Facility Compliance Research Articles

#504 The Joint Commission Safety Goals Applying Practice, Policy and Monitoring in Phase I and II PACU

During this presentation the participants will identify elements for performance as described in the 2007-2008 Joint Commission Safety Goals. Specific elements for performance related to Perianesthesia practice in Phase I and Phase II environments will be reviewed. Essential applications to practice, policy development and monitoring will be presented with practical suggestions to assure that regulatory requirements are met and are pertinent as well to individual and facility compliance.

Post-Hospital Transition to a Skilled Nursing Facility—Compliance, Competence, and Communication

<blockquote>Verifying signed admission orders with an initial phone call to the physician may not be required if the post-hospital care plan is written by the attending physician, meets federal and state regulations related to content, and requires no adjustment for clinical reasons</blockquote> <h4>EXCERPT</h4> <p>The long-term care industry is heavily regulated, and compliance with regulations often is used as one measure of nurses’ performance. However, compliance is no substitute for clinical competence. This article explores the nursing action of phoning physicians to verify the medical care plan when care recipients are transferred from acute to long-term care. Based on a record review and qualitative analysis, the clinical rationale for reviewing and adapting the hospital care plan to the long-term care environment is provided.</p>

Use of PASRR Programs to Assess Serious Mental Illness and Service Access in Nursing Homes

This study assessed the implementation of state Preadmission Screening and Resident Review (PASRR) programs with respect to identification of serious mental illness among nursing facility applicants and residents and access to mental health services. A national survey was conducted with representatives from agencies that implement PASRR in all 50 states and the District of Columbia. Also, 44 states sent PASRR data for review. Four states were selected for an in-depth study; six nursing homes per state were selected and one staff member from each facility was interviewed (N=24). Medical records were reviewed for 30 to 40 residents from each facility who met criteria for potentially having a disabling serious mental illness (N=786). Medical records showed that 50 percent of patients at the time of admission and 68 percent of patients at the time of the record review had a psychiatric diagnosis, typically a diagnosis of depressive disorder. At the time of admission, fewer records identified individuals with a serious mental illness (9 to 20 percent) or a primary diagnosis of any psychiatric illness (5 to 12 percent). Many records indicated that in-depth, required PASRR screens were not performed. Ninety percent of the states reported that Medicaid covers only basic psychiatric consultation services, such as medication monitoring, in nursing facilities. Between 30 and 32 percent of national survey respondents also characterized access to facilities that provide mental health services as limited and of variable quality. Although all 24 nursing facilities reported providing psychiatric consultation services, access to other mental health services, such as psychosocial rehabilitation or individual counseling, varied considerably. Nursing facility compliance with administration and documentation of PASRR screens appears problematic. Nevertheless, there do not appear to be excessively high numbers of residents with serious mental illness, suggesting that state PASRR programs may contribute positively to the identification of people with serious mental illness. However, many nursing facility residents have some type of psychiatric illness, and PASRR legislation does not appear to have enhanced their ability to gain access to mental health services beyond standard psychiatric consultation and medication therapy.

Citizen Complaints, Regulatory Violations, and Their Implications for Swine Operations in Illinois

Using a unique Environmental Protection Agency (EPA) livestock inspection data set, this paper presents an extensive empirical investigation of relationships between citizen complaints, swine production and community characteristics, EPA inspections, and regulatory violations. Our results suggest that facility and community characteristics have a relationship with citizen complaints. Also, complaint-initiated inspections are more efficient than regularly scheduled ones in terms of regulatory violation detection rates. Additionally, EPA inspectors and inspections influence a facility's compliance behavior. Except for building type and swine inventory intensity, facility and community characteristics are not associated with a facility's probability of regulatory violation.

The Effects of Community Characteristics on Polluter Compliance Levels

<i>This paper analyzes the effects of community characteristics on compliance levels—emissions relative to effluent limits—at polluting facilities. In particular, it examines both direct effects and indirect effects; the second type of effects represents the linking of two related effects: (1) effects of community characteristics on regulatory decisions to intervene against specific facilities with inspections and penalties; and (2) effects of regulatory interventions on facility compliance levels. Estimation reveals (1) community characteristics significantly affect both regulatory interventions and facility performance; (2) direct effects and indirect effects are generally comparable in magnitude; and (3) total effects are economically meaningful.</i> (JEL Q25)

Nursing Facility Compliance With Do-Not-Hospitalize Orders

This study sought to determine whether nursing homes comply with residents' do-not-hospitalize (DNH) orders prohibiting inpatient hospitalization. With the use of data from the nationally representative 1996 Nursing Home Component of the Medical Expenditure Panel Survey, a multivariate logistic regression model was developed. Three percent of residents had DNH orders. These residents were half as likely to be hospitalized. Residents in not-for-profit or public facilities were less likely to be hospitalized than those in for-profit homes. Hospitalization was more likely among men, racial or ethnic minorities, those with more diagnosed health conditions, and those in facilities in the South compared with those in the Midwest. Hospitalized residents with DNH orders had no limitations of activities of daily living, were not located in hospital-based nursing homes, were less likely to be in a for-profit facility, and were sicker than nonhospitalized residents with DNH orders. Improved education regarding advance directives, particularly DNH orders, is necessary for health care practitioners and patients. More consistent and rigorous policies should be implemented in nursing facilities.

Measuring Visual Opacity Using Digital Imaging Technology

The U.S. Environmental Protection Agency (EPA) Reference Method 9 (Method 9) is the preferred enforcement approach for verifying facility compliance with federal visible opacity standards. Supporters of Method 9 have cited its flexibility and low cost as important technological and economic advantages of the methodology. The Digital Opacity Compliance System (DOCS), an innovative technology that employs digital imaging technology for quantifying visible opacity, has been proposed as a technically defensible and economically competitive alternative to Method 9. Results from the field application of the DOCS at EPA-approved Method 9 smoke schools located in Ogden, UT, Augusta, GA, and Columbus, OH, demonstrated that, under clear sky conditions, the DOCS consistently met the opacity error rate established under Method 9. Application of hypothesis testing on the smoke school data set confirmed that the DOCS was equivalent to Method 9 under clear sky conditions. Under overcast sky conditions, human observers seemed to be more accurate than the DOCS in measuring opacity. However, within the smoke school environment, human observers routinely employ backgrounds other than sky (e.g., trees, telephone poles, billboards) to quantify opacity on overcast days. Under conditions that compel the use of sky as plume background (e.g., emission stacks having heights above the tree line), the DOCS appears to be a more accurate methodology for quantifying opacity than are human observers.

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Evaluate your facility's compliance with Accreditation Participation Requirements.

ADA compliance and the accessibility of physical activity facilities in western Oregon.

One of the mandates of Title III of the Americans With Disabilities Act (ADA) is to address the accessibility of public facilities for all people. The aim of this study was to determine how compliant physical activity facilities in western Oregon were with regard to Title III of the ADA. Comparisons were also made with the findings of a study conducted 5 years prior in a different geographic region. On the basis of direct observations and physical measurements taken during on-site visits to 50 physical activity facilities located in western Oregon during 2000-2001, facility compliance with Title III of the ADA was characterized in terms of 10 structural domains. No facility was found to be 100% ADA-compliant. Exterior entrance/doors (90%) and telephone accessibility (88%) were the areas where compliance was highest, whereas accessibility to and around exercise equipment (8%) and customer service desk (37%) were areas lowest in compliance. Relative to a previously published study, the facilities in western Oregon showed greater rates of ADA compliance in six of the 10 structural domains evaluated. There is an on-going need and legal mandate for increasing the accessibility of physical activity facilities. Furthermore, from a social-ecological perspective, the environmental constraints identified in this study might be limiting factors in efforts aimed at increasing individuals with disabilities' physical activity involvement.

Promotion of frequent tanning sessions by indoor tanning facilities: Two studies

Background: Indoor tanning may increase the risk of melanoma and other health problems. Frequent users of indoor tanning facilities may be at particularly high risk. Objective: In study 1 our purpose was to assess the prevalence and nature of indoor tanning advertisements; in study 2 we aimed to assess tanning facility compliance to recommended exposure schedules. Methods: In study 1, tanning facility advertisements over a 4-month period from 24 San Diego County newspapers were monitored. In study 2, we assessed compliance with recommended exposure schedules via a telephone interview of 60 San Diego County tanning facilities. Results: Approximately 75% of the indoor tanning advertisements promoted unlimited tanning. Only 5% of facilities were in compliance with recommended tanning schedules, and 100% offered “unlimited” tanning packages. Conclusions: These findings suggest that the indoor tanning industry, through pricing incentives that allow frequent sessions, may be promoting overexposure to UVR. Stronger legislation is needed to address this issue. (J Am Acad Dermatol 2002;46:700-5.)

Low-Hanging Fruit: Social Values and Industry Discretion in Toxics Use Reduction Policy

In this article, we examine the implementation of an innovative environmental policy, the Massachusetts Toxics Use Reduction Act (TURA), which seeks to shift environmental intervention into production through the reduction of toxics use. TURA attempts to promote change by requiring facilities to undertake toxics use reduction planning as a way to identify opportunities for reducing hazardous chemical use, and the creation of a new third-party policy actor known as the toxics use reduction planner to monitor facility compliance. We draw upon interviews with toxics use reduction planners to highlight the limited nature of change actually wrought by toxics use reduction planning. The article concludes that industry preferences, while not wholly inconsistent with change, have largely determined the way in which this public policy has been implemented.

Spill Prevention Control and Countermeasures: An Expedited Settlement Approach

ABSTRACT The U.S. Environmental Protection Agency (EPA) is responsible for implementing the Spill Prevention Control and Countermeasures (SPCC) regulations under the provisions of the Clean Water Act (CWA) as amended by the Oil Pollution Act of 1990 (OPA 90). These regulations apply to a wide array of facilities involved in exploration, production, refining, manufacturing, distribution, and processing. The agency conducts SPCC inspections as a method of validating compliance with these regulations. In an era of government re-invention, budget constraints and in the spirit of better customer service relations, EPA Region VI has developed an innovative means of obtaining facility compliance with the SPCC regulations. It is formally known as the expedited settlement approach. The purpose of this approach was to provide a more efficient and effective means of validating environmental compliance. The approach is a combination of simplified inspection and enforcement procedures with emphasis upon compliance assistance. The program's initial emphasis is directed at production facilities. The approach is designed to address environmental violations, which are easily correctable and generally have resulted in chronic type spills. This paper will examine the parameters of the expedited settlement approach, its application and implementation through the use of case studies. The results of the case studies will provide a barometer for the success and shortcomings of this type of approach.

Integrating Environmental Justice into EPA Permitting Authority

A recurrent issue arising out of the President?s Executive Order 12898 on Environmental Justice is the extent to which EPA possesses the authority to condition on environmental justice grounds permits that the Agency (and States with federally-approved programs) issues to regulated entities pursuant to the various federal environmental protection laws administered by EPA. A related question is the extent to which the permitting authority (state or federal) may deny a permit altogether solely on environmental justice grounds. This article questions the apparent assumption of many that no such permit conditioning or denial authority exists relating to environmental justice concerns. The article is concerned exclusively with the issue whether EPA possesses authority that it has not yet chosen to exercise. The article does not comprehensively address the distinct question whether EPA is required under existing statutory provisions to impose such conditions or deny such permits. The article concludes that EPA clearly has considerable authority to promote environmental justice through permit conditions and denials (and registration conditions and denials) that the Agency has yet to enlist effectively. More particularly, the article explores EPA's authority to restrict and deny the operation of environmentally risky facilities based on the factor that the community to be exposed is already disparately subject to such risks from other sources as well as the Agency?s authority to condition permits in a manner that requires the regulated entity itself to help the exposed community to build the community enforcement capacity necessary for the community to oversee and ensure the facility's compliance with applicable environmental laws.

US policy for disease control among imported nonhuman primates.

In 1990, in response to the occurrence of Ebola virus (subsequently identified as subtype Reston) infection among cynomolgus monkeys imported from the Philippines, the United States implemented strict disease control measures for handling nonhuman primates during transit and quarantine and initiated importer facility compliance inspections. Disease control measures emphasized protection of workers from exposure, use of containment facilities and procedures, measures to prevent spread of infection among animals, and laboratory testing of animals that die or become ill during quarantine. From 1991-1995, no outbreaks of filovirus infection occurred, and only one other disease outbreak (caused by Mycobacterium species) was recognized. In April 1996, Ebola virus (subtype Reston) infection was identified in another group of cynomolgus monkeys imported from the Philippines. The disease control measures implemented since the first Ebola virus (subtype Reston) outbreak appeared to work well. Currently, the 27 registered importer facilities import approximately 8500 nonhuman primates annually, and mortality rates are <1.0%. Importer facilities receive regular inspections, and compliance with disease control measures and disease reporting is excellent.

Integrating Environmental Justice into EPA Permitting Authority

A recurrent issue arising out of the President?s Executive Order 12898 on Environmental Justice is the extent to which EPA possesses the authority to condition on environmental justice grounds permits that the Agency (and States with federally-approved programs) issues to regulated entities pursuant to the various federal environmental protection laws administered by EPA. A related question is the extent to which the permitting authority (state or federal) may deny a permit altogether solely on environmental justice grounds. This article questions the apparent assumption of many that no such permit conditioning or denial authority exists relating to environmental justice concerns. The article is concerned exclusively with the issue whether EPA possesses authority that it has not yet chosen to exercise. The article does not comprehensively address the distinct question whether EPA is required under existing statutory provisions to impose such conditions or deny such permits. The article concludes that EPA clearly has considerable authority to promote environmental justice through permit conditions and denials (and registration conditions and denials) that the Agency has yet to enlist effectively. More particularly, the article explores EPA's authority to restrict and deny the operation of environmentally risky facilities based on the factor that the community to be exposed is already disparately subject to such risks from other sources as well as the Agency?s authority to condition permits in a manner that requires the regulated entity itself to help the exposed community to build the community enforcement capacity necessary for the community to oversee and ensure the facility's compliance with applicable environmental laws.

The military munitions rule

AbstractThe Federal Facility Compliance Act (FFCA) of 1992 expanded the waiver of sovereign immunity to allow imposition of fines and penalties against federal facilities for violating federal, state, and local solid and hazardous waste management requirements. Section 107 of the FFCA required the Administrator of the Environmental Protection Agency, in consultation with the Secretary of Defense and appropriate state officials, to propose and promulgate regulations identifying when conventional or chemical military munitions become hazardous waste subject to regulation under the Resource Conservation and Recovery Act (RCRA). The authors discuss the development of the EPA Munitions Rule and how environmental and military requirements are addressed in the rule.

EPA update: Fines and penalties promote federal facility compliance

EPA update: Fines and penalties promote federal facility compliance

A waiver of sovereign immunity for the CWA?

In 1992, the Supreme Court ruled in DOE v. Ohio, 112 S.Ct. 1627 (1992) that both the Clean Water Act (CWA) and the Resource Conservation and Recovery Act (RCRA) did not provide an explicit waiver of sovereign immunity which would allow enforcement of punitive fines and penalties (for past violations) against federal facilities. In response to this decision, Congress, in 1992, passed the Federal Facility Compliance Act (FFCA). This law amended RCRA to provide an explicit waiver of sovereign immunity. Members of Congress have expressed interest in amending the CWA to provide a similar waiver of sovereign immunity. This article discusses the arguments for and against including an FFCA-type waiver of sovereign immunity in the CWA. On its face, such a waiver would appear to be an attractive way to increase federal compliance with the CWA. However, it should not be assumed that such a waiver would increase CWA compliance in the same manner the FFCA has increased RCRA compliance. The article concludes that the best approach would be to provide a limited waiver of sovereign immunity for CWA violations. This limited waiver would allow punitive penalty enforcement by the Environmental Protection Agency (EPA) against federal agencies (even in those states that have state-run programs), but maintain the prohibition against state enforcement. This type of waiver would provide the benefits of punitive penalty enforcement, while protecting federal prerogatives from the vagaries of state enforcement actions.

Six methods to assess potential radioactive air emissions from a stack.

In accordance with U.S. Title 40, Code of Federal Regulations, Part 61, "National Emission Standards for Hazardous Air Pollutants," Subpart H, U.S. Department of Energy stack emissions which have the potential to cause an exposure > or = 1 muSv y-1 to the offsite maximally exposed individual must meet the continuous monitoring requirements dictated therein. Since February 1993, all 125 stacks operated by the Westinghouse Hanford Company on the U.S. Department of Energy's Hanford Site have been assessed for their potential unabated radionuclide emissions using one of six methods approved for use by the U.S. Environmental Protection Agency, Region 10. These potential emissions combined with the CAP88 code were used to produce dose estimates to the maximally exposed individual. Results show there are 106 stacks in compliance and below the potential to emit greater than the EPA threshold. The 19 remaining stacks will be brought into full compliance under a Federal Facilities Compliance Agreement which was established in February, 1994. While each method maintains the safety and protection of the occupational worker, the public, and the environment, significant cost benefits may be derived by applying the best available technology. The CAP88 code and the methods for estimating potential emissions are presented, as well as the associated results.

Noncompliance in Environmental Reporting: Are Violators Ignorant, or Evasive, of the Law?

Theory: An increasingly common regulatory tool is one that delegates the duty to provide information to the regulated entities, creating new problems in principalagency models of regulation. Hypotheses: Failure to comply with regulations mandating information provision is as much due to ignorance of reporting requirements as to willful evasion. Methods: A modified detection controlled estimation model for coverage, violation, and detection of facility compliance with the EPA's Toxics Release Inventory, estimated for facilities in Minnesota in 1991. Results: Violation is better understood by those variables associated with the likelihood that the firm is ignorant of TRI reporting requirements, than by those associated with evasion. Firms in violation tend to be small facilities, releasing or transferring small amounts of toxins to the environment.