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A publication produced by
Facility Risk Management
"Well done is better than
well said."
--Benjamin Franklin,
American inventor and statesman
In This Issue
Tip from the Expert
Regulatory News: Colorado Governmental Immunity Act
Regulatory News: Patient Safety Organizations
Regulatory News: ASC Waiver Application Requirements
Regulatory Update: CMS Operating Room Humidity Requirement
Professional Review Law Update--Colorado
News from COPIC
Online Learning
Copiscope Newsletter Highlights
The Latest from ECRI
Pennsylvania Patient Safety Advisory
Institute for Safe Medication Practices
Agency for Healthcare Resarch & Quality
News and Tools
Contact Us
Risk Management
24/7 Hotline:
(720) 858-6270 or
(800) 421-1834, ext. 6270
Save the Date!
The 2013 COPIC Patient Safety & Risk Management Forum will be held at the
J.W. Marriott Denver
in Cherry Creek, Colorado on 
October 2nd, 3rd, & 4th.
Watch for registration forms coming to your email in early August!
In The News
Congratulations to:
Gunnison Valley Hosp., Gunnison, CO;
Heart of the Rockies Regional Medical Center, Salida, CO;
Southwest Memorial Hospital, Cortez, CO; and Boone County Health Center,
Albion, NE!

These Critical Access Hospitals were each recognized by iVantage Health Analytics as a Top 100 Critical Access Hospital for 2013 in the rural hospital industry.


(This notification does not imply a product or service endorsement by COPIC.) 

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Becker's ASC Review


Upcoming Educational Conferences
ASHRM 2013 Annual Conference & Exhibition
October 27-30, 2013
Austin, Texas
Colorado Health & Hospital Association Annual Conference
September 11-19, 2013
Vail Marriott Resort
Vail, CO
CHARM Annual Conf.
September 20, 2013
JW Marriott Cherry Creek
Denver, CO
Colorado Rural Health Center Annual Conf.
October 17-18, 2013
Hotel Elegante
Colorado Springs, CO
Colorado Health & Hospital Association: Patient Safety Leadership Congress
October 22, 2013
Hyatt Regency Denver
Denver, CO
Nebraska Rural Health Conference
September 18-19, 2013
Kearney, NE
NHA Annual Meeting
October 23-25, 2013
Embassy Suites
La Vista, NE
Infection Control Resources 

APIC Guide to Preventing C-Diff Infections (Updated)


2012 CRE Toolkit: Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE)


The Joint Commission Implementation Guide for NPSG on Surgical Site Infections


New Department of Health and Human Services' HAI Action Plan updates and expands the initial version issued in 2009. It includes sections specific to infection reduction in ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities, as well as a section on increasing influenza vaccination of health care personnel.


"Infection Prevention Training for Ambulatory Surgery Centers" from the Department of Health and Human Services. While these training programs are designed for ambulatory surgery centers (ASC), many are also appropriate for outpatient facilities other than ASCs. CME is given for completed training sessions. 

Information Technology Resources 
High Five!
COPIC was impressed to learn of the proactive efforts the Spanish Peaks Regional Health Center made to prepare for evacuation when they were threatened by wildfire last month. It was no easy task!  
COPIC Better Medicine, Better Lives
  July 2013

Tip from the Expert

Dr. Matthew Baretich, President of Baretich Engineering, offers words of advice about equipment and instruments that are involved in patient events:

"Sequestering the equipment is essential, as soon as possible after the event. Some related issues: Keep the accessories and disposables too - and, if possible, the packaging (which may have lot numbers). Don't change the settings on the equipment. Plug the equipment in so that any data stored internally will not be lost. Save any printouts. If the equipment is part of a larger system (e.g., a bedside monitor that's part of a larger monitoring system), try to apply these same considerations to the system as well as to the particular piece of equipment.
I have found all of these factors to be important in understanding what happened. That lets us learn how to avoid the problem in the future and protect the interests of the organization in case legal action is taken later. Protecting the patient is, of course, the immediate concern during an incident. But the more information we can preserve the better."
Matthew Baretich, PhD, CPHRM, CHFM, PE, CCE, CHC
Baretich Engineering
Fort Collins, CO
Regulatory News: Colorado Governmental Immunity Act
Increase in the limits of liability available under the Colorado Governmental Immunity Act (CRS 24-10-101 et.seq.)-Effective July 1, 2013


If you are a qualified governmental immune facility, the new limit of liability statute will apply to your facility.

Essentially, new legislation passed in Colorado that increased limits from $150,000 for any injury to one person in a single occurrence to $350,000. The limit available for injury to two or more persons in any single occurrence increased from $600,000 to $990,000.

If a patient is provided care by an individual who is considered a public employee under the Colorado Governmental Immunity Act, COPIC recommends you include information in your patient intake forms along the following lines:


Governmental Immunity Notice

Medical care or treatment at ______________(your facility name) may be provided by individuals who are considered public employees by the Colorado Governmental Immunity Act. The Colorado Governmental Immunity Act, Article 10 of Title 24 of the Colorado Revised Statutes, limits the amount of damages recoverable from public employees and entities, requires a formal notice of a claim, and places a 180-day time limit on the period for filing such a notice of claim.

COPIC also recommends that facilities consult their personal or in-house legal counsel before inserting such language in case there are issues unique to the facility which should be considered.


Affected facilities will or may have already received an updated endorsement for their COPIC policy which recognized the new limits, effective 7/1/13, and should be attached to your COPIC policy. Should you have any questions about the above recommendations or the change to your policy, please contact your COPIC Underwriter directly at (800) 421-1834.

Regulatory News: Patient Safety Organizations 
The Affordable Care Act Patient Safety Organization (PSO) Requirements for Hospitals (Effective January 2015)  
There is a provision in the Patient Protection and Affordable Care Act (ACA) that as of January 2015, qualified health plans participating in the health insurance exchanges may only contract with hospitals that utilize a patient safety evaluation system (PSES), which is the collection, management, or analysis of information for reporting to or by a patient safety organization (PSO). A PSO refers to a private or public safety entity listed by the Department of Health and Human Services (HHS). The hospital must also implement a mechanism to ensure that each patient receives a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional.
There is an exception to this requirement for hospitals with fewer than 50 beds. The Secretary of HHS has the authority to promulgate regulations about this requirement and create exceptions, but there has been no HHS guidance on this to date. COPIC will watch this closely in the coming months.
Regulatory News: ASC Waiver Application Requirements
Waiver Application Requirements Regarding Ambulatory Surgery Centers (ASCs) in Colorado
COPIC has recently received multiple reports from our endoscopy center clients of being cited by the State during survey for not having a waiver in place. This waiver is required by all ASCs that do not have an operating room with the capability of administering general anesthesia in a sterile environment as cited below:
CDPHE Standards for Hospitals and Health Facilities, Chapter XX - Ambulatory Surgical Centers
Section 14 Surgical Services
A. Location: The ambulatory surgical center shall have at least one operating room that has the capability of administering general anesthesia to patients and is located in a sterile environment within the facility. The operating room(s) and accessory areas shall be located so that in and out traffic is properly controlled. The ambulatory surgical center may have additional, appropriately equipped treatment and/or procedures rooms for surgical procedures not requiring general anesthesia.
B.  1. If an ambulatory surgical center generally provides only surgical services that do not require general anesthesia, the facility may make application to the department for an appropriate modification of the requirements for a surgical suite provided that the facility can demonstrate the ability to implement a functional, sterile operating room whenever such use would be necessitated by patient needs.
2. The provisions of paragraph A shall not apply to ambulatory surgery centers licensed prior to January 30, 1995.
Click here for more information about the waiver application.
Regulatory Update: CMS Operating Room Humidity Requirement 
The Centers for Medicare & Medicaid Services (CMS) is lowering the humidity requirement for operating rooms.
CMS has made the change by issuing a categorical waiver. Hospitals and ambulatory surgery centers do not have to apply in advance or wait until they are cited to take advantage of this wavier. Facilities that want to use the waiver must document their decision to do so. At the beginning of any survey assessing Life Safety Code compliance, the facility must notify the survey team of its prior decision to use the waiver. Facilities should still monitor relative humidity levels in anesthetizing locations and must take action to ensure that humidity levels remain at or above 20 percent.

Please review the regulations for further guidance.
Professional Review Law Update--Colorado 
All health care entities that conduct professional review are reminded of the important registration requirement under the Colorado Professional Review Act.
In order to continue to receive the immunity afforded under CPRA, governing boards of entities that have one or more professional review committees must have registered with the Division of Regulatory Agencies (DORA) by July 1, 2013. If a governing board first establishes a PRC after July 1, 2013, it must register within 30 days after approving the written bylaws, policies, or procedures for the committee.
Further information can be found in the June 2013 issue of COPIC Topics Newsletter.
News from COPIC 
Now Available: Electronic Communication in Medical Practice
This guide for medical professionals, provided by COPIC, includes resources and information on key electronic communication issues. Click HERE to download.
Update on the "Key Concepts in Health Care Documentation: A Safety & Risk Perspective" Module
This integrative educational packet will be ready for trial-use in July. Those who requested to participate in the trial of the module will be contacted in July by Terri Gaertner to schedule a trial period.
When the trial period has ended, we will ask participants to complete a questionnaire of their experience which will assist us to refine the module. Once the trial process is completed, reviewed and refined, the module will be available online for use by our insureds. COPIC will notify our insureds via email when the module is available on our website.
Did you know there is a page on COPIC's website specially dedicated to our Hospital and Facility Services?
Visit page by clicking HERE, or find it under the "Our Services" section as one of the "Patient Safety and Risk Management" pages on our website.
This section was specifically designed for our insured facilities and includes access to:
  • Current and archived Facility e-Newsletters.
  • COPIC Facility Value Added Services including "Introductory Packets".
  • Past Patient Safety and Risk Managment Forum presentations and tools.
Online Learning
No travel necessary! COPIC On-Demand Courses are available online.
All insureds are welcome to take courses from their home or office computer and apply for CMEs, CNEs and/or COPIC points (eligible COPIC-insured physicians only) when available. Visit the Education Resources page on our website for the most current offerings.
New online courses available this month:
  • Communication Techniques Module 1 and 2
  • Difficult Interaction in the Office Setting

If you need to obtain a username and password for the COPIC website, please contact Kelsey Gifford.

If you have further questions on how to access the
on-demand courses, please contact Sunny Hessler.
Copiscope Newsletters
Highlights from recent issues of the 2013 Colorado Copiscope:
  • Surgical Provider Preventable Conditions
  • Prescription Drug Abuse Educational Resources
  • Physicians Spend Nearly 11 Percent of Their Careers with an Open, Unresolved Claim 
  • Inside COPIC: An Intensive Look at the World of Patient Safety and Medical Liability


  • Ten Tips to Help Promote Patient Safety
  • Patient Privacy and Social Media
  • Pitfalls in the Diagnosis and Treatment of Skin Cancer
  • Electronic Communications in Health Care


Highlights from recent issues of the 2013 Nebraska Copiscope:


  • Immunity for Health Care Providers Under Emergency Circumstances and as Volunteers
  • Caring for Breast Cancer Survivors
  • Steep Rise in Childbirth Complications
  • Sign Up for Drug Alerts from PDR Network


  • Informed Consent: Addressing What Patients Need to Know
  • COPIC Launches New Online Family Practice/Obstetrics Courses
  • Surgical Provider Preventable Conditions
  • Physicians Spend Nearly 11 Percent of Their Careers with an Open, Unresolved Claim

Missed an issue? Visit our Newsletter Archive.


The Latest from ECRI 
ECRI Healthcare Risk Control Membership News 

For Acute Care Facilities 


New Risk Analyses--May 2013

  • OSHA's Hazard Communication Standard
  • Safety Data Sheet For Hazardous Chemicals
  • Optimizing the IPM Program 
ECRI Operating Room Risk Management Membership News
For Ambulatory Surgery Centers

March 2013 
  • ORRM Device Alerts 

April 2013

  • Disruptive Practitioner Behavior
  • Disclosure of Unanticipated Outcomes
  • High-Alert Medications
  • Emergency Management

May 2013

  • ORRM Device Alerts

June 2013

  • Office-Based Surgery and Anesthesia
  • Immunization of Healtchare Personnel
  • Patient-Centered Care

For more info, visit ECRI Institute online.


Pennsylvania Patient Safety Advisory 
The June 2013 issue of the Pennsylvania Patient Safety Advisory (PPSA) includes the following articles:
Reviews and Analysis
  • Wrong Patient Medication Errors: An Analysis of Event Reports in PA and Strategies for Prevention
  • Skin Integrity, Immobility, and Pressure Ulcers in Class III Obese Patients
  • Spotlight on Electronic Health Record Errors: Paper or Electronic Hybrid Workflows
Focus on Infection Prevention
  • Infection Control Challenges: PA Nursing Homes are Making a Difference Through Implementation of Best Practice
  • Quarterly Update on Wrong Site Surgery: Trying to Hold the Gains

Other Features

  • Contracting for Safety: A Misused Tool
Institute for Safe Medication Practices (ISMP) 
In Case You Didn't Know:
As of January 2012, Nurse Advise-ERR Newsletter is being offered FREE to acute care hospitals, behavioral health facilities, community health clinics, surgical centers and birthing centers, as well as faculty at academic settings. Those who work in other settings can still purchase a subscription.
Please refer to the ISMP website for more information on signing up for your free newsletter. This is a great newsletter, so check it out!
  • March 2013 - A Clinical Reminder About the Safe Use of Insulin Vials
  • April 2013 - High Alert Medication List...Relatively Useless Without Risk-Reduction Strategies
  • May 2013 - Survey results show that Medication Safety Information provided by ISMP is valued and acted upon by hospital nurses
A Word About the Agency for Healthcare Research and Quality (AHRQ)
The AHRQ is a sector of the U.S. Health and Human Services branch that is home to the National Guideline Clearing House resource and many others. This is a public site and houses a wealth of health care resources.
Please take a few moments to visit its website and become familiar with the content. Many of the News and Tools links below are AHRQ resources. You can also sign up for its free electronic newsletter.  
News and Tools
Thank you for your commitment to patient safety and improving the practice of medicine. Always feel free to contact COPIC with any questions you may have about Patient Safety and Risk Management services.

Carol Anne Tarrant, RN, MS, JD, CPHRM

Director, Facility Patient Safety and Risk Management

Phone: 720-858-6000//Toll Free: 800-421-1834