How ASCs can tackle the most challenging accreditation standards: 3 Qs with Dr. Naomi Kuznets

Infection prevention, safe injection practices, privileging, credentialing and documentation management were the most common deficiencies cited in ambulatory quality studies last year, according to the Accreditation Association for Ambulatory Health Care 2019 quality roadmap.

Naomi Kuznets, PhD, vice president and senior director of the Institute for Quality Improvement for the association, weighed in on the findings of this year's report.

Note: Responses have been lightly edited for style and clarity.

Question: What resources can ASCs use to increase compliance with the challenging standards outlined in the report?

Dr. Naomi Kuznets: The first step may be reading the reasons why this is an issue and tips for compliance in the report itself.

The AAAHC also offers a variety of resources to help with compliance for various high deficiency standards (such as safe injection practices, medication reconciliation and allergy documentation). These include e-learning and webinar opportunities, patient safety toolkits and studies. There are also the in-person achieving accreditation meetings which are held quarterly.

Q: The report says that the deficiencies this year are similar to those from last year — why do you think that is?

NK: While many of the high deficiency standards continue to appear from year-to-year, we are seeing lower overall deficiency rates with certain standards such as conducting quality improvement studies and scenario-based drills.

Some standards are more complex and require understanding of the issue being addressed. For example, safe injection practices include very explicit guidelines on how to use and handle single-dose versus multidose vials.

Similarly, allergy documentation means not just documenting which allergies/sensitivities a patient has, but also the nature and severity of the reaction to the allergen. Credentialing and privileging means conducting credentialing and privileging for all providers, including allied healthcare providers.

Quality improvement includes several elements, and some of these are not necessarily intuitive for some providers/administrators. An example is setting a measurable performance goal. Some organizations are not familiar with scenario-based (acted out) emergency drills, as opposed to "desktop" (discussed) drills.

These standards may also be associated with a certain level of diligence and detail. For example, credentialing and privileging has to be done at certain intervals. A specific number of emergency drills also have to be completed at certain intervals in addition to the requirement of documenting how the emergency drill proceeded and any need for corrective action to improve the drill. Medication reconciliation and allergy documentation must be done at every visit and should be done in the same place in the patient record every time.

Q: To what do you attribute the improvement seen this year in the non-Medicare and Medicare deemed status standards?

NK: For both non-Medicare and Medicare ASCs, increasing compliance with healthcare professionals' use of emergency equipment and a safe evacuation plan may be associated with a greater understanding of the importance of these through both educational resources from AAAHC (there are emergency drills toolkit and webinars on these), the increasing numbers of natural and manmade disasters and media coverage of instances where these have 'gone wrong.'

For Non-Medicare ASCs, the increasing proportion of millennials in the workplace, as well as increased resources from AAAHC, may have fostered a better understanding of the importance of ongoing staff development and improvement.

For Medicare ASCs, AAAHC resources (including the endoscope reprocessing toolkit) and public knowledge of failures associated with new devices and products may have increased compliance with standards on providing appropriate education to operators of newly acquired devices and products.

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