Table 6.
Survey results using the Delphi method to examine potential endoscopy unit quality indicators for the Safety and Infection Control domain
| Safety | 1st round voting (n = 29), median (%), 1 = strongly disagree, 5 = strongly agree |
2nd round voting (n = 18), median (%) |
|||
|---|---|---|---|---|---|
| Related to quality | Meaningful to measure (%) | Feasible to measure (%) | Compliance in own endoscopy unit (%) | Related to quality (%) | |
| Nurses and physicians are credentialed with endoscopy unit policy relative to moderate sedation.∗ | 5 | 5 (82.1) | 5 (85.7) | 5 (85.7) | 5 (92.3) |
| Endoscopy unit has a written environmental disinfection policy. | 5 | 5 (81.5) | 5 (85.2) | 5 (76.9) | 5 (92.3) |
| Endoscopy unit has a system for reviewing adverse events and implementing strategies to prevent or reduce them.∗ | 5 | 5 (92.3) | 5 (77.8) | 5 (71.4) | 5 (83.3) |
| Presence of all sedation reversal agents is verified each day the facility is in operation.∗ | 5 | 5 (64.3) | 5 (75.0) | 5 (75.0) | 5 (83.3) |
| Endoscopy unit has a system for monitoring that all medical equipment, including rescue devices, are in proper working condition, and this is verified each day the facility is in operation.∗ | 5 | 5 (75.0) | 5 (85.7) | 5 (66.7) | 5 (83.3) |
| Resuscitation equipment, availability, and functional status are verified each day the facility is in operation.∗ | 5 | 5 (82.1) | 5 (92.9) | 5 (82.1) | 5 (82.4) |
| Endoscopy unit has written policies detailing safety procedures in the facility. | 5 | 5 (57.1) | 5 (75.0) | 5 (67.9) | 5 (72.2) |
| Endoscopy unit has a system for recording and tracking endoscopy-related adverse events.∗ | 5 | 5 (89.3) | 5 (67.9) | 5 (71.4) | 5 (72.2) |
| Endoscopy unit has a process in place to identify patients at risk for falls.∗ | 5 | 5 (53.6) | 5 (57.1) | 5 (57.1) | 5 (72.2) |
| Rate of unplanned admissions, emergency department visits, and observation stays within 7 days after receiving a colonoscopy. | 5 | 5 (69.2) | 4 (48.2) | 2 (22.2) | 5 (66.7) |
| Use of reversal agents for sedation is documented and tracked on a regular basis.∗ | 5 | 5 (64.3) | 5 (81.5) | 5 (64.3) | 5 (61.1) |
| Rates of modification, interruption, or termination of scheduled procedures because of sedation-related events.∗ | 5 | 5 (60.7) | 5 (64.3) | 4.5 (50.0) | 5 (61.1) |
| Number of adverse events that occur within 14 days of an endoscopic procedure including in-hospital deaths and nonelective hospital admissions is recorded. | 5 | 5 (64.3) | 5 (51.9) | 4 (14.3) | 5 (33.3) |
| Mechanism in place to contact patients 14 to 30 days after their procedure to identify delayed adverse events. | 5 | 4 (25.0) | 4 (17.9) | 2 (14.3) | 4 (27.8) |
| Infection control | Related to quality | Meaningful to measure (%) | Feasible to measure (%) | Compliance in own endoscopy unit (%) | Related to quality (%) |
|---|---|---|---|---|---|
| Process is in place to track each specific endoscope from storage, use, reprocessing, and back to storage. | 5 | 5 (82.1) | 5 (78.6) | 5 (85.7) | 5 (94.4) |
| Endoscopy unit has instructions immediately available for high-level disinfection that are specific to the endoscope models being used.∗ | 5 | 5 (85.7) | 5 (89.3) | 5 (81.5) | 5 (94.4) |
| Endoscopy unit has policies and procedures in place to ensure that reusable medical devices are cleaned and reprocessed in accordance with manufacturer’s instructions appropriately before use in another patient.∗ | 5 | 5 (88.9) | 5 (85.2) | 5 (78.6) | 5 (94.4) |
| Endoscopy unit has policies and procedures in place to identify damaged equipment and remove that equipment from service.∗ | 5 | 5 (75.0) | 5 (75.0) | 5 (66.7) | 5 (94.4) |
| Process is in place to maintain a log on the successful completion of each key step in reprocessing, including sufficient patient demographic information and endoscope identification for appropriate postprocedure event. | 5 | 5 (85.2) | 5 (84.6) | 5 (84.6) | 5 (88.9) |
| Endoscopy unit has a specific policy discussing the proper use of single-dose medication vials. | 5 | 5 (75.0) | 5 (85.7) | 5 (71.4) | 5 (88.9) |
| Endoscopy unit has policies and procedures that adhere to current ASGE and SGNA guidelines concerning safety and infection control in endoscopy. | 5 | 5 (82.1) | 5 (85.7) | 5 (70.4) | 5 (88.9) |
| Endoscopy unit has policies and procedures in place to ensure the proper use of devices marked single use only. | 5 | 5 (78.6) | 5 (82.1) | 5 (82.1) | 5 (88.9) |
| Policy to avoid the use of multidose vials when possible and document their appropriate use when they are used. | 5 | 5 (77.8) | 5 (77.8) | 5 (74.1) | 5 (88.9) |
| Handwashing facilities and alcohol-based hand gel are available to patients, visitors, and staff. | 5 | 5 (78.6) | 5 (78.6) | 5 (85.2) | 5 (88.9) |
| Core competencies for personnel involved in reprocessing endoscopes are verified initially and at least annually or when there is an adverse event or change in endoscopes or reprocessing equipment.∗ | 5 | 5 (85.2) | 5 (96.2) | 5 (84.6) | 5 (88.2) |
| Endoscopy unit monitors and records adherence to hand hygiene guidelines and provides feedback to personnel. | 5 | 5 (67.9) | 5 (60.7) | 5 (64.3) | 5 (77.8) |
| Process is in place to document the successful completion of training in safe injection practices, and then verification of compliance of all personnel regarding safe injection practices on a semiannual basis. | 4 | 4 (21.4) | 4 (32.1) | 3.5 (17.9) | 4 (22.2) |
Indicators that are shaded white had consensus reached on them (ie, median of “5” on the second round of voting for the relatedness parameter with ≥80% of respondents rating it a “5”) and were the 6 highest-rated indicators for this domain.
Note: Patients and payers did not participate in the voting process. Both groups were initially invited but opted not to participate.
ASGE, American Society for Gastrointestinal Endoscopy; SGNA, Society of Gastroenterology Nurses and Associates.
∗
Mandated by national regulatory or accreditation standards.