hospital at Home, a strong brand is key to educating
the consumer and providing the confidence needed for adoption of these
and other new modes of care and services.
The impact and implications of digital transformation in healthcare is not
fully-understood. However, we do know that having a strong brand
increases in importance because brands represent bridges of
understanding with consumers, patients, and staff.
We need to only look to the strength and familiarity of the Mayo
Clinic, Cleveland Clinic, or The Johns Hopkins brands to support this idea
because they engage with empathy, lead with purpose, keep it simple, and
make it memorable to maximize the patient experience.
While the creative elements needed to support digitized healthcare
services can’t be fully standardized, a set of tools and templates can
and should be leveraged. Doing so will make the marketing, sales, and
communication process more efficient, affordable, and effective.
Specifically, two types of infrastructure are needed to support the building
of a strong ASC brand and convey resonating messages, they are:
Hardware: A technology infrastructure made up of the tools and
capabilities to connect, sort, analyze, and access healthcare information
and services in a simple, safe, and secure way.
Software: A communication infrastructure made up of branded digital tools
and capabilities to create bridges of understanding, the empathy needed to
sustain the human factor, and the means to keep the caregiver-patient
relationship central to health and wellness.
Having these in place will help you and your ASC engage with those who
matter most because they enable communication and messaging to be
simple, understandable, consistent, and accessible to ensure people are
met where they are in their health and wellness journey.
Ron Cappello | CEO
Infinia Group LLC
646-209-0832
New York | Austin | Denver
www.infiniagroup.com
| WHY PHYSICIANS ARE OPENING AMBULATORY SURGERY CENTERS | |
Owning a medical practice generates significant income for many physicians. Along those lines, a growing number of physicians are opting for sole ownership of an ambulatory surgery center (ASC), which provides surgery, diagnostic services, and preventative interventions.
Physician's Weekly (09/08/22) Erin Finelli
Read More
| |
|
NJAASC OCTOBER GENERAL MEMBERSHIP MEETING
Wednesday, October 19, 2022
8am-1:30pm
We heard your feedback! Note updated time.
Galloping Hill Golf Course
3 Golf Drive
Kenilworth, NJ
See the Program and Topics Here!
Member Centers: Register your employees to attend for Free.
Non-member ASC’s: Register to attend for $200 per person.
Vendor Members attend for Free, as well as participate in the Vendor Exhibit! Attendees can visit the booths, participate in the prize giveaways, demonstrations, chat, view products and services!
Don’t miss the PRIZES! Besides the vendor give-a-ways, NJAASC is offering prizes to all registered ASC attendees! Visit the vendor booths to be automatically enrolled in the Grand Prize Drawing!
You cannot register using Internet Explorer. Please use another browser.
Registration Cut Off: Sunday October 16
| |
NJAASC SALARY SURVEY RECONFIGURATION | |
|
New Jersey Association of Ambulatory Surgery Center Members, as part of your benefit of membership, NJAASC has been conducting various Benchmarking Surveys. Since last year we have all experienced staffing shortages and struggles to retain employees. The link below is our 2022 NJAASC Benchmarking Salary survey: we are looking for a response from our ASC community about the struggles that you’re currently facing and what steps you are taking to remedy them. Please carefully fill out your salary and hourly figures from 2021 to complete this survey. The NJAASC did a survey earlier this spring on this data, but unfortunately there was confusion over hourly and salaried employees. Please resubmit your data according to each specific category so we can deliver the most accurate data.
This questionnaire is extremely easy to fill out; please fill in your center name at the end. All responses will be kept confidential. The NJAASC is looking for information on registered nurses, surgical techs, administrators, billing staff, officer managers, and other employees in your ASC office. Finally, please respond to certain questions about employee benefits to keep employees at your ASC listed in the survey.
| | |
|
REGISTER FOR CENTRAL SERVICES FALL SEMINAR
|
|
Infinia Group, a leading brand strategy and design consultancy, is pleased to introduce MERLIN: an online platform that enables members to easily access the tools needed to strengthen referral networks, build powerful brands, and drive business growth. | |
The information contained within is proprietary developed by NJAASC for its membership only. Any dissemination or use of this information by anyone to nonmembers is strictly prohibited without the written approval of NJAASC. | | | | |
