an update: joint commission standards and cms regulations or manager annual meeting john r. rosing,...

An Update: Joint Commission Standards and CMS Regulations

OR Manager Annual MeetingJohn R. Rosing, MHA, FACHE

Jennifer Cowel, RN, MBAPatton Healthcare Consulting

September 23, 2013Baltimore, Maryland

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SpeakerJohn R. Rosing, MHA, FACHE

Accreditation and Regulatory Compliance Consultant

Vice President and Principal Patton Healthcare Consulting

262-242-3631

JohnRosing@PattonHC.com

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Sentinel Event Alert #49Safe Opioid Use - Risk Factors

• Hx of sleep apnea or snoring• Smoker• Morbid obesity• Older age (>80 has almost 9X > risk)• No recent opioid use///opioid habituation• Concomitant use of benzodiazepines, antihistamines,

sedatives or other CNS depressants• Post surgical, notably abdominal///thoracic• Longer anesthesia times• Pre-existing pulmonary or cardiac disease

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Safe Opioid Use

• State Board of Medicine – Massachusetts– 27 incident reports since 2007– 77% concomitant morphine or lorazepam– 23% of patients were obese– 19% had sleep apnea– 15% asthma– 15% some other chronic respiratory condition– > age 60, female, most likely on night shift

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Safe Opioid Use – Actions Taken• Eliminate range orders for dose and time• Lower dose hydromorphone purchased• Eliminate Pyxis override for hydromorphone• Educate staff on 8:1 dose conversion between

morphine and hydromorphone• Specific privileging for hydromorphone ordering• Discourage hydromorphone use for outpatients• Closely monitor patients with known risk factors

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Safe Opioid Use - Key Recommendations

• Use conversion support systems when converting from one opioid to another or one route of administration to another.

• Use a sedation monitoring scale such as RASS, Pasero POSS or University of MI.

• As with any SEA, have paper trail showing consideration of recommendations and actions taken, plus subsequent QAPI

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QUESTIONS?

JohnRosing@PattonHC.com JenCowel@PattonHC.com

Kurt@PattonHC.com

Please visit and bookmark www.pattonhc.com

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