|
Speaker |
Laura A Dixon |
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Industry |
Healthcare |
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Speciality |
Nursing |
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Available |
All Days |
|
Duration |
120 Minutes |
Description
Just about every hospital in America accepts Medicare and Medicaid reimbursement and as such must follow the Center for Medicare and Medicaid Services (CMS) hospital interpretive guidelines. These regulations and interpretive guidelines must be followed for all patients in the hospital.
If a surveyor showed up at your hospital today, would you be prepared? Are you up to speed with the new antibiotic stewardship requirements and pharmacy’s involvement in the new regulations under the Hospital Improvement Rule which became final on November 29, 2019? The interpretive guidelines and survey procedure are pending from CMS. The CDC issued revised core elements for the hospital antibiotic stewardship program in November of 2019. CMS made changes to 3 of the 18 pharmacy tag numbers in 2020.
In 2020, CMS removed all references to the USP standards. They have included a requirement to follow all national standards of practice and the evidence-based literature.
CMS rewrote 10 of the 18 tag hospital pharmacy sections in November 2015 and many hospitals are still struggling with compliance. There has been increased scrutiny of the standards and an increase in the number of deficiencies for hospitals. This includes changes regarding the compounding of sterile medication and the beyond-use date (BUD) to align them with the acceptable standards of practice. The language was included to allow the surveyor to cite the hospitals at either the standard or condition level.
There have been many recent changes in the nursing section that address medication usage also. This includes changes to the timing of medication, self-administered medication, compounding, blood, and safe opioid use. There are three-time frames during which medications must be administered along with the QAPI requirements.
The OIG recommended surveyor training and the evaluation of 55 things in addition to revising the pharmacy standards which was done. More educated surveyors can increase the chances of finding a deficiency. The surveyor may ask for the contract if the hospital outsources compounding.
Medication errors are the most common medical error in hospitals today. CMS said that drug-related adverse outcomes occur in 1.9 million inpatient stays which is almost 5% of all admissions. There are also 838,000 patients a year who are treated as an outpatient who has a drug-related adverse event. Hospitals that spend more resources on medication issues generally have lower rates.
Information will be provided on the top problematic pharmacy standards by CMS. CMS is now issuing a deficiency report showing when the pharmacy is cited for being out of compliance. This program is a must to help ensure compliance with the hospital CoPs.
It is important for nursing to understand the medication and pharmacy standards since many of them apply to nursing. For the first time, CMS mentions that nursing needs to be aware of some of the pharmacy standards and vice versa. This includes medication errors, adverse events, drug incompatibilities, self-administered medication, and required medication policies. If a medication error or ADE occurs there must be notification of the physician, documentation in the medical record and it must be included in the PI data.
The timing of medication requires policies and procedures and training by hospitals. This section requires notification of the physicians and discusses when medications are administered outside of the timeframes. Hospitals should have a non-punitive approach and the definition of medication error should be broad enough to include near misses.
The CMS interpretive guidelines address medication management and pharmacy-related standards. These can be looked at when CMS conducts a complaint or validation survey. Medication management is not only a big issue with CMS but also with the Joint Commission. Medication errors are the largest number of medical errors in healthcare today. They are also the most common reason for unnecessary readmissions to the hospital.
Hospitals must work together to implement and follow these regulations. Problematic standards include verbal orders for medication, order for medications, and standing orders.
Learning Objectives
Agenda
Who Should Attend
(BS, JD, RN, CPHRM)
Laura A. Dixon recently served as the Regional Director of Risk Management and Patient Safety for Kaiser Permanente Colorado where she provided consultation and resources to clinical staff. Prior to joining Kaiser, she served as the Director, of Facility Patient Safety and Risk Management and Operations for COPIC from 2014 to 2020. In her role, Ms. Dixon provided patient safety and risk management consultation and training to facilities, practitioners, and staff in multiple states. Such services included the creation of presentations on risk management topics, assessment of healthcare facilities; and development of programs and compilation of reference materials that complement physician-oriented products.
Prior to joining COPIC, she served as the Director, of the Western Region, Patient Safety and Risk Management for The Doctors Company, Napa, California. In this capacity, she provided patient safety and risk management consultation to the physicians and staff in the western United States. Ms. Dixon’s legal experience includes medical malpractice insurance defense and representation of nurses before the Colorado Board of Nursing.
Ms. Dixon has more than twenty years of clinical experience in acute care facilities, including critical care, coronary care, peri-operative services, and pain management.
As a registered nurse and attorney, Laura holds a Bachelor of Science degree from Regis University, RECEP of Denver, a Doctor of Jurisprudence degree from Drake University College of Law, Des Moines, Iowa, and a Registered Nurse Diploma from Saint Luke’s School Professional Nursing, Cedar Rapids, Iowa. She is licensed to practice law in Colorado and California.