Massachusetts hospitals have committed to eliminating surgical smoke from their facilities by 2024. This preliminary webinar is intended to help provide facilities with tools, resources, and case studies to fulfill the mission.
WATCH THE WEBINAR HERE:
Presentation slides are available below:
Given the recent surge in cases of respiratory illness in children, MHA and the Department of Public Health hosted a webinar — High Flow Nasal Cannula (HFNC) in Bronchiolitis: Managing Care Outside the ICU — on November 2, 2022.
The webinar is tailored to clinicians who are managing patients with bronchiolitis on HFNC outside the ICU – in both community hospitals and sites where there may be a pediatric ICU that is currently at capacity. Please feel free to invite other involved staff members.
The webinar:
WATCH THE WEBINAR HERE:
Presentation slides are available below:
The MHA Board of Trustees is calling on all Massachusetts hospitals to eliminate surgical smoke from their facilities by 2024 through the implementation of a nationally recognized smoke evacuation program. Surgical smoke is produced by the destruction of tissue by use of lasers or electrosurgical devices. Research studies confirm that surgical smoke can contain toxic gases and vapors such as benzene, hydrogen cyanide, formaldehyde, and bioaerosols, as well dead and live material, including blood tissue particles, bacteria, and viruses.
MHA’s Clinical Issues Advisory Council (CIAC) – the group consisting of clinical leaders from across the state that advises the board – created the MHA Workgroup on Surgical Smoke Evacuation, which then developed and fielded surveys on the issue. A 2021 MHA survey found that of the 55 unique responders, 40% always use surgical smoke evacuators and 61% have a smoke evaluation policy in place.
“Massachusetts hospitals continue to improve their efforts to eliminate surgical smoke, but CIAC and now the MHA Board want to jumpstart those efforts,” said Michael Gustafson, M.D., president of UMass Memorial Medical Center, chair of CIAC, and a member of the MHA Board. “The necessary goal is to protect all members of the OR team – surgeons, nurses, allied healthcare staff, and, of course, patients – from hazard. It’s part of the culture of safety that all hospitals strive for.”
MHA sent a commitment letter to each hospital asking them to educate senior leadership on the long-term hazards of exposure to surgical smoke, implement a policy and invest in the devices to eliminate surgical smoke, and report back to MHA on their progress. Currently seven facilities in Massachusetts have received the Association of periOperative Registered Nurses (AORN) “Go Clear Award,” one of the nationally recognized programs hospitals can participate in to meet the MHA Board’s 2024 target.
Surgeons, whose hands hold the lasers and whose vision is affected by both smoke and the evacuation devices, are key to the success of the initiative. Dr. John J. Mazzucco, a general surgeon at Holyoke Medical Center, has been a leading advocate for the elimination of surgical smoke throughout the MHA process. “There is definitely a requirement to adapt to the new technology introduced into the OR,” he says. “But the benefits to the care team in terms of protecting them from the proven bioaerosols, as well dead and live material, including blood tissue particles, bacteria, and viruses far outweighs the need for the learning curve surgeons must undertake.”
Baystate Medical Center and Baystate Franklin Medical Center are among the Massachusetts hospitals that already have received AORN’s Go Clear Gold Award. “Because of how surgeries are conducted, patients are exposed to surgical smoke usually for short periods of time.” said Patricia Samra, R.N., VP of HR and Total Rewards at Baystate Health. “But studies have shown that perioperative nurses report twice as many respiratory issues as compared to the general population, and the hazard to those in the OR day in and out is of great concern. Eliminating surgical smoke not only makes sense from a clinical viewpoint, but it shows our staff – who work in extraordinarily stressful situations – that we place great importance on their health and wellbeing.”
MHA will be conducting education programs and sharing best practices in the coming months to assist hospitals reach the goal of eliminating surgical smoke by 2024.
Resources for Massachusetts hospitals will be compiled on this page.
In June 2017, the state’s Alzheimer’s and Related Dementias Acute Care Advisory Committee issued its final report with a goal of outlining strategies to provide optimal care to persons with dementia in acute care settings.
Following the issuance of the state report, MHA convened its own workgroup consisting of clinical and operational experts from its membership, as well as representatives of the Alzheimer’s Association. The MHA workgroup developed guidance that would assist hospitals with implementing care and management practices for patients with Alzheimer’s and related dementias based on the report from the statewide advisory committee.
During this time, Massachusetts enacted a new law – Chapter 220 of the Acts of 2018, effective November 7, 2018 – that would require all hospitals licensed by DPH to implement by October 1, 2021, an operational plan for the recognition and management of patients with dementia or delirium in acute care settings. The state is now mandating that physician, physician assistant, registered nurse, and practical nurse license renewal include a one-time completion of a course of training and education on the diagnosis, treatment, and care of patients with cognitive impairments.
The goal of this document – Guidance for Developing an Operational Plan to Address Diagnosis and Care for Patients with Alzheimer’s Disease and Related Dementias in Hospital Settings – is to provide guidance for hospitals on the clinical and operational practices that should be incorporated into a hospital’s operational plan to meet the new law, which is based on the statewide advisory committee report.
The National Academies has released a new report, Mechanisms for Organizational Behavior Change to Address the Needs of People Living with Alzheimer’s Disease and Related Dementias.
The report is available here, and more detail form the National Academies is below:
Patients diagnosed with Alzheimer’s disease and related dementias (ADRD) rely on family members, their community, and the health care system for progressively increasing support over the course of their disease. These people receive care through a frequently siloed health care system across hospitals, nursing homes, ambulatory care settings, and long-term care settings, as well as community- and home-based care. As the number of people living with a diagnosis of ADRD continues to grow, so does the need to provide better support for these people and their caregivers. The National Institute on Aging (NIA) Division of Behavioral and Social Research suggests that organizational behavior change will be needed for health care systems to integrate all of the services and supports required to provide high-quality care for people with ADRD.
NIA sponsored a workshop hosted by the National Academies of Sciences, Engineering, and Medicine to explore mechanisms to improve the quality of care for people living with ADRD and the potential of innovative payment models to incentivize health care systems to make the necessary systemic changes. The workshop convened a diverse array of experts in fields including nursing, geriatrics, health care economics, health care services research, quality measurement, social work, medical ethics, law, health care finance, and health care policy. This publication summarizes the presentation and discussion of the workshop.
In April 2023, the Massachusetts hosted a webinar entitled “Exploring Age and Dementia Friendly Design for Our Built Environment: How to Optimize Health and Wellness Through Physical Infrastructure Design”
The program’s slide presentation, as well as the Age and Dementia Friendly Design Guide, can be accessed below:
The unique safety and care needs of geriatric patients are receiving increased attention in hospitals, due in part to new state requirements for identifying patients with dementia and optimizing their care.
The below is a story from the Betsy Lehman Center’s October 18 Patient Safety Beat Publication:
As the population of Massachusetts ages, the unique safety and care needs of geriatric patients are receiving increased attention in hospitals, due in part to new state requirements for identifying patients with dementia and optimizing their care.
Sturdy Memorial Hospital, a community hospital in Attleboro, started more than five years ago to develop better systems for emergency care of geriatric patients, work they have more recently expanded into inpatient units.
Other Massachusetts hospitals, including Boston Medical Center, are also finding they are already in good alignment with new requirements that went into effect this month directing acute care hospitals to have an operational plan for patients with dementia.
The law, signed by Governor Charlie Baker in 2018, was originally scheduled to go into effect in October 2021, but key provisions were postponed a year in deference to the pressures put on hospitals by the coronavirus pandemic.
Sturdy Memorial and BMC talk about their approaches
Dr. Brian Patel, who is an emergency physician, Sr. Vice President of Medical Affairs, Chief Medical Officer and Chief Quality Officer at Sturdy Memorial, is one of a number of champions of improved care for geriatric patients in the hospital setting.
Dr. Patel served on a workgroup convened by the Massachusetts Health & Hospital Association in 2018 to develop guidance for complying with the new law, which prompted Sturdy to implement recommendations from the MHA workgroup’s 2018 report ahead of the law’s effective date. “We knew this work needed to be done. We used the plan as a framework to start advancing our geriatric care,” he says.
The law
As of October 1, 2022, a new state law mandates Massachusetts hospitals to create and implement a master plan for identifying patients with dementia and optimizing their care.
The background
Signed in 2018, the law was originally scheduled to go into effect last year but was postponed in deference to the pressures put on hospitals by the coronavirus pandemic.
The context
As hospitals have prepared to comply with the law, many have found they already have at least some elements of a master plan in place.
The resources
Massachusetts Health & Hospital Association and the Alzheimer’s Association offer guidance for complying with the state law. Many hospitals also use resources from programs such as Nurses Improving Care for Health System Elders and Age-Friendly Health Systems.
Dr. Patel reports that Sturdy participates in NICHE — Nurses Improving Care for Healthsystem Elders — a program designed to enhance nurses’ knowledge and evidence-based practices in caring for older adults and has been working closely with the American College of Emergency Physicians, which accredited Sturdy as a Bronze Level 3 geriatric ED in 2018 and, more recently as a Silver Level 3 in 2022.
“The work we’ve been doing with ACEP and on and the inpatient side with NICHE overlaps with the Massachusetts requirements around management of dementia and delirium,” says Dr. Patel. Sturdy also uses components of the Age-Friendly Health Systems initiative offered by the John A. Hartford Foundation and the Institute for Healthcare Improvement.
Boston Medical Center also has leveraged a variety of resources to build an operational plan for geriatric and dementia care. Lisa Caruso, M.D., geriatrician and Director of Quality and Patient Safety in the Department of Medicine at BMC, says the hospital joined the Age-Friendly Health System program in 2017. Dr. Caruso recalls that creating a geriatric order set, implementing a mobility program and using the Confusion Assessment Method were among their first improvement projects. All address the issue of delirium, which Dr. Caruso says, “is one of the worst things that can happen for somebody who has dementia in the hospital.”
Optimal dementia care extends across six functional domains
The Alzheimer’s Association estimates that the number of people ages 65 and older with Alzheimer’s dementia in Massachusetts will have increased more than 15% between 2020 and 2025 and that people with Alzheimer’s disease have almost twice as many emergency department visits and hospitalizations as seniors without dementia.
The MA Department of Public Health first issued recommendations for managing patients with dementia in acute care settings in 2017. Following up on its workgroup report from 2018, MHA published an operations “roadmap” in conjunction with the Alzheimer’s Association this summer.
The roadmap calls for attention to:
Liz McCarthy, Health Systems Director at the Alzheimer’s Association, New England region, explained during a webinar co-produced with MHA, that hospitals need to work on all six domains simultaneously. “You’re not starting with one of these,” said McCarthy. “They’re all going to be happening at roughly the same time.” She also emphasized the importance of engaging with the patient’s care partner throughout the hospital stay and the role of senior leadership to sponsor and direct this wide-ranging effort. McCarthy served with Dr. Patel on the MHA workgroup in 2018.
Describing BMC’s operational plan, Deborah Whalen, R.N.P., Associate Director Quality and Patient Safety in the Department of Medicine at BMC, emphasizes collaboration among the hospital’s departments. This is particularly evident in planning for transitioning patients with dementia to discharge. “Because we’re a safety net hospital,” says Whalen, “we have always focused on transitions in the various settings. We often work with our community partners as we help our patients move them through the settings and back into the community.”
Whalen also reflects on how the state law helped her and her colleagues at BMC see the work they already were doing in a new light and showcase it in the operational plan. “The law requires that we have a plan available for the Department of Public Health to review, right? We went farther than that,” says Whalen. “We created a plan that is alive. Now when DPH comes, they can walk through our organization and see it in action.”
In September 2022, MHA and the Alzheimer’s Association introduced a roadmap to assist Massachusetts healthcare providers in preparing for the implementation of a state-mandated operational plan for Alzheimer’s and related dementias.
The state’s Alzheimer’s and Related Dementias Acute Care Advisory Committee – established by the legislature – in 2017 issued a report of recommendations to provide optimal care to persons with dementia in acute care settings. In 2018, these recommendations were incorporated into legislation and passed into law as Chapter 220 of the Acts of 2018: An Act Relative to Alzheimer’s and Related Dementias.
Section 8 of the law requires all licensed hospitals to complete and implement an “operational plan for the recognition and management of patients with dementia or delirium in acute-care settings.” In July 2021, the required date for implementation was extended from October 2021 to October 1, 2022, due to the COVID-19 pandemic.
The MHA roadmap outlines an operational plan for senior leadership, recommendations of who should be on the team to implement the plan; identification of the six broad categories of an operational plan and the pathways to take to implement it, and suggested outcome measures for ongoing quality assurance and performance improvement.
WATCH: MHA and the Alzheimer’s Association hosted a one-hour webinar, which includes case examples from hospitals implementing their own operational plans.
The National Academy of Medicine today launched Resource Compendium for Health Care Worker Well-Being, which highlights tools that are ready to be deployed and strategies to address systems issues related to health care workers’ burnout. The compendium, which is a product of the Action Collaborative on Clinician Well-Being and Resilience, of which AHA is a participant, organizes resources into six essential elements: advancing organizational commitment; strengthening leadership behaviors; conducting workplace assessments; examining policies and practices; enhancing workplace efficiency; and cultivating a culture of connection and support.
“Stress, trauma and burnout among front-line health care workers are at historic levels as we head into the third year of the pandemic,” said AONL CEO Robyn Begley, DNP, R.N., who serves on the collaborative’s steering committee alongside AHA President and CEO Rick Pollack. “Health care is, at its core, people caring for people. NAM’s detailed plans and actionable resources will help support well-being and resiliency of caregivers who continue to make sacrifices for all of us.”
The workgroup developing the compendium was led in part by AHA past-chair and Carilion Clinic President and CEO Nancy Howell Agee.
Registration is FREE for both ANA members and non-members.
You may soon be faced with one of the most challenging aspects of the COVID-19 pandemic: The need for nurses with little or no critical care experience being called on to be part of a team caring for severely ill COVID-19 patients, many of whom must be on a ventilator to survive.
A FREE, On-Demand Series for ALL Nurses – Part of the ANA COVID-19 Webinar Series
Taught by a highly experienced critical care nurse specialist and educator, this program focuses on key skills needed when caring for a COVID-19 patient on a ventilator. Content is presented in an easy-to-understand – and use — manner. After viewing this webinar, you will be better prepared to be an effective part of a team caring for critically ill patients on a ventilator.
This 60-minute on-demand webinar contains four sections that you can view all at once or one at a time. Topics include:
