Becker's ASC Review spoke with Naomi Kuznets, PhD, vice president and senior director of the Accreditation Association for Ambulatory Health Care's Institute for Quality Improvement about the top deficiencies cited in this year's AAAHC Quality Roadmap, and how ASCs can improve.
Note: Responses have been lightly edited for clarity and style.
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Here are the insights Dr. Kuznets shared:
Question: According to the AAAHC Quality Roadmap, credentialing, privileging, peer review, documentation and quality improvement are the most common deficiencies for organizations. Why do you think deficiencies in these areas are the most common, and what can ASCs do to improve?
Dr. Naomi Kuznets: With regard to credentialing and privileging, the organization needs to check all health care providers. It makes sense to have credentials for both nurses and physicians, but if an organization doesn't have them for all health care providers, that would be an issue, as well as if they don't check regularly enough.
It helps to keep up with these standards to make sure that you have all the information you need, including the correct primary and/or secondary source verification. If a hospital privileges someone, that doesn't mean the ASC can rely on this. You have to do your own due diligence with regard to credentialing and privileging.
AAAHC standards aren't always intuitive and becoming compliant can take a lot of time and energy, but they're things organizations need to be aware of because they are important for ongoing patient care and for preparation before surveys.
Q: Deficiencies in infection prevention and safe injection practices are also two areas cited in the report. What standards are ASCs missing in these areas, and how can they stay compliant?
NK: One thing that we know overall is that health care providers specifically and the public in general are not very good at hand hygiene. It's been an issue in health care overall, not just ASCs. When it comes to safe injection practices, some guidelines are very straightforward like using a new sterile needle and a new syringe every time a provider administers an injection. Other safe injection practice guidelines are more complex especially when using multi-dose vials (MDVs). The safest thing to do is restrict each medication vial to a single patient, even if it is a multi-dose vial. Proper aseptic techniques including cleaning the septum and using a new sterile needle and syringe must always be followed. If multi-dose medication vials (MDVs) are used for more than one patient, a new sterile syringe and needle must be used each time the MDV is accessed. Additionally, the MDV must be opened and drawn in a clean area away from patient care [rather than] opening it in the exam or procedure room. For most medications, the medication should be drawn only for “immediate” (within an hour) use.
In surgery centers, because of convenience, the practice was to bring medications back and forth from a clean area into a patient care area on an anesthesia cart. If it's something that's supposed to be used or drawn in a clean area like a multidose vial, what you've done is you’ve made that multidose vial into a single-dose vial, by pulling the medication in a patient care area, Therefore, the MDV must be discarded after use on the one patient even if there is medication left in the vial.
Surgery center staff are very efficient. One of their efficiencies may have been to pull and prefill a bunch of syringes at once. The guidelines are if you fill the syringe, you should be using it immediately or at least within an hour unless the medication manufacturer says otherwise. Filling up all those syringes the night before the day of surgery is not a good idea, and it's something that guidelines speak out against. Many organizations need to familiarize themselves with what is acceptable and what isn't.
Q: What are some ways ASCs can adopt infection prevention and safe injection practices?
NK: Following guidelines shouldn't slow down turnarounds. If you have a clean area away from patient care, you should be able to pull a medication and use it within an hour at the very latest. Yes, ASCs try to be as efficient as possible, but how many syringes and other supplies would a center have to throw away if not used in a timely manner?
AAAHC has webinars and toolkits on these subjects. One of the biggest parts of staying compliant is familiarizing yourself with the key issues so that you don't fall into the trap of doing things the wrong or “old” way and not being the best ASC you can be.
Q: What are AAAHC-accredited organizations doing right in terms of compliance?
NK: ASCs are complying with most standards, and even the deficiencies we detail in the report only account for 10 to 20 percent of the total number of organizations being reviewed by the AAAHC.
What the report highlights is that compliance with these standards is not always easy, and ASCs should be paying attention to AAAHC standards because they're important for the best patient care. ASCs are not alone if they're having trouble with issues, such as credentialing and privileging or safe injection practices.
There are ways to deal with credentialing and privileging, for example, using tracking systems to make sure everyone comes up for review and verification of their credentials at the right time. With safe injection practices, everybody needs to be on the same page and use a new needle and a new syringe every time. The AAAHC has webinars and toolkits to help organizations comply with high deficiency Standards.
There are a number of our standards where we have 100 percent compliance, and those include standards you want to see high compliance in. For example. [we see high compliance in] making sure a patient understands what services the organization offers, providing timely consultations and referrals, and having policies on patient transfer in place in the event of an emergency.
Q. What do you hope ASCs and other healthcare organizations will take away from the report?
NK: What I would really love to see is organizations looking at their last survey report or, if they're going into or considering being surveyed, looking at the AAAHC Quality Roadmap 2018 and identifying if the deficiencies cited are the same issues they're having. The Quality Roadmap allows organizations to look closely at what surveyor remarks are in regard to the issues they may have and inform them about the tools that AAAHC offers to help with compliance.
