Bland National Change ACF3/29/19 1 Creating Change at a National Level Anticoagulation Forum Fort Lauderdale, FL.; April 12, 20189 Andrew C. Bland, MD, MBA, MSPA, FAAP, FACP

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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


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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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.


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


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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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

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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

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Standards

Accreditation and Certification Are Complementary

Stro

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Perin

atal

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Palli

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Accr

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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


Development Process

How an idea becomes a Standard

⎻Concept⎻Research⎻Expert Panel⎻Develop

⎻Engage Field⎻Testing⎻Final Standards⎻Launch⎻Post Launch


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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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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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


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.


Draft Standard


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.


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Draft Standard


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.



Draft Standard


guidelines for perioperative management of all patients on oral anticoagulants



Draft Standard

⎻EP 4⎻Uses a written policy addressing the need for basely ne

and ongoing laboratory tests to monitor and adjust anticoagulant therapy


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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



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



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


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Engage Field

⎻Field Review⎻Review Comments

⎻Final Standards⎻R3⎻Educate Field


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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141 5 0 0 1 0 6

6446

3210

31

2

374

10 12 8 40

50

10 0

15 0

20 0

25 0

30 0

35 0

40 0

LD.04

.0 3.13 E P 1

LD.04

.0 3.13 E P 2

LD.04

.0 3.13 E P 3

LD.04

.0 3.13 E P 4

LD.04

.0 3.13 E P 5

LD.04

.0 3.13 E P 6

LD.04

.0 3.13 E P 7

MS .0 5.01.0

1 E P 18

PC.01

.0 2.07 E P 1

PC.01

.0 2.07 E P 2

PC.01

.0 2.07 E P 3

PC.01

.0 2.07 E P 4

PC.01

.0 2.07 E P 5

PC.01

.0 2.07 E P 6

PC.01

.0 2.07 E P 7

PC.01

.0 2.07 E P 8

PI.01

.01.0

1 EP 4 0

PI.02

.01.0

1 EP 1 8

PI.02

.01.0

1 EP 1 9

Hospital Pain Standards Scoring Data Total Observations = 620

January 1- December 31, 2018


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Questions?

Documents

Bland National Change ACF3/29/19 1 Creating Change at a National Level Anticoagulation Forum Fort Lauderdale, FL.; April 12, 20189 Andrew C. Bland, MD, MBA, MSPA, FAAP, FACP