Unauthorized field modifications – what you don’t know can hurt you
I have an absolutely clear understanding that there are very few (OK, very, very, very few) healthcare facilities for which there is enough space for all the “stuff.” Depending on the vintage of the facility, there may be technology “improvements” that would have been considered right out of Buck Rogers (or The Jetsons or Star Wars, etc.) that now you (or somebody) has to find space to store, charge, etc.
Even before the days of value engineering, storage space (as a non-revenue-generating construct) tended to be on the more modest side of things in terms of capacity, but I can think of any number of instances in which you’d need almost a third more space in order to accommodate all the devices, supplies and equipment needed for patient care in the 21st Century.
The concern I’m having at the moment is those instances when point of care/point of service staff convert spaces that don’t get used very much, like shower and tub rooms, without necessarily going through any sort of process. Some of those spaces were not designed to accommodate clean storage (open floor drains, no supply air, etc.), which may very well represent a significant survey vulnerability, depending on what is being stored in these “other” spaces.
I’m starting to hear some murmurings in the survey world that, as the survey of the physical environment continues to meld with the survey of the effectiveness of infection prevention and control (I’m thinking that if you don’t have a zero rate of HAIs, no matter how low you go, if it’s more than naught, then you’re not quite perfect), the white gloves are starting to reign supreme in the imperfections of the physical environment.
As I have preached for quite some time now, there are no perfect buildings, so the days of no findings in the physical environment are but a distant (and receding) memory.
And yes, I know that this is something that could be identified during rounding, etc., and I “get” that everyone is trying to make the best use of the space as possible, but this is shaping up to be one of those “things” that everyone has to know about (maybe have a risk assessment in your back pocket, if you know what I mean). That means a lot of coordination, collaboration and communication with the folks “living” in the care environment, with more than a smidge of education.
I know it can be challenging to educate the front line folks to why these things are important and while you are happy to have them on your side, there are things that the building was not set up to do. Don’t let a surveyor be the one to find the well-intended modifications to the environment—it will make for a much more tolerable survey process.
About the Author: Steve MacArthur is a safety consultant with Chartis Clinical Quality Solutions (formerly known as The Greeley Company) in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at email@example.com.