An Update: Joint Commission Standards and CMS Regulations

1. An Update: Joint Commission Standards and CMS Regulations OR Manager Annual Meeting John R. Rosing, MHA, FACHE Jennifer Cowel, RN, MBA Patton Healthcare Consulting September 23, 2013 Baltimore, Maryland

2. Speaker John R. Rosing, MHA, FACHE • Accreditation and Regulatory Compliance Consultant • Vice President and Principal Patton Healthcare Consulting • 262-242-3631 • JohnRosing@PattonHC.com

3. 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

4. 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

5. 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

6. 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

7. QUESTIONS? JohnRosing@PattonHC.com JenCowel@PattonHC.com Kurt@PattonHC.com Please visit and bookmarkwww.pattonhc.com