By John Palmer
The Joint Commission is strengthening an antimicrobial stewardship program started three years ago, hoping to get medical centers and other ambulatory healthcare facilities to follow the lead of many hospitals that have begun to think twice about administering antimicrobial medications.
“The inappropriate use of antimicrobial medications contributes to antibiotic resistance and adverse drug events; improving antimicrobial prescribing practices is a patient safety priority,” according to a report in the July issue of Perspectives.
As a result of the new directives, the Joint Commission created a Medication Management (MM) standard containing five elements of performance that ambulatory healthcare settings will need to adhere to. The standard (MM.09.01.03) takes effect on January 1, 2020, and covers the following goals of antimicrobial stewardship:
- Identifying an antimicrobial stewardship leader
- Establishing an annual antimicrobial stewardship goal
- Implementing evidence-based practice guidelines related to the antimicrobial stewardship goal
- Providing clinical staff with educational resources related to the antimicrobial stewardship goal
- Collecting, analyzing, and reporting data related to the antimicrobial stewardship goal
This standard is not brand new—in fact, it is an extension of the original standard (MM.09.01.01), which has been in place since January 1, 2017. Most hospitals and nursing care centers have been under the original standard’s authority in an effort to curb antibiotic resistance in the U.S.
The new requirements will apply to medical centers, dental centers, episodic care facilities, occupational/worksite health facilities, urgent/immediate care centers, and convenient care centers.
When The Joint Commission first introduced the program in the July 2016 issue of Perspectives, it was based on eye-opening research from the World Health Organization suggesting that increased use of antimicrobial medications in U.S. hospitals threatens to weaken treatments of illnesses from bacteria, parasites, viruses, and fungi as those organisms develop resistance to the treatments.
In addition, the Centers for Disease Control and Prevention (CDC) published some alarming statistics claiming that up to 50% of all antibiotics prescribed in U.S. hospitals are either inappropriate or unnecessary. In nursing homes, the CDC estimated, 70% of long-term care residents receive an antibiotic of some sort every year.
According to the CDC, antibiotic resistance is “one of the biggest public health challenges of our time,” as 2 million people each year in the U.S. contract an infection that is resistant to antibiotic treatment, resulting in at least 23,000 deaths.
The existence of so-called “superbugs,” or multidrug-resistant organisms, continues to be a major problem in U.S. hospitals, with C. difficile (C. diff) among the most prevalent. While past indiscriminate prescribing of antibiotics seems to be the biggest issue surrounding the rise of these bugs, disinfection processes and housekeeping practices have also recently come under scrutiny.
For instance, a report published in the May 2017 issue of Applied and Environmental Microbiology, a publication of the American Society for Microbiology, followed a study by a team of researchers from the University of Virginia, Charlottesville. The team studied the pathways by which bacteria travel between patients and found that certain potentially deadly bacteria, such as E. coli, find their way outside of handwashing sinks due to splashing. The study also noted that, when left to mature, bacteria can form an infectious biofilm that can stack its way up from the inner pipework of the hospital’s plumbing into the strainer of the sink.
Speak Up to Prevent Falls
Another recently revived Joint Commission program is the “Speak Up to Prevent Falls” patient safety campaign. It was launched in 2002 in 70 countries to help prevent patient falls, either in healthcare facilities or at home.
The Joint Commission says there are hundreds of thousands of falls in hospitals alone, with injuries that cost an average of about $14,000 per person.
The Speak Up program teaches patients to help prevent falls through the following mnemonic:
- Speak up
- Pay attention
- Educate yourself
- Advocates (family members and friends) can help
- Know about your new medicine
- Use a quality healthcare organization
- Participate in all decisions about your care
The Speak Up program is not restricted to falls; it also helps inform the public about safety issues that can affect patients in hospitals and at home, with campaigns focusing on issues such as strokes, depression, preventing medicine errors, and infants’ and children’s health.
By providing free, downloadable education materials, the intent is to help educate patients about certain illnesses and safety issues and on how to make better medical decisions for themselves, all before they ever need to go to the hospital.
The 2019 refresh of the program offers downloadable infographics, animated videos, and expert podcasts, along with a distribution guide for healthcare organizations.
“The goal of Speak Up™ is to help patients and their advocates become active in their care,” according to Joint Commission literature. “Speak Up™ materials are intended for the public and have been put into a simplified (i.e., easy-to-read) format to reach a wider audience.”
Preventing falls has been a focus of The Joint Commission since 2015, when the organization issued Sentinel Event Alert 55 about the growing problem of patient falls in hospitals. According to statistics the accreditor cited at the time, 30%–50% of patient falls resulted in injuries and added more than six days to an average hospital stay.
“Falls resulting in injury are a prevalent patient safety problem,” the alert stated. “Elderly and frail patients with fall risk factors are not the only ones who are vulnerable to falling in health care facilities. Any patient of any age or physical ability can be at risk for a fall due to physiological changes due to a medical condition, medications, surgery, procedures, or diagnostic testing that can leave them weakened or confused.”
The Sentinel Event Alert recommended several steps for hospitals to help prevent and respond to falls in their facilities, including the following:
- Lead an effort to raise awareness of the need to prevent falls resulting in injury. This includes communication of safety information to clinical and nonclinical staff at every level.
- Establish an interdisciplinary falls injury prevention team or evaluate the membership of the team in place to ensure organizational infrastructure and capacity to reduce injury risk from falls. This includes team members from different departments, such as nursing and even IT.
- Use a standardized, validated tool to identify risk factors for falls, preferably integrated into the electronic medical record to help create a comprehensive, individualized assessment of fall and injury risk for each patient.
- Develop an individualized plan of care based on a patient’s identified fall and injury risks, and implement interventions based on the patient’s individual needs.
- Standardize and apply practices and interventions demonstrated to be effective, including a handoff communication process and education of patients at the bedside.
- Post-fall management practices, which includes a post-fall huddle with fellow staff members, a report and analysis of contributing factors to the fall, and continued patient reassessment.
Injuries resulting from falls and lifting patients don’t just affect patients, as statistics from the National Institute for Occupational Safety and Health suggest that there are 75 lift-related injuries for every 10,000 full-time hospital workers, and 107 injuries for every 10,000 workers at nursing homes and residential facilities. Hospital rates of workplace injury are nearly twice the national average for all industries, and nursing home rates are nearly three times as high.
The American Nurses Association has spoken out publicly to get hospitals to deploy equipment and adopt protocols so that no staffer ever moves a patient without device assistance.
Some hospitals have begun to install overhead lifts in their facilities consisting of a motorized hoist that can lift a patient into the air while the patient is secured in a sling. An overhead rail system allows nurses to move patients around the room or between rooms. Some models designed for obese patients have two motors and can lift as much as 1,000 pounds. The lifts can be pricey, though. Permanent overhead lifts cost an average of $16,000 per room to install and can be used only in that one room. In contrast, mobile devices cost an average of $6,000.
According to OSHA—which still has yet to develop mandates about how to properly lift patients, but actively encourages hospitals to help prevent slips, trips, and falls—the devices can be cost-effective, and their benefits far outweigh the costs. The initial capital investment in policies and equipment can be recovered within two to five years.
Consider the following benefits that OSHA says can be enjoyed by facilities that use lift-assist equipment:
- Reduced injuries
- Decreases in lost time and workers’ compensation claims
- Increased productivity
- Higher quality of work life and worker satisfaction
- Staff retention
- Better patient care and satisfaction
John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at firstname.lastname@example.org.