As patients fell ill with COVID-19 inside hospitals, government oversight fell short

One by one, the nurses taking care of actress Judi Evans at Riverside Community Hospital kept calling out sick.

Patients were coughing as staffers wheeled the maskless soap opera star around the California hospital while treating her for injuries from a horseback fall in May 2020, Evans said.

She remembered they took her to a room to remove blood from her compressed lung where another maskless patient was also getting his lung drained. He was crying out that he didn’t want to die of COVID-19.

No one had told her to wear a mask, she said. “It didn’t cross my mind, as I’m in a hospital where you’re supposed to be safe.”

While healthcare organizations often look at remote patient monitoring (RPM) as a means of caring for patients at home, Renown Health has launched a pilot project aimed at helping a rural hospital improve inpatient care.

And the Nevada health system’s president and CEO sees this as the first step in a much larger journey toward integrated care no matter where the patient is located.

The Suicide Prevention in Nursing: Breaking the Silence model, inspired by the first national longitudinal study of U.S nurse suicide, has been recognized as an Academy Edge Runner by the American Academy of Nursing.

Edge Runners are nurse-designed, innovative models of care or interventions with significant, demonstrated outcomes to improve health, impact cost, and influence policy.

Newsletter: Inside Accreditation & Quality

Vary the start time of your quarterly fire drills by at least an hour on each shift because surveyors will be checking.

And beware of establishing a pattern of scheduling drills because both The Joint Commission (TJC) and the Healthcare Facilities Accreditation Program (HFAP), now operating under the Accreditation Commission for Health Care (ACHC), have cited hospitals for problems.

CMS inspectors also regularly check fire drill logs

Newsletter: Inside Accreditation & Quality

Located in the Mojave Desert, Ridgecrest Regional Hospital in Ridgecrest, California, is a critical access hospital that is closer to Las Vegas than it is a major earthquake fault line. Still, there have been minor temblors, so an earthquake had been on their list of potential emergency events.

But it wasn’t high on the list—until July 4, 2019.

The healthcare complex is near a military installation and sits between the Death Valley and Sequoia national parks. Built in 2010, the main hospital has only 25 licensed hospital beds but is attached to a 26-bed distinct part transitional care unit/skilled nursing facility (SNF) and shares a campus with a 99-bed SNF, said Stephanie Meeks, MBA, HACP, the hospital’s emergency management and regulatory compliance manager, during a presentation at the DNV Healthcare annual symposium in November.

Newsletter: Inside Accreditation & Quality

The new, temporarily suspended CMS interim final rule (IFR) that requires staff vaccinations against COVID-19 will supersede state or local laws or orders that prevent vaccine mandates, notes Marge McFarlane, PhD, MT(ASCP), CHFM, CHSP, CJCP, HEM, MEP, with Superior Performance Consultants in LaPointe, Wisconsin.

But the CMS rule may not cover all healthcare entities.

On December 2, CMS suspended its mandate for COVID-19 vaccination of healthcare workers while the interim final rule is under a legal challenge. CMS has said hospitals can implement the requirements voluntarily.

If you move to implement the requirements of CMS’ Omnibus COVID-19 Health Care Staff Vaccination IFR announced November 4, 2021, be aware that physician offices do not need to comply with the IFR, says McFarlane.

Newsletter: Patient Safety Monitor Journal

An estimated 47.9 million adults—more than 19% of the population—provide informal care for an adult in their lives. What goes on outside of the hospital or care facility is no small ask, either: Two CDC surveys have found that 40% of adult caregivers report symptoms of anxiety or depression, and 10% report suicidal ideation.

In short, these caregivers need help once their loved ones leave the healthcare facility, especially as the COVID-19 pandemic worsens isolation and other barriers to health and success.

“One of the most important things I’ve always believed is that the patient belongs to the family, not to the system or plan,” says Claudia Fine, LCSW, MPH, chief professional officer with eFamilyCare. “And the family needs to be empowered to maximize their ability to ensure that the patient is as well as possible and has access to as many resources as they are entitled to and that they need.”

Newsletter: Patient Safety Monitor Journal

Real-time visibility into patient care beyond the acute care setting is more important than ever. Hospitals are more reliant on ambulatory care providers as part of the patient’s care journey, and the quality of patient outcomes depends on collaboration between hospitals, postacute providers, health plans, and other organizations. So how do we put data into action for better management of patient populations and outcomes?

“There’s been a lot of discussion around the shift to home-based care,” says Lissy Hu, CEO and founder of CarePort. “More patients want to recover in their home, outside the facility. How do we make that happen?”

If we’re seeing more patients who prefer to recover in their own residence versus at a nursing home, asks Hu, what does that mean for physicians, care managers, or other professionals coordinating these services for the patient?

Newsletter: Healthcare Life Safety Compliance

The first time in any job can be hard, but learning the ins and outs of survey compliance in facilities management—with standards on top of regulations on top of local requirements on top of state requirements—can be overwhelming.

We asked some experienced survey and safety experts what advice they’d offer to first-timers. And as with most any job in hospitals, the first thing is to spend awhile understanding the standards and the requirements, as well as the sections of the brick and mortar you are overseeing.

Newsletter: Healthcare Life Safety Compliance

Even pre-pandemic, hospitals were prime targets for hackers and other online threats. That condition has only grown worse over the past 18 months, with vaccine infrastructure becoming a tempting target for bad actors in addition to hospital systems’ continuing vulnerability to ransomware attacks.

Hospitals and other healthcare organizations must look for new ways to secure their data, but one area in their IT infrastructure is often overlooked: mainframe security. Ray Overby, co-founder and CTO of Key Resources, Inc., says that while the current healthcare environment has brought attention to the cybersecurity threats facing healthcare organizations, mainframes still fly under the radar. Mainframes are used to manage sensitive patient information, which means their security should be a top priority when it comes to staying compliant with HIPAA and other data regulators.

The challenges surrounding healthcare organization mainframes aren’t new, Overby says. They’re the same old problems, amplified and left unaddressed.

Newsletter: Healthcare Life Safety Compliance

There’s nothing simple about running a healthcare facility. With complex moving parts creating an operationally challenging environment, hospitals can’t afford to be inefficient or lag behind. How healthcare organizations use resources today is key to how they will evolve into the future.

The industry is undergoing a sea change. Healthcare was already working toward integrating systems for better interconnectivity and interoperability, and the COVID-19 pandemic amplified this initiative. Facilities old and new are striving to be more agile, tightly woven, and efficient. Organizations are looking to improve not just medical records, but physical operations as well, from HVAC to physical security and beyond.

But how can facility managers influence the monitoring, alignment, and management of these disparate systems? The pressure is on to move fast and increase efficiency as priorities shift during a global pandemic, even while backlogs of less-urgent procedures have slowed revenue.

Newsletter: Healthcare Safety Leader

In the upcoming year, surveys will include new standards, revised requirements, modified processes and procedures, and a continued focus on infection control and fire safety. However, none of that promises to be more difficult than facing the COVID-19 pandemic.

Unfortunately, there will still be a COVID-19 pandemic as the new year opens.

Both The Joint Commission (TJC) and DNV Healthcare will be surveying to new and revised standards, but few if any of the changes are unexpected. Many of them concentrate on eliminating repetitive requirements or aligning standards with new or changing CMS expectations.

Newsletter: Healthcare Safety Leader

In case you missed it, here’s a compilation of breaking news from the Accreditation & Quality Compliance Center since Healthcare Safety Leader was last published.

Newsletter: Healthcare Safety Leader

In the last Healthcare Safety Leader, we noted the caustic chemicals found in the basement of a hospital by Ernest E. Allen, ARM, CSP, CPHRM, CHFM, a former life safety surveyor and now Life Safety consultant with HealthTechS3, then asked, “What else should be in the basement?”

Whenever you see caustic or corrosive chemicals, remember that there should be an emergency eyewash within 10 seconds travel time or within 55 feet of the materials—or perhaps closer depending on how hazardous the chemicals are.

Problems with the location and maintenance of eyewash stations continue to attract the attention of surveyors.

Newsletter: Healthcare Safety Leader

Q: We just had a CMS validation survey and received a finding under K-tag K-926 for not having good enough documentation of training on oxygen transportation. How many times a year do we have to give training on this? Is annual plus new-hire training enough?

A: K-tag 926 references NFPA 99-2012, 11.5.2.1, which only says “periodic” training must be provided. The Annex section is quiet on how frequent “periodic” is, and the NFPA Handbook on NFPA 99-2012 does not address it either.

Newsletter: Medical Environment Update

Didn’t have time to gather your thoughts yet on OSHA’s emergency temporary standard (ETS) requiring vaccination and testing for employers with 100 or more employees? You can still offer up your two cents!

OSHA has extended the public comment period until January 19, 2022. (The original comment deadline was January 4.)

The ETS is on the Federal Register as Docket No. OSHA-2021-0007. You can file electronically at https://www.regulations.gov, which is the Federal e-Rulemaking Portal and the only way to submit comments on this rule, according to OSHA.