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3/29/19
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Creating Change at a National Level
Anticoagulation ForumFort Lauderdale, FL.; April 12, 20189
Andrew C. Bland, MD, MBA, MSPA, FAAP, FACPMedical Director, Healthcare Quality Evaluation
2© 2018 The Joint Com m ission . All R ights Reserved.
Agenda
Introduction to The Joint CommissionJoint Commission Levers to Improve CareWhat does The Joint Commission do and doesn’t doAccreditation vs CertificationHow New Standards get developedDissemination of Best PracticesClosed Loop Communication
3© 2018 The Joint Com m ission . All R ights Reserved.
An independent, not-for-profit organization founded in 1951
Evaluates and accredits nearly 21,000 health care organizations in the United States and 1,100 in 69 countries worldwideAccredits organizations across the spectrum of health care, including hospitals, SNFs, home care, and ambulatory care.
Advanced Certification programs for special areas: Stroke, Cardiac, Joint Replacement, Perinatal Care, etc.
The Joint Commission
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4© 2018 The Joint Com m ission . All R ights Reserved.
Our Mission and Vision
Mission: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.
Vision: All people always experience the safest, highest quality, best-value health care across all settings.
5© 2018 The Joint Com m ission . All R ights Reserved.
Our Levers to Improve CareStandards• Assess during on-site survey
Performance Measures
Share Leading Practices• Webinars• Leading practice library• Education during survey• Publications: Quick Safety, Sentinel Event Alert,
TJC Journal on Quality and Patient Safety
6© 2018 The Joint Com m ission . All R ights Reserved.
The Joint Commission’s Domains
Yes
Yes
Yes
Yes
Yes
No
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Accreditation vs. Certification
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AccreditationDoes this hospital have structures and processes in place to minimize patient harm?
Does this hospital have very low rates of patient harm?
STANDARDS
PERFORMANCE MEASURES
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9MEDICINE SURGERY OB/GYN PEDIATRICS
Infection Prevention and ControlMedication ManagementProvision of Care, Treatment, and ServicesMedical StaffNursing LeadershipEnvironment of Care/Life SafetyInformation ManagementRecord of Care, Treatment, and ServicesPerformance Improvement
Infection PreventionBlood Management
Medication Management
Accreditation ‒ Ideal State, v1
Communication, Coordination of CareRadiation Safety
Measures
Standards
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© C
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10MEDICINE SURGERY OB/GYN PEDIATRICS
Infection Prevention and ControlMedication ManagementProvision of Care, Treatment, and ServicesMedical StaffNursing LeadershipEnvironment of Care/Life SafetyInformation ManagementRecord of Care, Treatment, and ServicesPerformance Improvement
Accreditation ‒ Ideal State, v2
ALL-CAUSE HARM
Mea
sure
sSt
anda
rds
11© 2018 The Joint Com m ission . All R ights Reserved.
CertificationI know the (health care organization) is safe because it is accredited, but:
• How well does this doctor/center care for people with my condition? (measures)
• How well does this doctor/center perform the surgery/procedure I need? (measures)
• Do they have all the essential resources to care for me in any eventuality? (standards)
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Staffing requirements
Imaging equipmentTransfer agreements
Performance measurement
Performance improvement
Use of Thrombolytics
Risk-Adjusted Mortality for Aneurysm Repair
Anticoagulation for Atrial Fibrillation and Stroke
Certification (e.g., Stroke)
Time to Successful Endovascular Thrombectomy
Patient Functional Status at 30 days
Mea
sure
sSt
anda
rds
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Standards
Accreditation and Certification Are Complementary
Stro
ke
Perin
atal
Tota
l Joi
nt
Repl
acem
ent
Palli
ativ
e Ca
re
Bloo
dM
anag
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Com
preh
ensi
veCa
rdia
c
Accr
edita
tion
Infection Control – HAIs (NHSN)Blood Management – Transfusion Error Rate (NHSN)
Medication Management – Medication Error Rate (e-CQM?)Communication – Coordination of Care (CAHPS)
Radiation Safety – Rate of Wrong Dose, Wrong Procedure
Cert
ifica
tion
14© 2018 The Joint Com m ission . All R ights Reserved.
Development Process
How an idea becomes a Standard
⎻Concept⎻Research⎻Expert Panel⎻Develop
⎻Engage Field⎻Testing⎻Final Standards⎻Launch⎻Post Launch
15© 2018 The Joint Com m ission . All R ights Reserved.
Topics Under ConsiderationIs this an important quality/safety issue?Are there effective interventions to reduce risk?• Evidence from clinical studies• Best practices
What is the cost-to-benefit ratio of interventions?
Can we develop valid and reliable measures?Can we validly assess this on survey?
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16© 2018 The Joint Com m ission . All R ights Reserved.
Start
TUC Topic Request
Review by TUC Review Team Bland,Brockway, Castro, Kornfield, Pollak, Ryan
SortingFunnel
Topic Bestaddressed by
PreparePresentaion
Quick Safety orSentinel Event
ClinicalDecision Team
Retire Business Development
Presentto DHQEor TUCReviewTeam
Revise
Develop Pager& Add to
Priority List
Presentto TUC
Steering forapproval
Set De-velopmentSchedule
with DSSM
Retire
Standards?
Communications?Operations?
None of above New product?
Not a Standard
Revisions Required
Revisions Complete
ApproveReject
RecycleApproved
1
New Priorities for Anticoagulation
Safety
The Concept Arrives
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19© 2018 The Joint Com m ission . All R ights Reserved.
Research & Expert Panel
⎻Literature Reviews⎻Sensing Sessions with
leaders in the field⎻Formulate questions
for Expert Panel
⎻Convene Panel⎻Discussion
surrounding questions from Research
⎻Formulate Draft Standards
20© 2018 The Joint Com m ission . All R ights Reserved.
Draft Standard
⎻EP 1⎻Use approved protocols and evidence-based practice
guidelines for the initiation and maintenance of anticoagulant therapy that address medication selection; dosing, including adjustments for age and renal or liver function; drug–drug and drug–food interactions; and other risk factor as applicable.
NPSG.03.05.01Reduce the likelihood of patient harm associated with the use of anticoagulant therapy.
21© 2018 The Joint Com m ission . All R ights Reserved.
Draft Standard
⎻EP 2⎻Use approved protocols and evidence-based practice
guidelines for reversal of anticoagulation and management of bleeding events related to each anticoagulant medication, including the use of reversal agents and bleeding management modalities.
NPSG.03.05.01Reduce the likelihood of patient harm associated with the use of anticoagulant therapy.
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22© 2018 The Joint Com m ission . All R ights Reserved.
Draft Standard
⎻EP 2⎻Use approved protocols and evidence-based practice
guidelines for reversal of anticoagulation and management of bleeding events related to each anticoagulant medication, including the use of reversal agents and bleeding management modalities.
NPSG.03.05.01Reduce the likelihood of patient harm associated with the use of anticoagulant therapy.
23© 2018 The Joint Com m ission . All R ights Reserved.
Draft Standard
⎻EP 3⎻Use approved protocols and evidence-based practice
guidelines for perioperative management of all patients on oral anticoagulants
NPSG.03.05.01Reduce the likelihood of patient harm associated with the use of anticoagulant therapy.
24© 2018 The Joint Com m ission . All R ights Reserved.
Draft Standard
⎻EP 4⎻Uses a written policy addressing the need for basely ne
and ongoing laboratory tests to monitor and adjust anticoagulant therapy
NPSG.03.05.01Reduce the likelihood of patient harm associated with the use of anticoagulant therapy.
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25© 2018 The Joint Com m ission . All R ights Reserved.
Draft Standard
⎻EP 5⎻Addresses anticoagulation safety practiceds through the
following:• Establishes a process to identify, respond to and report Adverse Drug Events• Evaluating anticoagulation safety practices and measuring effectiveness of those actions
NPSG.03.05.01Reduce the likelihood of patient harm associated with the use of anticoagulant therapy.
26© 2018 The Joint Com m ission . All R ights Reserved.
Draft Standard
⎻EP 6⎻Provides education to patients and families specific to the
anticoagulant prescribed:• Adherence to dose and schedule• Importance of followup•Drug-drug and food-drug interactions• Adverse drug reactions
NPSG.03.05.01Reduce the likelihood of patient harm associated with the use of anticoagulant therapy.
27© 2018 The Joint Com m ission . All R ights Reserved.
Draft Standard
⎻No changes to Eps 7 & 8⎻Uses ony oral dose products, prefilled syringes or
premixed infusion bags⎻Uses programmalbe pumps for heparin adminstration
NPSG.03.05.01Reduce the likelihood of patient harm associated with the use of anticoagulant therapy.
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28© 2018 The Joint Com m ission . All R ights Reserved.
Engage Field
⎻Field Review⎻Review Comments
⎻Final Standards⎻R3⎻Educate Field
29© 2018 The Joint Com m ission . All R ights Reserved.
April 2, 2019
Speakers:William Dager, PharmD, BCPS (AQ-Cardiology)
Scott Kaatz, DO, MSc, FACP, SFHM
Contributors:Jack Ansell, MD
Allison Burnett, PharmDTracy Minichiello, MD
Preparing for New Joint Commission EPs Effective July 1: Best Practices in Anticoagulant Therapy (Part 1)
Post Launch
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31© 2018 The Joint Com m ission . All R ights Reserved.
141 5 0 0 1 0 6
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20 0
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Hospital Pain Standards Scoring Data Total Observations = 620
January 1- December 31, 2018
32© 2018 The Joint Com m ission . All R ights Reserved.
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35© 2018 The Joint Com m ission . All R ights Reserved.
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