This is a follow up to an article originally published in June 12, 2013
Over the last two-and-a-half years I have done a great deal of research into the responsibilities ASC nurses have with keeping up on their accreditation requirements. I also have been involved in dozens of "start up" ASCs over the last 15 years.
This research was used to create a fast, STANDARDIZED ELECTRONIC method of capturing logbook data. (WWW.AccreditSoft.com)
NEW OR STARTUP FACILITIES
When looking at startup centers, I noticed one issue that was present with every facility; FEAR! Many times a nurse will have the responsibility to get the facility ready for its first inspection. In many cases, this will be the nurses first time taking on such an endeavor. The doctor/owner has spent a great deal of money and it falls on the nurse administrator to get ready for the all important first inspection.
One of the first tasks is preparing the logbooks to document the day to day procedures such as checking to make sure equipment is functioning, the operating room is cleaned and disinfected and much more. To accomplish this, I have seen on more than one occasion, staff trolling the internet for log book forms or copying them from other facilities.
During this initial startup nurses become fearful of getting the correct form or, more to the point, the form that captures the information the accrediting organizations want. This is one the main points I am trying to make; WHAT IS THE CORRECT LOG FORM? The answer is: DEPENDS ON WHO YOU ASK.
Take the crash cart as an example. I have seen log forms for this item ask the tech to test the defibrillator with the plug in the wall and with the plug out of the wall. Forms that ask for the information on the printout to be recorded on the form and forms that simply want to know if the defibrillator is working correctly. I found over a dozen forms from similar ASCs asking different information about the same thing: a crash cart.
EXISTING FACILITIES
Filling in forms for logbooks takes time. The more information you have to enter, the more time is involved in doing so.
Let's use the sterilizer/autoclave in this example. I have seen sterilizer forms from two very similar facilities. One operating room, three bed recovery pain management accepting Medicare payments. One facility has a complex form that has many informational requirements. The other facility has a simple form that asks much less information.
The "SIMPLE" form had fields for DATE, STERILIZATION TIME, TEMP. PRESSURE, DRY TIME and the TECH’s INITIALS. The "COMPLEX" form had in addition to those: The NUMBER and CONTENTS of the packs, the TIME OF DAY and rather than entering TEMPERATURE and PRESSURE, the form asked if the temperature and pressure was PASS/FAIL. It had a place for what the pack indicator shows and it also asks for a signature and initials of the tech.
When I asked the "Complex Form" facility why they recorded so much information, I was told, "This is the form we were told to use by our consultant."
When I asked the "SIMPLE FORM" facility why they used their form, I was told, "This is what I found online. We have never had an inspector not accept it. We've used this form for years." Filling out the complex form took twice as long as the simple form.
"I'M WAY TO BUSY FOR THAT NOW"
One of the most serious issues in recording logbook data is; WHEN IT IS ENTERED?
The intent and what accreditation is all about is making sure the facility is attending to details that boil down to one issue: PATIENT SAFETY. The way we know a facility is attending to those details is documentation. The all important LOGBOOK. This is what an inspector is really interested in.
Did you check the defibrillator and anesthesia equipment BEFORE the patient was operated on? Is the back-up power working? Have you cleaned and disinfected the operating room?
Let's face it; nurses are very busy attending to patients and doctors. I don't think there is an ASC facility in existence that has not been in a position of "catching up" on logbook entries. It is the biggest problem in MANUAL accreditation recordkeeping. Something looks strange when there are five, 10, 20 days of entries with the same color ink, same handwriting, same everything!
This is especially true in small facilities where there is limited staff — facilities that have one nurse or tech doing everything. Plastic surgery, pain management and other small one or two doctor facilities are prime examples of "catching up."
ELECTRONIC LOGBOOKS
Electronic logbooks solve many problems or issues with accreditation recordkeeping. It creates standardized forms. (Out of the dozens of ASCs I have visited researching AccreditSoft, 90 percent had a different logbook form for a particular item) With standardized forms there is no more, "This is what our consultant told us," or no more internet trolling for forms. No more unnecessary, time consuming data entry.
When we started our initial research for developing AccreditSoft, we were very much aware of a very fine line. On one side, we had the techs and nurses. On the other we had the accrediting organizations. We had to design the software to be easy to use and take much less time to enter data than the old manual way. We also had to design it in a way that gives the inspector confidence in the data and that the ASC is compliant.
What we developed was a system that uses an iPad so a nurse or tech can move about the facility and enter information quickly. The date and time as well as the logged in tech's initials are displayed in the logbook report. No more "Catching up." We also allow for detailed comments by the tech/nurse for almost every situation.
AccreditSoft created an "UNFINISHED TASKS" report. At a glance, an inspector can view any logbook omissions. If a nurse or tech neglects to check the crash cart on a "surgery day," it is documented for the inspector. The inspection process for logbooks goes to light speed when using electronic logbooks.
Standardized recordkeeping allows both the ASC and the inspector to always be in sync. It eliminates a great deal of ambiguity and removes differences in "Inspector Preferences." It's not fair to the ASC to be told one thing by an inspector and three years later be told something entirely different.
ASCs and accreditation organizations are all about "standard of care." It's now time for "standards of recordkeeping."
Over the last two-and-a-half years I have done a great deal of research into the responsibilities ASC nurses have with keeping up on their accreditation requirements. I also have been involved in dozens of "start up" ASCs over the last 15 years.
This research was used to create a fast, STANDARDIZED ELECTRONIC method of capturing logbook data. (WWW.AccreditSoft.com)
NEW OR STARTUP FACILITIES
When looking at startup centers, I noticed one issue that was present with every facility; FEAR! Many times a nurse will have the responsibility to get the facility ready for its first inspection. In many cases, this will be the nurses first time taking on such an endeavor. The doctor/owner has spent a great deal of money and it falls on the nurse administrator to get ready for the all important first inspection.
One of the first tasks is preparing the logbooks to document the day to day procedures such as checking to make sure equipment is functioning, the operating room is cleaned and disinfected and much more. To accomplish this, I have seen on more than one occasion, staff trolling the internet for log book forms or copying them from other facilities.
During this initial startup nurses become fearful of getting the correct form or, more to the point, the form that captures the information the accrediting organizations want. This is one the main points I am trying to make; WHAT IS THE CORRECT LOG FORM? The answer is: DEPENDS ON WHO YOU ASK.
Take the crash cart as an example. I have seen log forms for this item ask the tech to test the defibrillator with the plug in the wall and with the plug out of the wall. Forms that ask for the information on the printout to be recorded on the form and forms that simply want to know if the defibrillator is working correctly. I found over a dozen forms from similar ASCs asking different information about the same thing: a crash cart.
EXISTING FACILITIES
Filling in forms for logbooks takes time. The more information you have to enter, the more time is involved in doing so.
Let's use the sterilizer/autoclave in this example. I have seen sterilizer forms from two very similar facilities. One operating room, three bed recovery pain management accepting Medicare payments. One facility has a complex form that has many informational requirements. The other facility has a simple form that asks much less information.
The "SIMPLE" form had fields for DATE, STERILIZATION TIME, TEMP. PRESSURE, DRY TIME and the TECH’s INITIALS. The "COMPLEX" form had in addition to those: The NUMBER and CONTENTS of the packs, the TIME OF DAY and rather than entering TEMPERATURE and PRESSURE, the form asked if the temperature and pressure was PASS/FAIL. It had a place for what the pack indicator shows and it also asks for a signature and initials of the tech.
When I asked the "Complex Form" facility why they recorded so much information, I was told, "This is the form we were told to use by our consultant."
When I asked the "SIMPLE FORM" facility why they used their form, I was told, "This is what I found online. We have never had an inspector not accept it. We've used this form for years." Filling out the complex form took twice as long as the simple form.
"I'M WAY TO BUSY FOR THAT NOW"
One of the most serious issues in recording logbook data is; WHEN IT IS ENTERED?
The intent and what accreditation is all about is making sure the facility is attending to details that boil down to one issue: PATIENT SAFETY. The way we know a facility is attending to those details is documentation. The all important LOGBOOK. This is what an inspector is really interested in.
Did you check the defibrillator and anesthesia equipment BEFORE the patient was operated on? Is the back-up power working? Have you cleaned and disinfected the operating room?
Let's face it; nurses are very busy attending to patients and doctors. I don't think there is an ASC facility in existence that has not been in a position of "catching up" on logbook entries. It is the biggest problem in MANUAL accreditation recordkeeping. Something looks strange when there are five, 10, 20 days of entries with the same color ink, same handwriting, same everything!
This is especially true in small facilities where there is limited staff — facilities that have one nurse or tech doing everything. Plastic surgery, pain management and other small one or two doctor facilities are prime examples of "catching up."
ELECTRONIC LOGBOOKS
Electronic logbooks solve many problems or issues with accreditation recordkeeping. It creates standardized forms. (Out of the dozens of ASCs I have visited researching AccreditSoft, 90 percent had a different logbook form for a particular item) With standardized forms there is no more, "This is what our consultant told us," or no more internet trolling for forms. No more unnecessary, time consuming data entry.
When we started our initial research for developing AccreditSoft, we were very much aware of a very fine line. On one side, we had the techs and nurses. On the other we had the accrediting organizations. We had to design the software to be easy to use and take much less time to enter data than the old manual way. We also had to design it in a way that gives the inspector confidence in the data and that the ASC is compliant.
What we developed was a system that uses an iPad so a nurse or tech can move about the facility and enter information quickly. The date and time as well as the logged in tech's initials are displayed in the logbook report. No more "Catching up." We also allow for detailed comments by the tech/nurse for almost every situation.
AccreditSoft created an "UNFINISHED TASKS" report. At a glance, an inspector can view any logbook omissions. If a nurse or tech neglects to check the crash cart on a "surgery day," it is documented for the inspector. The inspection process for logbooks goes to light speed when using electronic logbooks.
Standardized recordkeeping allows both the ASC and the inspector to always be in sync. It eliminates a great deal of ambiguity and removes differences in "Inspector Preferences." It's not fair to the ASC to be told one thing by an inspector and three years later be told something entirely different.
ASCs and accreditation organizations are all about "standard of care." It's now time for "standards of recordkeeping."