The following are four recent questions asked of Sheldon S. Sones, RPh, FASCP, president of Sheldon S. Sones and Associates, a pharmacy and accreditation consulting firm based in Newington, Conn.
1. Q: When an ophthalmic ointment is ordered, is there a dosing guideline required in the order?
Sheldon Sones: No. One of the manufacturers of a common product used in ambulatory surgery centers that I reviewed this with pointed to the official package insert which states "apply a small amount."
Note, however, in the case of nitroglycerin ointment (obviously not an ophthalmic) there is a specific "length" stipulated. That product has largely been replaced by dose-specific patches. For other products, including ophthalmics, specific amounts are not routinely specified.
2. Q: In handling Cavicide wipes, are gloves required?
SS: Yes. This is a widely used and recommended product. However, it is not innocuous to the skin. The MSDS (material safety data sheet) is clear: "avoid skin contact."
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3. Q: There is access to the controlled drug safe by several of our staff. Does this then require twice daily counts?
SS: Generally yes, but bear in mind that each state may have stricter regulations regarding the controlled drug counts. Those then prevail. Usually, only if the access is limited to specifically authorized staff, preferably two individuals, will counts on withdrawal from the safe and then monthly suffice. As a point of clarification, this applies to the main safe supply and not the working or PACU stock. The latter requires daily count at start and end of each service day.
4. Q: I read that Medicare is going to offer reward for quality via "process measures." Can you explain further?
SS: This will be a pivotal part of our practice environment going forward. Basically President Obama and Medicare are saying to hospitals and all providers that we will reward excellence and determine that excellence via "process measures," which is a way of embracing the benchmarking concepts we all know have been long supported by overseers.
Since 2001, our service has been documenting great process measures such as infection rates, antibiotic administration in relation to incision, falls, vitrectomies, perforations, reversals in GI as well as scope in/out times and more recently cecum out. It all comes together with the Medicare offer of reward for quality. I think it's great news for ASCs as we have a great story to tell, including embracing these concepts not because of the new Medicare initiative, but with so many success stories in problem identification and resolution and doing this benchmarking long before "we had to."
Learn more about Sheldon S. Sones and Associates and www.sheldonsones.com.
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