MedStar Health vendor, access program: one system's story

AORN Journal,  Nov, 2007  by Cheryl Hardy

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Ever since the publication of the Institute of Medicine s To Err is Human: Building a Safer Health System, (1) there has been an increased, nationwide focus on identifying risks to patients and decreasing or eliminating these risks to create a safer patient environment. Perioperative nursing managers at MedStar Health, a not-for-profit, community-based health care organization serving the Baltimore, Maryland/Washington, DC, area, identified the presence of sales and service vendor representatives in the system's facilities as a potential patient safety issue.

Vendor representatives frequently access restricted areas such as the OR or cardiac catheterization laboratory during patient procedures. Although vendor representatives have limited access to confidential patient information, MedStar Health had no documentation of criminal background checks, substance abuse testing, or health status for these individuals.

Vendor representatives also frequently are present during nurse or physician inservice programs on equipment or procedures; however, MedStar Health had no documentation to verify the representatives' education or certification. Concern about this lack of information and competency validation prompted perioperative nursing managers at MedStar Health to create a corporate vendor badging system for all representatives entering a MedStar Health facility for any business-related purposes.

THE MEDSTAR HEALTH SYSTEM

MedStar Health comprises seven hospitals and more than 25 diversified businesses with more than 23,000 employees and 4,600 affiliated physicians. It is the largest health system in the Baltimore, Maryland/Washington, DC, region, caring for more than half a million patients each year. MedStar Health has more than 130 ORs, 35 cardiac catheterization laboratories, and more than 350,000 emergency department visits annually.

MedStar Health constantly strives to become more efficient and effective in all areas of patient and employee safety. Processes, procedures, and practices to ensure patient safety are continually examined, monitored, and updated through a variety of mechanisms and methods. The complexity of coordinating a system of this size around an identified, system-level safety issue requires detailed planning and a competent communication strategy, so personnel in the Resource Management Department (RMD), MedStar Health's internal performance improvement consulting team, assisted personnel in the Corporate Materials Management Department during the planning and development phases of this project. The RMD team was given the task of designing the vendor access program to the point of implementation. After implementation, the responsibility for the program was assigned to the Corporate Materials Management Department, which also is responsible for its ongoing maintenance.

EARLY INVESTIGATION AND DECISIONS

The project began with the RMD team exploring whether any other large hospital systems had identified this same safety issue and whether any had implemented programs to address it. This investigation revealed that the issue was not unique to MedStar Health and did, in fact, exist in most hospitals regardless of size and geographic location. Several other health systems had developed programs to address the security issues posed by on-site vendors and were willing to share some of their findings. Sentara Healthcare in Norfolk, Virginia, had an established vendor badging program, the fundamentals of which they were willing to share. The RMD team used Sentara Healthcare's basic program design and tailored it to include the specific requirements that were important to the MedStar Health values and mission.

An additional useful resource during this process was AORN's "Position statement on the role of the health care industry representative in the perioperative/invasive procedure setting," (2) which was ratified by AORN's House of Delegates in March 2006. This position statement was created to better outline the function and responsibilities of health care industry representatives in hospital settings.

After the RMD team had reviewed all of the existing MedStar hospital policies on vendor management, it was clear that there were differences and inconsistencies in current practices throughout the system. A corporate policy was written that would be applicable to all the MedStar Health hospitals and bring continuity to the program. Input for this policy was received from all business units and areas that would be affected by it.

Early in the process, staff members of the RMD had to decide whether MedStar would collect the necessary documentation and create the vendor identification badges or outsource these functions. Because this was a corporate program, it seemed appropriate to centralize this process; however, it was believed that doing so could create an unreasonable burden on personnel in the Security Departments at the individual hospitals. A decision therefore was made to outsource this process. The RMD team explored options with several companies and signed a three-year contract with one of them for the initial creation of the vendor representatives' badges. When the contract terminates, MedStar Health officials will decide whether to manage the badging process internally or to continue outsourcing.