Strategies to Enhance Patient Care and Compliance with Pain Order Duplications and Gaps

According to the Joint Commission every patient has a right to pain management. Due to multimodal pain management, pain orders have the potential for duplication as well as gaps in therapy. At our institution, we evaluated pain orders and implemented strategies that aimed to reduce those gaps. We found that current ordering practices permitted the use of varying visual analog scale (VAS) ranges (e.g., VAS 1-3 and 1-5) which inherently increased the potential for duplicate therapies. When gaps in therapy occurred, medication orders for corresponding VAS scores were not available and thus, therapy was delayed. Additionally, current administration policies did not take into account patient preferences for less potent agents which can also cause a delay in care. In summary, simple strategies, discussed in this article, may be implemented at the hospital level to optimize patient care while maintaining recommendations by the Joint Commission for clear medication orders.

Abstract P297: The Accuracy of the Comprehensive Stroke Performance CSTK-5b Measure Rates

Introduction: Symptomatic intracerebral hemorrhage (ICH) is a feared complication of reperfusion therapy in acute ischemic stroke. The Joint Commission (JC) national quality measure Comprehensive Stroke (CSTK-5b) reflects the rate of symptomatic ICH after mechanical thrombectomy (MT) and is used as a marker of comprehensive stroke center (CSC) performance. We sought to determine the accuracy of the CSKT-5b as determined by vascular neurologists. Methods: We reviewed the CSTK-5b failures in our JC certified CSC program for the years 2018 and 2019. Our CSC abstractors follow the instructions from the Joint Commission National Quality Measures manual without deviation and do not allow for clinician over-ride or adjudication (consistent with manual instructions). All CSKT-5b failures were reviewed by study neurologists to determine the true CSTK-5b rate. Data was collected on National Institute of Health Stroke Scale (NIHSS), symptomatic ICH, and neuroimaging results. European Cooperative Acute Stroke Study (ECASS) definitions were used and included hemorrhagic infarction (HI) (grade 1 or 2) and parenchymal hematoma (PH) (grade 1 or 2). Results: Among 361 MT patients for the 2 year period, the CSTK-5b failure rate reported to JC was 34/250 (13.6%), whereas the true rate was 21/250 (8.4%). Among the 13 cases that were miscoded, the ECASS grading included 1 HI-1, 7 HI-2, 1 PH-1, and 4 subarachnoid hemorrhage, and all had a 4 point change in NIHSS that was determined to be clinically unrelated to ICH. Comparing annual data, the 2018 CSTK-5b failure rate was 14/111 (12.6%) whereas the true CSTK-5b failure rate was 7/111 (6.3%). In 2019, the CSTK 5b failure rate was 20/139 (14.4%), whereas the true CSTK-5b failure rate was 14/139 (10.1%). Conclusions: Non-physician abstractors relying on instructions from the JC manual over-estimate the rate of CSKT-5b measure failure. The determination of symptomatic ICH after MT is complex and requires clinical knowledge for accuracy.

The Accreditation Process

Achieving accredited status for hematopoietic cell transplantation (HCT) programme shows an ongoing commitment to the quality and safety of the services offered and of the activities performed. Accreditation is considered a standard through which a healthcare facility or service is shown to offer quality and healthcare that meet minimum standards and guidelines offered by different quality boards (at national and international levels). Among the most well-known accreditation agencies in the world are the Joint Commission and the Joint Commission on Accreditation of Healthcare Organizations (JC and JCAHO), the International Society for Quality in Health Care (ISQua), the Accreditation Commission for Health Care, Inc. (ACHC), the Healthcare Quality Association on Accreditation (HQAA) and, specifically for HCT programmes, the FACT and the JACIE.Any patient entering a healthcare facility wants and deserves to know that staff is trained and facilities are clean and well maintained and that procedures follow standards that reduce chances of error, infection or negligence.

Enforcing : The Joint

On March 30, 1981, Ronald Reagan, president of the USA, was shot in an assassination attempt. During his lifesaving surgery at the George Washington Hospital, the nation was riveted by the clear and calm account of its progress by the hospital’s physician spokesman, Dennis O’Leary. Five years later, O’Leary became the head of the Joint Commission on Accreditation of Hospitals.

New Challenges to Transboundary Unitization in the Gulf of Mexico

In the last two decades, the search for untapped oil reserves led to many innovations in oil and gas exploration. As new technology continues to open new horizons, oil companies are increasingly able to drill at deeper ocean depths to tap offshore reserves. Offshore drilling poses problems where oil reserves hundreds of miles from shore cross an international boundary line. While American courts typically apply the rule of capture to determine who owns the subsoil resources, international law requires countries to work together to maximize the efficient, safe extraction of the resources. In 2012, the United States and Mexico drafted a treaty that would govern the unitization of an offshore transboundary oil field. Today, Mexico’s energy laws are very different. A new administration threatens to unravel recent liberal reforms, and the United States has become more hostile to Chinese investment in the region. With these political challenges in mind, the treaty is very vague on critical issues, particularly its dispute resolution clause, which the United States and Mexico must strengthen if the treaty is to be effective and shared transboundary resources develop efficiently to the benefit of both nations. The treaty creates a body called the Joint Commission to create much of the treaty’s policy and procedure. In order to maintain good relations and a healthy energy sector, the Joint Commission needs to create subsidiary committees subject to its control and comprised of various experts to ensure the treaty is implemented impartially.