There are various regulatory agencies at the federal, state and local levels that monitor both health care facilities and health care practitioners to promote safety and quality. Rules and regulations for the health care industry are established by these agencies and compliance is monitored. In addition, there are agencies that provide accreditation that is voluntary but key to influencing quality, safety and reimbursement practices in health care facilities. Accrediting agencies provide regular inspection of facilities.
Eliminating errors and ensuring quality outcomes is a shared responsibility of all health care workers in every setting. Emergency nurses are at the front line of patient contact and have an important view of safety in a unique clinical setting. ENA has actively participated in providing feedback on pending regulatory requirement changes and additions either through IQSIP or ENA public policy statements.
Some of the regulatory agencies that interact with health care practitioners in their facilities are:
Centers for Disease Control and Prevention (CDC)
This federal agency provides expertise, information and tools that are needed to protect health; prevent disease, injury and disability; and prepare for new health threats. The CDC monitors and strives to control infectious diseases. The Clinician Outreach and Communication Activity (COCA) division provides clinicians with current and reliable information on emerging health threats. Information for clinicians can be found at www.bt.cdc.gov/coca/.
ENA has collaborated with the CDC on the following initiatives:
· Communication of information on the 2010-2011 influenza season
Centers for Medicare and Medicaid Services (CMS)
This federal agency works to establish quality and cost effective care standards for participants and determines reimbursement levels for that care. The CMS Conditions of Participation are a part of the Code of Federal Regulation and care providers must comply to receive reimbursement.
ENA has provided feedback regarding the following:
· Hospital anesthesia services interpretive guidelines
· Memorandum summary on hospital anesthesia services interpretive guidelines
· FAQs for revisions to anesthesia services interpretive guidelines
Food and Drug Administration (FDA)
This federal agency provides oversight of blood products, medical devices, drugs, vaccines and biologics. The FDA issues alerts to the health care industry and watches for medical error and adverse reactions to treatments.
The Joint Commission (TJC)
This agency provides accreditation services to health care organizations. Over the past decade, TJC has been instrumental in focusing the attention of all health care providers on the importance of patient safety through National Patient Safety Goals.
ENA has reviewed the following issued by TJC:
· Field Review – NPSG Medication Reconciliation
· Performance Measures – Sudden Cardiac Arrest Prevention
ENA over the years has issued joint statements with ACEP and AAEM expressing serious concerns on several key indicators that impact the delivery of care in the emergency setting:
· Medication Reconciliation – May 2010
· Nurse Initiated Protocols – November 2007
· Pharmacy Review of Medications – April 2007
· Pharmacy Review of All Medications – November 2006
· Medication Reconciliation – May 2006
ENA publishes its Public Policy Agenda biennially to:
1. Focus and establish the priority issues to be addressed by ENA
2. Inform members, government officials, colleague organizations and the media about ENA's public policy concerns
3. Provide a continuing framework for ENA to review and report on actions that address current and past policy concerns
Details on the public policy statements can be found at http://www.ena.org/government/policystatements/Pages/statement.aspx