AORN Journal
Volume 89, Issue 3 , Pages 485-487, March 2009

Ambulatory Surgery Centers: Same Standards; Different Venues

  • Ann Geier, RN, MS, CNOR, CASC (Vice president of operations)

      Affiliations

    • Ambulatory Surgical Centers of America, Hanover, MA
    • ,
  • Donna Gelardi-Slosburg, RN, BSN, LHRM, CASC (Executive director)

      Affiliations

    • ASC Quality Collaboration, St Petersburg, FL

Article Outline

 

In the fast-paced world of ambulatory surgery centers (ASCs), how do we ensure quality and safe care for our patients? Whether you are transitioning from working in a hospital to working in an ASC or you have been in the ASC industry for many years, the foundation for quality and safety goes back to the basic practices we all learned in nursing school (Table 1). In addition, many of us remember the mantras of our nursing instructors, “when in doubt, throw it out,” or “nurses are the patient's advocate.” These sayings have stuck in our minds for the 60 years of combined practice we have experienced. Personally, we are thankful that they are there as reminders to do things correctly.

Table 1. Basic Nursing Practice Reminders
The nursing process: an organized sequence of problem-solving
Assessment: collect and organize data
Diagnosis: analyze data
Planning: prioritize, identify measurable goals
Implementation: carry out the plan of care
Evaluation: monitor outcomes, resolve, continue
The 5 rights of medication administration
Right medication
Right patient
Right route
Right dose
Right time
The Universal Protocol™1
Preoperative verification process
Marking the surgical site
Time out
Infection control
Hand hygiene
Clipping hair versus shaving
Aseptic technique
Documentation
Write or print legibly
Record facts not interpretations
Use measurable data
Use approved abbreviations

Editor's note: The Universal Protocol is a trademark of the Joint Commission, Oakbrook Terrace, IL.

1 Universal Protocol. The Joint Commission. http://www.jointcommission.org/PatientSafety/UniversalProtocol. Accessed January 23, 2009.

We truly believe that all nurses seek to practice at the highest level and provide quality care. Yet, in the real world of short turnover times, greater complexity in procedures and technology, and higher patient acuity, there is an increased risk that patient safety standards will be compromised. What specific quality measures for ASCs exist?

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ASC Quality Measures 

Although the Centers for Medicare and Medicaid Services (CMS) has not specified national quality measures for ASCs, the ASC Quality Collaboration—a cooperative group of organizations and companies interested in ensuring that ASC quality data are measured and reported in a meaningful way—has taken an active role in developing quality measures for ASCs. Currently, six measures have been endorsed by the National Quality Forum (NQF):1, 2

•patient burn;

•prophylactic IV antibiotic timing;

•patient fall in the ASC;

•wrong site, side, patient, procedure, and implant;

•hospital transfer/admission; and

•appropriate surgical site hair removal.

Definitions and criteria for each of these measures are available at http://www.ascquality.org/documents/Summary6ASCmeasuresendorsedbyNQF.xls.

In an effort to further ensure quality care in ASCs, the CMS has updated its conditions for coverage that become effective May 18, 2009.3 Section 416.43 of the CMS conditions for coverage states that quality assessment and performance improvement requires ASCs to “develop, implement and maintain an ongoing, data-driven quality assessment and performance improvement program.”3(p68789),4 More details are available on the Ambulatory Surgery Center Association web site at http://ascassociation.org/cfcredline.pdf. Tips and tools related to quality or accreditation are available from

•the Accreditation Association for Ambulatory Health Care, http://www.aaahc.org;

•the American Association for Accreditation of Ambulatory Surgery Facilities, http://www.aaaasf.org; and

•the Joint Commission, http://www.jointcommission.org.

As we discuss quality initiatives for ASCs, it is important that we stay abreast of the initiatives that will affect health care in general and our patients' lives in particular. Nurses familiar with changing regulations and clinical advances are stronger patient advocates. In any health care environment, it is important to “speak out” when you suspect basic practices or national standards are being breached. We have many available resources locally, nationally, and within AORN5, 6 that can strengthen our advocacy role.

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Strengthen Your Practice 

At AORN's Congress, a specific educational track addresses areas of concern to freestanding ASCs. These courses are valuable educational experiences taught by our industry leaders. We hope to see a large ASC representation in Chicago at the 2009 Congress. Unfortunately, we know many ASC nurses are not able to attend Congress because of time limitations and constrained budgets. Anyone interested in attending Congress in 2010 should be aware that there are numerous sources of scholarship dollars available through our industry partners and the AORN Foundation. To learn more, visit http://www.aorn.org/AORNFoundation.

We are pleased to represent ASCs on the AORN Journal Editorial Board, but we need your help. Tell us what you want to read about in the AORN Journal. How can we support you and strengthen your practice? You can contact the AORN Journal staff via e-mail at aornjournal@aorn.org. Let us hear from you!

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References 

  1. ASC Quality Collaboration endorsed quality measures . ASC Quality Collaboration . http://www.ascquality.org/documents/Summary6ASCmeasuresendorsedbyNQF.xls Accessed January 23, 2009.
  2. Appendix B: Specifications of the national voluntary concensus standards for ambulatory care: ambulatory surgical centers . In: National Voluntary Concensus Standards for Ambulatory Care Part 2 . Washington, DC: National Quality Forum; 2008;p. B2–B3 http://www.qualityforum.org/pdf/reports/AmbulatoryPart2Nonmembers.pdf Accessed January 28, 2009.
  3. Medicare program: changes to the hospital outpatient prospective payment system and CY 2009 payment rates; changes to the ambulatory surgical center payment system and CY 2009 payment rates; hospital conditions of participation: requirements for approval and re-approval of transplant centers to perform organ transplants—clarification of provider and supplier termination policy Medicare and Medicaid programs: changes to the ambulatory surgical center conditions for coverage; final rule. 73(223) Fed Regist. (November 18, 2008) 68502, 68712-68716, 68789 (codified at 42 CFR §410, §416, §419). http://edocket.access.gpo.gov/2008/pdf/E8-26212.pdf. Accessed January 28, 2009.
  4. Resources from the ASC Association  . Conditions for coverage redline version. Ambulatory Surgery Center Association . http://ascassociation.org/cfcredline.pdf Accessed January 23, 2009
  5. AORN guidance statement  . Postoperative patient care in the ambulatory surgery setting . In: Perioperative Standards and Recommended Practices . Denver, CO: AORN, Inc; 2008;p. 219–225
  6. AORN guidance statement  . Preoperative patient care in the ambulatory surgery setting . In: Perioperative Standards and Recommended Practices . Denver, CO: AORN, Inc; 2008;p. 227–232

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Resource 

  1. Seifert PC . Measuring ambulatory care quality [Editorial] . AORN J . 2008;88(3):351–353

PII: S0001-2092(09)00113-6

doi:10.1016/j.aorn.2009.02.005

AORN Journal
Volume 89, Issue 3 , Pages 485-487, March 2009

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