A few weeks ago Medical Facilities Licensing conducted a surprise complaint investigation of our Arizona State Hospital’s Forensic Campus. Last week we received notification that no deficiencies were found during the 3-day on-site inspection - which included an in-depth review of policies, procedures, documentation and patient care standards. Congratulations to the entire Forensic Campus team for a job well done – especially folks working in Direct Care, Nursing, Medical Services and Quality Management.
Archive for the ‘Licensing’ category
Our Licensing, Preparedness and Healthcare-Associated Infections shops joined forces with APIC Consulting Inc. to provide a free day-long event to provide training to skilled nursing facilities about how to prevent healthcare-associated infections. The training will be based on the Infection Preventionist’s Guide to Long-Term Care.
The goals are to help healthcare providers to: 1) identify infection prevention challenges in the long-term care setting; 2) teach the basics of infection prevention; 3) better understand the essential components of an effective infection prevention program; and 4) better understand the management of multidrug-resistant organisms.
Infection Preventionists from skilled nursing facilities will learn key concepts and basic principles for infection prevention and how to deliver tools and evidence-based interventions to reduce risk in healthcare facilities…helping us to achieve targeted improvements in public health outcomes as part of our strategic plan.
The 2014 Arizona Long-Term Care Infection Prevention and Control Collaborative is scheduled for today at the Black Canyon Conference Center. The event will highlight Division of Licensing data and opportunities, ADHS Outbreak and Exposure Protocol, surveillance, isolation precautions, seasonal influenza, best practices to prevent infections, environment and equipment to name a few. It’s a great opportunity for you to connect with partners and exchange information and knowledge of current infectious disease topics.
Navigating the vast number, type, and location of licensed facilities just got easier. Our GIS team developed a terrific interactive website that can help you find information about a specific facility or facility type in the State. The ADHS Licensed Facilities application features Long Term Care Facilities, Hospitals, group homes for folks with developmental disabilities, Residential, Medical, Childcare, and even Pharmacies. A simple zoom and click feature provides you information on the type, address and contact information.
The Map to Care in AZ can help you find licensed facilities in your area. It also gives licensed facilities a new view on their region to network and partner with others, especially for public health emergency preparedness planning. Additional resources include Arizona Health Matters with data information about the community to help planners, policy makers, and the community learn about health issues and identify improvements.
Improving health outcomes at licensed healthcare facilities in Arizona requires 2 main ingredients. Having regulations and encourage continuous quality improvement (which is now complete) and providing our licensed facilities with the information they need to implement practices (in accordance with the regulations) to execute positive change.
Now that we’ve finished developing the new regulations, it’s time to build the knowledge base so facilities can use those new regulations to improve care. To that end… three of our Licensing Bureaus (Medical, Long Term Care, and Residential Living) have been busy conducting combined provider and surveyor trainings and attending association meetings. Literally hundreds of key staff from dozens of different types of institutions have been participating in the trainings- which focus on the practical nuts and bolts of how (and why) to comply with and use the new regulations to improve outcomes.
During the past couple of months our providers have learned about our new outcome based regulations… with the ultimate goal of improving compliance, reducing enforcement, and improving public health outcomes. This approach to licensing supports the public health vision of “Health and Wellness for all Arizonans.”
The first big fire of the season started this week in Oak Creek Canyon- called the Slide fire. Smoke is usually the first public health impact from wildland fires. The air quality in Flagstaff and Sedona has been generally OK- but poor at times depending on the winds (smoke levels in Sedona have been high during the early morning hours the last couple of nights). Here’s a link to the data for the ADEQ’s portable air quality monitors in the area. The website includes hourly air quality data for East and West Flagstaff, Fort Tuthill, Camp Verde, Prescott, Sedona, Show Low, Springerville, and Payson.
We play a significant role in response where there are wildfires in Arizona. Our licensing folks monitor the need for evacuation of hospitals, assisted living and behavioral health facilities. Our environmental health folks work with the local health departments and the ADEQ to make decisions about health advisories related to smoke. Our emergency preparedness staff supports local public health for any support we can give to protect the health of people who need to be evacuated and in surrounding areas. You can read more in our Wildfire Smoke and Your Health brochure and in our ADHS Wildfire Plan.
Last week we passed a major milestone in our Strategic Plan when we filed our final new set of rules for the Arizona’s 5,500 licensed healthcare facilities. With this week’s filing – we’ve now completed our overhaul of the State’s regulations for hospitals, behavioral health inpatient facilities, nursing care institutions, recovery care centers, hospices, behavioral health residential facilities, assisted living facilities, outpatient surgical centers, outpatient treatment centers, adult day health care facilities, home health agencies, behavioral health specialized transitional facilities, substance abuse transitional facilities, behavioral health respite homes, adult behavioral health therapeutic homes, child care facilities and the regulatory standards for licensed professional midwives.
During our 4 year regulatory reform effort, we worked hard with our partners to develop a better set of rules. The new model sets some prescriptive minimum standards – and then requires facility operators to develop an additional set of policies and procedures to ensure patient and resident health & safety. Facilities are also required to measure patient and resident outcomes. If they have bad (preventable) outcomes – our survey teams will determine whether the facility wasn’t following its policies and procedures, had inadequate policies and procedures, or both.
While the rules are done, we still need to educate and train our survey teams and healthcare facilities on the new regulations. Because the final rules depend largely on outcomes and solid policies and procedures rather than just static standards – this effort won’t happen overnight. It’ll probably take about 18 months to get everybody up to speed on the new expectations.
We license and inspect abortion clinics in AZ. Due to a court settlement agreement (unlike other health care institutions we license) we’re currently required to get an administrative search warrant before conducting an unannounced inspection of an abortion clinic. For a routine compliance inspection, we need to give them 10 days-notice.
On Tuesday, the Governor signed HB 2284, which (when it becomes effective later this Summer) will make our abortion clinics inspection authority more consistent with our authority for the other health care institutions we license. Basically, we’ll have the authority to conduct an unannounced inspection when we have reasonable cause to believe the clinic isn’t adhering to licensing requirements or any other law or rule concerning abortions without getting an administrative search warrant. We’ll start a rulemaking shortly to adjust our rules so they’re consistent with the new statute.
Those of you in Public Health Licensing have heard me talk about the difference between compliance and enforcement more than once. They’re 2 different things. Compliance means that a licensed healthcare, residential or childcare facility meets our standards and expectations. Enforcement is an action that we occasionally take in order to get a facility into compliance.
In other words, our goal is always compliance- not enforcement. The most cost effective way to achieve compliance is to provide clear and understandable customer assistance, provide education during on-site surveys, set clear expectations, and work effectively with our licensees and associations to make sure they understand what we expect. When customer assistance, education and clarity aren’t enough to get compliance, we sometimes need to resort to enforcement actions to move a licensee into compliance.
The bottom line is that while we sometimes need to take enforcement actions to incentivize a facility to become and/or stay compliant- it’s usually the least cost-effective tool in our toolbox.
Three years ago we made the commitment to overhaul the way we regulate Arizona’s 5,500 licensed healthcare facilities. Our goal was to move from the existing prescriptive regulations to a new set of outcome-based rules. The idea was to shift from the former 2-dimensional standards to a deeper set of 3-dimensional regulations.
The final regulations that we’re publishing at the end of April are tied to outcomes. The model puts more responsibility on the facility’s managers to ensure that they’ve developed policies and procedures to ensure they’re meeting the needs of the people they serve.
The new model basically sets some prescriptive minimum standards- and then requires facility operators to develop an additional set of policies and procedures to ensure patient and resident health & safety. Facilities are also required to measure patient and resident outcomes. If they have bad (preventable) outcomes- our survey teams will determine whether they weren’t following their policies and procedures, had inadequate policies and procedures, or both.
The new final regulations aren’t the finish line. Our next task is to educate and train our survey teams and regulated healthcare facilities on the new regulations. Because the final rules depend largely on outcomes and solid policies and procedures rather than just static standards- this effort won’t happen overnight. It’ll probably take about 18 months to get everybody up to speed on the new expectations.
Congratulations to our committed Stakeholders and Team ADHS for collaborating on the development of regulations that’ll be improving Health and Wellness for all Arizonans for years to come.
Healthcare-Associated infections are a major (often preventable) threat to patient safety. Last week the National and State Healthcare Associated Infections Progress Report expanded on previous reports- detailing progress toward the eliminating healthcare-associated infections. The HAI Progress Report found significant reductions for nearly all infections- including in AZ. Central line-associated bloodstream infections and surgical site infections continued to approach the 5-year goals set in the National Action Plan to Prevent Health Care-Associated Infections.
Arizona’s public health system takes a layered approach to preventing HAI’s in our state. It starts with our Licensing team- who regulates the healthcare institutions where the care happens. Our Medical Facilities Licensing team and our HAI Program collaborate to ensure the safety of patients in Arizona by jointly providing technical assistance and guidance to licensed healthcare facilities in response to identified infection control breaches. The next layer is our network of public health disease detectives. Our Healthcare-Associated Infections Program and the counties conduct epidemiologic investigations when we get reports of unsafe injection practices affecting multiple patients.
Our HAI Program and Advisory Committee also generate guidance documents for healthcare facilities and provide best practices for infection control and injection safety like materials produced through the CDC’s One and Only Campaign and Arizona’s Stakeholder-driven No Place Like Home initiative- which partners with the national Partnership for Patients: Better Care, Lower Costs project.