On September 24, Governor Charlie Baker declared a public health emergency due to severe lung disease associated with the use of e-cigarettes and vaping products, as well as what the state terms an epidemic of e-cigarette use among youths. Department of Public Health Commissioner Monica Bharel, M.D., instituted a four-month ban on the sale and display of all e-cigarettes and vaping products in Massachusetts, including all flavored and non-flavored vaping products, whether the products contain nicotine or marijuana.
  
In issuing the order, Bharel conceded that the abrupt ban would be difficult for those with behavioral health or substance use disorder issues, and those trying to quit smoking through the use of vaping. She wrote to the provider community, “Your patients—both youth and adults—will need your help adjusting to this change … People who vape with the goal of reducing the amount of cigarettes they smoke should be steered toward FDA-approved options for nicotine replacement therapy.” The Board of Registration of Pharmacy issued an order expanding access to FDA-approved, over-the-counter nicotine replacement therapy products, including gum, lozenges and patches, through a statewide standing order that facilitates insurance coverage for the products.
  
MHA commended the administration for the vaping ban, saying it is necessary “until we can fully understand the causes of the reported illnesses and deaths associated with vaping. Massachusetts hospitals are committed to doing their part to resolve the issue – not only for our state but for the nation. Because of the serious health consequences posed by these products – especially for youth – MHA also has advocated for swift passage of HB1902/SB1279, which would permanently ban all flavored tobacco, including e-cigarettes and vaping products.” Last Thursday, the legislature’s Public Health Committee gave the bills a favorable report.

The American Nurses Credentialing Center has designated Brigham and Women’s Faulkner Hospital as a “Magnet” facility, meaning the hospital has great nursing outcomes, high job satisfaction, low turnover rates, and a supportive culture. 
 
There are only 498 Magnet facilities out of the 6,300-plus U.S. hospitals. The process to achieve Magnet designation is long and difficult.
 
“Magnet recognition provides our community with the ultimate benchmark to measure the quality of patient care,” said Brigham and Women’s Faulkner Hospital’s CNO and V.P. of Patient Care Services Cori Loescher, R.N. “Achieving Magnet recognition reinforces the culture of excellence that is a cornerstone of how we serve our community. It’s also tangible evidence of our nurses’ commitment to providing the very best care to our patients, of which we are extremely proud.” 
 
Of the 498 Magnet hospitals nationwide, 10 are in Massachusetts. In addition to Brigham and Women’s Faulkner Hospital, they are Baystate Medical Center, Boston Children's Hospital, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Lowell General Hospital, Massachusetts General Hospital, South Shore Hospital, and New England Baptist Hospital and Winchester Hospital, which are both part of Beth Israel Lahey Health.

Cambridge Health Alliance undertook an Agency for Healthcare Research & Quality-sponsored 15-month safety improvement program to reduce infections in the ICU at its Cambridge and Everett hospitals. The effort – involving an assessment of potential problems, increased staff education, use of proven best practices, leadership buy-in and more – resulted in a dramatic reduction in urinary tract infections as well as central line-associated bloodstream infections (CLABSI).
 
Specifically, the “working toward zero” philosophy at the health system resulted in just one CLABSI throughout 2019 and zero catheter-associated urinary tract infections (CAUTIs).
 
Hospitals tackling infections usually employ the comprehensive unit-based safety program (CUSP) method developed by the U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality. CUSP offers a series of toolkits to educate staff and build teamwork to get everyone on board – from frontline nurses to ancillary staff – in the effort to improve care.
 
The Cambridge and Everett CUSP teams consisted of the chief nursing officer, associate CNO for critical care, associate CNO for professional practice, ICU nurse managers, ICU educator, front-line staff nurses, infection preventionists, medical director of critical care, critical care doctors, and infectious disease physicians.
 
They first worked to define the problem, pinpointing the hospitals’ relatively high use of urinary catheters and central line devices, the lack of practice standardization, and the fact that previous safety practices and improvements were not regularly sustained. The team then determined the baseline rates of catheters and central lines, and developed an action plan to reduce them.
 
To improve the caregiver-patient link they instituted the “AIDET” communications framework, which is a process from the Studer Group that stresses five communications behaviors: Acknowledge, Introduce, Duration, Explanation, and Thank You. To improve nurse-to-nurse communication, they instituted a standard process for each patient handoff. CAUTI and CLABSI “prevention bundles” were developed to ensure standard protocols relating to decision-making, insertion, assessment and documentation, line care, removal, and more. A whole host of other detailed, step-by-step, repeatable processes were laid out and re-emphasized in ongoing team education programs.
 
Developing a culture of safety in a do-no-harm environment was established by creating modality bundles for CAUTI and CLASBI. This was the framework for the nursing staff in the ICU to consistently follow a strategic process that resulted in measurable outcomes.
  
Lynette M. Alberti, R.N., Cambridge Health Alliance’s Senior Vice President and Chief Nursing Officer, said, “While achieving zero harm may seem impossible, it is not. This work is an important step in our journey to becoming a high-reliability, zero-harm organization.” That statement has been the driving force behind the facility’s effort to build a culture of safety.
  
Perhaps the biggest improvement at Cambridge was a re-emphasis on the “culture of safety,” meaning that anyone on the team – but especially the front-line nurses – can question at any time the need, or continued need, for line/tube insertion. “Safety Bedside Shift Reporting” with the patient has become a new standard of practice and a key driver of reducing harm events in both hospitals. “Multidisciplinary rounding” means the team gathers and gets to talk openly about how the central lines and catheters are being employed.
 
Patricia Noga, R.N., MHA’s VP for Clinical Affairs, said the path Cambridge Health Alliance took for its improvement project is similar to what is occurring at other hospitals across Massachusetts.
 
“The sort of improvements in care that Cambridge Health Alliance showed in this project is contingent on a committed team ensuring that each step for every patient is given the team’s unwavering attention and best practice implementation,” she said. “It’s easy to waver from tried and true processes but CHA’s results show that creating a culture where all voices are listened to and respected ensures that everyone is more apt to stay on the path towards improvement.”

Where you live affects your health. You can watch your weight, exercise, and cut down on alcohol, but if you live in a dangerous neighborhood, or one where you can’t easily get to a grocery store with healthy eating options, or if the structure you live in triggers respiratory problems or keeps you from getting a good night’s sleep, your health will suffer. Addressing such “social determinants of health” – housing, education, transportation, and low-income, to name a few – are increasingly part of hospitals’ focus as they care for the populations in their service areas.
  
In October, MHA, the Alliance for Community Health Integration, the Boston Area Accountable Care Organization Social Determinants of Health Collaboration, and the Massachusetts League of Community Health Centers are holding a two-part webinar series to draw attention to the link between health and housing. MHA last week reached out to the hospital community with information about how to register for the webinars.

The Massachusetts Sepsis Consortium, of which MHA is a member, last Thursday launched its statewide public awareness campaign called Sepsis Smart.
 
About 270,000 people die from sepsis every year in the U.S. – that’s more than from prostate cancer, breast cancer and AIDS combined. Sepsis is the leading cause of death in U.S. hospitals, but 35% of adults have never heard of it and the majority cannot identify the most common symptoms. The statewide Sepsis Smart campaign aims to educate people about sepsis and what to do if someone they know is showing signs of this serious condition.
 
The signs of sepsis, which are often confused with the signs of other illnesses, are fever and chills, extreme tiredness, confusion, shortness of breath, lightheadedness, and unexplained pain. The Sepsis Smart campaign wants people to recognize the signs and ask their doctor, when nothing helps and the symptoms get worse, “Could this be sepsis?”

Beginning in April 2012, an alliance of healthcare organizations began work to reform the medical liability system in Massachusetts to deal fairly and honestly with unanticipated adverse healthcare outcomes. This effort was called Communication, Apology, and Resolution (CARe), and was followed by passage of Chapter 224 of the Acts of 2012, which included several provisions designed to foster more conversation between provider and patient prior to engaging in legal action.
 
In the CARe program, patients and families who experience adverse medical events are provided full communication about the facts of the event, and have the opportunity to ask questions and receive timely, honest answers. In cases of preventable injury, providers and healthcare organizations apologize, discuss with patients what will be done to prevent the error from recurring, and work with their insurers to give patients a fair and timely resolution and, if appropriate, compensation, without the patient having to resort to litigation.
 
Some hospitals piloted the CARe program and their results were positive; there were no cost increases, at some sites claim and defense costs were even lower than previously reported, and caregivers strongly supported the program.
 
The Massachusetts Alliance for Communication and Resolution Following Medical Injury (MACRMI) is available to help all Massachusetts healthcare organizations get a CARe program up and running for free. For more information, visit the MACRMI website.

Legal healthcare compliance is an ever-changing landscape. Join us at MHA’s Compliance Institute and hear from legal and regulatory experts on some of today’s top issues for hospitals regarding healthcare law. We’ll cover current enforcement issues and hear directly from the offices of the Massachusetts and U.S. Attorneys General. We’ll also review the Stark and kickback laws, among other hot topics, and conclude with a roundtable discussion of leading hospital compliance officers who will look at ways to adapt in the current environment. We hope you’ll join us at this informative program, which takes place on Friday, November 8, from 8 a.m. to 12:15 p.m. at MHA Conference Center, Burlington, Mass. More information is available here.

On Tuesday, the Joint Committee on Financial Services, chaired by Sen. Jim Welch (D-West Springfield) and Rep. James Murphy (D-Weymouth), will hold a hearing regarding legislation promoted by more than 30 healthcare provider, consumer, technology, business and telecommunications organizations to expand access to telemedicine services in Massachusetts.

Telemedicine is a tool that healthcare providers, payers, patients, and employers can use to improve access to care for patients, improve health outcomes for chronic illnesses, and reduce costs associated with seeking in-person medical visits with healthcare providers. Telemedicine allows all patients (regardless of whether they live in rural or urban areas) convenient access to all levels of healthcare services (including but not limited to primary care providers, specialists, and behavioral health clinicians).

By streamlining provider evaluations of patients suffering from chronic (and expensive) diseases such as asthma, congestive heart failure, chronic obstructive pulmonary disease, diabetes, and hypertension, telemedicine has been shown to improve outcomes. Telemedicine also has been shown to help reduce hospital readmissions, lengths of stay, and emergency room visits.
 
“Expanding access, strengthening the essential link between physicians and their patients, and reducing costs – these are all elements of the well-crafted bill before the committee,” said MHA’s President & CEO Steve Walsh. “The time is right to move telemedicine forward in Massachusetts and, in doing so, improve the patient experience for the commonwealth’s residents.”

Telemedicine continues to be a priority this legislative session as Governor Charlie Baker, in his inaugural address in January, announced support for it. Last session, both the House and Senate were on record in support of provisions to advance and expand telemedicine services.  The tMED coalition (Massachusetts Telemedicine Coalition) convened by MHA is looking to build upon that support as both branches contemplate health care reform bills this session.