april 2013

Zero Tolerance for Workplace Violence paGe 1 & 6

STeriliZaTion: cleaninG and packaGinG paGeS 1-2

all aboard The hipaa buS! paGe 3-4

Globally harmoniZed SySTem of claSSificaTion and labelinG of chemicalS TraininG. paGe 5

SiGn-in SheeT paGe 7

888.862.6742www.totalmedicalcompliance.com

in this issue Zero Tolerance for Workplace ViolenceWith a world full of policies and regulations, workplace safety is another one of those better-safe-than-sorry areas of management where prevention is critical. As defined by NIOSH, workplace violence is, “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.” Under OSHA’s General Duty Clause, employers are responsible for providing a place of employment that is free from recognizable hazards that cause or are likely to cause death or physical harm to employees. It is recommended that employers establish a Violence Prevention Program.

How do you establish a program? It starts with a zero tolerance policy. A zero tolerance policy can be defined as a policy that allows no exceptions and sends a clear message to all involved that there are consequences for violent actions. It should apply to employees, patients, vendors and anyone else you may come in contact with of compliance with the omnibus HIPAA rules.

As a healthcare worker, you are considered to be at high risk; therefore, it is also important to recognize what may put you in harm’s way. Analyze your work environment; think about your risk factors. Do you have narcotics or large amounts of cash in the office? Are your parking lots well lit? Are you in a high crime location or have unrestricted visitor access?

The American Medical Association outlines 5 strategies physicians should utilize when providing care to patients recently discharged from the hospital. Click here to read more

Efficacy of the influenza vaccine leads the CDC direction to say, “we simply need a better vaccine against influenza, one that works better and lasts longer.” Click here to read more

If you like this type of update, please check out our Facebook, LinkedIn, blog and Twitter accounts. We are striving to provide you important compliance information and industry updates real time!

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aWeSome

TMC Survey of The MonTh - free T-ShIrTParticipants qualify for a chance to win TMC Gear. More than five winners per month.

Click to enter today!

STeriliZaTion: cleaninG and packaGinGWhether you work in a dental or medical practice you may find yourself performing sterilization procedures. If you are working in sterilization, it is important to understand the basic steps to any sterilization process. The Centers for Disease Control has classified all reusable patient care items into 3 categories: Critical (Requiring Heat Sterilization), Semi Critical (Requiring Heat or Chemical Sterilization or Disinfection), and Non Critical (Requiring Cleaning and Low Level Disinfection). Any patient care item that is designed for re-use and is heat tolerant should be heat sterilized. The use of heat sterilization is the more desirable method as it can be monitored for quality assurance more easily than other methods of sterilization.

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sterilization: Cleaning and paCkagingcontinued from page 1

The sterilization process begins when you start your clean-up procedures following dismissal of your patient. It is important to remember that OSHA requires the use of PPE that is task appropriate. So if you are handling any items that could possibly cut or puncture your skin, the use of heavy duty utility gloves is required at this point. Don the appropriate PPE, and place all re-usable patient care items into a closeable container for transport to sterilization.

Once your re-usable patient care items reach sterilization, they should either be cleaned immediately or be placed in a water or enzymatic detergent holding solution to prevent any patient fluids or bio burden from drying on the surface of the instrument. Liken this to washing your dishes at home. If you place dirty dishes in the sink and let them sit, they are harder to clean later, and often come out of the dishwasher with food still stuck on them. Leaving bio burden on patient care items hinders the sterilization process. So remember, the first step in any sterilization process is cleaning.

Once items have been cleaned; either by hand (if there are no sharp items), in an ultrasonic, or an FDA approved instrument washer, allow them to dry before bagging or wrapping them. Ensure that the product you are using to package your instruments is FDA approved and is compatible with the method of sterilization you are using. Follow the manufacturer’s instructions when in doubt.

The use of both internal and external indicators is recommended for each package processed through heat sterilization. A lot of the products used for packaging items today are engineered with both the internal and external indicators as an integrated part of the product.(More next month on this important topic!) Remember to date each package, and place them loosely into your autoclave or other method of sterilization. Most sterilization failures result from “stuffing” your sterilization chamber too full.

Once the sterilization cycle is complete, make sure all packages are dry before removing them. Removing packages while they are wet allows a phenomenon called wicking to occur: the wet packaging will actually draw, or wick dust and microorganisms from the outside to the inside of the package thus negating the sterilization process.

Knowing and properly performing all of the steps in the sterilization cycle is an important part of instrument and patient care item recirculation. However, it is not enough to simply follow these steps if we never check our work. The use of sterilization monitoring is an important component of the sterilization process - one that cannot be neglected. Meet me back here next month to talk about sterility assurance!

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all aboard the hipaa bus!

Omnibus HIPAA Rule – One STOP at a Time

Stop #2

Last month we reviewed the definition of a business associate and the changes required by the updated rule. At Stop # 2 we will review the elements of a compliant Business Associate Agreement and a Notice of Privacy Practices.

A Business Associate Agreement (BAA) is a requirement of the privacy rule and must be in place between covered entities and their business associates, as well as business associates and their subcontractors (see the March edition of The Advisor for a complete review). If a BAA was not in place on January 25, 2013, a BAA must be obtained no later than September 23, 2013. If BAA was in place on January 25, 2013 the contract must be updated to meet standards no later than September 23, 2014.

The updated BAA should include the following items:

• Establish the uses and disclosures which are allowed by the business associate. Remember the minimum necessary standard applies to business associate activity.

• Provision to comply with the security rule with respect to electronic protected health information (ePHI) if the business associate has access to, or uses, discloses, or maintains ePHI.

• Provision the BA must comply with the elements of the Privacy Rule which apply to the CE.

• Breach reporting requirements. Breach reporting should include the timeframe expected for the communication of a potential breach scenario keeping in mind impacted patients must be notified quickly and no later than 60 days from when the situation is discovered.

A sample BAA has been provided by Health and Human Services and a copy can be found on the TMC website here Commentary in the omnibus HIPAA Rules states that the agreement “represents an opportunity for the parties to clarify their respective responsibilities under the HIPAA rules”, and to “notify the BA of its status under the HIPAA Rules, so that it is fully aware of its obligations and potential liabilities. Start now to ensure business associate agreements are in place by the appropriate enforcement date!

Notice of Privacy Practices must be updated!

The Notice of Privacy Practices outlining how protected health information will be used and disclosed and notifying patients of their rights under the HIPAA Rules will need to be updated by September 23, 2013. The following statements must be included in your facilities updated Notices.

• Statement which outlines the types of uses and disclosures which will require authorization.

• Release of psychotherapy notes – Do not have to include if do not record or maintain this information.

• Disclosures for marketing purposes.• Disclosures for any purposes which require the sale of PHI.

• Statement that other uses and disclosures will not be made without written authorization.

• Notice of updated rights:• Right to restrict certain disclosures of protected health information

to a health plan where the individual pays out of pocket in full for the health care item or service.

• Will receive notification in the event of a breach scenario.• Notice of fundraising communications and the opportunity to opt out.

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Direct care providers are not required to print and hand out a revised NPP to all individuals seeking treatment, only to NEW patients to the facility. However, the updated Notice must be posted in a clear and prominent location and copies of the NPP must be provided to individuals who request a copy. Don’t forget to update the NPP on the company website.

TMC is pleased to share with their HIPAA clients an example of a revised Notice of Privacy Practices. It can be located on the Client Portal under the HIPAA Forms section. The document is provided in an electronic format so that it may be customized to meet the needs of the facility.

Next month join us for Stop #3 as we review the revised definition of breach and the impact this may have on operations in your facility.

TMC is here to assist you with your compliance with the newly published omnibus rules. While we will provide monthly newsletter articles, we are frequently posting information on our Facebook account, Twitter, and the TMC blog to further explain all the changes driven by the mega rule. One bus stop at a time we will get you to your destination of compliance with the HIPAA omnibus rules. You CAN be successful!

oshaHow do we know that we have the latest OSHA posters? Sometimes companies call us trying to sell us the annual updated OSHA posters for a large amount of money. Should we purchase the posters just in case?

hipaaI can’t believe we have to re-do our Notice of Privacy Practices (NPP) along with everything else we have to keep up with. Do we have to give these to all patients right away?

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all aboard the hipaa bus!

it’s Your CallEach month we provide two scenarios for you to review, ponder and decide what you feel is the best course of action. Make your call and then...

check our blog to find the answers!

Will You ansWer?

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globallY harmonized sYstem of ClassifiCation and labeling of ChemiCals (ghs) training.

In 2012, The US Occupational Health and Safety Administration (OSHA) updated its Hazard Communication Standard (HCS), making significant changes to Safety Data Sheets (SDS), labeling and other forms of hazard communication to be in alignment with the United Nations’ GHS. The updated regulation requires employers to train employees on the new label elements and safety data sheet format by December 1, 2013.

TMC is in the process of updating the current on-line training program to meet the additional training requirements of the GHS update. Until these revisions are complete a training video has been added to the Client Portal under TMC Training Programs. This short 8 minute video serves as an adjunct to our online OSHA training. Please ensure all workers utilizing the TMC online training review this additional material in order to meet the training requirement.

Practices must begin now to monitor changes and train workers on new or updated information as SDSs are received from manufacturers. The Hazard Communication Standard has long been dubbed “The Employees Right to Know” and now with the GHS update, employees have the right to know AND to understand what chemicals you’re working with.

As you march towards another compliance hurdle, remember you do not have to weather the storm alone. TMC professionals are here to help with GHS training, secondary container labeling, updating your written HCS, and as always, we offer our eMSDS program to help make the SDS transition smoother.

For any client who has purchased a training DVD since January 2013, we will mail an updated DVD once the revisions are completeWe apologize for this inconvenience and will notify all users as soon as the online training has been updated.

zero toleranCe for WorkplaCe ViolenCe

With a world full of policies and regulations, workplace safety is another one of those better-safe-than-sorry areas of management where prevention is critical. As defined by NIOSH, workplace violence is, “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.” Under OSHA’s General Duty Clause, employers are responsible for providing a place of employment that is free from recognizable hazards that cause or are likely to cause death or physical harm to employees. It is recommended that employers establish a Violence Prevention Program.

How do you establish a program? It starts with a zero tolerance policy. A zero tolerance policy can be defined as a policy that allows no exceptions and sends a clear message to all involved that there are consequences for violent actions. It should apply to employees, patients, vendors and anyone else you may come in contact with.

As a healthcare worker, you are considered to be at high risk; therefore, it is also important to recognize what may put you in harm’s way. Analyze your work environment; think about your risk factors. Do you have narcotics or large amounts of cash in the office? Are your parking lots well lit? Are you in a high crime location or have unrestricted visitor access?

After identifying potential hazards, you will want to include engineering controls and workplace adaptations based on the hazards identified. Examples would include:

• Installation of deadbolts and alarm systems• Place curved mirrors at hallway intersections or concealed areas• Use a closed-circuit video recording for high-risk areas on a 24-hour

basis• Arrange furniture to prevent entrapment of staff• Using the “buddy system” when walking to and from your vehicle• Do not keep large amounts of cash in the office

As always, employee training is an essential component. Ensure that all employees are trained and know the importance of reporting acts of violence. Everyone needs to be prepared should an incident occur and understand that workplace violence will be taken seriously and promptly addressed.

It only takes one violent incident to help you realize just how important safety precautions are. In fact, it can have a devastating impact on the employee as well as the employer and the side effects can linger long after the incident. Early intervention includes having a well written Violence Prevention Program which includes engineering and administrative controls and employee education in place. For more safety tips and information about preventing workplace violence, look in your TMC OSHA manual behind the Emergency Procedures tab or click here which has been dedicated to educating employers and workers about staying safe.

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april 2013888.862.6742www.totalmedicalcompliance.com

Print and post newsletter in office forstaff review. Each member should signthis form when completed. Keep on fileas proof of training on these topics.

instruCtions

Zero Tolerance for Workplace Violence paGe 1 & 6

STeriliZaTion: cleaninG and packaGinG paGeS 1-2

all aboard The hipaa buS! paGe 3-4

Globally harmoniZed SySTem of claSSificaTion and labelinG of chemicalS TraininG. paGe 5

SiGn-in SheeT paGe 7

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