DIANE BRILEY: Those 'nonsense regulations' ensure the safety of patients
Images
I have been a registered nurse since 1963. Patient safety has always been one of my passions. Because of that, I would like to take issue with some of the comments made by local cardiologist William Bezdek in his Jan. 25 Community Voices article, "The government agency that's holding our hospitals hostage." The Centers for Medicare & Medicaid Services is trying to promote patient safety in our hospitals, at least for those hospitals that enjoy CMS contracts. What Dr. Bezdek refers to as "nonsense regulations" are actually changes instituted to promote the safety and welfare of patients, and not just a waste of time.
According to Bezdek, the following requirements are nonsense:
* CMS requires all medication orders to include documentation of the route of administration. If a doctor leaves the route off an order for metformin, for example, because it is currently administered by only one route, do we just overlook it when he leaves it off something else, too, or do we have to waste time calling him for clarification every time? Is it too much to expect him to follow a common-sense rule, as we do for all other physicians, to include the route in every order? Consistency is the key here. If the route is documented for every medication, then it won't be forgotten in a critical instance. It is a given that administering by incorrect route can be life-threatening.
* CMS requires that all notes and entries be time-stamped. When errors occur, and the attempt is being made to reconstruct a situation to determine exactly what happened, to prevent a similar recurrence, the time an order was written can be critical. How else can you backtrack to see if that first dose was given in a timely fashion? It is only common sense that all orders should have the date and time they were written -- it's called accountability. To do otherwise is just plain lazy.
* CMS requires that all angiographic procedures be done with the doctor dressed appropriately in scrubs. Perhaps this physician's technique is flawless, but believe me, many others aren't, so let's give the benefit of doubt to the patient. Nosocomial infections, which are hospital-acquired infections, continue to be rampant, so let's overdo on the side of caution. If there are studies that show that street clothes -- less clean attire -- is not harmful to patients, then Bezdek should have provided that data and analysis.
* CMS has given the hospital violations for using traditional Latin abbreviations. Does this physician have any idea how many times "QID"(four times a day) has been mistaken for "QD" (once a day) due to the unclear handwriting of physicians? The result is that the patient is grossly undermedicated, possibly resulting in a very negative outcome. Who is usually blamed? The nurse.
I would submit that Bezdek is missing the whole point, and that is to provide the safest possible care to hospitalized patients. Physician resistance and pushback to many of the CMS regulations causes ongoing friction among workers and the waste of time, when what is needed is for physician leaders to endorse these safety measures. Those who are interested in safe, quality care are gratified to see system changes that will serve to decrease the number of errors, and ultimately the number of patient deaths, in our hospitals. These are some of the goals of CMS.
Diane Briley of Bakersfield is a retired nurse. She served as the risk manager at Kaiser Permanente Bakersfield from 2001 to 2008. She was the first Certified Professional in Healthcare Risk Management (CPHRM), under the auspices of the American Hospital Association, in Kern County. Another View is a critical response to a previous editorial, column or news story.
