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Currents To Medical Center Employees: At the recent Board of Trustees meeting, John Heffner, M. D., Medical Center medical director, briefed the board on the Medical Center’s performance improvement and patient safety programs. Patient safety and performance improvement will be “central themes” for the JCAHO survey scheduled for Nov. 17 - 21. Details on these programs can be located on the Medical Center Intranet (www.musc.edu/medcenter/JCAHO) and in the recently issued MUSC Medical Center Information Handbook which covers JCAHO-related matters.  Paul Bush, PharmD., Medical Center Pharmacy Services director, gave the board an overview of  Pharmacy Services’ organization and operations. Dr. Bush discussed the efforts of the Medication Safety Team which focuses on medication errors, adverse drug events, removing barriers to communication, increased practitioner awareness, improving detection and reporting of errors, implementing technologies that enhance safety, and community education in patient safety. He explained how the use of robotics and bar coding enhances Pharmacy Services’ efforts toward patient safety. Dr. Bush also pointed out that Pharmacy Services’ performance improvement projects increased patient safety while improving efficiency, resulting in a savings of approximately $1.45 million annually. Frank Clark, Ph.D., MUSC chief information officer, reported to the board the administration’s intent to issue a request for proposals (RFP) to select a primary partner or primary partner consortium for a tightly integrated patient safety-focused clinical information system. Dr. Clark emphasized that a single vendor system (instead of the current “best of breed” systems) will be expensive, but will enable the Medical Center to move toward a highly integrated system to replace over time the current, poorly integrated systems that are difficult to maintain. Dr. Clark anticipated that phase one of this project could be accomplished in three years and  would include installing a point-of-care clinical system (Electronic Medical Record) as well as pharmacy and medical / surgical distribution services. It’s projected that phase two will take place in four to seven years and will involve replacement of the radiology system, lab system and other systems as needed, such as patient accounting, materials management, and admissions, discharge and transfer systems. The single vendor concept involves close and ongoing  working relations with the users (MUSC employees) and the vendor. Dr. Clark will be reporting back to the board in December on progress with the RFP process.  Finally, DHEC recently approved our Certificate of Need (CON) for phase one of the new hospital facility. This was a major step. We are now working on addressing any design issues with the Board of Architectural Review (BAR) and resolving the financing. Thank you very much. W. Stuart Smith Vice President for Clinical Operations and Executive Director, MUSC Medical Center   STAR Productions presents ‘StepMom’  Annette Drachman, Medical Center Legal Affairs director, introduced her presentation on patient rights and responsibilities by describing a scene from the movie “Stepmom,” where Susan Sarandon’s character makes the decision to discontinue her cancer treatment. In support of JCAHO standards, Medical Center policy C-1 states that all patients have the right to considerate, respectful care at all times and under all circumstances, with recognition of their personal dignity and autonomy. The MUSC Medical Center’s policy assures practices that respect the rights of all patients regardless of race, creed, sex, national origin, religion, age, disability, diagnosis, or sources of payment for care. Patients have the right to impartial access to treatment within the hospital’s capacity and scope of its mission and services. If the hospital cannot provide the care required by the patient, the patient or their family is informed and provided alternatives for care. Patients have the right to complete and current information regarding their diagnosis, treatment, any known prognosis, and outcomes of care, including unanticipated outcomes. Patients also have the right to access necessary protective services. In treating a patient, consider the patient’s psychosocial, cultural, and spiritual values.  Patients have the right to express spiritual and cultural beliefs provided they do not interfere with others or hospital operations. Provide assistance with advance directives, actively involve them in their own care, provide assistance with conflict resolution, and provide support care at end of life. Concerning active participation, patients are involved in all aspects of their care and informed consent is obtained. The elements of informed consent are potential benefits and drawbacks, potential problems related to recuperation, the likelihood of success, the possible results of non-treatment, and any significant alternatives. Medical Center Policy C-2 mandates that informed consent must be obtained prior to any procedure or treatment in non-emergent situations such as surgical procedures, conscious sedation, non-surgically related blood transfusion, radiation or nuclear therapy, and prior to any taping. Always consider the rights and values of the patient first and foremost and document informed refusal of treatment should it occur. Provide appropriate translation services including those of limited English proficiency, hearing impaired or sight impaired. Use visual aids if appropriate, assess and document patient understanding, and obtain a signature on all consent documents. For more information concerning informed consent, consult the Adult Healthcare Consent Act. Patients should be involved in resolving dilemmas about care decisions surrounding admission, treatment or discharge. These dilemmas may result in differences between decision-makers and must be addressed with appropriate behavior. Hospital staff should address, if necessary, withholding resuscitative services and forgoing or withdrawing life-sustaining treatment. Care and dignity of dying patients will be honored through effective pain management, consultations with the patient and patient’s family, and acknowledgment of the psychosocial and spiritual concerns of the patient and their family. Other patient rights include confidentiality of the patient’s location, identity, and medical information to the extent required by law, access to an accounting of disclosures of health information, personal privacy, safety and security, consultation, and freedom from abuse. Comments on the Medical Center’s Oct. 15 and 16 Walkthroughs Rosemary Ellis, quality director, presented managers with items to brush up on before November’s JCAHO survey, according to Jim Weiss, JCAHO consultant. Those items are as follows: Staff must be familiar with the JCAHO Patient Safety Goals. Pharmacy crash cart box tag - record the number on the review log and check it against the tag. Remind employees where the fire alarm pull stations and all exits are. Please assure all oxygen cylinders are secured appropriately. General observation: employees not routinely wearing identification badges or not having them visible. Check policy and enforce. Amnesty Key Day Results Mary Allen, Quality Management, reported on outcomes of the Amnesty Key Day held Sept. 10 and 11. The 2002-2003 Failure Mode Effects Analysis (FMEA) on PCA pumps identified a need to improve management of PCA pump keys. These keys had the potential to be misplaced due to the small size and lack of a standardized tracking procedure.  The PCA task force aided by medication safety committee's (MST and MCIG), decided to expand recovery efforts to all MUSC keys that were not currently in use. Many areas participated in the effort including all Inpatient units, Short Stay, Children’s Hospital, Ambulatory Care, IOP, CMH TCU, Radiology, and Endoscopy. The collection of keys filled several large buckets yielding 16 PCA keys, one epidural key and assorted door and other keys. PCA and Epidural keys were returned to Pharmacy. The remaining keys were managed by Hospital Security. Many thanks to MUSC Volunteers for assisting with key container collection. Units 10 West and Main OR were credited with collecting the most number of keys. MICU had the most original keys and MSICU staff was awarded MUSC water bottles for retrieving the most PCA keys.  The plan to standardize PCA key processes includes adding a key ring to assist with PCA key identification, housing PCA keys in AcuDose and requiring key sign out with each use. Managers were asked to account for PCA keys at the end of each shift and report discrepancies via Patient Safety Net (PSN). Managers were also asked to report PCA pump non-availability via PSN.