Hand-off communication does affect patient safety.

When there is a cacophony of activity happening all at once, it is difficult to find the time for proper hand-offs and the communication that accompanies the hand-off. The patient is very often hustled from one department to another and from one healthcare professional to another-this in spite of everyone's best efforts to keep the patient's "transitions smooth" without any interruptions, catastrophes, or other unbidden woe. This article will focus on the need for hand-off communications that are methodical yet flexible and that promote patient safety.

Pay-for-Performance and Recovery Audit Contractors: the whys and wherefores of these programs.

Pay-for-Performance programs reward physicians, hospitals, and other providers of healthcare when the services they provide reach predetermined quality and efficiency goals. On the other hand, the Recovery Audit Contractor program is a form of Pay-for-Performance through which private companies hired by the Centers for Medicare & Medicaid Services identify improper payments made on claims of healthcare services to Medicare beneficiaries. Pay-for-Performance programs and the Recovery Audit Contractor project are discussed in this article in an effort to provide a baseline of understanding about these programs to those working in peri-operative areas.

Compliance and the perioperative nurse.

While compliance efforts often occur "behind the scenes," there is much more to compliance than many people believe. This article will provide a brief glimpse at the components of a compliance program and some of the Office of Inspector General-targeted areas that may affect those in the perioperative area.

Knowledge is power: averting safety-compromising events in the OR.

Surgical procedures can be unpredictable, and safety-compromising events can jeopardize patient safety. Perioperative nurses should be watchful for factors that can contribute to safety-compromising events, as well as the errors that can follow, and know how to avert them if possible. Knowledge is power and increased awareness of patient safety issues and the resources that are available to both health care practitioners and consumers can help perioperative nurses ward off patient safety problems before they occur.

The Joint Commission update for peri-operative services-2009.

As part of its continuous quality improvement efforts, The Joint Commission began a standards improvement initiative (SII) in October 2006, the result of which will be "felt" by most accredited organizations (ambulatory care organizations, critical access hospitals, home care, hospitals, and office-based surgery) on January 1, 2009. The remaining organizations (behavioral health, laboratory, and long-term care) will go through a similar experience on January 1, 2010. The essence of SII was the changes made by The Joint Commission through consolidating, rewording, revising, and restructuring of chapters, standards, and elements of performance (EPs). Although few new standards have actually been added, there are nuances that, if not noted, may cause considerable difficulty to organizations during upcoming accreditation surveys. This article discusses SII and the standards and EPs that impact and pose "opportunities for improvement" for peri-operative services.

Preventable hospital-acquired conditions: the whys and wherefores.

The changes to the Centers for Medicare & Medicaid Services (CMS) Inpatient Prospective Payment System published in the Federal Register (, Vol. 72, No. 162) on August 22, 2007, introduced the term preventable "hospital-acquired conditions" (HACs). These printed rules and regulations came about through a provision in the Deficit Reduction Act of 2005 (Pub. No. 109-171) and required the Secretary of the Department of Health and Human Services to track and report on conditions considered to be high cost, high volume (or both); assigned a higher paying "diagnosis related group" (DRG) when present as a secondary diagnosis; and were thought to be reasonably preventable when evidence-based guidelines were employed. In order to comply with this mandate, the CMS, a federal agency within Health and Human Services, was assigned the task of choosing "preventable" HACs, also referred to as "serious preventable events," for which reporting and tracking would be conducted; with the added opportunity of reporting and tracking data regarding a patient's "present on admission" condition. These preventable HACs become of particular interest to hospitals on October 1, 2008. That is the day CMS begins freeing itself from paying hospitals for the targeted preventable HACs that afflict Medicare patients during their hospital stay and which were not present at the time of the patients' admission to the hospital. It is a form of pay-for-performance.

Proposed regulations for enforcement of the Patient Safety and Quality Improvement Act of 2005.

The Patient Safety and Quality Improvement "proposed rule" (2008) was published in the Federal Register on February 12, 2008. This "proposed rule," with a comment period extending to April 14, 2008, was created for the purpose of implementing specific facets of the Patient Safety and Quality Improvement Act of 2005; those dealing with the establishment of Patient Safety Organizations (PSOs), confidentiality protection for patient safety activities, and patient safety work product, and reporting by the Secretary of the Department of Health and Human Services (HHS) to Congress regarding successful strategies that have reduced medical errors and have thereby increased patient safety.

Complying with the 2008 National Patient Safety Goals.

In 2003, the joint commission began publishing National Patient Safety Goals (NPSGs) and requiring accredited health care organizations to comply with these goals in an effort to reduce the number of medical errors. THE NPSGS are updated yearly with new requirements to promote specific improvements in patient safety. This article provides a review of the 2008 NPSGs and suggests ways in which information technology systems can address health care organizations' compliance with some of these goals.

Emerging technologies in the OR and their effect on perioperative professionals.

New and emerging technologies can help increase the quality of health care, but implementing these technologies in a perioperative setting can create many challenges. Practitioners need to be aware of premises underlying future trends in health care and the kinds of technological changes that they can expect. Robots, digital displays, patient tracking systems, artificial organs, and magnetic sensors are some of the emerging technologies that are changing the perioperative landscape. Practitioners must be prepared to implement strategies that address the practical aspects of integrating these new technologies into the perioperative area.

JCAHO'S National Patient Safety Goals 2006.

The Joint Commission of Accreditation of Healthcare Organizations released their first set of National Patient Safety Goals in 2002, which became effective in January 2003. This original set of goals is reviewed and a new set published every year. This article provides a review of the 2006 National Patient Safety Goals with an emphasis on perioperative/perianesthesia implications.

Update on the National Patient Safety Goals--changes for 2005.

Each year sice 2003, the Joint Commission on Accreditation of Healthcare Organizations has established National Patient Safety Goals for accredited health care organizations. The goals are developed to promote improvement in patient safety by helping health care organizations address specific safety concerns. This article discusses the current goals and highlights new information for 2005.

What is in a name--sedation or anesthesia.

The Joint Commission on Accreditation of Healthcare Organizations' sedation standards detail the differences between sedation and anesthesia. These standards, however, note that it is important that those applying sedation be trained to rescue patients who may slip from moderate sedation into deep sedation or from deep sedation into anesthesia.