Tuesday, December 3, 2019

MEDICAL GAS SYSTEMS IN TODAY'S SURGERY CENTERS




Medical gas systems are a standard feature of most healthcare facilities, and they require special monitoring and maintenance to ensure they are operating properly. Unlike other medical equipment and systems, their use of gas under pressure makes them vulnerable to a unique set of unexpected failures, which may not be readily apparent. This makes medical gas preventative maintenance critical to a problem-free working environment.

We understand you want your medical gas systems to be compliant and pass inspection, and most of all, increase safety for your patients. We understand it's crucial to keep your medical gas systems running smoothly so you have no unexpected failures, and you have the proper equipment to do your job competently and worry-free.

We are concentrated on making sure your hospital and your patients are getting all they need from your medical gas equipment.







According to NFPA code (5.1.15), all medical gas and vacuum systems need to have a routine maintenance program.

What does a routine maintenance program mean?
It means a program that puts patient safety first which is always a top priority. And helps healthcare facilities prepare for any survey process, on-going maintenance, and repairs that will mitigate failures.

Top Medical Gas System Maintenance Questions [We Can Help You Answer]

question and answers
Photo by Pixabay from Pexels


1. When was the last time your system was inspected?
Healthcare facilities need timely inspections on piping, outlets/inlets, valves, flex connections, alarms, and source equipment. A successful survey requires operational, maintenance, and repair information on hand.

2. Are you concerned that you are not receiving proper flow or pressure in your medical gas system?
National statistics show that the average minute spent in the operating room costs $72. Having improper suction in the operating room is a problem, both in terms of cost and safety because it means the removal of liquids, solids and waste gases may take longer than necessary.
This is due to the fact that an ideal flow rate may not be reached as a result of poor suction.

3. Are you concerned of a possible leak in your medical gas equipment?
Low suction or vacuum may indicate a leak in the system and may result in excess operational cost. Adequate vacuum at the wall in the operating room is needed to allow the physician to titrate the exact level needed for the task at hand.

A leak in a medical gas system in the ASC environment is a problem in terms of quality, cost due to material losses, and also one of safety. There can be an ongoing avoidable cost in terms of gas waste and overly frequent cylinder replacement, and more serious cost implications if a poorly functioning system leads to source equipment failure or longer procedure times.

The best approach, whether in a small clinic or a large MULTI-ASC, is to have a comprehensive medical gas preventative maintenance program in place to identify and avert these problems as soon as they arise.

4. Are you aware of the most current NFPA codes on required maintenance?
a. NFPA 99 2018, 5.1.14.2.2.5, states credentialing to the requirements of ASSE 6040 and ASSE 6030 are appropriate qualifications.
b. Code 5.1.14.2.2.4 cites:  "Scheduled maintenance for equipment and procedures shall be established through the risk assessment of the facility and developed with consideration of the original equipment manufacturer recommendations and other recommendations as required by the authority having jurisdiction."
c. 5.1.14.2.3.1: Nonstationary booms and articulating assemblies, other than head walls utilizing flexible connectors, shall be tested for leaks, per manufacturer's recommendations, every 18 months or at a duration as determined by a risk assessment.

5. Do you know the original equipment manufacturer recommendations for each component in the medical gas system?
Within code an ASC should reference what the equipment manufacturer recommends.
Different items need to be checked daily, weekly, monthly, and annually based on the equipment and sub equipment. The main point is maintenance on medical gas equipment cannot be overlooked or ignored, despite the technologies employed or the frequency of use. Equipment is directly connected to patient care, patient and employee safety.

6. Was your system inspected & tested by a qualified individual?
Compliance requires that all inspections, testing, and maintenance are conducted by qualified personnel. For any new installations, additions, or renovations, a verification is required. To become an ASSE 6030 Verifier, an individual must have at least two years of documented practical experience in the verification of medical gas systems, as well as completion of a minimum 32-hour training course instructed by an ASSE 6050 instructor.
Persons maintaining systems shall demonstrate appropriate qualifications by attaining their ASSE 6040 Maintenance Personnel qualification, 6030 qualification, or complete a documented training program acceptable to the facility.

7. Do you manage medical gas repairs and maintenance with a computerized monitoring solution?
The best approach is to have a computerized monitoring solution in place that monitors the whole system, from the source of the gas, through the piping and finally to the patient. A fully-featured software program provides to ability to map out the entirety of your piped gas system, with individual components barcoded for easy identification and replacement if necessary.
You ideally want a software solution that allows you to access information on required medical gas preventative maintenance from multiple computer stations.

8. Are you aware of all your medical gas equipment that does not use "oil"?
Equipment that does not use oil often may also have no maintenance plan at all because the ASC believes there is nothing else needed to do, but all life safety equipment has to be cycled regularly to assure it will work on demand.
Also, equipment that uses no oil still requires an in-depth maintenance program and when overlooked/ignored the equipment will wear down and fail to operate. This is not only equipment that isn’t used often, but equipment that can be used every day, every hour.

9. Do you properly monitor your central supply systems?
The medical gas source equipment used will vary, depending on the type of gas and the size of the institution. For smaller needs, cylinder-only solutions are often adequate.
For large hospitals with substantial requirements, cyrogenic liquid systems may be utilized to provide piped gas. Compressors are also used to provide medical air, and vacuum pumps are needed for suction. Failing to properly monitor these complex pressurized systems can be costly, both in terms of increased use of consumables and damage to permanent equipment.

 
Guidelines written in search bar on virtual screen
Preventative Maintenance means inspecting, testing and updating source equipment that supply the array of gases used in the ASC: Medical air, Nitrous Oxide, Carbon Dioxide, Medical-Surgical Vacuum and Waste Anesthesia Gas Disposal (WAGD). 

PM means checking the components of each supply system to verify their proper operation and inspection of the machines' parts for wear or obstruction.
  • Each pump or compressor has an hour meter that shows how much it has been used. All medical gas source equipment shall be redundant: that is, the  primary supply that has a companion, perhaps duplexed or multiplexed, that are always on standby in the event the primary pump fails or is unable to keep up with demand. Regular alteration of components is key. The length of run time prescribes oil changes and other checks of critical components.
  • Filters are checked and often replaced to make sure the output meets applicable standards.
  • Belts and mechanical connections between the drive system and the pump or compressor are checked to verify they are working well, and to detect labored operation of the pump.
  • If oil is used it is checked for condition and level. Oil use indicates worn parts inside the pump.
  • The drains are checked to verify free flow and proper operation. As air is compressed it “wrings” the humidity out of the air and this water must have a clear path to the drain or it can back up into the compressor itself.
  • The voltage and amperage of the running pump are checked to verify it is operating to the manufacturer’s specifications. An electrical motor pulling more than the specified electricity signals worn internal components and labored operation.
  • The audible and visual indicators are checked to verify they are lit when they should be and they will light up when a default condition exists. Likewise, all the various alarms are tested to ensure proper set points.
  • The operating temperature of the unit is monitored and the high temperature shut off is activated to avoid burning out a pump or compressor.
  • The valves and rings are checked in reciprocating compressors.
  • The actual dew point (or the amount of water in the output) is measured and compared to the set values of the dew point alarm. Some water in the air makes breathing easier for patients, but too much can clog lines, equipment and actually labor breathing.
  • The room condition is noted as well. There should be regular airflow to the external ventilation to prevent overheating.

Conclusion

Surgery Centers today need ways to confirm that all the equipment and devices that affect life safety are working to spec and are reliable.





Friday, November 1, 2019

Benchmarking Studies by a collective group of surgery centers across the USA.

These are the studies to rank how well your facility is doing by this national benchmarked areas within your ASC.  They are:

Operational benchmarks

1. Administrator salary is $109,184. 1

2. Administrators in the west receive the highest salary, at $114,109 while administrators in the Midwest receive the lowest salary at $104,317.

3. Staff hours per case at ASCs is 12.8 hours.

4. Administrative hours per case is four hours.

5. Nurse hours per case in one- to two-OR centers is 5.2 hours.

6. Administrative hours at one- to two-OR centers is 3.8 hours.

7. Nurse hours at ASCs with three- to four-ORs is 6.3 hours.

8. Administrative hours at ASCs with three- to four-ORs is 4.1 hours.

9. ASCOA surgery centers have a per room goal of 10 cases per day to encourage compressed schedules. 2

10. GI and pain-driven centers with less than five clinical hours would have a total of around eight staff hours per case.

11. Centers with more complicated cases such as orthopedics and spine would have clinical hours around seven to eight hours per case and total staff hours around 10 to 12 hours per case.

12. Average room turnover time goal is seven to 10 minutes at ASCOA surgery centers, depending on the case mix.

13. 53 percent of ambulatory surgery centers maintain paper records and 23 percent track their supply chain on spreadsheets. 3

14. Typical surgery centers have 19 cases per day. 4

15. 74 percent of the cases are performed by the top five physicians at the ASC.

16. ASCs have of three surgical cases per operating room per day.

17. Total operating expenses per OR is $1.2 million.

18. Employee salary and wages per operating room is $421,820.

19. Medical and surgical expenses per OR are $375.37.

20. General and administrative expenses per OR are $259.38.

21. Total cases per center is 4,714 per year.

22. Average number of non-surgical cases per year is 1,146.

23. 765 cases are performed per operating room annually, with 4.6 cases per day.

24. ASC procedure rooms see around 1,144 non-surgical cases per room annually, with 4.6 procedures per day.

25. The top five physicians performed 54 percent of the ASC's case volume.

26. Surgery centers with more than four operating rooms performed 24 cases per day, while those with one to two operating rooms performed 12 cases per day.

27. Surgery centers with one to two operating rooms had the highest annual surgical case rate per operating room, at 782, while those with more than four operating rooms hosted 744 cases annually per operating room.

28. Non-surgical case volume per year at facilities with one to two operating rooms is 1,017 cases per procedure room.

29. Surgery centers with three to four ORs reported 769 non-surgical cases per procedure room annually, which dropped to 705 cases in centers with more than four ORs.

30. In surgery centers with more than four ORs, only 22 percent of the cases were performed by the top two physicians, while 62 percent were performed by the top 10 physicians.

31. Median operating room time per patient encounter: 50.2 minutes. 5

32. Procedure room time per patient encounter: 34.2 minutes.

33. Median rate of unscheduled direct transfers: .6 transfers per 1,000 patient encounters.

34. 34 percent of ASC leaders plan to standardize products used in their center. 6

35. 24 percent plan to evaluate their GPO.

36. 19 percent plan to implement an order management system.

37. 6 percent plan to change or join a GPO.

38. 6 percent plan to change distributors.

Revenue cycle benchmarks

39. 79.9 percent of ASCs collect between 0 to 30 days from the date of service to the check date. 7

40. 13.3 percent of ASCs receive cash collection between 31 and 60 days from the service date to the check date.

41. 20 percent of ASC claims are not collected for more than 30 days. 8

42. The top reason for ASC procedures to receive an unexpected denial is "claims or service lacks information which is needed for adjudication." The second most common reason is "duplicate claim or service" followed by "procedure or treatment is deemed experimental or investigational by the payer."

43. Commercial insurance companies have a 12 percent unexpected denial rate for the top 10 CPT codes that have unexpected denials at ASCs.

44. Medicare's unexpected denial rate is 6 percent for the top 10 CPT codes that have unexpected denials at ASCs.

45. Medicaid has a 26 percent denial rate for the top 10 CPT codes that have unexpected denials at ASCs.

46. Around 47 percent of ASCs with fewer than 3,000 cases have 0 to 30 A/R days, while 18.7 percent have 31 to 60 A/R days. 9

47. Most ASCs with at least 6,000 cases annually have 0 to 30 A/R days.

48. Of all ASCs, about 15.9 percent have more than 120 A/R days.

49. For ASCs with three to four ORs, average ENT revenue is $1,734 per case.

50. Average GI/endoscopy revenue per case for medium-sized ASCs is $776.

51. Orthopedics revenue per case for three- to four-OR ASCs is $2,617.

52. Average general surgery revenue per case for medium sized ASCs is $1,721.

53. For ASCs with three to four ORs, average ophthalmology revenue is $1,249 per case.

54. Average plastic surgery revenue per case for medium-sized ASCs is $1,516.

55. Podiatry revenue per case for three- to four-OR ASCs is $2,021.

56. For medium sized ASCs, average OB/GYN revenue per case is $1,958.

57. Average pain management revenue per case for three- to four-OR ASCs is $890.

58. Revenue per case for urology procedures in medium-sized ASCs is $1,476.

59. ASCOA centers have a goal of low-to-mid 30s for A/R days out. 10

Clinical benchmarks

60. 89 percent of patients wait at least a month after scheduling cataract surgery before undergoing the procedure.11

61. 96 percent of patients are able to schedule their cataract surgery at their desired time in the ASC.

62. 94 percent of patients resume daily living within a week of undergoing cataract surgery.

63. 94 percent of patients reported improved vision after cataract surgery in an ASC.

64. 98 percent of patients say they're comfortable while undergoing cataract surgery in the ASC and 99 percent are comfortable after discharge.

65. 99 percent of patients report they would recommend cataract surgery after undergoing the procedure in an ASC.

66. Pre-procedure time is 81 minutes for cataract surgeries.

67. Procedure time for cataract surgeries in ASCs is 14 minutes.

68. Discharge time for cataract surgeries is 21 minutes.

69. 77 percent of colonoscopy patients report little or no discomfort during bowel preparation. 12

70. 81 percent of colonoscopy patients wait less than a month between scheduling their colonoscopy and having the procedure.

71. 98 percent of colonoscopy patients report being comfortable after discharge.

72. 99 percent of colonoscopy patients report little or no discomfort during the procedure and would recommend it to others.

73. 100 percent of colonoscopy patients report understanding the procedure.

74. Colonoscopy procedure time is nine to 29 minutes.

75. Pre-procedure time for colonoscopy is 17 to 129 minutes, covering patient check-in to scope insertion.

76. Colonoscopy discharge time is 15 to 75 minutes for ASCs.

77. Pre-procedure time for knee arthroscopy is 88 minutes, and organizations with shortest times attribute results to calling patients the day before to remind them of the appointment and pre-procedure requirements.13

78. Knee arthroscopy procedure time is 28 minutes in the ASC.

79. Discharge time for knee arthroscopy is 75 minutes in the ASC, and organizations with short discharge times attribute results to having patients leave the operating room as they are waking up to assess their comfort level as soon as possible.

80. 75 percent of knee arthroscopy patients wait less than a month for their procedure after scheduling.

81. 89 percent of knee arthroscopy patients are able to schedule the procedure as soon as they wanted in the ASC.

82. 99 percent of knee arthroscopy patients say they are comfortable post-discharge in the ASC.

83. Pre-procedure time for low back injections is 43 minutes, and organizations with the shortest discharge times attribute results to not using or using low levels of sedation or controlling the type and amount of medication administered. 83

84. Procedure time is seven minutes for low back injections in the surgery center.

85. Discharge time after low back injections in the ASC is 22 minutes, with a range of one to 42 minutes.

86. 90 percent of patients wait less than a month from scheduling their low back injection to undergoing the procedure in the ASC.

87. 93 percent of patients say they are able to schedule their low back injections in an ASC within a "reasonable" period to time.

88. 85 percent of patients report returning to daily activities after undergoing low back injections in ASCs.

89. 80 percent of patients say they experienced less pain after the low back injections, and 50 percent reduced pain medications after the procedure.

Growth benchmarks

90. 100 percent of surgery center management companies in the HealthCare Appraisers 2013 ASC Valuation Survey found orthopedics/sports medicine a desirable specialty. 15

91. 94 percent of ASC management companies find orthopedic spine a desirable specialty in 2013.

92. 94 percent of ASC management companies find ENT desirable in 2013.

93. 88 percent of ASC management companies find general surgery desirable in 2013

94. 88 percent of ASC management companies find pain management desirable in 2013.

95. 82 percent of ASC management companies find gastroenterology a desirable specialty in 2013.16

96. There were 113 new Medicare-certified ambulatory surgery centers in 2012.

97. Medicare made $3.5 billion in payments to ambulatory surgery centers in 2011.

98. There were 5,344 Medciare-certified ambulatory surgery centers in 2011, up 1.8 percent over the previous year.17

99. Between 2001 and 2011, the number of ambulatory surgery center operating rooms doubled in the United States and in 2011, 60 percent of hospitals had an ASC within five minutes of their facility. 18

100. Objective Health predicts that procedure volumes for cases such as shoulder arthroscopy, which Medicare paid ASCs 42 percent lower than hospital outpatient departments in 2012, will continue to increase in ASCs.

Endnotes:

1. VMG Multispecialty ASC Intellimarker 2011.
2. Based on benchmarks provided by ASCOA
3. 2011 supply chain survey from Provista.
4. 10 Statistics on Surgery Center Case Volume based on VMG Multispecialty ASC Intellimarker 2011.
5. ASC Association's Outcomes Monitoring Project 2nd Quarter 2010 Report
6. 2011 supply chain survey from Provista.
7. RemitData, based on 25 percent of all national outpatient remittances from September 2012.
8. RemitData, based on data collected between Nov. 5, 2012 to Feb. 11, 2013.
9. VMG Multi-Specialty ASC Study 2011 Intellimarker
10. Benchmarks provided by ASCOA
11. Benchmarking study from AAAHC based on clinical studies of cataract extraction surgeries with lens insertions. The study includes 92 organizations with a combined 170,000 cataract surgeries per year.
12. Benchmarking study from AAAHC on clinical findings for colonoscopy from 100 organizations performing 353,300 colonoscopies between July and December 2012.
13. Benchmarking study from AAAHC on clinical findings for knee arthroscopy in the ASC based on data from 41 organizations that perform a combined total of 9,190 knee arthroscopies annually. The study was conducted between July and December 2012.
14. Benchmarking study from AAAHC on clinical findings for low back pain in ambulatory care settings based on data from 31 organizations that perform a combined total of more than 64,890 low back injections annually. The data was collected between July and December of 2012.
15.  HealthCare Appraisers 2010 ASC Valuation Survey and 2013 ASC Valuation Survey.
16. MedPAC Health Care Spending and the Medicare Program June 2013 Report.
17. March 2013 Report to the Congress: Medicare Payment Policy.
18. Objective Health Infographic: The Increased Competition of Ambulatory Surgery Centers (ASCs) to US Hospitals.

Source: http://www.beckersasc.com/lists/100-surgery-center-benchmarks-statistics-to-know.html

Monday, September 9, 2019

Most common deficiencies for AAAHC-ASC

Most common deficiencies for AAAHC Chapter 2 “Governance”, Subchapter I “General Requirements” In order to avoid deficiencies for Governance I, the governing body must meet a minimum of once a year and keep documented minutes. Most centers have a board that meets and keeps minutes; however, the minutes must include an annual review of the items below. Minutes lacking this approved list is the most common deficiency surveyors see for Subchapter 2.I: 1. Rights of Patients 2. QI Management & Improvement Program 3. Infection Prevention and Control Program 4. Annual Safety Program 5. Policies and Procedures 6. Scope of Care 7. Job descriptions for officers such as Director, Administrator, and Medical Director These items are simple to add to the annual board minutes and also meet Standard G: Annual Review of AAAHC accreditation requirements. Another often deficient Standard is D that requires: “Within 15 Calendar days of significant organization ownership, operational, or quality of care events, the organization notifies AAAHC of the event in writing.” Some organizations fail to let AAAHC know when: 1. The name of the organization changes 2. Majority ownership changes 3. Re-location of the center or an addition in number of ORs 4. Anesthesia level change from MAC to General 5. Change from single specialty to multi-specialty 6. Change in management company or administrator Kristine Mighion

Tuesday, May 14, 2019

Want some help with those tasking jobs like eye wash station weekly checks?

We have developed some easy to use ticket like documents for you to quickly and easily manage those tasks that haunt us all in being compliant.  Try these out by downloading or saving the image file and printing them up and see if this makes it more fun for the staff in order for you to get optimal compliance.  See these images below:




Tuesday, April 30, 2019

Changes to the NFPA 99 that you need to know about today!

NFPA 99 Healthcare Facilities code provides performance criteria for healthcare facilities that follow a risk-based approach, where it is the risk posed to patients, staff or visitors, that defines safety guidelines. The main criteria of the Code's scope is to keep healthcare facilities up-to-code with its occupants safe.

"What Applies to My Facility"? 



Understanding and interpreting an NFPA code can often leave facility manager’s
scratching their head. Requirements are not always so black and white and
determining which edition of the NFPA code applies to your facility can be a
frustrating endeavor.
 
Moreover, once the correct interpretation of the code has been established, there is still the question of its application to your individual scenario. Risk assessments must be performed to determine the correct category and level of care provided and the corresponding application.
 
Applying NFPA 99 varies depending on the level of care required and provided. 

NFPA 99 (Recent History 

Since July 5, 2016 the Centers for Medicare and Medicaid Services (CMS) has
adopted the 2012 edition of NFPA 99. From a medical gas compliance perspective, this is the edition to which facilities are held accountable.
 
However, since NFPA 99 is not intended to be a retroactive code, only select portions of NFPA 99-2012 shall apply to systems existing prior to the July 5, 2016 adoption. Specifically, the inclusion of NFPA 99-2012 Tentative Interim Amendment (TIA) 12-4, outlines the sections that apply to both new and existing construction.
 
Similarly, much of the criteria in TIA 12-4 can also be found in The Joint Commission Hospital Accreditation Standard, EC.02.05.09. It should be noted, however, that individual AHJ’s (authorities having jurisdiction) are permitted to adopt subsequent editions of NFPA 99 for the purposes of new construction.

Annual Evaluation of Medical Gas System 

When performing an annual evaluation of your medical gas system, it is important
to know which sections of NFPA 99 apply. This will require a thorough understanding of your risk category, as well as historical knowledge of your facility since any pipeline alterations, renovations or modernizations may impact the application.
 
For example, if an older facility had a portion remodeled and the pipeline is breached, the area in the immediate vicinity would need to be installed to the most recently adopted edition of NFPA 99 for that jurisdiction.
 
Conversely, the older portions of the systems not meeting the 2012 edition may still be acceptable to the AHJ as long as their continued use does not present a distinct hazard to life. In either scenario, a comprehensive understanding of your facility and its relationship with NFPA 99 is vital.
 
Knowing which sections of your facility may require upgrades can be beneficial for infrastructure budgeting, and ensuring the smooth operation of your medical gas system for years to come.

Current NFPA 99 HealthCare Facilities Code - 2018 Edition  

Changes in the 2018 edition help you work more efficiently to ensure healthcare safety.  
Here are some of the details that will be required under the NFPA 99-2018 code that are different from earlier versions. Cites are from the code currently.

1. Oxygen Concentrators

Chapter 5 includes requirements that now allow for the use of oxygen concentrators as central supply sources for piped medical gas systems. 5.1.3.5.11* Oxygen Concentrator Supply Units.
5.1.3.5.11.1 states Oxygen concentrator supply units for use with medical gas pipelines shall produce oxygen meeting the requirements of Oxygen 93 USP or Oxygen USP.
What it means...
The 2018 edition adds requirements for onsite oxygen production by a concentrator. Oxygen concentrators are and continue to be, limited in use for most facilities in the United States. Remote areas, such as Hawaii, Alaska, and other island territories implementing NFPA 99 will now have some guidance on their use.
Background on why that change has been made...
The technology behind these supply sources is nothing new and their use has previously been part of the ISO Standard, but is now addressed by NFPA.
How the change may impact the present or future design of medical gas and vacuum systems...

Ultimately, this addition to the 2018 code will have little to no impact on most facilities within the United States since a majority of hospitals are supplied by a traditional cryogenic fluid central supply system (previously referred to as a bulk cryogenic liquid system).

2. Vacuum Filtration 5.1.3.7.4

The detailed requirements for vacuum filtration are defined in the code. The filters are required to be as efficient as HEPA (0.3μ (microns) and 99.97% high efficiency)
What it means...
 
Medical-Surgical Vacuum Central Supply Systems now require inlet filtration on
the patient side of the vacuum producer.
 
Background on why that change has been made...
 
While the science is still out and more data is required, there has been a
concern that infectious or other hazardous materials may be transmitted from
the patient terminal back to the supply source. The addition of this filtration is
to alleviate some of those potential concerns.
 
How the change may impact the present or future design of medical gas and vacuum systems...
 
Manufacturers will need to incorporate these filtration requirements into the
design of their new vacuum systems. 

3. Corrugated Medical Gas Tubing

5.1.10.1.4 Corrugated medical tubing (CMT) is now a permitted material for medical gas and vacuum systems.
What it means...
The additional inclusion of corrugated medical tubing will allow installers another piping option, particularly for difficult installations. Ease of installation, reduced cost, and less chance of contamination are benefits that are invaluable for healthcare facilities. CMT is a fabricated tubing with flexibility making it ideal for retrofits and new construction.
Kevin Hoben, OmegaFlex® CEO, a global manufacturer of metal hoses, says
"Copper tubing has always been costly to install with countless brazed sections that make a system vulnerable to leaks and contamination. MediTrac comes in one, long length to eliminate hotwork, and its unique design makes it easy to bend as needed to fit a space." 
MediTrac is fully compliant with NFPA 99 (2018) code. 
Background on why that change has been made...
This is a new technology for medical gas piping.
How the change may impact the present or future design of medical gas and vacuum systems...
Corrugated medical tubing's usage can be beneficial, particularly for the installation of positive pressure piping in pre-existing construction. It can reduce the number of installed joints and aid in installations where space or brazed joints can be difficult.
How to implement the change...   
Contact your installer to see if CMT tubing would be beneficial to your next project.

4. The Addition of Chapter 15: Dental Gas and Vacuum SystemsThis chapter was added specifically to dental gas and vacuum systems to address their precise needs.  

What it means...
With the previous changes to NFPA 99, particularly as it relates to the change from an occupancy-based document to a risk-based standard, there were some issues with requirements for dental facilities, which were historically addressed as a Category 3 system.
Background on why that change has been made...
 
Since Category 1 procedures can be performed in a dental setting,
the need for an expanded chapter was necessary. Now, within a dental setting,
NFPA addresses Categories 1-3.
How the change may impact the present or future design of medical gas and vacuum systems...
This change will allow for a more detailed understanding and implementation of NFPA 99 for all manner of dental system installations.  

5. "Governing Body" Wording

In addition, we are seeing a global change in the 2018 edition. 

In addition, we are seeing a global change in the 2018 edition. 
The term "governing body" is changed to "healthcare facility's governing body". This is to help clarify or highlight the intent. Governing body represents the people who are responsible for the operation of the healthcare facility.   

Sunday, April 21, 2019

Nursing Shortages in the hospital will soon hit the ambulatory surgery centers, are you ready?

In Denver, 78-year-old Mary Heidenreich died when a nurse who had
flunked a medication competency test accidentally gave her a fatal dose of
intravenous drugs.

In Wichita, Kan., 38-year-old Deedra Tolson bled to death after an
emergency hysterectomy when her nurse, busy caring for 12 other patients,
failed to hear her feeble cries for help.

In Alliance, Ohio, 30-year-old Lisa Vitale was waiting to give birth when she
felt searing pain rip through her abdomen. An overworked nurse misread
Vitale's fetal monitoring strip and failed to notice that her baby was in
acute distress. Born hours after an emergency cesarean section could have
saved his health, Vitale's son suffered severe brain damage that left him
unable to drink from a bottle and required round-the-clock medical care.

In Florida, William T. Fain, 80, fell, hit his head, suffered brain damage and
died two weeks later, an autopsy report said all while under the care of an
agency nurse at Westside Regional Medical Center. Fain came to the ER
after a seizure on Super Bowl Sunday in 2006, his family said in a
negligence suit filed last month. Doctors ordered nurses to send Fain to the
ICU and, in the interim, take steps to prevent him from falling from his bed,
the suit said. They were to put up bedrails, lower the bed and check him
more often. The agency nurse on his case did none of those steps, the suit
said. After he spent 12 hours in the ER, and shortly after his family left for the
evening, nurses found Fain on the floor. He fell, hit his head, suffered brain
damage and died two weeks later, an autopsy report said.

Realizing all of these incidents were Acute Care related, how long can we dodge
this National Nursing Shortage in the Ambulatory Care setting?

• No matter what your historical staffing vacancy rates have been, it
is time we all begin to plan for the inevitable. Fewer nursing students are entering the field than vacant positions are needing to be filled. According to the Nurses Coalition, only one spot
out of ten vacancies are being filled by nursing graduates, leaving a 90% vacancy rate that often times than not, they are filled by temporary staff, agency staff, or just left with an open schedule and no nursing hours to give to the patient as they deserve.

Let's put together our great minds, let's join together to think outside this box we've known to achieve the unknown, and unchartered territory.  Ideas, thoughts, out there thoughts, please leave them for us in the comment sections of this blog.  Thank you. 

Friday, April 19, 2019

The checklist for patient and staff safety, do this every morning before the first surgical case.

  • OR temps and humidity levels are within acceptable ranges.
  • Medical gases levels are adequate.
  • Refrigerators and freezers where medications are stored maintained their temperatures overnight.
  • OR doors are fully closed, not propped open.
  • Electronic access doors are functioning properly.
  • Hallways are clear of obstructions.
  • Fire extinguishers are easily accessible.
  • Crash carts have been tested and are fully stocked.
  • All lights within the department are on and are working properly.
  • Cords in ORs are out of walking pathways or safely covered.
  • Sharps containers aren't filled to capacity.
  • Headcovers, shoe covers, face masks and eye shields are readily available.
  • Hand soap and antiseptic dispensers are full.

By doing these simple rounds of items that should be checked before the beginning of every surgery day, you add an enormous amount of patient safety and staff safety to the layer of work that is worth its weight in gold.

Friday, April 5, 2019

California has removed the Moratorium on new Durable Medical Equipment Companies Enrollment!

Discontinuation of the Moratorium on the Enrollment of Durable Medical
Equipment Providers Located Outside of California and in Los Angeles, Orange,
Riverside and San Bernardino Counties.

The Department of Health Care Services (DHCS) ended the moratorium on the
enrollment of durable medical equipment (DME) providers located outside of California
and in Los Angeles, Orange, Riverside and San Bernardino Counties on
February 23, 2019.

This bulletin provides information for DME applicants in the affected
counties applying for enrollment in the Medi-Cal Fee-For-Service Program during the
six-month period following the expiration of the moratorium.


Title 42, Code of Federal Regulations (CFR), Section 455.450(e)(2), and Welfare and
Institutions Code (W&I), Section 14043.38(b)(4), specify that a provider that would have
been prevented from applying for enrollment due to a moratorium that has been lifted in
the past six months, be screened at the “high” categorical risk level.

In addition, the Centers for Medicare and Medicaid Services (CMS) currently designates
all newly enrolling DME suppliers as a “high” categorical risk, subjecting all new DME
applicants to fingerprinting for criminal background checks. (Title 42, CFR §§ 424.518,
455.434, and 455.450).

A “high” risk screening requires a provider or applicant to submit proof that fingerprints
for all the required individuals have been submitted to an authorized State Identification
Bureau (Bureau of Criminal Information and Analysis, Department of Justice [DOJ] in
California). Providers and applicants must attach a copy of a prefilled DOJ Request for
Live Scan Service (BCIA 8016) form for each required individual with their application,
date stamped and show verification that all fees have been paid, by either a “PAID”
stamp from the public Live Scan operator or a receipt of payment.

For more detailed information on which individuals are required to submit fingerprints,
please review the Information Bulletin Regarding Medi-Cal Requirement to Submit
Fingerprints for a Criminal Background Check.

If you are a currently enrolled DME provider that is not located out-of-state or in one of
the counties that were subject to the moratorium, you do not need to be screened as
“high” risk.

Additionally, if you are a currently enrolled DME provider and you would have met one
of the exemptions listed below, you do not need to be screened as “high” risk but you
must submit a cover letter with your application advising which exemption you meet and
include any necessary supporting documentation.

1. DME applicants who for the purpose of the Medi-Cal Program choose to be
enrolled for medically necessary lactation aids. DME providers of lactation aids
shall be reimbursed for items mentioned in the Medi-Cal Provider Manual for
Lactation Management Aids [found in Durable Medical Equipment (DME): Bill for
DME (dura bil dme)];

2. DME applicants who for the purpose of the Medi-Cal Program choose to be
enrolled as Customized Wheelchair DME (CWDME) providers and/or Oxygen
and Respiratory Equipment DME (OREDME) providers;

a. CWDME providers shall sell, service, and/or repair customized
wheelchairs as medically necessary for Medi-Cal beneficiaries. An
enrolled CWDME provider shall be reimbursed for items authorized in the
Medi-Cal Provider Manual for wheelchairs, modifications and accessories.

b. OREDME providers shall sell, service, and/or repair Oxygen and
Respiratory Equipment. An enrolled provider shall be reimbursed for items
authorized in the Medi-Cal Provider Manual, under the Oxygen and
Respiratory Equipment Group and deemed medically necessary for
Medi-Cal beneficiaries.

3. Current Medi-Cal enrolled DME providers seeking to add a new business
location in the same county, so long as the DME provider enrolled in the program
after October 12, 1999 and is not adding new business activities, categories of
service or billing codes other than those approved for enrollment at its existing
location;

4. Applicants who will be enrolled solely for reimbursement of Medicare cost-sharingamounts;

5. An application that is submitted because an existing Medi-Cal enrolled DME
provider, which is part of a group of affiliated corporations (as defined by Cal.
Corporations Code, Section 150), is transferring its assets to an affiliated
the corporation that is a part of the same group of affiliated corporations;

6. An application that is submitted because an existing Medi-Cal enrolled DME
provider, who is an individual operating as an unincorporated sole proprietorship,
has incorporated that sole proprietorship, with all of the existing issued shares of
the new corporation is owned by that individual who is also the president of
the new corporation;

7. An application that is submitted because there has been a cumulative change of
50 percent or more in the person(s) with an ownership or control interest in an
existing Medi-Cal enrolled DME provider provided that the change only consists
of a reorganization or consolidation among existing person(s) previously
identified in the last complete application package that was approved for
enrollment as having an ownership interest in the provider totaling 5 percent or
greater;

8. Applications submitted pursuant to California Code of Regulations, Title 22,
Section 51000.55 or Section 51006, Subparts (a)(1), (a)(2), (a)(3) or (a)(5);

9. Applications submitted pursuant to California Code of Regulations, Title 22,
Section 51000.30(b)(3) provided that there is no change in the person(s)
previously identified in the last complete application package that was approved
for enrollment as having control or ownership interest in the provider totaling
5 percent or greater;

10. Applications submitted pursuant to California Code of Regulations, Title 22,
Section 51000.30(a) only because an existing Medi-Cal enrolled DME provider
has changed its location provided that its previous business was located in one
of the following counties: Los Angeles, Orange, Riverside, or San Bernardino and
is not adding new business activities, categories of service or billing codes other
than those approved for enrollment;

11. Applicants that are the only person or entity in the United States that provides
specific product or service that is a Medi-Cal covered benefit; or,

12. DME applicants who, for the purpose of the Medi-Cal program, choose to enroll
to provide only the services and/or replacement parts for a Medi-Cal covered
device for an enrolled Medi-Cal beneficiary, when those services and/or parts are
not available from an enrolled Medi-Cal provider on the date of application.
You are required to be screened at the “high” categorical risk level and submit
fingerprints for a criminal background check if any of the following apply:

1. If you are a newly enrolling DME provider;
2. If the Department determines that you do not meet an exemption; or
3. If you do not want to go through an exemption review.

Failure to submit fingerprints for a criminal background check when required will result
in the denial of the application package. (42 CFR § 455.416; W&I Code §
14043.26[f][4][E])

Additional information about the Medi-Cal requirements for submitting fingerprints is
available in the Information Bulletin Regarding Medi-Cal Requirement to Submit
Fingerprints for a Criminal Background Check.

If you have any additional questions, please contact the Provider Enrollment Message
Center at (916) 323-1945 or submit your question via e-mail to PEDCorr@dhcs.ca.gov.

Friday, March 15, 2019

Surgery Centers meeting CMS requirements as it relates to Generators/Emergency Power Back UP Systems

To meet CMS’ Life Safety Code requirements, facilities are required to have one of two types of emergency power systems. This can be in the form of either a generator that takes fuel (like diesel) or battery system - mentioned below. The two categories are Type 1 and Type 3.  

The easiest way to think about it is if a facility is performing any kind of procedure that has general anesthesia where a patient may be put on a ventilator, then Type 1 is required.  In this scenario, the ventilator needs power no matter what or the patient may be in danger.  In the case of sedation where a patient is continuing to breath unassisted, the patient will not be in immediate danger if there is a power failure, so minimum Type 3 is required (Type 1 could be provided, it would just be going above and beyond).


Type 1
Type 3
What is on emergency power
Emergency lighting, nurse call, fire alarm, equipment for procedures (usually red outlets); typically enough for facility to stay in (almost) full operation.
Emergency lighting, fire alarm, designated outlets and/or equipment
Duration
Minimum 4 hours
Either 90 minutes, or as long as it would take to stop the procedure, whichever is longer

Having said this, there are battery packs with 4 hour durations.

So, the facility needs to make the determination that will provide for the greatest patient safety based on its procedures and patients.
 

Thursday, February 28, 2019

The Uber Driver and an outpatient surgery center patient. Hear Ye, Hear Ye!

Before you go and get all up in excitment for all those patients that got cancelled because they had no one to drive them home, I throw a wrench or two into your irrational thinking.

First of all, let us divide the patients that undergo local anesthesia procedures versus the ones that have IV Sedation and up to General Anesthesia.  For the clarification, patients that undergo local anesthesia only, these patients DO NOT need to be driven home or have an adult remain with them for 24hours post op.

Now, let's talk sedation and all the things in between it and general anesthesia.  Foremost, the definition of how the state of California defines what can and cannot be done in an outpatient surgery center that does not possess accreditation or Medicare Certification is this, "Anytime a medical procedure is performed under anesthesia that places patients at risk of losing their life-preserving protective reflexes, the medical procedure must be done in a licensed, certified, or accredited setting."

Now let us look at the accreditation standards for anesthesia and going home alone and or driving themselves home postop.  The consistency between all accrediting firms is that if the patient receives any sedation at all, anything other than local anesthesia, then the patient must be driven home and not allowed to drive themselves.  Point #1.

Any patient that receives anesthesia considered deep sedation, mac, or general, and all the ones in between, these patients should not be allowed to be home alone for the first 24 hours.  Point #2.

Either one of these rules in accreditation standards requires that there be an order from the physician that orders and allows the deviation from the standard by showing the physician physically assessed them and finds them to be stable and resolved of any side effects from the anesthesia to where they can either drive themselves and/or supervise themselves postop the first 24 hours.

It would be feasible to assume that the Governing Body would and could make it part of the facility policy that local cases can drive, uber, be driven by friend, any of the above.  While they also could be alone the first 24 hours.  Everything other than local, then this should be a case by case situation depending on the patient, their living situation, their age, their cognitive abilities, etc. postop.

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