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Surveyors: Handoff process is "best they've ever seen"
'Great ideas' shared during sit-down sessions
At Anaheim Memorial Medical Center, a 224-bed acute care hospital in Orange County, CA, surveyors from The Joint Commission were so impressed with the handoff communication process for perioperative services, they asked for a sample of the hospital's tool.
"They noted that our process was the best they had ever seen," says Tamra Kaplan, PharmD, vice president of ancillary and support services. During the leadership conference, surveyors asked for the pocket card that perioperative services staff use as a prompt for effective handoff communication. The tool lists key pieces of patient information that need to be shared between pre-operative, intra-operative, and post-operative team members. The survey team gave high marks to the Situation Background Assessment Recommendation (SBAR) technique used to communicate critical information during handoffs throughout the organization. "They saw it consistently applied across all services and disciplines during the survey process," says Kaplan.
The surveyors also complimented the performance indicators related to quality of care and patient safety integrated in each contract service that are then reported up through the organization to the governing board. Indicators were defined in the contract specific to each clinical service, with ongoing data collection and documentation of action plans for identified issues.
In general, the surveyors seemed to sincerely understand the challenges of providing high-quality, safe patient care every day. "The surveyors provided many opportunities each day for education and consultation, and our management team felt comfortable taking advantage of this," Kaplan says.
On several occasions, surveyors offered to give special sessions related to topics such as documenting timely reporting of critical values and enhancing the scope of environmental tours to improve safety in outpatient areas. "The extent of education and consultation provided, both during tracers and in sit-down sessions, was truly impressive," Kaplan says. "They offered these on several occasions and we never said no."
For example, staff asked for a sit-down session with representatives from imaging, pharmacy, and administration, and subsequently spent 45 minutes discussing the hospital's current process and interpretation of the standards for contrast administration. "The end result was that we did not get a supplemental, and we had great ideas shared with us that surveyors had seen at other hospitals, which we then used to modify our process."
The hospital's management team has been conducting ongoing monthly tracers in patient care areas for the last three years, which was evident to surveyors. "Surveyors could appreciate throughout the four-day survey that we operate from the philosophy of 'survey ready, every day,' and that Joint Commission expectations are ingrained in our culture," Kaplan says.
Surveyors were especially pleased to see that the significant amount of performance improvement data collected by staff is actually used to affect change. "Our PI report forms include specific actions taken and when, with ongoing follow-up data that either demonstrates improvement or a continuing opportunity," says Kaplan.
Data are also reported using dashboards, with internal and external benchmarks noted. "We set goals for ourselves relative to the benchmarks, and a timeframe for achieving that goal," says Kaplan. For example, the patient access and throughput performance improvement team reports data on ED diversions, bed availability and turnover, and the percentage of increase in inpatient admissions resulting from process improvements.
"They were also very positive about the teamwork and open communication channels between departments and disciplines, such as nursing and pharmacy," she says.
In terms of best practices they had seen at other facilities, the surveyors shared information regarding achieving the elimination of unacceptable abbreviations in a paper-based environment. "This is certainly no easy task," says Kaplan. "They emphasized that it takes hard work, but the most effective interventions are immediate."
The surveyors suggested having a pharmacist contact the prescribing physician prior to dispensing the drug to let them know that an unacceptable abbreviation had been used. "The hospital they mentioned had strong leadership support from administration and medical staff to ensure that physicians responded positively to staff phone calls," says Kaplan. "In a three-month period, unacceptable abbreviations were essentially eliminated."
[For more information, contact:
Tamra Kaplan, PharmD, Vice President, Ancillary & Support Services, Anaheim Memorial Medical Center, 1111 W. La Palma Avenue, Anaheim, CA 92801. Phone: (714) 999-3942. E-mail: email@example.com.]