40 CFR 51.372 - State Implementation Plan submissions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... compliance; (5) Legal authority requiring or allowing implementation of the I/M program and providing either broad or specific authority to perform all required elements of the program; (6) Legal authority for I/M... without an I/M program is approved by EPA); (7) Implementing regulations, interagency agreements, and...

40 CFR 51.372 - State Implementation Plan submissions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... compliance; (5) Legal authority requiring or allowing implementation of the I/M program and providing either broad or specific authority to perform all required elements of the program; (6) Legal authority for I/M... without an I/M program is approved by EPA); (7) Implementing regulations, interagency agreements, and...

40 CFR 51.372 - State Implementation Plan submissions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... compliance; (5) Legal authority requiring or allowing implementation of the I/M program and providing either broad or specific authority to perform all required elements of the program; (6) Legal authority for I/M... without an I/M program is approved by EPA); (7) Implementing regulations, interagency agreements, and...

40 CFR 51.372 - State Implementation Plan submissions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... compliance; (5) Legal authority requiring or allowing implementation of the I/M program and providing either broad or specific authority to perform all required elements of the program; (6) Legal authority for I/M... without an I/M program is approved by EPA); (7) Implementing regulations, interagency agreements, and...

Proportional Topology Optimization: A New Non-Sensitivity Method for Solving Stress Constrained and Minimum Compliance Problems and Its Implementation in MATLAB

PubMed Central

Biyikli, Emre; To, Albert C.

2015-01-01

A new topology optimization method called the Proportional Topology Optimization (PTO) is presented. As a non-sensitivity method, PTO is simple to understand, easy to implement, and is also efficient and accurate at the same time. It is implemented into two MATLAB programs to solve the stress constrained and minimum compliance problems. Descriptions of the algorithm and computer programs are provided in detail. The method is applied to solve three numerical examples for both types of problems. The method shows comparable efficiency and accuracy with an existing optimality criteria method which computes sensitivities. Also, the PTO stress constrained algorithm and minimum compliance algorithm are compared by feeding output from one algorithm to the other in an alternative manner, where the former yields lower maximum stress and volume fraction but higher compliance compared to the latter. Advantages and disadvantages of the proposed method and future works are discussed. The computer programs are self-contained and publicly shared in the website www.ptomethod.org. PMID:26678849

40 CFR 52.626 - Compliance schedules.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Compliance schedules. 52.626 Section 52.626 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Hawaii § 52.626 Compliance schedules. (a) [Reserved] (b...

78 FR 28924 - Self Regulatory Organizations; Chicago Stock Exchange, Inc.; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-16

... Change Amending Rule Governing the Anti-Money Laundering Compliance Program May 10, 2013. Pursuant to... of the Proposed Rule Change CHX proposes to amend its Anti-Money Laundering Compliance Program (the... Financial institutions, including broker-dealers, must develop and implement Anti-Money Laundering (``AML...

Experience with a pharmacy technician medication history program.

PubMed

Cooper, Julie B; Lilliston, Michelle; Brooks, DeAnne; Swords, Bruce

2014-09-15

The implementation and outcomes of a pharmacy technician medication history program are described. An interprofessional medication reconciliation team, led by a clinical pharmacist and a clinical nurse specialist, was charged with implementing a new electronic medication reconciliation system to improve compliance with medication reconciliation at discharge and capture compliance-linked reimbursement. The team recommended that the pharmacy department be allocated new pharmacy technician full-time-equivalent positions to assume ownership of the medication history process. Concurrent with the implementation of this program, a medication history standard was developed to define rules for documentation of what a patient reports he or she is actually taking. The standard requires a structured interview with the patient or caregiver and validation with outside sources as indicated to determine which medications to document in the medication history. The standard is based on four medication administration category rules: scheduled, as-needed, short-term, and discontinued medications. The medication history standard forms the core of the medication history technician training and accountability program. Pharmacy technicians are supervised by pharmacists, using a defined accountability plan based on a set of medical staff approved rules for what medications comprise a best possible medication history. Medication history accuracy and completeness rates have been consistently over 90% and rates of provider compliance with medication reconciliation rose from under 20% to 100% since program implementation. A defined medication history based on a medication history standard served as an effective foundation for a pharmacy technician medication history program, which helped improve provider compliance with discharge medication reconciliation. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Affirmative Action Compliance Program for Fiscal Year 1980

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

Eleven chapters are used to delineate Lawrence Berkeley Lab's compliance, namely: (1) a description of LBL's facility, history, staff, mission, etc; (2) Affirmative Action policy statement; (3) dissemination (internal and external) per the implementation regulations; (4) identification of Affirmative Action responsibilities; (5) personnel policies; (6) past goal-setting process and accomplishment; (7) work-force array, job groups, availability determinations, identification of underutilization, and goals and timetables; (8) identification of problem areas and action-oriented programs; (9) listing and brief description of specific LBL Affirmative Action programs; (10) compliance with sex-discrimination guidelines; and (11) compliance with guidelines on discrimination because of religion or nationalmore » origin.« less

Contextual Information for the Potential Enhancement of Annual Radiation Protection Program Review Reports.

PubMed

Emery, Robert J; Gutiérrez, Janet M

2017-08-01

Organizations possessing sources of ionizing radiation are required to develop, document, and implement a "radiation protection program" that is commensurate with the scope and extent of permitted activities and sufficient to ensure compliance with basic radiation safety regulations. The radiation protection program must also be reviewed at least annually, assessing program content and implementation. A convenience sample assessment of web-accessible and voluntarily-submitted radiation protection program annual review reports revealed that while the reports consistently documented compliance with necessary regulatory elements, very few included any critical contextual information describing how important the ability to possess radiation sources was to the central mission of the organization. Information regarding how much radioactive material was currently possessed as compared to license limits was also missing. Summarized here are suggested contextual elements that can be considered for possible inclusion in annual radiation protection program reviews to enhance stakeholder understanding and appreciation of the importance of the ability to possess radiation sources and the importance of maintaining compliance with associated regulatory requirements.

Implementation of a commercial-grade dedication program - Benefits and lessons learned

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harrington, M.; MacFarlane, I.

1991-01-01

The recent issuance of industry guidelines, the Nuclear Management and Resources Council procurement initiative, and a US Nuclear Regulatory Commission NRC generic letter on commercial-grade item dedication (CGD) has been viewed by many utility managers and executives as only adding to the existing burden of compliance with regulatory requirements. While the incorporation of these documents into existing CGD programs has created additional costs, the resulting enhanced dedication programs have also produced benefits beyond regulatory compliance, and some lessons have been learned. This paper discusses the benefits and the lessons learned during implementation of an enhanced CGD program at New Hampshiremore » Yankee's (NHY's) Seabrook nuclear plant. Based on NHY's experience, it is believed that the benefits described in this paper can be realized by other utilities implementing CGD programs.« less

40 CFR 52.2307 - Small business assistance program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Texas § 52.2307 Small business... implement a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to...

40 CFR 52.1935 - Small business assistance program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Oklahoma § 52.1935 Small business... implement a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to...

40 CFR 52.1935 - Small business assistance program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 4 2014-07-01 2014-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Oklahoma § 52.1935 Small business... implement a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to...

40 CFR 52.2307 - Small business assistance program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 5 2013-07-01 2013-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Texas § 52.2307 Small business... implement a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to...

40 CFR 52.1935 - Small business assistance program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 4 2011-07-01 2011-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Oklahoma § 52.1935 Small business... implement a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to...

40 CFR 52.2307 - Small business assistance program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 5 2012-07-01 2012-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Texas § 52.2307 Small business... implement a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to...

40 CFR 52.2307 - Small business assistance program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 5 2014-07-01 2014-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Texas § 52.2307 Small business... implement a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to...

40 CFR 52.1935 - Small business assistance program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 4 2012-07-01 2012-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Oklahoma § 52.1935 Small business... implement a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to...

40 CFR 52.2307 - Small business assistance program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 4 2011-07-01 2011-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Texas § 52.2307 Small business... implement a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to...

40 CFR 52.1935 - Small business assistance program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 4 2013-07-01 2013-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Oklahoma § 52.1935 Small business... implement a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to...

40 CFR 52.240 - Compliance schedules.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Compliance schedules. 52.240 Section 52.240 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS California § 52.240 Compliance schedules. (a) The requirements of § 51.262(a) of this chapter are...

40 CFR 52.240 - Compliance schedules.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 3 2013-07-01 2013-07-01 false Compliance schedules. 52.240 Section 52.240 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS California § 52.240 Compliance schedules. (a) The requirements of § 51.262(a) of this chapter are...

40 CFR 52.240 - Compliance schedules.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 3 2014-07-01 2014-07-01 false Compliance schedules. 52.240 Section 52.240 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS California § 52.240 Compliance schedules. (a) The requirements of § 51.262(a) of this chapter are...

40 CFR 52.240 - Compliance schedules.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 3 2012-07-01 2012-07-01 false Compliance schedules. 52.240 Section 52.240 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS California § 52.240 Compliance schedules. (a) The requirements of § 51.262(a) of this chapter are...

40 CFR 52.240 - Compliance schedules.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 3 2011-07-01 2011-07-01 false Compliance schedules. 52.240 Section 52.240 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS California § 52.240 Compliance schedules. (a) The requirements of § 51.262(a) of this chapter are...

Fraud and abuse. Building an effective corporate compliance program.

PubMed

Matusicky, C F

1998-04-01

In 1997, General Health System (GHS), a not-for-profit integrated delivery system headquartered in Baton Rouge, Louisiana, developed a formal corporate compliance program. A newly appointed corporate compliance officer worked with key GHS managers and employees to assess the organization's current fraud and abuse prevention practices and recommend changes to meet new regulatory and organizational requirements. Then a structure for implementing these changes was developed, with staff training at its core. The program required a significant initial outlay of financial and human resources. The benefits to the organization, however, including a greater ability to respond quickly and effectively to possible compliance problems and better organizational communications, were worth the investment.

Dedicated Operating Room Teams and Clinical Outcomes in an Enhanced Recovery after Surgery Pathway for Colorectal Surgery.

PubMed

Grant, Michael C; Hanna, Andrew; Benson, Andrew; Hobson, Deborah; Wu, Christopher L; Yuan, Christina T; Rosen, Michael; Wick, Elizabeth C

2018-03-01

Our aim was to determine whether the establishment of a dedicated operating room team leads to improved process measure compliance and clinical outcomes in an Enhanced Recovery after Surgery (ERAS) program. Enhanced Recovery after Surgery programs involve the application of bundled best practices to improve the value of perioperative care. Successful implementation and sustainment of ERAS programs has been linked to compliance with protocol elements. Development of dedicated teams of anesthesia providers was a component of ERAS implementation. Intraoperative provider team networks (surgeons, anesthesiologists, and certified registered nurse anesthetists) were developed for all cases before and after implementation of colorectal ERAS. Four measures of centrality were analyzed in each network based on case assignments, and these measures were correlated with both rates of process measure compliance and clinical outcomes. Enhanced Recovery after Surgery provider teams led to a decrease in the closeness of anesthesiologists (p = 0.04) and significant increase in the clustering coefficient of certified registered nurse anesthetists (p = 0.005) compared with the pre-ERAS network. There was no significant change in centrality among surgeons (p = NS for all measures). Enhanced Recovery after Surgery designation among anesthesiologists and nurse anesthetists-whereby individual providers received an in-service on protocol elements and received compliance data was strongly associated with high compliance (>0.6 of measures; p < 0.001 for each group). In addition, high compliance was associated with a significant reduction in length of stay (p < 0.01), surgical site infection (p < 0.002), and morbidity (p < 0.009). Dedicated operating room teams led to increased centrality among anesthesia providers, which in turn not only increased compliance, but also improved several clinical outcomes. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Report: EPA Needs to Improve Tracking of National Petroleum Refinery Compliance Program Progress and Impacts

EPA Pesticide Factsheets

Report #2004-P-00021, June 22, 2004. EPA and the U.S. Department of Justice have developed and implemented an integrated refinery compliance strategy that addresses the most important noncompliance problems.

Dissemination of the CDC's Hand Hygiene Guideline and impact on infection rates

PubMed Central

Larson, Elaine L.; Quiros, Dave; Lin, Susan X.

2007-01-01

Background The diffusion of national evidence-based practice guidelines and their impact on patient outcomes often go unmeasured. Methods Our objectives were to (1) evaluate implementation and compliance with clinical practices recommended in the new Centers for Disease Control and Prevention (CDC) Hand Hygiene Guideline, (2) compare rates of health care-associated infections (HAI) before and after implementation of the Guideline recommendations, and (3) examine the patterns and correlates of changes in rates of HAI. We used pre- and post-Guideline implementation site visits and surveys in the setting of 40 US hospitals—members of the National Nosocomial Infections Surveillance System—and measured HAI rates 1 year before and after publication of the CDC Guideline and used direct observation of hand hygiene compliance and Guideline implementation scores. Results All study hospitals had changed their policies and procedures and provided products in compliance with Guideline recommendations; 89.8% of 1359 staff members surveyed anonymously reported that they were familiar with the Guideline. However, in 44.2% of the hospitals (19/40), there was no evidence of a multidisciplinary program to improve compliance. Hand hygiene rates remained low (mean, 56.6%). Rates of central line-associated bloodstream infections were significantly lower in hospitals with higher rates of hand hygiene (P < .001). No impact of Guideline implementation or hand hygiene compliance on other HAI rates was identified. Other factors occurring over time could affect rates of HAI. Observed hand hygiene compliance rates were likely to overestimate rates in actual practice. The study may have been of too short duration to detect the impact of a practice guideline. Conclusion Wide dissemination of this Guideline was not sufficient to change practice. Only some hospitals had initiated multidisciplinary programs; practice change is unlikely without such multidisciplinary efforts and explicit administrative support. PMID:18063132

Dissemination of the CDC's Hand Hygiene Guideline and impact on infection rates.

PubMed

Larson, Elaine L; Quiros, Dave; Lin, Susan X

2007-12-01

The diffusion of national evidence-based practice guidelines and their impact on patient outcomes often go unmeasured. Our objectives were to (1) evaluate implementation and compliance with clinical practices recommended in the new Centers for Disease Control and Prevention (CDC) Hand Hygiene Guideline, (2) compare rates of health care-associated infections (HAI) before and after implementation of the Guideline recommendations, and (3) examine the patterns and correlates of changes in rates of HAI. We used pre- and post-Guideline implementation site visits and surveys in the setting of 40 US hospitals--members of the National Nosocomial Infections Surveillance System--and measured HAI rates 1 year before and after publication of the CDC Guideline and used direct observation of hand hygiene compliance and Guideline implementation scores. All study hospitals had changed their policies and procedures and provided products in compliance with Guideline recommendations; 89.8% of 1359 staff members surveyed anonymously reported that they were familiar with the Guideline. However, in 44.2% of the hospitals (19/40), there was no evidence of a multidisciplinary program to improve compliance. Hand hygiene rates remained low (mean, 56.6%). Rates of central line-associated bloodstream infections were significantly lower in hospitals with higher rates of hand hygiene (P < .001). No impact of Guideline implementation or hand hygiene compliance on other HAI rates was identified. Other factors occurring over time could affect rates of HAI. Observed hand hygiene compliance rates were likely to overestimate rates in actual practice. The study may have been of too short duration to detect the impact of a practice guideline. Wide dissemination of this Guideline was not sufficient to change practice. Only some hospitals had initiated multidisciplinary programs; practice change is unlikely without such multidisciplinary efforts and explicit administrative support.

Effects of a Classwide Teacher-Implemented Program to Promote Preschooler Compliance

ERIC Educational Resources Information Center

Beaulieu, Lauren; Hanley, Gregory P.

2014-01-01

We used a multiple baseline design across skills to evaluate the effects of a program to teach a classroom of children to respond to their name and a group call (i.e., precursors) as well as to peer mediate these precursors to promote compliance with a variety of multistep instructions. Teachers taught these skills via classwide behavior skills…

Dissemination and Implementation Strategies of Lower Extremity Preventive Training Programs in Youth: A Clinical Review.

PubMed

DiStefano, Lindsay J; Frank, Barnett S; Root, Hayley J; Padua, Darin A

Neuromuscular preventive training programs effectively reduce injury and improve performance in youth athletes. However, program effectiveness is directly linked to program compliance, fidelity, and dosage. Preventive training programs are not widely adopted by youth sport coaches. One way to promote widespread dissemination and compliance is to identify implementation strategies that influence program adoption and maintenance. It is unknown how previously published programs have followed the elements of an implementation framework. The objective of this review was to evaluate how elements of the 7 steps of implementation, developed by Padua et al, have been performed in the evidence of lower extremity preventive training programs. A systematic review of the literature from 1996 through September 2016 was conducted using electronic databases. Investigations that documented implementation of a sport team-based neuromuscular preventive training program in youth athletes and measured lower extremity injury rates were included. Clinical review. Level 4. A total of 12 studies met the inclusion criteria and were reviewed. Information regarding the completion of any of the 7 steps within the implementation framework developed by Padua et al was extracted. None of the 12 articles documented completion of all 7 steps. While each study addressed some of the 7 steps, no study addressed maintenance or an exit strategy for youth athletes. Program implementation appears limited in obtaining administrative support, utilizing an interdisciplinary implementation team, and monitoring or promoting fidelity of the intervention. Despite strong evidence supporting the effectiveness of preventive training programs in youth athletes, there is a gap between short-term improvements and long-term implementation strategies. Future interventions should include all 7 steps of the implementation framework to promote transparent dissemination of preventive training programs.

40 CFR 52.1119 - Identification of plan-conditional approval.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Implementation Plan Revision for a Small Business Technical and Environmental Compliance Assistance Program dated... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Identification of plan-conditional... PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Massachusetts § 52.1119...

40 CFR 52.1519 - Identification of plan-conditional approval.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Implementation Plan Revision for a Small Business Technical and Environmental compliance Assistance Program dated... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Identification of plan-conditional... PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) New Hampshire § 52.1519...

Impact of Sport Context and Support on the Use of a Self-Report Measure for Athlete Monitoring

PubMed Central

Saw, Anna E.; Main, Luana C.; Gastin, Paul B.

2015-01-01

Athlete self-report measures (ASRM) are a popular method of athlete monitoring in high-performance sports. With increasing recognition and accessibility, ASRM may potentially be utilized by athletes from diverse sport contexts. The purpose of the present study was to improve understanding of ASRM implementation across different sport contexts by observing uptake and compliance of a newly implemented ASRM over 16 weeks, and investigating the perceived roles and factors influencing implementation. Athletes (n=131) completed an electronic survey at baseline and week 16 on their perceptions and experiences with ASRM implementation respectively. Despite initial interest, only 70 athletes attempted to use the ASRM. Of these athletes, team sport athletes who were supported by their coach or sports program to use the ASRM were most compliant (p < 0.001) with a mean compliance of 84 ± 21 %. Compliance for self-directed individual and team sport athletes was 28 ± 40 % and 8 ± 18 % respectively. Self-directed athletes were motivated to monitor themselves, and rated desired content and minimal burden as key factors for initial and ongoing compliance. Supported athletes were primarily motivated to comply for the benefit of their coach or sports program rather than themselves, however rated data output as a key factor for their continued use. Factors of the measure outweighed those of the social environment regardless of sport context, however the influence of social environmental factors should not be discounted. The findings of the present study demonstrate the impact of sport context on the implementation of an ASRM and the need to tailor implementation strategies accordingly. Key points Athletes perceive ASRM and the factors influencing implementation differently. Therefore, to encourage compliance, it is important to tailor implementation strategies to the athlete and their sport context to increase appeal and minimize unappealing factors. Athletes using an ASRM on their own accord typically favor a measure which meets their needs and interests, with minimal burden. Athletes using an ASRM under the direction and support of their coach or sports program typically favor feedback and a positive social environment. PMID:26664269

Impact of Sport Context and Support on the Use of a Self-Report Measure for Athlete Monitoring.

PubMed

Saw, Anna E; Main, Luana C; Gastin, Paul B

2015-12-01

Athlete self-report measures (ASRM) are a popular method of athlete monitoring in high-performance sports. With increasing recognition and accessibility, ASRM may potentially be utilized by athletes from diverse sport contexts. The purpose of the present study was to improve understanding of ASRM implementation across different sport contexts by observing uptake and compliance of a newly implemented ASRM over 16 weeks, and investigating the perceived roles and factors influencing implementation. Athletes (n=131) completed an electronic survey at baseline and week 16 on their perceptions and experiences with ASRM implementation respectively. Despite initial interest, only 70 athletes attempted to use the ASRM. Of these athletes, team sport athletes who were supported by their coach or sports program to use the ASRM were most compliant (p < 0.001) with a mean compliance of 84 ± 21 %. Compliance for self-directed individual and team sport athletes was 28 ± 40 % and 8 ± 18 % respectively. Self-directed athletes were motivated to monitor themselves, and rated desired content and minimal burden as key factors for initial and ongoing compliance. Supported athletes were primarily motivated to comply for the benefit of their coach or sports program rather than themselves, however rated data output as a key factor for their continued use. Factors of the measure outweighed those of the social environment regardless of sport context, however the influence of social environmental factors should not be discounted. The findings of the present study demonstrate the impact of sport context on the implementation of an ASRM and the need to tailor implementation strategies accordingly. Key pointsAthletes perceive ASRM and the factors influencing implementation differently. Therefore, to encourage compliance, it is important to tailor implementation strategies to the athlete and their sport context to increase appeal and minimize unappealing factors.Athletes using an ASRM on their own accord typically favor a measure which meets their needs and interests, with minimal burden.Athletes using an ASRM under the direction and support of their coach or sports program typically favor feedback and a positive social environment.

Beyond surgical care improvement program compliance: antibiotic prophylaxis implementation gaps.

PubMed

Hawkins, Russell B; Levy, Shauna M; Senter, Casey E; Zhao, Jane Y; Doody, Kaitlin; Kao, Lillian S; Lally, Kevin P; Tsao, KuoJen

2013-10-01

Despite increased compliance with Surgical Care Improvement Project infection measures, surgical-site infections are not decreasing. The aim of this study was to test the hypothesis that documented compliance with antibiotic prophylaxis guidelines on a pediatric surgery service does not reflect implementation fidelity or adherence to guidelines as intended. A 7-week observational study of elective pediatric surgical cases was conducted. Adherence was evaluated for appropriate administration, type, timing, weight-based dosing, and redosing of antibiotics. Prophylactic antibiotics were administered appropriately in 141 of 143 cases (99%). Of 100 cases (70%) in which antibiotic prophylaxis was indicated, compliance was documented in 100% cases in the electronic medical record, but only 48% of cases adhered to all 5 guidelines. Lack of adherence was due primarily to dosing or timing errors. Lack of implementation fidelity in antibiotic prophylaxis guidelines may partly explain the lack of expected reduction in surgical-site infections. Future studies of Surgical Care Improvement Project effectiveness should measure adherence and implementation fidelity rather than just documented compliance. Copyright © 2013 Elsevier Inc. All rights reserved.

Underground storage tank management plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1994-09-01

The Underground Storage Tank (UST) Management Program at the Oak Ridge Y-12 Plant was established to locate UST systems in operation at the facility, to ensure that all operating UST systems are free of leaks, and to establish a program for the removal of unnecessary UST systems and upgrade of UST systems that continue to be needed. The program implements an integrated approach to the management of UST systems, with each system evaluated against the same requirements and regulations. A common approach is employed, in accordance with Tennessee Department of Environment and Conservation (TDEC) regulations and guidance, when corrective actionmore » is mandated. This Management Plan outlines the compliance issues that must be addressed by the UST Management Program, reviews the current UST inventory and compliance approach, and presents the status and planned activities associated with each UST system. The UST Management Plan provides guidance for implementing TDEC regulations and guidelines for petroleum UST systems. (There are no underground radioactive waste UST systems located at Y-12.) The plan is divided into four major sections: (1) regulatory requirements, (2) implementation requirements, (3) Y-12 Plant UST Program inventory sites, and (4) UST waste management practices. These sections describe in detail the applicable regulatory drivers, the UST sites addressed under the Management Program, and the procedures and guidance used for compliance with applicable regulations.« less

Emergency Telemedicine: Achieving and Maintaining Compliance with the Emergency Medical Treatment and Labor Act.

PubMed

Rockwell, Kimberly Lovett; Gilroy, Alexis

2018-03-12

Telemedicine is a growing and important platform for medical delivery in the emergency department. Emergency telemedicine outlays often confront and conflict with important federal healthcare regulations. Because of this, academic medical centers, critical access hospitals, and other providers interested in implementing emergency telemedicine have often delayed or forgone such services due to reasonable fears of falling out of compliance with regulatory restrictions imposed by the Emergency Medical Treatment and Labor Act ("EMTALA"). This article offers insights into methods for implementing emergency telemedicine services while maintaining EMTALA compliance. Critical analysis of EMTALA and its attendant regulations. The primary means of ensuring EMTALA compliance while implementing emergency telemedicine programs include incorporating critical clinical details into the services contracts and implementing robust written policies that anticipate division of labor issues, the need for backup coverage, triaging, patient transfer protocols, and credentialing issues. With adequate up-front due diligence and meaningful contracting, hospitals and telemedicine providers can avoid common EMTALA liability pitfalls.

Implementing a Comprehensive Research Compliance Program: A Handbook for Research Officers

ERIC Educational Resources Information Center

Dade, Aurali, Ed.; Olafson, Lori, Ed.; DiBella, Suzan M., Ed.

2015-01-01

The senior research compliance administrator has emerged as a critically important position as universities and other research organizations face an increasingly intricate regulatory environment. These administrators are tasked with a special challenge: ensuring that their institutions conduct safe, ethical, and compliant research while also…

40 CFR 35.3510 - Establishment of the DWSRF program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... application. (3) If more than one State agency participates in implementation of the DWSRF program, the roles... will facilitate compliance with national primary drinking water regulations applicable under section...

Implementing exertional heat illness prevention strategies in US high school football.

PubMed

Kerr, Zachary Y; Marshall, Stephen W; Comstock, R Dawn; Casa, Douglas J

2014-01-01

Approximately 6500 high school football athletes are treated annually for exertional heat illness (EHI). In 2009, the National Athletic Trainers Association (NATA)-led Inter-Association Task Force (NATA-IATF) released preseason heat acclimatization guidelines to help athletes become accustomed to environmental factors contributing to EHI. This study examines compliance with NATA-IATF guidelines and related EHI prevention strategies. The study used a cross-sectional survey completed by 1142 certified athletic trainers (AT), which captured compliance with 17 NATA-IATF guidelines and EHI prevention strategies in high school football during the 2011 preseason. On average, AT reported football programs complying with 10.4 NATA-IATF guidelines (SD = 3.2); 29 AT (2.5%) reported compliance with all 17. Guidelines with the lowest compliance were as follows: "Single-practice days consisted of practice no more than three hours in length" (39.7%); and "During days 3-5 of acclimatization, only helmets and shoulder pads should be worn" (39.0%). An average of 7.6 EHI prevention strategies (SD = 2.5) were used. Common EHI prevention strategies were as follows: having ice bags/cooler available (98.5%) and having a policy with written instructions for initiating emergency medical service response (87.8%). Programs in states with mandated guidelines had higher levels of compliance with guidelines and greater prevalence of EHI prevention strategies. A low proportion of surveyed high school football programs fully complied with all 17 NATA-IATF guidelines. However, many EHI prevention strategies were voluntarily implemented. State-level mandated EHI prevention guidelines may increase compliance with recognized best practices recommendations. Ongoing longitudinal monitoring of compliance is also recommended.

Development and Implementation of a Web-based Evaluation System for an Internal Medicine Residency Program.

ERIC Educational Resources Information Center

Rosenberg, Mark E.; Watson, Kathleen; Paul, Jeevan; Miller, Wesley; Harris, Ilene; Valdivia, Tomas D.

2001-01-01

Describes the development and implementation of a World Wide Web-based electronic evaluation system for the internal medicine residency program at the University of Minnesota. Features include automatic entry of evaluations by faculty or students into a database, compliance tracking, reminders, extensive reporting capabilities, automatic…

Ecological Monitoring and Compliance Program 2007 Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hansen, Dennis; Anderson, David; Derek, Hall

2008-03-01

In accordance with U.S. Department of Energy (DOE) Order 450.1, 'Environmental Protection Program', the Office of the Assistant Manager for Environmental Management of the DOE, National Nuclear Security Administration Nevada Site Office (NNSA/NSO) requires ecological monitoring and biological compliance support for activities and programs conducted at the Nevada Test Site (NTS). National Security Technologies, LLC (NSTec), Ecological Services has implemented the Ecological Monitoring and Compliance (EMAC) Program to provide this support. EMAC is designed to ensure compliance with applicable laws and regulations, delineate and define NTS ecosystems, and provide ecological information that can be used to predict and evaluate themore » potential impacts of proposed projects and programs on those ecosystems. This report summarizes the EMAC activities conducted by NSTec during calendar year 2007. Monitoring tasks during 2007 included eight program areas: (a) biological surveys, (b) desert tortoise compliance, (c) ecosystem mapping and data management, (d) sensitive plant monitoring, (e) sensitive and protected/regulated animal monitoring, (f) habitat monitoring, (g) habitat restoration monitoring, and (h) biological monitoring at the Nonproliferation Test and Evaluation Complex (NPTEC). The following sections of this report describe work performed under these eight areas.« less

The role of healthcare communications agencies in maintaining compliance when working with the pharmaceutical industry and healthcare professionals.

PubMed

Cairns, Angela; Yarker, Yvonne E

2008-05-01

Relationships between the pharmaceutical industry and healthcare professionals continue to drive discussion about the potential for conflicts of interest. Despite greater regulation and oversight, there are still calls for increased transparency and further restrictions on these relationships. Regulatory authorities, the pharmaceutical industry, professional societies, and other interested parties have responded by developing robust guidelines for interactions between the pharmaceutical industry and healthcare professionals. This, in turn, is driving change in the way that healthcare communications agencies work, increasing the need for them to visibly demonstrate processes that ensure their employees comply with relevant laws, regulations, and guidelines. In our group of healthcare communications agencies we have established an internal compliance program and developed a policy that reflects the services we provide, and we recommend that other agencies adopt a similar program. Compliance training, implemented by a nominated compliance team, can be enforced by including compulsory tests for employees who interact with the pharmaceutical industry and healthcare professionals, with annual reassessment. The compliance team also has an important role to play in ensuring ongoing communication and staff education, including awareness of new legal and best practice developments. Management of the compliance program is essential, with clear mechanisms for auditing and evaluation, and the inclusion of compliance adherence in staff performance objectives. A visible framework for handling potential compliance issues should also be developed, with clear definitions of different levels of noncompliance and potential associated consequences. Compliance programs may also include other elements, such as terminology and documentation guidance, so that the program becomes an integral tool used by employees on a daily basis. With a robust internal compliance program, healthcare communication agencies can play a significant role in helping maintain appropriate pharmaceutical industry-healthcare professional relationships in an increasingly regulated and scrutinized environment.

40 CFR 52.460 - Small business stationary source technical and environmental compliance assistance program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Small business stationary source... PLANS Delaware § 52.460 Small business stationary source technical and environmental compliance... Environmental Control submitted a plan for the establishment and implementation of a Small Business Stationary...

Implementation of sustainable evidence-based practice for the assessment and management of pain in residential aged care facilities.

PubMed

Savvas, Steven; Toye, Christine; Beattie, Elizabeth; Gibson, Stephen J

2014-12-01

Pain is common in residential aged care facilities (RACFs). In 2005, the Australian Pain Society developed 27 recommendations for good practice in the identification, assessment, and management of pain in these settings. This study aimed to address implementation of the standards and evaluate outcomes. Five facilities in Australia participated in a comprehensive evaluation of RACF pain practice and outcomes. Pre-existing pain management practices were compared with the 27 recommendations, before an evidence-based pain management program was introduced that included training and education for staff and revised in-house pain-management procedures. Post-implementation audits evaluated the program's success. Aged care staff teams also were assessed on their reports of self-efficacy in pain management. The results show that before the implementation program, the RACFs demonstrated full compliance on 6 to 12 standards. By the project's completion, RACFs demonstrated full compliance with 10 to 23 standards and major improvements toward compliance in the remaining standards. After implementation, the staff also reported better understanding of the standards (p < .001) or of facility pain management guidelines (p < .001), increased confidence in therapies for pain management (p < .001), and increased confidence in their training to assess pain (p < .001) and recognize pain in residents with dementia who are nonverbal (p = .003). The results show that improved evidence-based practice in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce via this implementation program has shown improvements in staff self-efficacy and practice. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

General RMP Guidance - Chapter 6: Prevention Program (Program 2)

EPA Pesticide Factsheets

Sound prevention practices are founded on safety information, hazard review, operating procedures, training, maintenance, compliance audits, and accident investigation. These must be integrated into a risk management system that you implement consistently.

75 FR 9103 - Approval and Promulgation of Air Quality Implementation Plans; Illinois; NOX

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-01

... State Implementation Plan (SIP) that would terminate the provisions of the Nitrogen Oxides (NO X ) Budget Trading Program that apply to electric generating units. EPA is no longer operating the NO X Budget Trading Program as a compliance option under the NO X SIP Call. These sources are now subject to...

75 FR 9146 - Approval and Promulgation of Air Quality Implementation Plans; Illinois; NOX

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-01

... Illinois State Implementation Plan (SIP) that would terminate the provisions of the Nitrogen Oxides (NO X ) Budget Trading Program that apply to electric generating units. EPA is no longer operating the NO X Budget Trading Program as a compliance option under the NO X SIP Call. These sources are now subject to...

75 FR 41963 - Wheat and Oilseed Programs; Durum Wheat Quality Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-20

... Programs; Durum Wheat Quality Program AGENCY: Farm Service Agency and Commodity Credit Corporation, USDA. ACTION: Final rule. SUMMARY: This rule implements specific requirements for the Durum Wheat Quality... of the Council on Environmental Quality (40 CFR parts 1500-1508), and FSA regulations for compliance...

Effectiveness and acceptance of a health care-based mandatory vaccination program.

PubMed

Leibu, Rachel; Maslow, Joel

2015-01-01

To decrease the risk of transmission of hospital-associated transmission of influenza and pertussis through mandatory vaccination of staff. A mandatory influenza and toxoid-diphtheria toxoid-acellular pertussis program was implemented systemwide. A structured vaccine exemption program was implemented for those requesting a medical and/or religious/moral/ethical exemption. Systemwide influenza vaccination rates increased from 67% historically, 76.2% in the 2012 to 2013 influenza season, to 94.7% in 2013 to 2014 with an overall compliance rate of 97.8%. Toxoid-diphtheria toxoid-acellular pertussis vaccination rates systemwide reached 94.9%, with an overall compliance rate of 98%. Higher rates were experienced at individual hospital facilities compared with the corporate location. Successful vaccination campaign outcomes can be achieved through diligent enforcement of mandatory vaccination, masking, and other infection prevention procedures.

Apollo Quality Program.

PubMed

Sibal, Anupam; Dewan, Shaveta; Uberoi, R S; Kar, Sujoy; Loria, Gaurav; Fernandes, Clive; Yatheesh, G; Sharma, Karan

2012-01-01

Ensuring patient safety is a vital step for any hospital in achieving the best clinical outcomes. The Apollo Quality Program aimed at standardization of processes for clinical handovers, medication safety, surgical safety, patient identification, verbal orders, hand washing compliance and falls prevention across the hospitals in the Group. Thirty-two hospitals across the Group in settings varying from rural to semi urban, urban and metropolitan implemented the program and over a period of one year demonstrated a visible improvement in the compliance to processes for patient safety translating into better patient safety statistics.

40 CFR 52.183 - Small business assistance program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Arkansas § 52.183 Small business assistance... a Small Business Stationary Source Technical and Environmental Compliance Assistance Program...

40 CFR 52.183 - Small business assistance program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 3 2013-07-01 2013-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Arkansas § 52.183 Small business assistance... a Small Business Stationary Source Technical and Environmental Compliance Assistance Program...

40 CFR 52.183 - Small business assistance program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 3 2012-07-01 2012-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Arkansas § 52.183 Small business assistance... a Small Business Stationary Source Technical and Environmental Compliance Assistance Program...

40 CFR 52.183 - Small business assistance program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 3 2014-07-01 2014-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Arkansas § 52.183 Small business assistance... a Small Business Stationary Source Technical and Environmental Compliance Assistance Program...

40 CFR 52.183 - Small business assistance program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 3 2011-07-01 2011-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Arkansas § 52.183 Small business assistance... a Small Business Stationary Source Technical and Environmental Compliance Assistance Program...

75 FR 78733 - Notice of Lodging of Consent Decree Under the Clean Air Act

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-16

... alleges that U.S. Oil violated the National Emission Standards for Hazardous Air Pollutants for Benzene Waste Operations (the ``Benzene NESHAP''), 40 CFR part 61, Subpart FF, the National Emission Standards... Benzene NESHAP compliance program; and (4) implement measures, in addition to compliance with the LDAR...

A Case Study of the Impact of a Sytematic Evaluation Process in a Graduate Medical Education Residency Program

ERIC Educational Resources Information Center

Kromrei, Heidi T.

2014-01-01

The Accreditation Council for Graduate Medical Education has charged institutions that sponsor accredited Graduate Medical Education programs (residency and fellowship specialty programs) with overseeing implementation of mandatory annual program evaluation efforts to ensure compliance with regulatory requirements. Physicians receive scant, if…

14 CFR 1203.202 - Responsibilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM NASA Information Security Program § 1203.202 Responsibilities. (a) The Chairperson, NASA Information Security...) Ensuring effective compliance with and implementation of “the Order” and the Information Security Oversight...

14 CFR 1203.202 - Responsibilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM NASA Information Security Program § 1203.202 Responsibilities. (a) The Chairperson, NASA Information Security...) Ensuring effective compliance with and implementation of “the Order” and the Information Security Oversight...

40 CFR 52.991 - Small business assistance program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Louisiana § 52.991 Small business assistance... a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to meet...

40 CFR 52.991 - Small business assistance program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 3 2012-07-01 2012-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Louisiana § 52.991 Small business assistance... a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to meet...

40 CFR 52.991 - Small business assistance program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 3 2013-07-01 2013-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Louisiana § 52.991 Small business assistance... a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to meet...

40 CFR 52.991 - Small business assistance program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 3 2014-07-01 2014-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Louisiana § 52.991 Small business assistance... a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to meet...

40 CFR 52.991 - Small business assistance program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 3 2011-07-01 2011-07-01 false Small business assistance program. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS Louisiana § 52.991 Small business assistance... a Small Business Stationary Source Technical and Environmental Compliance Assistance Program to meet...

A study of the effectiveness of a workplace violence intervention for small retail and service establishments.

PubMed

Casteel, Carri; Peek-Asa, Corinne; Greenland, Sander; Chu, Lawrence D; Kraus, Jess F

2008-12-01

Examine the effectiveness of a robbery and violence prevention program in small businesses in Los Angeles. Gas/convenience, liquor and grocery stores, bars/restaurants, and motels were enrolled between 1997 and 2000. Intervention businesses (n = 305) were provided training, program implementation materials, and recommendations for a comprehensive security program. Control businesses (n = 96) received neither training nor program materials. Rate ratios comparing intervention to control businesses were 0.90 for violent crime (95% confidence limits [CL] = 0.53, 1.53) and 0.81 for robbery (95% CL = 0.38, 1.73). The reduction in violent crime was concentrated in high-compliance intervention businesses (risk ratio = 0.74, 95% CL = 0.40, 1.36). Low-compliance intervention businesses had practically the same postintervention crime as the control businesses. Our results suggest that the workplace violence intervention may reduce violent crime among high-risk businesses, especially those with high program compliance.

[Effects of TES program on exercise capacity, self-efficacy and patient compliance in patients with myocardial infarction].

PubMed

Choo, Jina; Kim, Ja-Mae; Hong, Kyung-Pyo

2003-12-01

This study aimed to develop a TES program to improve exercise capacity to promote patient compliance to the prescribed exercise, and to test the feasibility of the program. The 8-week TES program consisted of three components : exercise training, self-efficacy enhancement and social support. Using the matching of gender, age, and the left ventricular ejection fraction, thirty one subjects were consecutively assigned to either TES group (n=15, 52+7 years) or Control group (n=16, 58+11 years) 3 weeks after MI. With the exception of exercise compliance (only after the TES program), the exercise capacity and exercise self-efficacy were both measured both before and after the 8-week TES program. The VO2peak (p=.043), anaerobic threshold (p=.023) and exercise duration (p=.015) improved in TES group compared to Control group after 8 weeks. The cardiac exercise self-efficacy (p=.036) was significantly higher in TES group than Control group. There was a significant increase of exercise compliance(p=.005) in TES group compared to Control group. The 8-week TES program improved the exercise capacity, exercise self-efficacy and exercise compliance. A appropriately implemented TES program in cardiovascular nursing practice may promote healthy behavioral modification and, therefore, contributing to reduce the risk of mortality and morbidity in MI patients.

Negotiating Implementation of High-Stakes Performance Assessment Policies in Teacher Education: From Compliance to Inquiry

ERIC Educational Resources Information Center

Peck, Charles A.; Gallucci, Chrysan; Sloan, Tine

2010-01-01

Teacher education programs in the United States face a variety of new accountability policies at both the federal and the state level. Many of these policies carry high-stakes implications for students and programs and involve some of the same challenges for implementation as they have in the P-12 arena. Serious dilemmas for teacher educators…

Generation of structural topologies using efficient technique based on sorted compliances

NASA Astrophysics Data System (ADS)

Mazur, Monika; Tajs-Zielińska, Katarzyna; Bochenek, Bogdan

2018-01-01

Topology optimization, although well recognized is still widely developed. It has gained recently more attention since large computational ability become available for designers. This process is stimulated simultaneously by variety of emerging, innovative optimization methods. It is observed that traditional gradient-based mathematical programming algorithms, in many cases, are replaced by novel and e cient heuristic methods inspired by biological, chemical or physical phenomena. These methods become useful tools for structural optimization because of their versatility and easy numerical implementation. In this paper engineering implementation of a novel heuristic algorithm for minimum compliance topology optimization is discussed. The performance of the topology generator is based on implementation of a special function utilizing information of compliance distribution within the design space. With a view to cope with engineering problems the algorithm has been combined with structural analysis system Ansys.

33 CFR Appendix B to Part 325 - NEPA Implementation Procedures for the Regulatory Program

Code of Federal Regulations, 2012 CFR

2012-07-01

... substantive compliance with any other Federal law. For example, compliance with the Endangered Species Act, the Clean Water Act, etc., is always mandatory, even for actions not requiring an EA or EIS. The... Endangered Species Act of 1973 (16 U.S.C. 1531 et seq.), Executive Order 11990, Protection of Wetlands, (42 U...

33 CFR Appendix B to Part 325 - NEPA Implementation Procedures for the Regulatory Program

Code of Federal Regulations, 2011 CFR

2011-07-01

... substantive compliance with any other Federal law. For example, compliance with the Endangered Species Act, the Clean Water Act, etc., is always mandatory, even for actions not requiring an EA or EIS. The... Endangered Species Act of 1973 (16 U.S.C. 1531 et seq.), Executive Order 11990, Protection of Wetlands, (42 U...

33 CFR Appendix B to Part 325 - NEPA Implementation Procedures for the Regulatory Program

Code of Federal Regulations, 2014 CFR

2014-07-01

... substantive compliance with any other Federal law. For example, compliance with the Endangered Species Act, the Clean Water Act, etc., is always mandatory, even for actions not requiring an EA or EIS. The... Endangered Species Act of 1973 (16 U.S.C. 1531 et seq.), Executive Order 11990, Protection of Wetlands, (42 U...

33 CFR Appendix B to Part 325 - NEPA Implementation Procedures for the Regulatory Program

Code of Federal Regulations, 2010 CFR

2010-07-01

... substantive compliance with any other Federal law. For example, compliance with the Endangered Species Act, the Clean Water Act, etc., is always mandatory, even for actions not requiring an EA or EIS. The... Endangered Species Act of 1973 (16 U.S.C. 1531 et seq.), Executive Order 11990, Protection of Wetlands, (42 U...

33 CFR Appendix B to Part 325 - NEPA Implementation Procedures for the Regulatory Program

Code of Federal Regulations, 2013 CFR

2013-07-01

... substantive compliance with any other Federal law. For example, compliance with the Endangered Species Act, the Clean Water Act, etc., is always mandatory, even for actions not requiring an EA or EIS. The... Endangered Species Act of 1973 (16 U.S.C. 1531 et seq.), Executive Order 11990, Protection of Wetlands, (42 U...

Johnson Space Center Health and Medical Technical Authority

NASA Technical Reports Server (NTRS)

Fogarty, Jennifer A.

2010-01-01

1.HMTA responsibilities: a) Assure program/project compliance with Agency health and medical requirements at identified key decision points. b) Certify that programs/projects comply with Agency health and medical requirements prior to spaceflight missions. c) Assure technical excellence. 2. Designation of applicable NASA Centers for HMTA implementation and Chief Medical Officer (CMO) appointment. 3. Center CMO responsible for HMTA implementation for programs and projects at the center. JSC HMTA captured in "JSC HMTA Implementation Plan". 4. Establishes specifics of dissenting opinion process consistent with NASA procedural requirements.

Impact of a pharmaceutical care program on liver transplant patients' compliance with immunosuppressive medication: a prospective, randomized, controlled trial using electronic monitoring.

PubMed

Klein, Anja; Otto, Gerd; Krämer, Irene

2009-03-27

Compliance with immunosuppressive therapy plays a major role in the long-term success of organ transplantation. Thus, strategies to promote compliance in posttransplant care are of particular interest. At the pharmacy department of the University Hospital Mainz, a program for pharmaceutical care of organ transplant patients has been developed for the first time ever. The main objective of the presented study was to examine the influence of this program on liver transplant patients' compliance with immunosuppressive therapy. To measure compliance, medication event monitoring systems were used. Dosing compliance (DC) was calculated for each patient and the mean DC was compared between the two groups. Further direct and indirect methods of measuring compliance served to confirm the electronic compliance data. Pharmaceutical care of liver transplant patients led to a significant increase in compliance with the immunosuppressive therapy. The mean DC of the intervention group was 90%+/-6% compared with 81%+/-12% in the control group (P=0.015). Only two patients (10%) in the intervention group and nine patients (43%) in the control group showed a DC less than 80% (P=0.032). Furthermore, patients in the intervention group were more likely to achieve target blood levels. Patients who received pharmaceutical care with traditional patient care showed significantly better compliance with their immunosuppressive medication than patients who received only traditional patient care. Pharmaceutical care proved to be an effective intervention that should be implemented in posttransplant care.

Complying with physician gain-sharing restrictions.

PubMed

O'Hare, P K

1998-05-01

Many IDSs are considering implementing gain-sharing programs as a way to motivate their physicians to provide high-quality, cost-effective services. Before embarking on such programs, however, IDSs need to understand the legal requirements associated with such programs to ensure that the gain-sharing arrangement is in compliance with Federal law.

40 CFR 52.786 - Inspection and maintenance program.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., commitment to timely adopt and implement enhanced inspection and maintenance (I/M) rules for Lake and Porter... parts of the program to certify compliance. (e) After July 1, 1976, the State of Indiana, County of... pertaining to the development and adoption of necessary authority for the I/M program. This disapproval...

40 CFR 52.786 - Inspection and maintenance program.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., commitment to timely adopt and implement enhanced inspection and maintenance (I/M) rules for Lake and Porter... parts of the program to certify compliance. (e) After July 1, 1976, the State of Indiana, County of... pertaining to the development and adoption of necessary authority for the I/M program. This disapproval...

Pediatric surgery fellowship compliance to the 80-hour work week.

PubMed

Ladd, Alan P

2006-04-01

The goal of this study was to determine the compliance of pediatric surgery fellowships with Accreditation Council for Graduate Medical Education (ACGME) duty hour restrictions while confronting a reduced resident workforce. An evaluation of training programs was performed by surveying pediatric surgery fellows on aspects of work hours, ACGME guideline compliance, operative case volume, employment of physician extenders, and didactic education. A 74% survey response rate was achieved. Of the respondents, 95% felt fully aware of ACGME guidelines. Although 95% of programs had mechanisms for compliance in place, only 45% of fellows felt compliant. Median work hours were 80 to 90 hours per week. Although subordinate residents were felt to obtain better compliance (>86%), only 69% of fellows perceived greater service commitment as a result. No impact on volume of operative cases was perceived. Of the programs, 89% employed physician extenders and 55% used additional fellows, but no overall effect on fellow work hours was evident. Fellows did not identify an improvement in the quality of clinical fellowships with guideline implementation. A minority of fellows comply with ACGME guidelines. Vigilance of duty hour tracking correlates to better compliance. A shift of patient care to fellows is perceived. Use of support personnel did not significantly aid compliance.

Report: EPA Region 8 Needs to Better Manage the Risk Management Program for Airborne Chemical Releases

EPA Pesticide Factsheets

Report #09-P-0130, March 30, 2009. The two Region 8 offices jointly responsible for implementing the CAA 112(r) Risk Management Program have not effectively planned or coordinated compliance assurance activities.

Compliance through pollution prevention opportunity assessments at Edwards AFB -- Development, results and lessons learned

DOE Office of Scientific and Technical Information (OSTI.GOV)

Beutelman, H.P.; Lawrence, A.

1999-07-01

Edwards Air Force Base (AFB), located in the Mojave Desert of southern California, is required to comply with environmental requirements for air pollution emissions, hazardous waste disposal, and clean water. The resources required to meet these many compliance requirements represents an ever increasing financial burden to the base, and to the Department of Defense. A recognized superior approach to environmental management is to achieve compliance through a proactive pollution prevention (P2) program which mitigates, and when possible, eliminates compliance requirements and costs, while at the same time reducing pollution released to the environment. At Edwards AFB, the Environmental Management Officemore » P2 Branch developed and implemented a strategy that addresses this concept, better known as Compliance Through Pollution Prevention (CTP2). At the 91st AWMA Annual Meeting and Exhibition, Edwards AFB presented a paper on its strategy and implementation of its CTP2 concept. Part of that strategy and implementation included accomplishment of process specific focused P2 opportunity assessments (OAs). Starting in 1998, Edwards AFB initiated a CTP2 OA project where OAs were targeted on those operational processes, identified as compliance sites, that contributed most to the compliance requirements and costs at Edwards AFB. The targeting of these compliance sites was accomplished by developing a compliance matrix that prioritized processes in accordance with an operational risk management approach. The Edwards AFB CTP2 PPOA project is the first of its kind within the Air Force Material Command, and is serving as a benchmark for establishment of the CTP2 OA process.« less

40 CFR 281.24 - Memorandum of agreement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... state roles and responsibilities in areas including, but not limited to: Implementation of partial state programs; enforcement; compliance monitoring; EPA oversight; and sharing and reporting of information. At...

Double-tick realization of binary control program

NASA Astrophysics Data System (ADS)

Kobylecki, Michał; Kania, Dariusz

2016-12-01

This paper presents a procedure for the implementation of control algorithms for hardware-bit compatible with the standard IEC61131-3. The described transformation based on the sets of calculus and graphs, allows translation of the original form of the control program to the form in full compliance with the original, giving the architecture represented by two tick. The proposed method enables the efficient implementation of the control bits in the FPGA with the use of a standardized programming language LD.

75 FR 66411 - Small Entity Compliance Guide: Women-Owned Small Business Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-28

...-Owned Small Business (WOSB) Program. This guide sets forth in plain language the requirements for... effective February 4, 2011 because the agency is in the process of working with the Federal Acquisition Regulatory Council to implement this program in the Federal Acquisition Regulations. In addition, the SBA is...

45 CFR 158.605 - Responses to allegations of noncompliance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the violation. (c) Evidence documenting the development and implementation of internal policies and... Section 158.605 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH... policies and procedures may include or consist of a voluntary compliance program. Any such program should...

Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina.

PubMed

Rosenthal, Victor D; Guzman, Sandra; Safdar, Nasia

2005-09-01

Hand hygiene is a fundamental measure for the control of nosocomial infection. However, sustained compliance with hand hygiene in health care workers is poor. We attempted to enhance compliance with hand hygiene by implementing education, training, and performance feedback. We measured nosocomial infections in parallel. We monitored the overall compliance with hand hygiene during routine patient care in intensive care units (ICUs); 1 medical surgical ICU and 1 coronary ICU, of 1 hospital in Buenos Aires, Argentina, before and during implementation of a hand hygiene education, training, and performance feedback program. Observational surveys were done twice a week from September 2000 to May 2002. Nosocomial infections in the ICUs were identified using the National Nosocomial Infections Surveillance (NNIS) criteria, with prospective surveillance. We observed 4347 opportunities for hand hygiene in both ICUs. Compliance improved progressively (handwashing adherence, 23.1% (268/1160) to 64.5% (2056/3187) (RR, 2.79; 95% CI: 2.46-3.17; P < .0001). During the same period, overall nosocomial infection in both ICUs decreased from 47.55 per 1000 patient-days (104/2187) to 27.93 per 1000 patient days (207/7409) RR, 0.59; 95% CI: 0.46-0.74, P < .0001). A program consisting of focused education and frequent performance feedback produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction in nosocomial infection rates in the ICUs.

Improving Coverage and Compliance in Mass Drug Administration for the Elimination of LF in Two ‘Endgame’ Districts in Indonesia Using Micronarrative Surveys

PubMed Central

Krentel, Alison; Damayanti, Rita; Titaley, Christiana Rialine; Suharno, Nugroho; Bradley, Mark; Lynam, Timothy

2016-01-01

Background As the Global Programme to Eliminate Lymphatic Filariasis (LF) approaches its 2020 goal, an increasing number of districts will enter the endgame phase where drug coverage rates from mass drug administration (MDA) are used to assess whether MDA can be stopped. As reported, the gap between reported and actual drug coverage in some contexts has overestimated the true rates, thus causing premature administration of transmission assessment surveys (TAS) that detect ongoing LF transmission. In these cases, districts must continue with additional rounds of MDA. Two districts in Indonesia (Agam District, Depok City) fit this criteria—one had not met the pre-TAS criteria and the other, had not passed the TAS criteria. In both cases, the district health teams needed insight into their drug delivery programs in order to improve drug coverage in the subsequent MDA rounds. Methodology/Principal Findings To inform the subsequent MDA round, a micronarrative survey tool was developed to capture community members’ experience with MDA and the social realm where drug delivery and compliance occur. A baseline survey was implemented after the 2013 MDA in endemic communities in both districts using the EPI sampling criteria (n = 806). Compliance in the last MDA was associated with perceived importance of the LF drugs for health (p<0.001); perceived safety of the LF drugs (p<0.001) and knowing someone in the household has complied (p<0.001). Results indicated that specialized messages were needed to reach women and younger men. Both districts used these recommendations to implement changes to their MDA without additional financial support. An endline survey was performed after the 2014 MDA using the same sampling criteria (n = 811). Reported compliance in the last MDA improved in both districts from 57% to 77% (p<0.05). Those who reported having ever taken the LF drug rose from 79% to 90% (p<0.001) in both sites. Conclusions/Significance Micronarrative surveys were shown to be a valid and effective tool to detect operational issues within MDA programs. District health staff felt ownership of the results, implementing feasible changes to their programs that resulted in significant improvements to coverage and compliance in the subsequent MDA. This kind of implementation research using a micronarrative survey tool could benefit underperforming MDA programs as well as other disease control programs where a deeper understanding is needed to improve healthcare delivery. PMID:27812107

7 CFR 1410.64 - Transition Incentives Program.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the land to production using sustainable grazing or crop production methods; (3) Modify the CRP... plan; and (3) Implement sustainable grazing or crop production in compliance with the conservation plan...

7 CFR 1410.64 - Transition Incentives Program.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the land to production using sustainable grazing or crop production methods; (3) Modify the CRP... plan; and (3) Implement sustainable grazing or crop production in compliance with the conservation plan...

7 CFR 1410.64 - Transition Incentives Program.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the land to production using sustainable grazing or crop production methods; (3) Modify the CRP... plan; and (3) Implement sustainable grazing or crop production in compliance with the conservation plan...

7 CFR 1410.64 - Transition Incentives Program.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the land to production using sustainable grazing or crop production methods; (3) Modify the CRP... plan; and (3) Implement sustainable grazing or crop production in compliance with the conservation plan...

7 CFR 62.000 - Meaning of terms.

Code of Federal Regulations, 2011 CFR

2011-01-01

... official assessments. Branch. The Audit, Review, and Compliance Branch of the Livestock and Seed Program... in QSVP services who has applied for service under this part. Assessment. A systematic review of the adequacy of program or system documentation, or the review of the completeness of implementation of a...

An educational intervention to improve hand hygiene compliance in Vietnam.

PubMed

Phan, Hang Thi; Tran, Hang Thi Thuy; Tran, Hanh Thi My; Dinh, Anh Pham Phuong; Ngo, Ha Thanh; Theorell-Haglow, Jenny; Gordon, Christopher J

2018-03-07

Hand hygiene compliance is the basis of infection control programs. In developing countries models to improve hand hygiene compliance to reduce healthcare acquired infections are required. The aim of this study was to determine hand hygiene compliance following an educational program in an obstetric and gynecological hospital in Vietnam. Health care workers from neonatal intensive care, delivery suite and a surgical ward from Hung Vuong Hospital, Ho Chi Minh City, Vietnam undertook a 4-h educational program targeting hand hygiene. Compliance was monitored monthly for six months following the intervention. Hand hygiene knowledge was assessed at baseline and after six months of the study. There were 7124 opportunities over 370 hand hygiene recording sessions with 1531 opportunities at baseline and 1620 at 6 months following the intervention. Hand hygiene compliance increased significantly from baseline across all sites (43.6% [95% Confidence interval CI: 41.1-46.1] to 63% [95% CI: 60.6-65.3]; p < 0.0001). Health care worker hand hygiene compliance increased significantly after intervention (p < 0.0001). There were significant improvements in knowledge scores from baseline to 2 months post educational intervention with mean difference standard deviations (SD): 1.5 (2.5); p < 0.001). A simple educational model was implemented in a Vietnamese hospital that revealed good hand hygiene compliance for an extended period of time. Hand hygiene knowledge increased during the intervention. This hand hygiene model could be used in developing countries were resources are limited.

A Review of Factors That Influence Individual Compliance with Mass Drug Administration for Elimination of Lymphatic Filariasis

PubMed Central

Krentel, Alison; Fischer, Peter U.; Weil, Gary J.

2013-01-01

Background The success of programs to eliminate lymphatic filariasis (LF) depends in large part on their ability to achieve and sustain high levels of compliance with mass drug administration (MDA). This paper reports results from a comprehensive review of factors that affect compliance with MDA. Methodology/Principal Findings Papers published between 2000 and 2012 were considered, and 79 publications were included in the final dataset for analysis after two rounds of selection. While results varied in different settings, some common features were associated with successful programs and with compliance by individuals. Training and motivation of drug distributors is critically important, because these people directly interact with target populations, and their actions can affect MDA compliance decisions by families and individuals. Other important programmatic issues include thorough preparation of personnel, supplies, and logistics for implementation and preparation of the population for MDA. Demographic factors (age, sex, income level, and area of residence) are often associated with compliance by individuals, but compliance decisions are also affected by perceptions of the potential benefits of participation versus the risk of adverse events. Trust and information can sometimes offset fear of the unknown. While no single formula can ensure success MDA in all settings, five key ingredients were identified: engender trust, tailor programs to local conditions, take actions to minimize the impact of adverse events, promote the broader benefits of the MDA program, and directly address the issue of systematic non-compliance, which harms communities by prolonging their exposure to LF. Conclusions/Significance This review has identified factors that promote coverage and compliance with MDA for LF elimination across countries. This information may be helpful for explaining results that do not meet expectations and for developing remedies for ailing MDA programs. Our review has also identified gaps in understanding and suggested priority areas for further research. PMID:24278486

A Multidisciplinary Patient Navigation Program Improves Compliance With Adjuvant Breast Cancer Therapy in a Public Hospital.

PubMed

Castaldi, Maria; Safadjou, Saman; Elrafei, Tarek; McNelis, John

Cancer health disparities affecting low-income and minority patients have been well documented to lead to poor outcomes. This report examines the impact of patient navigation on adherence to prescribed adjuvant breast cancer treatment. A multidisciplinary patient navigation program was initiated at a public safety net hospital to improve compliance with 3 National Quality Forum measures: (1) administration of combination chemotherapy for women with Stage (defined by the American Joint Committee on Cancer [AJCC]) T1c, II, or III hormone receptor-negative breast cancer within 120 days; (2) administration of endocrine therapy for women with AJCC Stage T1c, II, or III hormone receptor-positive breast cancer within 365 days; and (3) radiation therapy for women receiving breast-conserving surgery within one year. Implementation of a multidisciplinary patient navigation program reduced time to treatment and improved compliance with adjuvant therapy for breast cancer in an underserved minority community.

Compliance Groundwater Monitoring of Nonpoint Sources - Emerging Approaches

NASA Astrophysics Data System (ADS)

Harter, T.

2008-12-01

Groundwater monitoring networks are typically designed for regulatory compliance of discharges from industrial sites. There, the quality of first encountered (shallow-most) groundwater is of key importance. Network design criteria have been developed for purposes of determining whether an actual or potential, permitted or incidental waste discharge has had or will have a degrading effect on groundwater quality. The fundamental underlying paradigm is that such discharge (if it occurs) will form a distinct contamination plume. Networks that guide (post-contamination) mitigation efforts are designed to capture the shape and dynamics of existing, finite-scale plumes. In general, these networks extend over areas less than one to ten hectare. In recent years, regulatory programs such as the EU Nitrate Directive and the U.S. Clean Water Act have forced regulatory agencies to also control groundwater contamination from non-incidental, recharging, non-point sources, particularly agricultural sources (fertilizer, pesticides, animal waste application, biosolids application). Sources and contamination from these sources can stretch over several tens, hundreds, or even thousands of square kilometers with no distinct plumes. A key question in implementing monitoring programs at the local, regional, and national level is, whether groundwater monitoring can be effectively used as a landowner compliance tool, as is currently done at point-source sites. We compare the efficiency of such traditional site-specific compliance networks in nonpoint source regulation with various designs of regional nonpoint source monitoring networks that could be used for compliance monitoring. We discuss advantages and disadvantages of the site vs. regional monitoring approaches with respect to effectively protecting groundwater resources impacted by nonpoint sources: Site-networks provide a tool to enforce compliance by an individual landowner. But the nonpoint source character of the contamination and its typically large spatial extend requires extensive networks at an individual site to accurately and fairly monitor individual compliance. In contrast, regional networks seemingly fail to hold individual landowners accountable. But regional networks can effectively monitor large-scale impacts and water quality trends; and thus inform regulatory programs that enforce management practices tied to nonpoint source pollution. Regional monitoring networks for compliance purposes can face significant challenges in the implementation due to a regulatory and legal landscape that is exclusively structured to address point sources and individual liability, and due to the non-intensive nature of a regional monitoring program (lack of control of hot spots; lack of accountability of individual landowners).

77 FR 70547 - Financial Crimes Enforcement Network; Proposed Collection; Comment Request; Renewal Without...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-26

... terrorism, and to implement counter-money laundering programs and compliance procedures.\\3\\ Regulations... merchants, introducing brokers in commodities, money services businesses, and mutual funds). Estimated Total...

Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection.

PubMed

Lam, Barbara C C; Lee, Josephine; Lau, Y L

2004-11-01

Health care-associated infections persist as a major problem in most neonatal intensive care units. Hand hygiene has been singled out as the most important measure in preventing hospital-acquired infection. However, hand hygiene compliance among health care workers (HCWs) remains low. The objective of this study was to assess the frequency and nature of patient contacts in neonatal intensive care units and observe the compliance and technique of hand hygiene among HCWs before and after the implementation of a multimodal intervention program. The nature and frequency of patient contacts, the hand hygiene compliance, and hand-washing techniques of HCWs were observed unobtrusively to reflect the baseline compliance and to investigate factors for noncompliance. The intervention consisted of problem-based and task-orientated hand hygiene education, enhancement of minimal handling protocol and clustering of nursing care, liberal provision of alcohol-based hand antiseptic, improvement in hand hygiene facilities, ongoing regular hand hygiene audit, and implementation of health care-associated infection surveillance. The observational study was repeated 6 months after the completion of the intervention program, which extended over 1-year period. Overall hand hygiene compliance increased from 40% to 53% before patient contact and 39% to 59% after patient contact. More marked improvement was observed for high-risk procedures (35%-60%). The average number of patient contacts also decreased from 2.8 to 1.8 per patient per hour. There was improvement in most aspects of hand-washing technique in the postintervention stage. The health care-associated infection rate decreased from 11.3 to 6.2 per 1000 patient-days. A problem-based and task-orientated education program can improve hand hygiene compliance. Enhancement of minimal handling and clustering of nursing procedures reduced the total patient contact episodes, which could help to overcome the major barrier of time constraints. A concurrent decrease in health care-associated infection rate and increase in hand hygiene compliance was observed in this study. The observational study could form part of an ongoing audit to provide regular feedback to HCWs to sustain the compliance.

Assessment at AACSB Schools: A Survey of Deans

ERIC Educational Resources Information Center

Wheeling, Barbara M.; Miller, Donald S.; Slocombe, Thomas E.

2015-01-01

The purpose of this research was to document the extent to which Association to Advance Collegiate Schools of Business (AACSB)-accredited business schools have implemented strategies to improve students' ability to achieve program learning objectives. Assessment of academic programs is increasingly important at AACSB schools. Compliance with…

32 CFR 291.4 - Policy.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROGRAM DEFENSE NUCLEAR AGENCY (DNA) FREEDOM OF INFORMATION ACT PROGRAM § 291.4 Policy. (a) Compliance with the FOIA. DNA personnel are expected to comply with the FOIA and this part in both letter and spirit. This strict adherence is necessary to provide uniformity in the implementation of the DNA FOIA...

32 CFR 291.4 - Policy.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROGRAM DEFENSE NUCLEAR AGENCY (DNA) FREEDOM OF INFORMATION ACT PROGRAM § 291.4 Policy. (a) Compliance with the FOIA. DNA personnel are expected to comply with the FOIA and this part in both letter and spirit. This strict adherence is necessary to provide uniformity in the implementation of the DNA FOIA...

32 CFR 291.4 - Policy.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROGRAM DEFENSE NUCLEAR AGENCY (DNA) FREEDOM OF INFORMATION ACT PROGRAM § 291.4 Policy. (a) Compliance with the FOIA. DNA personnel are expected to comply with the FOIA and this part in both letter and spirit. This strict adherence is necessary to provide uniformity in the implementation of the DNA FOIA...

32 CFR 291.4 - Policy.

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROGRAM DEFENSE NUCLEAR AGENCY (DNA) FREEDOM OF INFORMATION ACT PROGRAM § 291.4 Policy. (a) Compliance with the FOIA. DNA personnel are expected to comply with the FOIA and this part in both letter and spirit. This strict adherence is necessary to provide uniformity in the implementation of the DNA FOIA...

32 CFR 291.4 - Policy.

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROGRAM DEFENSE NUCLEAR AGENCY (DNA) FREEDOM OF INFORMATION ACT PROGRAM § 291.4 Policy. (a) Compliance with the FOIA. DNA personnel are expected to comply with the FOIA and this part in both letter and spirit. This strict adherence is necessary to provide uniformity in the implementation of the DNA FOIA...

40 CFR 264.19 - Construction quality assurance program.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Compliance with the hydraulic conductivity requirements must be verified by using in-situ testing on the... specifications in the permit. The program must be developed and implemented under the direction of a CQA officer... description of how they will be constructed. (2) Identification of key personnel in the development and...

40 CFR 264.19 - Construction quality assurance program.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Compliance with the hydraulic conductivity requirements must be verified by using in-situ testing on the... specifications in the permit. The program must be developed and implemented under the direction of a CQA officer... description of how they will be constructed. (2) Identification of key personnel in the development and...

Physician Peer Assessments for Compliance with Methadone Maintenance Treatment Guidelines

ERIC Educational Resources Information Center

Strike, Carol; Wenghofer, Elizabeth; Gnam, William; Hillier, Wade; Veldhuizen, Scott; Millson, Margaret

2007-01-01

Introduction: Medical associations and licensing bodies face pressure to implement quality assurance programs, but evidence-based models are lacking. To improve the quality of methadone maintenance treatment (MMT), the College of Physicians and Surgeons of Ontario, Canada, conducts an innovative quality assurance program on the basis of peer…

Air Force IT System Security Compliance with Law and Policy

DTIC Science & Technology

2016-04-01

production /1/saf_cio_a6/publication/afpd33-2/afpd33-2.pdf 21 AFI33-210, Air Force Certification and Accreditation Program (AFCAP), October 2014: http...cyber systems for support and operation. Today’s system certification and compliancy tracking methods are very costly, time intensive, unrealistic...and often lag behind operational and test requirements. However, with changes to policy and implementation requirements, the IT system certification

Avoiding criminal liabilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blattner, J.W.; Bramble, G.M.

1994-06-01

Armed with more than 120 investigative agents, the US Environmental Protection Agency, through its attorneys at the Dept. of Justice, charges 5 to 10 engineers and business people with criminal violations of the nation's environmental regulations in any given week. There are some 10,000 pages of federal (let alone state) environmental regulations. The rules apply to large and small companies alike. As a practical matter, the sheer scope and complexity of environmental regulatory programs make 100% compliance virtually unattainable for most industrial enterprises. Where it is no longer a defense to claim lack of knowledge of one's regulatory obligations, andmore » where courts allow the inference of criminal knowledge based on what the defendant should have known, what is a company to do The environmental audit provides a solution to this problem. Progressive audit programs are established with three goals in mind: to ensure that programs and practices at facilities are in compliance with applicable rules and regulations; to affirm that management systems are in place at the facilities to support ongoing compliance; and to identify needs or opportunities where it may be desirable to go beyond compliance to protect human health and the environment. This paper discusses the implementation of an audit program.« less

The SBIRT program matrix: a conceptual framework for program implementation and evaluation.

PubMed

Del Boca, Frances K; McRee, Bonnie; Vendetti, Janice; Damon, Donna

2017-02-01

Screening, Brief Intervention and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of services to those at risk for the adverse consequences of alcohol and other drug use, and for those with probable substance use disorders. Research on successful SBIRT implementation has lagged behind studies of efficacy and effectiveness. This paper (1) outlines a conceptual framework, the SBIRT Program Matrix, to guide implementation research and program evaluation and (2) specifies potential implementation outcomes. Overview and narrative description of the SBIRT Program Matrix. The SBIRT Program Matrix has five components, each of which includes multiple elements: SBIRT services; performance sites; provider attributes; patient/client populations; and management structure and activities. Implementation outcomes include program adoption, acceptability, appropriateness, feasibility, fidelity, costs, penetration, sustainability, service provision and grant compliance. The Screening, Brief Intervention and Referral to Treatment Program Matrix provides a template for identifying, classifying and organizing the naturally occurring commonalities and variations within and across SBIRT programs, and for investigating which variables are associated with implementation success and, ultimately, with treatment outcomes and other impacts. © 2017 Society for the Study of Addiction.

DOE's Remote-Handled TRU Waste Characterization Program: Implementation Plan

EPA Pesticide Factsheets

Remote-handled (RH) transuranic (TRU) waste characterization, which involves obtaining chemical, radiological, and physical data, is a primary component of ensuring compliance of the Waste Isolation Pilot Plant (WIPP) with regulatory requirements.

Development and release of phenological data products—A case study in compliance with federal open data policy

USGS Publications Warehouse

Rosemartin, Alyssa H.; Langseth, Madison L.; Crimmins, Theresa M.; Weltzin, Jake F.

2018-01-31

In Autumn 2015, USA National Phenology Network (USA-NPN) staff implemented new U.S. Geological Survey (USGS) data-management policies intended to ensure that the results of Federally funded research are made available to the public. The effort aimed both to improve USA-NPN data releases and to provide a model for similar programs within the USGS. This report provides an overview of the steps taken to ensure compliance, following the USGS Science Data Lifecycle, and provides lessons learned about the data-release process for USGS program leaders and data managers.

Development and outcomes of a program to translate the evidence for spinal manipulation into physical therapy practice

PubMed Central

Kramer, Christopher D; Koch, William H; Fritz, Julie M

2013-01-01

Objectives: To describe a program to translate evidence into practice for the use of manipulation with a sub-group of patients with low back pain and report the program's outcomes following implementation. We compared outcomes based on appropriate inclusion in the program and compliance with the evidence being translated. Methods: The evidence translation program was based on evidence that patients meeting two criteria (duration of symptoms <16 days, no symptoms distal to knee) were likely to respond to a physical therapy that included manipulation in the first two visits. Implementation addressed potential barriers with referring physicians, physical therapists, and scheduling staff to this evidence. Outcomes for patients in the program were tracked following implementation. Process outcomes were appropriateness of inclusion (met both criteria), compliance with evidence for providing thrust manipulation in the first two visits, and number of physical therapy visits. Clinical outcomes were based on Oswestry scores from the first, interim (after two to three visits), and final visit. Results: A total of 577 patients entered the evidence translation program (mean age  =  43.0, 56.8% female); 79.5% were appropriate inclusions and 83.0% received manipulation. The use of manipulation was associated with fewer visits (mean difference  =  0.54 visits, 95% CI: 0.037, 1.04, P  =  0.035), and appropriate inclusion was associated with greater Oswestry change (mean difference at the final visit  =  6.6 points, 95% CI: 1.6, 11.6; P  =  0.010). Discussion: Implementing evidence into practice is difficult; however, barriers can be anticipated and overcome. Tracking the outcomes of an implementation program is critical to evaluating its benefit to patients. Additional research using experimental designs are necessary to evaluate the effectiveness of various treatments implemented in physical therapy practice. PMID:24421630

Enforcing the minimum drinking age: state, local and agency characteristics associated with compliance checks and Cops in Shops programs.

PubMed

Montgomery, Jacob M; Foley, Kristie Long; Wolfson, Mark

2006-02-01

To identify state, local and organizational characteristics associated with local law enforcement agencies' implementation of two dramatically different approaches to enforcement of underage drinking laws: compliance checks and Cops in Shops programs. Compliance checks use underage decoys to attempt to purchase alcohol from retail merchants, while Cops in Shops programs deploy undercover law enforcement officers in alcohol outlets to detect and cite persons under the age of 21 who attempt to purchase alcohol. Cross-sectional telephone interview conducted as part of the Tobacco Enforcement Study (TES), which examined enforcement of laws related to youth access to tobacco. Data were collected in 1999 among law enforcement agencies in all 50 states of the United States. Representatives of city police departments, departments of public safety, sheriffs or county police were included (n = 920 local agencies). Alcohol compliance checks and Cops in Shops programs were the primary outcomes. Covariates included state level policies (e.g. beer tax), agency resources (e.g. number of sworn officers) and community demographics (e.g. college dormitory population). Local enforcement agencies were more likely to perform alcohol compliance checks than to have a Cops in Shops program (73.9% compared to 41.1% in cities > 25 000 and 55.7% compared to 23.9% in cities < or = 25 000). Conducting compliance checks for tobacco age-of-sale laws was positively associated with alcohol compliance checks and Cops in Shops (OR 3.30, P < 0.001; OR 1.84, P = 0.001, respectively). Having a Drug Abuse Resistance Education (DARE) officer was negatively related to conducting compliance checks (OR 0.67, P = 0.03). Special community policing units were associated with departments having Cops in Shops programs (OR 1.80, P = 0.006). This study used a nationally representative sample of communities to better understand state and local factors that shape local law enforcement agencies' use of two distinct approaches to underage drinking enforcement. The strong link observed between tobacco and alcohol compliance checks may indicate a culture within some law enforcement agencies supporting strict enforcement of age-of-sale laws.

Underground storage tank management plan, Oak Ridge Y-12 Plant, Oak Ridge, Tennessee

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1997-09-01

The Underground Storage Tank (UST) Program at the Oak Ridge Y-12 Plant was established to locate UST systems at the facility and to ensure that all operating UST systems are free of leaks. UST systems have been removed or upgraded in accordance with Tennessee Department of Environment and Conservation (TDEC) regulations and guidance. With the closure of a significant portion of the USTs, the continuing mission of the UST Management Program is to manage the remaining active UST systems and continue corrective actions in a safe regulatory compliant manner. This Program outlines the compliance issues that must be addressed, reviewsmore » the current UST inventory and compliance approach, and presents the status and planned activities associated with each UST system. The UST Program provides guidance for implementing TDEC regulations and guidelines for petroleum UST systems. The plan is divided into three major sections: (1) regulatory requirements, (2) active UST sites, and (3) out-of-service UST sites. These sections describe in detail the applicable regulatory drivers, the UST sites addressed under the Program, and the procedures and guidance for compliance.« less

78 FR 14415 - Agency Information Collection Activities; Comment Request of the Proposed Changes to the Report...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-05

... protect against international terrorism, and to implement counter-money laundering programs and compliance... identification, investigation, and prosecution of individuals involved in money laundering, the financing of...

40 CFR 49.160 - Registration program for minor sources in Indian country.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Implementation Plan Provisions Federal Minor New Source Review Program in Indian Country § 49.160 Registration...) Identification and description of any existing air pollution control equipment and compliance monitoring devices.... (ii) If your true minor source is not an oil and natural gas source and you commence construction...

40 CFR 96.255 - Banking.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS FOR STATE IMPLEMENTATION PLANS CAIR SO2 Allowance Tracking System § 96.255 Banking. (a) CAIR SO2 allowances may be banked for future use or transfer in a compliance account or a general account in accordance with paragraph (b) of this section. (b) Any CAIR SO2...

75 FR 19241 - Financial Crimes Enforcement Network; Amendment to the Bank Secrecy Act Regulations; Defining...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-14

... definition of mutual fund in the rule requiring mutual funds to establish anti-money laundering (``AML...-money laundering programs and compliance procedures.\\1\\ Regulations implementing the BSA appear at 31... transactions.\\7\\ \\5\\ Anti-Money Laundering Programs for Mutual Funds, 67 FR 21117 (April 29, 2002); Customer...

49 CFR 26.37 - What are a recipient's responsibilities for monitoring the performance of other program...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 1 2011-10-01 2011-10-01 false What are a recipient's responsibilities for... Contracting § 26.37 What are a recipient's responsibilities for monitoring the performance of other program participants? (a) You must implement appropriate mechanisms to ensure compliance with the part's requirements...

49 CFR 26.37 - What are a recipient's responsibilities for monitoring the performance of other program...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 1 2014-10-01 2014-10-01 false What are a recipient's responsibilities for... Contracting § 26.37 What are a recipient's responsibilities for monitoring the performance of other program participants? (a) You must implement appropriate mechanisms to ensure compliance with the part's requirements...

49 CFR 26.37 - What are a recipient's responsibilities for monitoring the performance of other program...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 1 2012-10-01 2012-10-01 false What are a recipient's responsibilities for... Contracting § 26.37 What are a recipient's responsibilities for monitoring the performance of other program participants? (a) You must implement appropriate mechanisms to ensure compliance with the part's requirements...

49 CFR 26.37 - What are a recipient's responsibilities for monitoring the performance of other program...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 1 2013-10-01 2013-10-01 false What are a recipient's responsibilities for... Contracting § 26.37 What are a recipient's responsibilities for monitoring the performance of other program participants? (a) You must implement appropriate mechanisms to ensure compliance with the part's requirements...

Implementation of a drug-use and disease-state management program.

PubMed

Skledar, S J; Hess, M M

2000-12-15

A drug-use and disease-state management (DUDSM) program was instituted in 1996 at a teaching hospital associated with a large nonprofit health care system. The program's goals are to optimize pharmacotherapeutic regimens, evaluate health outcomes of identified disease states, and evaluate the economic impact of pharmacotherapeutic options for given disease states by developing practice guidelines. Through a re-engineering process, resources within the pharmacy department were identified that could be devoted to the DUDSM program, including the use of clinical pharmacy specialists, promotion of staff pharmacists into the DUDSM program, a pharmacy technician, and information systems support. A strength of the program is its systematic approach for developing and implementing new initiatives, as well as monitoring compliance with all initiatives on an ongoing basis. The initiative-design process incorporates continuous quality improvement principles, outcome design and evaluation, competency assessment for all pharmacists, multidisciplinary collaboration, and sophisticated information systems. Seventy-five initiatives have been implemented, ranging from simple dose-optimization strategies for specific drugs to complicated practice guidelines for managing specific disease states. Improved patient outcomes have been documented, including reduced length of stay, postsurgical wound infection, adverse drug reactions, and medication errors. Documented cost savings exceeded $4 million annually for fiscal years 1996-97 through 1999-2000. Overall compliance with DUDSM initiatives exceeds 80%, and physician service profiling has been initiated to monitor variant prescribing. The DUDSM program has successfully integrated practice guidelines into therapeutic decision-making, resulting in improved patient-care outcomes and cost savings.

Corporate compliance: framework and implementation.

PubMed

Fowler, N

1999-01-01

The federal government has created numerous programs to combat fraud and abuse. The government now encourages healthcare facilities to have a corporate compliance program (CCP), a plan that reduces the chances that the facility will violate laws or regulations. A CCP is an organization-wide program comprised of a code of conduct and written policies, internal monitoring and auditing standards, employee training, feedback mechanisms and other features, all designed to prevent and detect violations of governmental laws, regulations and policies. It is a system or method ensuring that employees understand and will comply with laws that apply to what they do every day. Seven factors, based on federal sentencing guidelines, provide the framework for developing a CCP. First, a facility must establish rules that are reasonably capable of reducing criminal conduct. Second, high-level personnel must oversee the compliance effort. Third, a facility must use due care in delegating authority in the compliance initiative. Fourth, standards must be communicated effectively to employees, and fifth, a facility must take reasonable steps to achieve compliance. Sixth, standards must be enforced consistently across the organization and last, standards must be modified or changed for reported concerns, to ensure they are not repeated. PROMINA Health System, Inc. in Atlanta, Ga., designed a program to meet federal guidelines. It started with a self-assessment to define its areas or risk. Next, it created the internal structure and assigned organizational responsibility for running the CCP. PROMINA then developed standards of business and professional conduct, established vehicles of communication and trained employees on the standards. Finally, it continues to develop evidence of the program's effectiveness by monitoring and documenting its compliance activities.

40 CFR 256.27 - Recommendation for schedules leading to compliance with the prohibition of open dumping.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste Disposal Programs § 256.27 Recommendation for schedules leading...

40 CFR 256.26 - Requirement for schedules leading to compliance with the prohibition of open dumping.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste Disposal Programs § 256.26 Requirement for schedules leading to...

40 CFR 256.26 - Requirement for schedules leading to compliance with the prohibition of open dumping.

Code of Federal Regulations, 2011 CFR

2011-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste Disposal Programs § 256.26 Requirement for schedules leading to...

40 CFR 256.27 - Recommendation for schedules leading to compliance with the prohibition of open dumping.

Code of Federal Regulations, 2011 CFR

2011-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES GUIDELINES FOR DEVELOPMENT AND IMPLEMENTATION OF STATE SOLID WASTE MANAGEMENT PLANS Solid Waste Disposal Programs § 256.27 Recommendation for schedules leading...

Design and implementation of the National Water-Quality Assessment Program: a United States example: understanding the limitations of using compliance-monitoring data to assess the water quality of a large river basin

USGS Publications Warehouse

Wangsness, David J.

1997-01-01

In the 1980s it was determined that existing ambient and compliance-monitoring data could not satisfactorily evaluate the results of hundreds of billions of dollars spent for water-pollution abatement in the United States. At the request of the US Congress, a new programme, the National Water-Quality Assessment, was designed and implemented by government agency, the US Geological Survey (USGS). The Assessment has reported status and trends in surface- and ground-water quality at national, regional, and local scales since 1991. The legislative basis for US monitoring and data-sharing policies are identified as well as the successive phases of the design and implementation of the USGS Assessment. Application to the Danube Basin is suggested. Much of the water-quality monitoring conducted in the United States is designed to comply with Federal and State laws mandated primarily by the Clean Water Act of 1987 and the Safe Drinking Water Act of 1986. Monitoring programs generally focus on rivers upstream and downstream of point-source discharges and at water-supply intakes. Few data are available for aquifer systems, and chemical analyses are often limited to those constituents required by law. In most cases, the majority of the available chemical and streamflow data have provided the information necessary to meet the objectives of the compliance-monitoring programs, but do not necessarily provide the information requires for basin-wide assessments of the water quality at the local, regional, or national scale.

Implementation of a written protocol for management of central venous access devices: a theoretical and practical education, including bedside examinations.

PubMed

Ahlin, Catharina; Klang-Söderkvist, Birgitta; Brundin, Seija; Hellström, Birgitta; Pettersson, Karin; Johansson, Eva

2006-01-01

The objectives of this study were to evaluate registered nurses' (RN) compliance with a local clinical central venous access device (CVAD) protocol after completing an educational program and to determine RNs' perception of the program. Seventy-five RNs working in hematology participated in the educational part of the program. Sixty-eight RNs were examined while changing CVAD dressings or placing a Huber needle into a port on actual patients. Sixty percent of the RNs passed the examination and reported that the program increased their knowledge. The results indicated that the educational program could be recommended for use when implementing a new clinical protocol.

Technical approach to groundwater restoration. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1993-11-01

The Technical Approach to Groundwater Restoration (TAGR) provides general technical guidance to implement the groundwater restoration phase of the Uranium Mill Tailings Remedial Action (UMTRA) Project. The TAGR includes a brief overview of the surface remediation and groundwater restoration phases of the UMTRA Project and describes the regulatory requirements, the National Environmental Policy Act (NEPA) process, and regulatory compliance. A section on program strategy discusses program optimization, the role of risk assessment, the observational approach, strategies for meeting groundwater cleanup standards, and remedial action decision-making. A section on data requirements for groundwater restoration evaluates the data quality objectives (DQO) andmore » minimum data required to implement the options and comply with the standards. A section on sits implementation explores the development of a conceptual site model, approaches to site characterization, development of remedial action alternatives, selection of the groundwater restoration method, and remedial design and implementation in the context of site-specific documentation in the site observational work plan (SOWP) and the remedial action plan (RAP). Finally, the TAGR elaborates on groundwater monitoring necessary to evaluate compliance with the groundwater cleanup standards and protection of human health and the environment, and outlines licensing procedures.« less

Systematic follow-up after curative surgery for colorectal cancer in Norway: a population-based audit of effectiveness, costs, and compliance.

PubMed

Körner, Hartwig; Söreide, Kjetil; Stokkeland, Pål J; Söreide, Jon Arne

2005-03-01

In this study, we analyzed the Norwegian guidelines for systematic follow-up after curative colorectal cancer surgery in a large single institution. Three hundred fourteen consecutive unselected patients undergoing curative surgery for colorectal cancer between 1996 and 1999 were studied with regard to asymptomatic curable recurrence, compliance with the program, and cost. Follow-up included carcinoembryonic antigen (CEA) interval measurements, colonoscopy, ultrasonography of the liver, and radiography of the chest. In 194 (62%) of the patients, follow-up was conducted according to the Norwegian guidelines. Twenty-one patients (11%) were operated on for curable recurrence, and 18 patients (9%) were disease free after curative surgery for recurrence at evaluation. Four metachronous tumors (2%) were found. CEA interval measurement had to be made most frequently (534 tests needed) to detect one asymptomatic curable recurrence. Follow-up program did not influence cancer-specific survival. Overall compliance with the surveillance program was 66%, being lowest for colonoscopy (55%) and highest for ultrasonography of the liver (85%). The total program cost was 228,117 euro (US 280,994 dollars), translating into 20,530 euro (US 25,289 dollars) for one surviving patient after surgery for recurrence. The total diagnosis yield with regard to disease-free survival after surgery for recurrence was 9%. Compliance was moderate. Whether the continuing implementation of such program and cost are justified should be debated.

Patient navigation and the quality of breast cancer care: an analysis of the breast cancer care quality indicators.

PubMed

Weber, Joseph J; Mascarenhas, Debra C; Bellin, Lisa S; Raab, Rachel E; Wong, Jan H

2012-10-01

Patient navigation programs are initiated to help guide patients through barriers in a complex cancer care system. We sought to analyze the impact of our patient navigator program on the adherence to specific Breast Cancer Care Quality Indicators (BCCQI). A retrospective cohort of patients with stage I-III breast cancer seen the calendar year prior to the initiation of the patient navigation program were compared with patients treated in the ensuing two calendar years. Quality indicators deemed appropriate for analysis were those associated with overcoming barriers to treatment and those associated with providing health education and improving patient decision-making. A total of 134 consecutive patients between January 1, 2006 and December 31, 2006 and 234 consecutive patients between January 1, 2008 and December 31, 2009 were evaluated for compliance with the BCCQI. There was no significant difference in the mean age or race/ethnic distribution of the study population. In all ten BCCQI evaluated, there was improvement in the percentage of patients in compliance from pre and post implementation of a patient navigator program (range 2.5-27.0 %). Overall, compliance with BCCQI improved from 74.1 to 95.5 % (p < 0.0001). Indicators associated with informed decision-making and patient preference achieved statistical significance, while only completion axillary node dissection in sentinel node-positive biopsies in the process of treatment achieved statistical significance. The implementation of a patient navigator program improved breast cancer care as measured by BCCQI. The impact on disease-free and overall survival remains to be determined.

Above reproach: developing a comprehensive ethics and compliance program.

PubMed

Yuspeh, A; Whalen, K; Cecelic, J; Clifton, S; Cobb, L; Eddy, M; Fainter, J; Packard, J; Postal, S; Steakley, J; Waddey, P

1999-01-01

How can a healthcare organization improve the public's confidence in the conduct of its business operations? What can it do to ensure that it can thrive despite being the subject of public and governmental scrutiny and doubt? Healthcare providers must establish standards of conduct that are above reproach and ensure that those standards are clearly articulated and strictly adhered to. This article describes the merits of a comprehensive ethics and compliance program, suggests five basic elements of such a program--organizational support/structure, setting standards, creating awareness, establishing a mechanism for reporting exceptions, and monitoring and auditing--and then demonstrates how those elements should be applied in several high-risk areas. Fundamentally, an ethics and compliance program has two purposes: to ensure that all individuals in an organization observe pertinent laws and regulations in their work; and to articulate a broader set of aspirational ethical standards that are well-understood within the organization and become a practical guideline for organization members making decisions that raise ethical concerns. Every ethics and compliance program should contain certain fundamental aspects. First, the effort must have the active support of the most senior management in the organization. To instill a commitment to ethics and compliance absent a clear and outspoken commitment to such purposes by organization leaders is simply impossible. Second, an ethics and compliance program is fundamentally about organizational culture--about instilling a commitment to observe the law and, more generally, to do the right thing. Third, ethics and compliance are responsibilities of operating management (sometimes called line management). Although staff such as compliance officers are obligated to provide the necessary resources for a successful program and to design the program, such staff officers cannot achieve implementation and execution. Only operating managers can do that. Fourth, an ethics and compliance effort should be about the conduct of individuals, not about "checking the boxes" in a model plan or generating attractive written or educational materials. Such an effort is about individuals on a day-to-day basis knowing what is expected of them and doing it and about never compromising integrity, regardless of pressures faced. A great deal of progress has been made in healthcare organizations in the development of increasingly sophisticated ethics and compliance programs. A particularly energetic focus has been placed on these programs since formal government guidance regarding compliance programs was first issued in the laboratory area about two years ago and as more sophisticated automated monitoring tools have been developed. As ethics and compliance programs have become more sophisticated, certain best practices have been established. This discussion will set forth approaches to ethics and compliance in the context of what are believed to be illustrative best practices. Much of what is described here is descriptive of the efforts of Columbia/HCA Healthcare Corporation from October 1997 to the present; however, this article has been presented not as a mere descriptive piece but rather as a set of normative guidelines. We hope that other healthcare providers will find this to be of practical use. Provider settings pose certain unique challenges that are specifically addressed in this discussion; however, many of the issues raised can be adapted to other healthcare organizations. For simplicity's sake, because the authors of this article all work on a daily basis primarily with hospitals, the article is written from a hospital perspective.

Template for success: using a resident-designed sign-out template in the handover of patient care.

PubMed

Clark, Clancy J; Sindell, Sarah L; Koehler, Richard P

2011-01-01

Report our implementation of a standardized handover process in a general surgery residency program. The standardized handover process, sign-out template, method of implementation, and continuous quality improvement process were designed by general surgery residents with support of faculty and senior hospital administration using standard work principles and business models of the Virginia Mason Production System and the Toyota Production System. Nonprofit, tertiary referral teaching hospital. General surgery residents, residency faculty, patient care providers, and hospital administration. After instruction in quality improvement initiatives, a team of general surgery residents designed a sign-out process using an electronic template and standard procedures. The initial implementation phase resulted in 73% compliance. Using resident-driven continuous quality improvement processes, real-time feedback enabled residents to modify and improve this process, eventually attaining 100% compliance and acceptance by residents. The creation of a standardized template and protocol for patient handovers might eliminate communication failures. Encouraging residents to participate in this process can establish the groundwork for successful implementation of a standardized handover process. Integrating a continuous quality-improvement process into such an initiative can promote active participation of busy general surgery residents and lead to successful implementation of standard procedures. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Smoke-free or not: a pilot evaluation in selected Beijing Hospitals

PubMed Central

2013-01-01

Background China enacted a policy to ban smoking in hospitals. The Chinese Association for Tobacco Control (CATC) developed a program to help hospitals implement this policy. They conducted a program and an assessment in 3 Chinese cities (Beijing, Shanghai and Guangdong). A more in-depth evaluation was implemented with a sub-sample of hospitals in Beijing (N = 7) to provide an independent assessment. This independent assessment focused on evaluating policy development and an assessment of secondhand smoke (SHS) to determine compliance with the smoke-free policy initiative. Methods Pre- and post-survey data were collected at each of the selected hospitals with a total sample of 2835 physicians at pre-intervention and 2812 at post-intervention. Smoking rates pre- and post-policy implementation, change in knowledge, attitudes and practices among physicians, and compliance with policy were assessed. Measurements of airborne nicotine concentrations in selected locations in each hospital were taken: main hospital lobby; main outpatient center; emergency waiting room; and stairwell adjacent to a large inpatient ward. Hospital policies were collected, translated and rated for incorporated components necessary to implement a smoke-free policy. Results Physicians’ smoking rates decreased and attitudes towards tobacco control improved significantly from pre-to post-intervention. Smoking was still reported in certain areas of the hospital with 96% of passive nicotine monitors as well as self-report indicating continued smoking. Nicotine levels ranged from <0.0056 to 3.94 μg/m3), with an overall mean of .667 μg/m3. Hospitals that established stronger policies seemed to have lower levels of nicotine, suggesting a relationship between policy development and compliance. This finding is interesting but just suggestive and requires further investigation to truly demonstrate if stronger policies improve compliance and produce better outcomes. Conclusion As implementation strategies for smoke-free environments are improved and more resources are focused on hospitals, China is making progress toward achieving smoke-free hospitals. Using a model program could increase the prevalence of SHS policies across China. However, relying only on survey data may not provide an accurate assessment of this progress, and more extensive evaluation efforts are useful to understand how change can and does occur. PMID:24134057

TASK B: EVALUATION OF GDOT’S OVERCONCENTRATION IN CERTAIN PROCUREMENT CATEGORIES

DOT National Transportation Integrated Search

2015-09-01

The Georgia Department of Transportation (GDOT) is a recipient of federal funds from the U.S. Department of Transportation (U.S. DOT). Therefore, it must implement a Disadvantaged Business Enterprise (DBE) Program in compliance with Federal Regulatio...

The Forsyth County Cervical Cancer Prevention Project--II. Compliance with screening follow-up of abnormal cervical smears.

PubMed

Michielutte, R; Dignan, M; Bahnson, J; Wells, H B

1994-12-01

The Forsyth County Cervical Cancer Prevention Project was a community-wide cancer education program to address the problem of cervical cancer incidence and mortality among minority women in Forsyth County, North Carolina. This paper reports program results with regard to increasing compliance with follow-up for abnormal cervical smears. An analysis of trends prior to and after implementation of the educational program was conducted in one private and two public health primary care clinics to provide an assessment of impact of the project in improving compliance with follow-up among black women. A similar analysis also was conducted for white women. The results of medical record reviews of follow-up procedures for 878 abnormal cervical smears suggested a modest program effect among black women. The percentage of black women who returned for follow-up and treatment of an abnormal cervical smear significantly increased during the time the program was in effect. The trend analysis further indicated that the decline did not begin prior to the intervention period and was maintained throughout the duration of the intervention. No significant change in the percentage who returned for follow-up was found for white women.

Health care workers' hand decontamination practices: an Irish study.

PubMed

Creedon, Sile A

2006-02-01

The primary purpose of this quasi-experimental research is to observe health care workers' compliance with hand-hygiene guidelines during patient care in an intensive care unit in Ireland before (pretest) and after (posttest) implementation of a multifaceted hand-hygiene program. Health care workers' attitudes, beliefs, and knowledge in relation to compliance with handwashing guidelines were also investigated. A convenience sample of nurses, doctors, physiotherapists, and care assistants (n = 73 observational participants, n = 62 questionnaire respondents) was used. Data (N = 314 observations, 62 questionnaires) were analyzed descriptively and cross-tabulated using chi-square (Pearson's) and Mann-Whitney statistical tests. Results revealed that a significant shift (32%) occurred in health care workers' compliance with handwashing guidelines (pretest 51%, posttest 83%, p < .001) following the interventional hand-hygiene program. Significant changes were also found in relation to health care workers' attitudes, beliefs, and knowledge (p < .05).

International Review of the Development and Implementation of Energy Efficiency Standards and Labeling Programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhou, Nan; Zheng, Nina; Fridley, David

2012-02-28

Appliance energy efficiency standards and labeling (S&L) programs have been important policy tools for regulating the efficiency of energy-using products for over 40 years and continue to expand in terms of geographic and product coverage. The most common S&L programs include mandatory minimum energy performance standards (MEPS) that seek to push the market for efficient products, and energy information and endorsement labels that seek to pull the market. This study seeks to review and compare some of the earliest and most well-developed S&L programs in three countries and one region: the U.S. MEPS and ENERGY STAR, Australia MEPS and Energymore » Label, European Union MEPS and Ecodesign requirements and Energy Label and Japanese Top Runner programs. For each program, key elements of S&L programs are evaluated and comparative analyses across the programs undertaken to identify best practice examples of individual elements as well as cross-cutting factors for success and lessons learned in international S&L program development and implementation. The international review and comparative analysis identified several overarching themes and highlighted some common factors behind successful program elements. First, standard-setting and programmatic implementation can benefit significantly from a legal framework that stipulates a specific timeline or schedule for standard-setting and revision, product coverage and legal sanctions for non-compliance. Second, the different MEPS programs revealed similarities in targeting efficiency gains that are technically feasible and economically justified as the principle for choosing a standard level, in many cases at a level that no product on the current market could reach. Third, detailed survey data such as the U.S. Residential Energy Consumption Survey (RECS) and rigorous analyses provide a strong foundation for standard-setting while incorporating the participation of different groups of stakeholders further strengthen the process. Fourth, sufficient program resources for program implementation and evaluation are critical to the effectiveness of standards and labeling programs and cost-sharing between national and local governments can help ensure adequate resources and uniform implementation. Lastly, check-testing and punitive measures are important forms of enforcement while the cancellation of registration or product sales-based fines have also proven effective in reducing non-compliance. The international comparative analysis also revealed the differing degree to which the level of government decentralization has influenced S&L programs and while no single country has best practices in all elements of standards and labeling development and implementation, national examples of best practices for specific elements do exist. For example, the U.S. has exemplified the use of rigorous analyses for standard-setting and robust data source with the RECS database while Japan's Top Runner standard-setting principle has motivated manufacturers to exceed targets. In terms of standards implementation and enforcement, Australia has demonstrated success with enforcement given its long history of check-testing and enforcement initiatives while mandatory information-sharing between EU jurisdictions on compliance results is another important enforcement mechanism. These examples show that it is important to evaluate not only the drivers of different paths of standards and labeling development, but also the country-specific context for best practice examples in order to understand how and why certain elements of specific S&L programs have been effective.« less

Provision of Early Intervention and Special Education Services to Eligible DoD Dependents. Final rule.

PubMed

2015-06-25

This rule reissues the current regulations and: Establishes policy, assigns responsibilities, and implements the non-funding and non-reporting provisions in DoD for: Provision of early intervention services (EIS) to infants and toddlers with disabilities and their families, as well as special education and related services to children with disabilities entitled under this part to receive education services from the DoD; implementation of a comprehensive, multidisciplinary program of EIS for infants and toddlers with disabilities and their families who, but for age, are eligible to be enrolled in DoD schools; provision of a free appropriate public education (FAPE), including special education and related services, for children with disabilities, as specified in their individualized education programs (IEP), who are eligible to enroll in DoD schools; and monitoring of DoD programs providing EIS, and special education and related services for compliance with this part. This rule also establishes a DoD Coordinating Committee to recommend policies and provide compliance oversight for early intervention and special education.

Implementing a pressure ulcer prevention bundle in an adult intensive care.

PubMed

Tayyib, Nahla; Coyer, Fiona; Lewis, Peter A

2016-12-01

The incidence of pressure ulcers (PUs) in intensive care units (ICUs) is high and numerous strategies have been implemented to address this issue. One approach is the use of a PU prevention bundle. However, to ensure success care bundle implementation requires monitoring to evaluate the care bundle compliance rate, and to evaluate the effectiveness of implementation strategies in facilitating practice change. The aims of this study were to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of PUs, within ICU, and to evaluate the effectiveness of strategies used to enhance the implementation compliance. An observational prospective study design was used. Implementation strategies included regular education, training, audit and feed-back and the presence of a champion in the ICU. Implementation compliance was measured along four time points using a compliance checklist. Of the 60 registered nurses (RNs) working in the critical care setting, 11 participated in this study. Study participants demonstrated a high level of compliance towards the PU prevention bundle implementation (78.1%), with 100% participant acceptance. No significant differences were found between participants' demographic characteristics and the compliance score. There was a significant effect for time in the implementation compliance (Wilks Lambda=0.29, F (3, 8)=6.35, p<0.016), indicating that RNs needed time to become familiar with the bundle and routinely implement it into their practice. PU incidence was not influenced by the compliance level of participants. The implementation strategies used showed a positive impact on compliance. Assessing and evaluating implementation compliance is critical to achieve a desired outcome (reduction in PU incidence). This study's findings also highlighted that while RNs needed time to familiarise themselves with the care bundle elements, their clinical practice was congruent with the bundle elements. Copyright © 2016 Elsevier Ltd. All rights reserved.

International Comparison of Product Certification and Verification Methods for Appliances

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhou, Nan; Romankiewicz, John; Fridley, David

2012-06-01

Enforcement of appliance standards and consumer trust in appliance labeling are important foundations of growing a more energy efficient economy. Product certification and verification increase compliance rates which in turn increase both energy savings and consumer trust. This paper will serve two purposes: 1) to review international practices for product certification and verification as they relate to the enforcement of standards and labeling programs in the U.S., E.U., Australia, Japan, Canada, and China; and 2) to make recommendations for China to implement improved certification processes related to their mandatory standards and labeling program such as to increase compliance rates andmore » energy savings potential.« less

42 CFR 422.503 - General provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... oversight and control over the MA organization's policies and personnel to ensure that management actions... management aspects of the organization. (iii) At a minimum, an executive manager whose appointment and... effectiveness of the compliance programs. (C)(1) Each MA organization must establish and implement effective...

42 CFR 422.503 - General provisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... oversight and control over the MA organization's policies and personnel to ensure that management actions... management aspects of the organization. (iii) At a minimum, an executive manager whose appointment and... effectiveness of the compliance programs. (C)(1) Each MA organization must establish and implement effective...

Impact of a Community-Based Lymphedema Management Program on Episodes of Adenolymphangitis (ADLA) and Lymphedema Progression - Odisha State, India

PubMed Central

Mues, Katherine E.; Deming, Michael; Kleinbaum, David G.; Budge, Philip J.; Klein, Mitch; Leon, Juan S.; Prakash, Aishya; Rout, Jonathan; Fox, LeAnne M.

2014-01-01

Background Lymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression. Methodology/Principal Findings A lymphedema management program was implemented in Odisha State, India from 2007–2010 by the non-governmental organization, Church's Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value  = 0.0004), while those whose lymphedema regressed increased over time (P-value<0.0001). Overall compliance to lymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions. Conclusions/Significance These results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and rate of ADLA episodes. PMID:25211334

Prevention of venous thromboembolism amongst patients in an acute tertiary referral teaching public hospital: a best practice implementation project.

PubMed

Sykes, Pamela Kathleen; Walsh, Kenneth; Darcey, Chenqu Mimi; Hawkins, Heather Lee; McKenzie, Duncan Scott; Prasad, Ritam; Thomas, Anita

2016-06-01

Deep vein thrombosis and pulmonary embolism are known collectively as venous thromboembolism (VTE). These conditions are possible complications in hospitalized patients that can extend hospital stay, result in unplanned readmission, and are associated with long-term disability and death. Despite strong evidence, many patients do not receive optimal thromboprophylaxis. VTE prevention is a top priority in healthcare systems worldwide. The aim of the project was to establish a standardized hospital-wide VTE prevention program and to improve awareness of, and compliance with, best practice standards in the prevention of VTE. A multidisciplinary team utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System program to facilitate the collection of pre and post implementation audit data. The Getting Research into Practice program was also used to conduct a situational analysis to identify barriers, enablers, and implementation strategies while taking into account the context in which the changes were to occur. Hospital-acquired VTE data were collected to monitor the impact, if any, on patient outcomes. The project was conducted in three different phases over a 2.5-year period in an acute care public hospital. A comprehensive suite of professionally crafted guidelines, tools, and resources were developed to facilitate clinician acceptance of evidence-based practices. Comparison of compliance results showed variable improvements with four audit criteria. Formalized patient risk assessment improved to 7.5% with the introduction of a new form. High-risk patients receiving appropriate prophylaxis improved to 81% in medical and 83% in surgical patients, on an existing high background compliance rate. A total of 59% of staff attended a VTE update education in-service. No patients received information about adverse VTE events prior to discharge. The hospital-acquired VTE rate decreased slightly from 0.65 to 0.52 events per 1000 overnight bed days. Overall the project achieved improvements in compliance with best practice standards. A number of delays and barriers contributed to some of the planned interventions not being fully implemented at the time of the follow-up audit. Contributing factors included the lack of electronic capabilities, some processes not being fully embedded into routine clinical workflows, lack of staff time, and identification of an additional organizational barrier relating to practical issues in providing patient education at discharge. A second action cycle is recommended in an attempt to further improve compliance, ensure intervention fidelity, and embed practices into routine daily workflows to positively impact patient and organizational outcomes.

Compliance with the Aerospace MACT Standard at Lockheed Martin

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kurucz, K.L.; Vicars, S.; Fetter, S.

1997-12-31

Actions taken and planned at four Lockheed Martin Corporation (LMC) facilities to comply with the Aerospace MACT Standard are reviewed. Many LMC sites have taken proactive steps to reduce emissions and implement low VOC coating technology. Significant administrative, facility, and material challenges remain to achieve compliance with the upcoming NESHAP and Control Technology Guideline (CTG) standards. The facilities discussed herein set up programs to develop and implement compliance strategies. These facilities manufacture military aircraft, missiles, satellites, rockets, and electronic guidance and communications systems. Some of the facilities are gearing up for new production lines subject to new source MACT standards.more » At this time the facilities are reviewing compliance status of all primers, topcoats, maskants and solvents subject to the standard. Facility personnel are searching for the most efficient methods of satisfying the recordkeeping, reporting and monitoring, sections of the standards while simultaneously preparing or reviewing their Title V permit applications. Facility decisions on paint booths are the next highest priority. Existing dry filter paint booths will be subject to the filtration standard for existing paint booths which requires the use of two-stage filters. Planned paint booths for the F-22 program, and other new booths must comply with the standard for new and rebuilt booths which requires three stage or HEPA filters. Facilities looking to replace existing water wash paint booths, and those required to retrofit the air handling equipment to accommodate the two-stage filters, are reviewing issues surrounding the rebuilt source definition.« less

Development, implementation, and compliance of treatment pathways in radiation medicine.

PubMed

Potters, Louis; Raince, Jadeep; Chou, Henry; Kapur, Ajay; Bulanowski, Daniel; Stanzione, Regina; Lee, Lucille

2013-01-01

While much emphasis on safety in the radiation oncology clinic is placed on process, there remains considerable opportunity to increase safety, enhance outcomes, and avoid ad hoc care by instituting detailed treatment pathways. The purpose of this study was to review the process of developing evidence and consensus-based, outcomes-oriented treatment pathways that standardize treatment and patient management in a large multi-center radiation oncology practice. Further, we reviewed our compliance in incorporating these directives into our day-to-day clinical practice. Using the Institute of Medicine guideline for developing treatment pathways, 87 disease specific pathways were developed and incorporated into the electronic medical system in our multi-facility radiation oncology department. Compliance in incorporating treatment pathways was assessed by mining our electronic medical records (EMR) data from January 1, 2010 through February 2012 for patients with breast and prostate cancer. This retrospective analysis of data from EMR found overall compliance to breast and prostate cancer treatment pathways to be 97 and 99%, respectively. The reason for non-compliance proved to be either a failure to complete the prescribed care based on grade II or III toxicity (n = 1 breast, 3 prostate) or patient elected discontinuance of care (n = 1 prostate) or the physician chose a higher dose for positive/close margins (n = 3 breast). This study demonstrates that consensus and evidence-based treatment pathways can be developed and implemented in a multi-center department of radiation oncology. And that for prostate and breast cancer there was a high degree of compliance using these directives. The development and implementation of these pathways serve as a key component of our safety program, most notably in our effort to facilitate consistent decision-making and reducing variation between physicians.

The FBI compression standard for digitized fingerprint images

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brislawn, C.M.; Bradley, J.N.; Onyshczak, R.J.

1996-10-01

The FBI has formulated national standards for digitization and compression of gray-scale fingerprint images. The compression algorithm for the digitized images is based on adaptive uniform scalar quantization of a discrete wavelet transform subband decomposition, a technique referred to as the wavelet/scalar quantization method. The algorithm produces archival-quality images at compression ratios of around 15 to 1 and will allow the current database of paper fingerprint cards to be replaced by digital imagery. A compliance testing program is also being implemented to ensure high standards of image quality and interchangeability of data between different implementations. We will review the currentmore » status of the FBI standard, including the compliance testing process and the details of the first-generation encoder.« less

FBI compression standard for digitized fingerprint images

NASA Astrophysics Data System (ADS)

Brislawn, Christopher M.; Bradley, Jonathan N.; Onyshczak, Remigius J.; Hopper, Thomas

1996-11-01

The FBI has formulated national standards for digitization and compression of gray-scale fingerprint images. The compression algorithm for the digitized images is based on adaptive uniform scalar quantization of a discrete wavelet transform subband decomposition, a technique referred to as the wavelet/scalar quantization method. The algorithm produces archival-quality images at compression ratios of around 15 to 1 and will allow the current database of paper fingerprint cards to be replaced by digital imagery. A compliance testing program is also being implemented to ensure high standards of image quality and interchangeability of data between different implementations. We will review the current status of the FBI standard, including the compliance testing process and the details of the first-generation encoder.

Narcotics reduction, quality and safety in gynecologic oncology surgery in the first year of enhanced recovery after surgery protocol implementation.

PubMed

Bergstrom, Jennifer E; Scott, Marla E; Alimi, Yewande; Yen, Ting-Tai; Hobson, Deborah; Machado, Karime K; Tanner, Edward J; Fader, Amanda N; Temkin, Sarah M; Wethington, Stephanie; Levinson, Kimberly; Sokolinsky, Sam; Lau, Brandyn; Stone, Rebecca L

2018-06-01

Enhanced Recovery After Surgery (ERAS) programs are mechanisms for achieving value-based improvements in surgery. This report provides a detailed analysis of the impact of an ERAS program on patient outcomes as well as quality and safety measures during implementation on a gynecologic oncology service at a major academic medical center. A retrospective review of gynecologic oncology patients undergoing elective laparotomy during the implementation phase of an ERAS program (January 2016 through December 2016) was performed. Patient demographics, surgical variables, postoperative outcomes, and adherence to core safety measures, including antimicrobial and venous thromboembolism (VTE) prophylaxis, were compared to a historical patient cohort (January 2015 through December 2015). Statistical analyses were performed using t-tests, Wilcoxon rank sum tests, and Chi squared tests. The inaugural 109 ERAS program participants were compared to a historical patient cohort (n=158). There was no difference in BMI, race, malignancy, or complexity of procedure between cohorts. ERAS patients required less narcotics (70.7 vs 127.4, p=0.007, oral morphine equivalents) and PCA use (32.1% vs. 50.6%, p=0.002). Despite this substantial reduction in narcotics, ERAS patients did not report more pain and in fact reported significantly less pain by postoperative day 3. There were no differences in length of stay (5days), complication rates (13.8% vs. 20.3%, p=0.17) or 30-day readmission rates (9.5 vs 11.9%, p=0.54) between ERAS and historical patients, respectively. Compliance with antimicrobial prophylaxis was 97.2%. However, 33.9% of ERAS patients received substandard preoperative VTE prophylaxis. ERAS program implementation resulted in reductions in narcotic requirements and PCA use without changes in length of stay or readmission rates. Compliance should be diligently audited during the implementation phase of ERAS programs, with special attention to adherence to pre-existing core safety measures. Copyright © 2018 Elsevier Inc. All rights reserved.

28 CFR 42.731 - Complaints.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROCEDURES Nondiscrimination on the Basis of Age in Federally Assisted Programs or Activities; Implementation of the Age Discrimination Act of 1975 Compliance Procedures § 42.731 Complaints. (a) General. This... complainant first learned of the alleged violation, and is signed by the complainant). (3) When a complaint is...

28 CFR 42.731 - Complaints.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROCEDURES Nondiscrimination on the Basis of Age in Federally Assisted Programs or Activities; Implementation of the Age Discrimination Act of 1975 Compliance Procedures § 42.731 Complaints. (a) General. This... complainant first learned of the alleged violation, and is signed by the complainant). (3) When a complaint is...

Report: Substantial Changes Needed in Implementation and Oversight of Title V Permits If Program Goals Are To Be Fully Realized

EPA Pesticide Factsheets

Report #2005-P-00010, March 9, 2005. Our analysis identified concerns with five key aspects of Title V permits, including permit clarity, statements of basis, monitoring provisions, annual compliance certifications, and practical enforceability.

The National Shipbuilding Research Program. Shipyard MACT Implementation Plan and Compliance Tools

DTIC Science & Technology

1996-06-01

display a currently valid OMB control number. 1. REPORT DATE JUN 1996 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE The National...ACHIEVABLE CONTROL TECHNOLOGY SECTION TWO: MODEL SHIPYARD IMPLEMENTATION PLAN SECTION THREE: THINNING RATION CALCULATION SHEETS FOR OPTIONS 2 & 3 AND...INTERPRETATION OF THE SHIPYARD MAXIMUM ACHIEVABLE CONTROL TECHNOLOGY EPA’s Maximum Achievable Control Technology Rule for Shipyards: A Plain English

76 FR 14793 - Procedures for Monitoring Bank Secrecy Act Compliance and Fair Credit Reporting: Technical...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-18

... regulations in 12 CFR 326.8, and specific cross- references to the Customer Identification Program (``CIP''), 31 CFR 103.121, in 12 CFR 326.8, 12 CFR 334.82, and Appendix J to Part 334. The CIP regulation, which... of the Customer Identification Program (CIP) rules implementing 31 U.S.C. 5318(l) (31 CFR 1020.220...

Challenges to sustainability of hand hygiene at a rural hospital in Rwanda.

PubMed

Holmen, Ian C; Niyokwizerwa, Dan; Nyiranzayisaba, Berthine; Singer, Timothy; Safdar, Nasia

2017-08-01

Many hand hygiene (HH) programs have been implemented across Sub-Saharan Africa (SSA); however, most of these have been in large, referral hospitals. Our objective was to assess the impact of HH programs aimed at improving compliance at a rural hospital, and to identify unique challenges to HH sustainability. Interventions to improve HH through providing handwashing stations, health care worker (HCW) training, and alcohol handrub were completed in 2014 and 2015. HH infrastructure, compliance, and glove use were assessed among HCWs after the intervention in 2015 and 2016. HCWs were interviewed about challenges to sustainability of HH compliance. Total HH compliance decreased 32.1% between 2015 and 2016 (P < .001). HH for patient protection was completed significantly less than HH for HCW protection in 2016, and HCWs appeared to substitute HH for patient protection with glove use. A high rate of physician turnover was associated with a larger decrease in HH compliance compared with nurses, and interviews suggested recruiting and retention of key personnel might play a role in HH sustainability. Availability of alcohol-based handrub in patient rooms decreased from 100% in 2015 to 79.5% in 2016 (P < .01). Many challenges exist to sustaining HH compliance in SSA. In rural settings, difficulty recruiting and retaining trained personnel, inconsistent availability in HH infrastructure, and variability in HCW HH training may be contributing factors. Copyright © 2017. Published by Elsevier Inc.

The New Accreditation Council for Graduate Medical Education Next Accreditation System Milestones Evaluation System: What Is Expected and How Are Plastic Surgery Residency Programs Preparing?

PubMed

Sillah, Nyama M; Ibrahim, Ahmed M S; Lau, Frank H; Shah, Jinesh; Medin, Caroline; Lee, Bernard T; Lin, Samuel J

2015-07-01

The Accreditation Council for Graduate Medical Education Next Accreditation System milestones were implemented for plastic surgery programs in July of 2014. Forward progress through the milestones is an indicator of trainee-appropriate development, whereas regression or stalling may indicate the need for concentrated, targeted training. Online software at www.surveymonkey.com was used to create a survey about the program's approaches to milestones and was distributed to program directors and administrators of 96 Accreditation Council for Graduate Medical Education-approved plastic surgery programs. The authors had a 63.5 percent response rate (61 of 96 plastic surgery programs). Most programs report some level of readiness, only 22 percent feel completely prepared for the Next Accreditation System milestones, and only 23 percent are completely satisfied with their planned approach for compliance. Seventy-five percent of programs claim to be using some form of electronic tracking system. Programs plan to use multiple tools to capture and report milestone data. Most programs (44.4 percent) plan to administer evaluations at the end of each rotation. Over 70 percent of respondents believe that the milestones approach would improve the quality of resident training. However, programs were less than confident that their current compliance systems would live up to their full potential. The Next Accreditation System has been implemented nationwide for plastic surgery training programs. Milestone-based resident training is a new paradigm for residency training evaluation; programs are in the process of making this transition to find ways to make milestone data meaningful for faculty and residents.

The Impact of Anesthesia-Influenced Process Measure Compliance on Length of Stay: Results From an Enhanced Recovery After Surgery for Colorectal Surgery Cohort.

PubMed

Grant, Michael C; Pio Roda, Claro M; Canner, Joseph K; Sommer, Philip; Galante, Daniel; Hobson, Deborah; Gearhart, Susan; Wu, Christopher L; Wick, Elizabeth

2018-05-17

Process measure compliance has been associated with improved outcomes in enhanced recovery after surgery (ERAS) programs. Herein, we sought to assess the impact of compliance with measures directly influenced by anesthesiology in an ERAS for colorectal surgery cohort. From January 2013 to April 2015, data from 1140 consecutive patients were collected for all patients before (pre-ERAS) and after (ERAS) implementation of an ERAS program. Compliance with 9 specific process measures directly influenced by the anesthesiologist or acute pain service was analyzed to determine the impact on hospital length of stay (LOS). Process measure compliance was associated with a stepwise reduction in LOS. Patients who received >4 process measures (high compliance) had a significantly shorter LOS (incident rate ratio [IRR], 0.77; 95% CI, 0.70-0.85); P < .001) compared to low compliance (0-2 process measures) counterparts. Multivariable regression suggests that utilization of multimodal nausea and vomiting prophylaxis (IRR, 0.78; 95% CI, 0.68-0.89; P < .001), scheduled postoperative nonsteroidal pain medication use (IRR, 0.76; 95% CI, 0.67-0.85; P < .001), and strict adherence to a postoperative opioid administration (IRR, 0.58; 95% CI, 0.51-0.67; P < .001) protocol for breakthrough pain were independently associated with reduced LOS. Our findings suggest that increased compliance with process measures directly influenced by the anesthesiologists and in concert with a formal anesthesia protocol is associated with reduced LOS. Engaging anesthesiology colleagues throughout the surgical encounter increases the overall value of perioperative care.

Hand hygiene promotion and the participation of infection control link nurses: an effective innovation to overcome campaign fatigue.

PubMed

Seto, Wing Hong; Yuen, Shanny W S; Cheung, Christina W Y; Ching, Patricia T Y; Cowling, Benjamin J; Pittet, Didier

2013-12-01

Campaign fatigue was evident in a large hospital in Hong Kong when hand hygiene compliance remained just above 50% after 4 years of aggressive and varied promotional activities. A new innovative strategy was developed that directly involved the infection control link nurses both in formulating the strategy and in implementing the various proposed programs. The new strategy was successful in increasing hand hygiene compliance to 83%. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

49 CFR 1.50 - Office of Drug & Alcohol Policy & Compliance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... international drug testing and control issues and is the principal advisor to the Secretary on rules related to the drug and alcohol testing of safety-sensitive transportation employees in aviation, trucking... developing drug and alcohol testing programs and implementing the President's National Drug Control Strategy. ...

Report: Enhanced EPA Oversight Needed to Address Risks From Declining Clean Air Act Title V Revenues

EPA Pesticide Factsheets

Report #15-P-0006, October 20, 2014. Weaknesses in the EPA's oversight of Title V revenues and expenditures jeopardize program implementation and, in turn, compliance with air regulations for many of the nation's largest sources of air pollution.

Database management systems for process safety.

PubMed

Early, William F

2006-03-17

Several elements of the process safety management regulation (PSM) require tracking and documentation of actions; process hazard analyses, management of change, process safety information, operating procedures, training, contractor safety programs, pre-startup safety reviews, incident investigations, emergency planning, and compliance audits. These elements can result in hundreds of actions annually that require actions. This tracking and documentation commonly is a failing identified in compliance audits, and is difficult to manage through action lists, spreadsheets, or other tools that are comfortably manipulated by plant personnel. This paper discusses the recent implementation of a database management system at a chemical plant and chronicles the improvements accomplished through the introduction of a customized system. The system as implemented modeled the normal plant workflows, and provided simple, recognizable user interfaces for ease of use.

Certifying Domain-Specific Policies

NASA Technical Reports Server (NTRS)

Lowry, Michael; Pressburger, Thomas; Rosu, Grigore; Koga, Dennis (Technical Monitor)

2001-01-01

Proof-checking code for compliance to safety policies potentially enables a product-oriented approach to certain aspects of software certification. To date, previous research has focused on generic, low-level programming-language properties such as memory type safety. In this paper we consider proof-checking higher-level domain -specific properties for compliance to safety policies. The paper first describes a framework related to abstract interpretation in which compliance to a class of certification policies can be efficiently calculated Membership equational logic is shown to provide a rich logic for carrying out such calculations, including partiality, for certification. The architecture for a domain-specific certifier is described, followed by an implemented case study. The case study considers consistency of abstract variable attributes in code that performs geometric calculations in Aerospace systems.

41 CFR 60-20.1 - Title and purpose.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 20-SEX DISCRIMINATION GUIDELINES § 60-20.1 Title and purpose. The purpose of the provisions in this part is to set forth the interpretations and guidelines of the Office of Federal Contract Compliance Programs regarding the implementation of Executive Order 11246, as amended for the promotion and insuring...

40 CFR 63.10890 - What are my management practices and compliance requirements?

Code of Federal Regulations, 2014 CFR

2014-07-01

... pollution prevention management practices for metallic scrap and mercury switches in § 63.10885 and binder... of mercury switches and a site-specific plan implementing the material specifications according to... scrap providers who participate in a program for removal of mercury switches that has been approved by...

40 CFR 63.10890 - What are my management practices and compliance requirements?

Code of Federal Regulations, 2012 CFR

2012-07-01

... pollution prevention management practices for metallic scrap and mercury switches in § 63.10885 and binder... of mercury switches and a site-specific plan implementing the material specifications according to... scrap providers who participate in a program for removal of mercury switches that has been approved by...

40 CFR 63.10890 - What are my management practices and compliance requirements?

Code of Federal Regulations, 2013 CFR

2013-07-01

... pollution prevention management practices for metallic scrap and mercury switches in § 63.10885 and binder... of mercury switches and a site-specific plan implementing the material specifications according to... scrap providers who participate in a program for removal of mercury switches that has been approved by...

10 CFR 4.570 - Compliance procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 501 of the Rehabilitation Act of 1973 (29 U.S.C. 791). (c) The Civil Rights Program Manager, Office of Small Business and Civil Rights, shall be responsible for coordinating implementation of this section... the right to appeal. (h) Appeals of the findings of fact and conclusions of law or remedies must be...

76 FR 55947 - Industrial Relations Promotion Project, Phase II in Vietnam

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-09

... to award sole source (Cooperative Agreement). SUMMARY: The U.S. Department of Labor (USDOL), Bureau.../Nathan Group LLC (DAI) for the purpose of implementing a program to strengthen compliance with... to perform the type of activity to be funded.. DAI, through its Industrial Relations Promotion...

49 CFR 350.319 - What are permissible uses of High Priority Activity Funds?

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Implement, promote, and maintain national programs to improve CMV safety. (2) Increase compliance with CMV safety regulations. (3) Increase public awareness about CMV safety. (4) Provide education on CMV safety and related issues. (5) Demonstrate new safety related technologies. (b) These funds will be allocated...

The Principals' Impact on the Implementation of Inclusion

ERIC Educational Resources Information Center

Thompson, Carmelita

2015-01-01

The principal is the key element in shaping and sustaining educational programs that provide children with disabilities the opportunity to be educated in the general education setting. Federal mandates require compliance in educational services for children with disabilities. This has changed the role of principals in education. As schools strive…

Integrated Forensics Approach To Fingerprint PCB Sources In Sediments Using Immunoassays And GC/MS Congener Analyses

EPA Science Inventory

Determining the original source of contamination to a heterogeneous matrix such as sediments is a requirement for both clean-up and compliance programs within the military. Understanding the source of contaminants to sediment in industrial settings is a prerequisite to implement...

An Integrated Forensics Approach To Fingerprint PCB Sources In Sediments Using RSC And ACF

EPA Science Inventory

Determing the original source of contamination to a heterogeneous matrix matrix such as sediment is a requirement for both clean-up and compliance programs. Identifying the source of sediment contaminants in industrial settings is a pre-requisite to implementing any proposed se...

29 CFR 1952.175 - Changes to approved plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., California's Small Employer Voluntary Compliance Program, implemented on March 1, 1981, was approved by the... on January 1, 1977, was approved by the Assistant Secretary on March 6, 1978. (b) On January 1, 1978... employee access to the employer's log and summary of occupational injuries and illnesses. (d) In accordance...

29 CFR 1952.175 - Changes to approved plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., California's Small Employer Voluntary Compliance Program, implemented on March 1, 1981, was approved by the... on January 1, 1977, was approved by the Assistant Secretary on March 6, 1978. (b) On January 1, 1978... employee access to the employer's log and summary of occupational injuries and illnesses. (d) In accordance...

KC-46 Tanker Aircraft: Program Generally Stable but Improvements in Managing Schedule Are Needed

DTIC Science & Technology

2013-02-27

testing, and supplier management. An important contractual requirement (and best practice ) is for Boeing to release 90 percent of the total engineering...design is stable, and manufacturing processes are mature. As we reported last year, while the program has implemented many acquisition best practices ...assessed the program’s acquisition plan to determine compliance with acquisition legislation and acquisition best practices . What GAO Recommends GAO

12 CFR 1710.19 - Compliance and risk management programs; compliance with other laws.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Compliance and risk management programs... Practices and Procedures § 1710.19 Compliance and risk management programs; compliance with other laws. (a... management program. (1) An Enterprise shall establish and maintain a risk management program that is...

[Level of implementation of the Program for Safety and Health at Work in Antioquia, Colombia].

PubMed

Vega-Monsalve, Ninfa Del Carmen

2017-07-13

This study describes the level of implementation of the Program for Safety and Health at Work in companies located in the Department of Antioquia, Colombia, and associated factors. A cross-sectional survey included 73 companies with more than 50 workers each and implementation of the program. A total of 65 interviews were held, in addition to 73 checklists and process reviews. The companies showed suboptimal compliance with the management model for workplace safety and health proposed by the International Labor Organization (ILO). The component with the best development was Organization (87%), and the worst was Policy (67%). Company executives contended that the causes of suboptimal implementation were the limited commitment by area directors and scarce budget resources. Risk management mostly aimed to comply with the legal requirements in order to avoid penalties, plus documenting cases. There was little implementation of effective checks and controls to reduce the sources of work accidents. The study concludes that workers' health management lacks effective strategies.

Implementing and sustaining a hand hygiene culture change programme at Auckland District Health Board.

PubMed

Roberts, Sally A; Sieczkowski, Christine; Campbell, Taima; Balla, Greg; Keenan, Andrew

2012-05-11

In January 2009 Auckland District Health Board commenced implementation of the Hand Hygiene New Zealand (HHNZ) programme to bring about a culture change and to improve hand hygiene compliance by healthcare workers. We describe the implementation process and assess the effectiveness of this programme 36 months after implementation. In keeping with the HHNZ guideline the implementation was divided into five steps: roll-out and facility preparation, baseline evaluation, implementation, follow-up evaluation and sustainability. The process measure was improvement in hand hygiene compliance and the outcome measure was Staphylococcus aureus clinical infection and bacteraemia rates. The mean (95% CI; range) baseline compliance rates for the national reporting wards was 35% (95% CI 24-46%, 25-61%). The overall compliance by the 7th audit period was 60% (95% CI 46-74; range 47-91). All healthcare worker groups had improvement in compliance. The reduction in healthcare-associated S. aureus bacteraemia rates following the implementation was statistically significant (p=0.027). Compliance with hand hygiene improved following implementation of a culture change programme. Sustaining this improvement requires commitment and strong leadership at a senior level both nationally and within each District Health Board.

Compliance and Verification of Standards and Labelling Programs in China: Lessons Learned

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saheb, Yamina; Zhou, Nan; Fridley, David

2010-06-11

After implementing several energy efficiency standards and labels (30 products covered by MEPS, 50 products covered by voluntary labels and 19 products by mandatory labels), the China National Institute of Standardization (CNIS) is now implementing verification and compliance mechanism to ensure that the energy information of labeled products comply with the requirements of their labels. CNIS is doing so by organizing check testing on a random basis for room air-conditioners, refrigerators, motors, heaters, computer displays, ovens, and self -ballasted lamps. The purpose of the check testing is to understand the implementation of the Chinese labeling scheme and help local authoritiesmore » establishing effective compliance mechanisms. In addition, to ensure robustness and consistency of testing results, CNIS has coordinated a round robin testing for room air conditioners. Eight laboratories (Chinese (6), Australian (1) and Japanese (1)) have been involved in the round robin testing and tests were performed on four sets of samples selected from manufacturer?s production line. This paper describes the methodology used in undertaking both check and round robin testing, provides analysis of testing results and reports on the findings. The analysis of both check and round robin testing demonstrated the benefits of a regularized verification and monitoring system for both laboratories and products such as (i) identifying the possible deviations between laboratories to correct them, (ii) improving the quality of testing facilities, (iii) ensuring the accuracy and reliability of energy label information in order to strength the social credibility of the labeling program and the enforcement mechanism in place.« less

Compliance and Verification of Standards and Labeling Programs in China: Lessons Learned

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saheb, Yamina; Zhou, Nan; Fridley, David

2010-08-01

After implementing several energy efficiency standards and labels (30 products covered by MEPS, 50 products covered by voluntary labels and 19 products by mandatory labels), the China National Institute of Standardization (CNIS) is now implementing verification and compliance mechanism to ensure that the energy information of labeled products comply with the requirements of their labels. CNIS is doing so by organizing check testing on a random basis for room air-conditioners, refrigerators, motors, heaters, computer displays, ovens, and self -ballasted lamps. The purpose of the check testing is to understand the implementation of the Chinese labeling scheme and help local authoritiesmore » establishing effective compliance mechanisms. In addition, to ensure robustness and consistency of testing results, CNIS has coordinated a round robin testing for room air conditioners. Eight laboratories (Chinese (6), Australian (1) and Japanese (1)) have been involved in the round robin testing and tests were performed on four sets of samples selected from manufacturer's production line. This paper describes the methodology used in undertaking both check and round robin testing, provides analysis of testing results and reports on the findings. The analysis of both check and round robin testing demonstrated the benefits of a regularized verification and monitoring system for both laboratories and products such as (i) identifying the possible deviations between laboratories to correct them, (ii) improving the quality of testing facilities, (iii) ensuring the accuracy and reliability of energy label information in order to strength the social credibility of the labeling program and the enforcement mechanism in place.« less

Implementation of Enhanced Recovery After Surgery: a strategy to transform surgical care across a health system.

PubMed

Gramlich, Leah M; Sheppard, Caroline E; Wasylak, Tracy; Gilmour, Loreen E; Ljungqvist, Olle; Basualdo-Hammond, Carlota; Nelson, Gregg

2017-05-19

Enhanced Recovery After Surgery (ERAS) programs have been shown to have a positive impact on outcome. The ERAS care system includes an evidence-based guideline, an implementation program, and an interactive audit system to support practice change. The purpose of this study is to describe the use of the Theoretic Domains Framework (TDF) in changing surgical care and application of the Quality Enhancement Research Initiative (QUERI) model to analyze end-to-end implementation of ERAS in colorectal surgery across multiple sites within a single health system. The ultimate intent of this work is to allow for the development of a model for spread, scale, and sustainability of ERAS in Alberta Health Services (AHS). ERAS for colorectal surgery was implemented at two sites and then spread to four additional sites. The ERAS Interactive Audit System (EIAS) was used to assess compliance with the guidelines, length of stay, readmissions, and complications. Data sources informing knowledge translation included surveys, focus groups, interviews, and other qualitative data sources such as minutes and status updates. The QUERI model and TDF were used to thematically analyze 189 documents with 2188 quotes meeting the inclusion criteria. Data sources were analyzed for barriers or enablers, organized into a framework that included individual to organization impact, and areas of focus for guideline implementation. Compliance with the evidence-based guidelines for ERAS in colorectal surgery at baseline was 40%. Post implementation compliance, consistent with adoption of best practice, improved to 65%. Barriers and enablers were categorized as clinical practice (22%), individual provider (26%), organization (19%), external environment (7%), and patients (25%). In the Alberta context, 26% of barriers and enablers to ERAS implementation occurred at the site and unit levels, with a provider focus 26% of the time, a patient focus 26% of the time, and a system focus 22% of the time. Using the ERAS care system and applying the QUERI model and TDF allow for identification of strategies that can support diffusion and sustainment of innovation of Enhanced Recovery After Surgery across multiple sites within a health care system.

A multifaceted program to prevent ventilator-associated pneumonia: impact on compliance with preventive measures.

PubMed

Bouadma, Lila; Mourvillier, Bruno; Deiler, Véronique; Le Corre, Bertrand; Lolom, Isabelle; Régnier, Bernard; Wolff, Michel; Lucet, Jean-Christophe

2010-03-01

To determine the effect of a 2-yr multifaceted program aimed at preventing ventilator-acquired pneumonia on compliance with eight targeted preventive measures. Pre- and postintervention observational study. A 20-bed medical intensive care unit in a teaching hospital. A total of 1649 ventilator-days were observed. The program involved all healthcare workers and included a multidisciplinary task force, an educational session, direct observations with performance feedback, technical improvements, and reminders. It focused on eight targeted measures based on well-recognized published guidelines, easily and precisely defined acts, and directly concerned healthcare workers' bedside behavior. Compliance assessment consisted of five 4-wk periods (before the intervention and 1 month, 6 months, 12 months, and 24 months thereafter). Hand-hygiene and glove-and-gown use compliances were initially high (68% and 80%) and remained stable over time. Compliance with all other preventive measures was initially low and increased steadily over time (before 2-yr level, p < .0001): backrest elevation (5% to 58%) and tracheal cuff pressure maintenance (40% to 89%), which improved after simple technical equipment implementation; orogastric tube use (52% to 96%); gastric overdistension avoidance (20% to 68%); good oral hygiene (47% to 90%); and nonessential tracheal suction elimination (41% to 92%). To assess overall performance of the last six preventive measures, using ventilator-days as the unit of analysis, a composite score for preventive measures applied (range, 0-6) was developed. The median (interquartile range) composite scores for the five successive assessments were 2 (1-3), 4 (3-5), 4 (4-5), 5 (4-6), and 5 (4-6) points; they increased significantly over time (p < .0001). Ventilator-acquired pneumonia prevalence rate decreased by 51% after intervention (p < .0001). Our active, long-lasting program for preventing ventilator-acquired pneumonia successfully increased compliance with preventive measures directly dependent on healthcare workers' bedside performance. The multidimensional framework was critical for this marked, progressive, and sustained change.

Westinghouse corporate development of a decision software program for Radiological Evaluation Decision Input (REDI)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bush, T.S.

1995-03-01

In December 1992, the Department of Energy (DOE) implemented the DOE Radiological Control Manual (RCM). Westinghouse Idaho Nuclear Company, Inc. (WINCO) submitted an implementation plan showing how compliance with the manual would be achieved. This implementation plan was approved by DOE in November 1992. Although WINCO had already been working under a similar Westinghouse RCM, the DOE RCM brought some new and challenging requirements. One such requirement was that of having procedure writers and job planners create the radiological input in work control procedures. Until this time, that information was being provided by radiological engineering or a radiation safety representative.more » As a result of this requirement, Westinghouse developed the Radiological Evaluation Decision Input (REDI) program.« less

Hip protector compliance: a 13-month study on factors and cost in a long-term care facility.

PubMed

Burl, Jeffrey B; Centola, James; Bonner, Alice; Burque, Colleen

2003-01-01

To determine if a high compliance rate for wearing external hip protectors could be achieved and sustained in a long-term care population. A 13-month prospective study of daytime use of external hip protectors in an at-risk long-term care population. One hundred-bed not-for-profit long-term care facility. Thirty-eight ambulatory residents having at least 1 of 4 risk factors (osteoporosis, recent fall, positive fall screen, previous fracture). The rehabilitation department coordinated an implementation program. Members of the rehabilitation team met with eligible participants, primary caregivers, families, and other support staff for educational instruction and a description of the program. The rehabilitation team assumed overall responsibility for measuring and ordering hip protectors and monitoring compliance. By the end of the third month, hip protector compliance averaged greater than 90% daily wear. The average number of falls per month in the hip protector group was 3.9 versus 1.3 in nonparticipants. Estimated total indirect staff time was 7.75 hours. The total cost of the study (hip protectors and indirect staff time) was 6,300 US dollars. High hip protector compliance is both feasible and sustainable in an at-risk long-term care population. Achieving high compliance requires an interdisciplinary approach with one department acting as a champion. The cost of protectors could be a barrier to widespread use. Facilities might be unable to cover the cost until the product is paid for by third-party payers.

Design and implementation of a compliant robot with force feedback and strategy planning software

NASA Technical Reports Server (NTRS)

Premack, T.; Strempek, F. M.; Solis, L. A.; Brodd, S. S.; Cutler, E. P.; Purves, L. R.

1984-01-01

Force-feedback robotics techniques are being developed for automated precision assembly and servicing of NASA space flight equipment. Design and implementation of a prototype robot which provides compliance and monitors forces is in progress. Computer software to specify assembly steps and makes force feedback adjustments during assembly are coded and tested for three generically different precision mating problems. A model program demonstrates that a suitably autonomous robot can plan its own strategy.

The effectiveness of a multidisciplinary QI activity for accidental fall prevention: Staff compliance is critical

PubMed Central

2012-01-01

Background Accidental falls among inpatients are a substantial cause of hospital injury. A number of successful experimental studies on fall prevention have shown the importance and efficacy of multifactorial intervention, though success rates vary. However, the importance of staff compliance with these effective, but often time-consuming, multifactorial interventions has not been fully investigated in a routine clinical setting. The purpose of this observational study was to describe the effectiveness of a multidisciplinary quality improvement (QI) activity for accidental fall prevention, with particular focus on staff compliance in a non-experimental clinical setting. Methods This observational study was conducted from July 2004 through December 2010 at St. Luke’s International Hospital in Tokyo, Japan. The QI activity for in-patient falls prevention consisted of: 1) the fall risk assessment tool, 2) an intervention protocol to prevent in-patient falls, 3) specific environmental safety interventions, 4) staff education, and 5) multidisciplinary healthcare staff compliance monitoring and feedback mechanisms. Results The overall fall rate was 2.13 falls per 1000 patient days (350/164331) in 2004 versus 1.53 falls per 1000 patient days (263/172325) in 2010, representing a significant decrease (p = 0.039). In the first 6 months, compliance with use of the falling risk assessment tool at admission was 91.5% in 2007 (3998/4368), increasing to 97.6% in 2010 (10564/10828). The staff compliance rate of implementing an appropriate intervention plan was 85.9% in 2007, increasing to 95.3% in 2010. Conclusion In our study we observed a substantial decrease in patient fall rates and an increase of staff compliance with a newly implemented falls prevention program. A systematized QI approach that closely involves, encourages, and educates healthcare staff at multiple levels is effective. PMID:22788785

Compliance issues raised by the United States' ratification and implementation of the education articles of the Convention on the Rights of the Child.

PubMed

Adams, Christopher; Rubel, Jordana

2010-01-01

This article evaluates compliance issues the United States could face in ratifying the education provisions of the United Nations Convention on the Rights of the Child (CRC). The authors compare states parties' obligations under the education provisions of the CRC--as construed by the CRC committee--with federal and state education protections and programs in the United States. The authors conclude that the United States currently complies with most of the provisions and faces minimal risk in ratifying the remaining provisions.

Web-based interventions in multiple sclerosis: the potential of tele-rehabilitation.

PubMed

Tallner, Alexander; Pfeifer, Klaus; Mäurer, Mathias

2016-07-01

The World Wide Web is increasingly used in therapeutic settings. In this regard, internet-based interventions have proven effective in ameliorating several health behaviors, amongst them physical activity behavior. Internet-delivered interventions have shown positive effects on physical activity and physical function in persons with MS (pwMS). In this review we give an overview on several online exercise programs for pwMS and discuss the advantages and drawbacks of web-based interventions. Although participants of online exercise programs reported a high acceptance and satisfaction with the intervention, decreasing compliance was a major issue. A possible remedy might be the implementation of game-design elements to increase compliance and long-term adherence to internet-delivered interventions. In addition we believe that the integration of social networks seems to be a promising strategy.

Response of School Districts to the New York State Concussion Awareness and Management Act: Review of Policies and Procedures.

PubMed

Kajankova, Maria; Oswald, Jennifer M; Terranova, Lauren M; Kaplen, Michael V; Ambrose, Anne F; Spielman, Lisa A; Gordon, Wayne A

2017-06-01

By 2014, all states implemented concussion laws that schools must translate into daily practice; yet, limited knowledge exists regarding implementation of these laws. We examined the extent to which concussion management policies and procedure (P&P) documents of New York State school districts comply with the State's Concussion Awareness and Management Act (the Act). We also aimed to identify barriers to compliance. Forty-seven school districts provided P&P documents. We examined compliance with the Act and the relationship between compliance and each district's demographics. Compliance varied across school districts, with higher overall compliance in large city school districts compared to county districts. However, there was low compliance for several critical items. We found no statistically significant relationship between compliance and demographics. School districts need to increase compliance with concussion legislation to ensure the adequate implementation necessary for the law to impact health and educational outcomes. The results provide important information to individuals charged with the responsibility of implementation and ultimately reducing the negative outcomes associated with brain injuries in schools. © 2017, American School Health Association.

Wetland mitigation compliance in the western upper peninsula of Michigan.

PubMed

Hornyak, Melissa M; Halvorsen, Kathleen E

2003-11-01

The Army Corps of Engineers (ACE) is generally responsible for the implementation of federal Clean Water Act wetland regulations. It therefore plays an important role in the protection of wetlands within the United States. Unfortunately, past evaluators of ACE's implementation of these regulations found low rates of regulatory compliance. However, the fact that two states have taken responsibility for the implementation of these regulations within their boundaries provided the opportunity to assess whether one of these states might be doing a better job of enforcement. This paper reports on compliance with some of these regulations within one Michigan region. We evaluated permittee compliance with paperwork filing requirements related to wetland mitigation projects. Sixty-seven percent of county road commission permittees were out of compliance with at least one filing requirement. Forty percent of private and non-county government permittees were out of compliance. Our results therefore suggest that serious problems exist with Michigan's implementation of wetland regulations. They do not suggest that compliance in this state is significantly better than in states under ACE administration. We believe that increased agency monitoring and enforcement would improve compliance.

Relative Displacement Method for Track-Structure Interaction

PubMed Central

Ramos, Óscar Ramón; Pantaleón, Marcos J.

2014-01-01

The track-structure interaction effects are usually analysed with conventional FEM programs, where it is difficult to implement the complex track-structure connection behaviour, which is nonlinear, elastic-plastic and depends on the vertical load. The authors developed an alternative analysis method, which they call the relative displacement method. It is based on the calculation of deformation states in single DOF element models that satisfy the boundary conditions. For its solution, an iterative optimisation algorithm is used. This method can be implemented in any programming language or analysis software. A comparison with ABAQUS calculations shows a very good result correlation and compliance with the standard's specifications. PMID:24634610

78 FR 42999 - Financial Crimes Enforcement Network; Comment Request; Renewal Without Change-Administrative...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-18

...: Businesses or other for-profit and non-profit institutions. Frequency: N/A. An agency may not conduct or... made available for review as soon as possible but no earlier than five business days after the close of... international terrorism, and to implement counter-money laundering programs and compliance procedures.\\1...

75 FR 63545 - Proposed Collection; Comment Request; Bank Secrecy Act Suspicious Activity Report Database...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-15

... request an appointment with the Disclosure Officer by telephoning (703) 905-5034 (not a toll-free call... terrorism, and to implement counter-money laundering programs and compliance procedures.\\2\\ Regulations... public comments received in response to this notice. \\4\\ BSA E-Filing is a free service provided by Fin...

The OSHA Communication Standard and State Right-to-Know Laws.

ERIC Educational Resources Information Center

Roll, Michalene H.

1990-01-01

As a result of a 1988 federal appellate court mandate, schools and colleges in 24 states and 2 territories with OSHA-approved state plans must inform their employees about hazardous chemicals to which they may be exposed. School administrators should implement a responsible program meeting regulatory compliance, tort liability, and public…

Environmental Implementation Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1994-02-01

The Environmental Implementation Plan (EIP) is a dynamic long-range environmental-protection plan for SRS. The EIP communicates the current and future (five year) environmental plans from individual organizations and divisions as well as site environmental initiatives which are designed to protect the environment and meet or exceed compliance with changing environmental/ regulatory requirements. Communication with all site organizations is essential for making the site environmental planning process work. Demonstrating environmental excellence is a high priority embodied in DOE and WSRC policy. Because of your support and participation in the three EIP initiatives; Reflections, Sectional Revision, and Integrated Planning, improvements are beingmore » made to the EIP and SRS environmental protection programs. I appreciate the ``Partnership in Environmental Excellence`` formed by the environmental coordinators and professionals who work daily toward our goal of compliance and environmental excellence. I look forward to seeing continued success and improvement in our environmental protection programs through combined efforts of all site organizations to protect our employees, the public health, and the environment. Together, we will achieve our site vision for SRS to be the recognized model for Environmental Excellence in the DOE Nuclear Weapons Complex.« less

Implementing a Daily Maintenance Care Bundle to Prevent Central Line-Associated Bloodstream Infections in Pediatric Oncology Patients.

PubMed

Duffy, Elizabeth A; Rodgers, Cheryl C; Shever, Leah L; Hockenberry, Marilyn J

2015-01-01

Eliminating central line-associated bloodstream infection (CLABSI) is a national priority. Central venous catheter (CVC) care bundles are composed of a series of interventions that, when used together, are effective in preventing CLABSI. A CVC daily maintenance care bundle includes procedural guidelines for hygiene, dressing changes, and access as well as specific timeframes. Failure to complete one of the components of the care bundle predisposes the patient to a bloodstream infection. A nurse-led multidisciplinary team implemented and, for six months, sustained a daily maintenance care bundle for pediatric oncology patients. This quality improvement project focused on nursing staffs' implementation of the daily maintenance care bundle and the sustainment of the intervention. The project used a pre-post program design to evaluate outcomes of CVC daily maintenance care bundle compliancy and CLABSI. A statistically significant increase between the pre- and post-assessments of the compliance was noted with the CVC daily maintenance care bundle. CLABSI infection rates decreased during the intervention. Strategies to implement practice change and promote sustainability are discussed. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

Milestone-specific, Observed data points for evaluating levels of performance (MODEL) assessment strategy for anesthesiology residency programs.

PubMed

Nagy, Christopher J; Fitzgerald, Brian M; Kraus, Gregory P

2014-01-01

Anesthesiology residency programs will be expected to have Milestones-based evaluation systems in place by July 2014 as part of the Next Accreditation System. The San Antonio Uniformed Services Health Education Consortium (SAUSHEC) anesthesiology residency program developed and implemented a Milestones-based feedback and evaluation system a year ahead of schedule. It has been named the Milestone-specific, Observed Data points for Evaluating Levels of performance (MODEL) assessment strategy. The "MODEL Menu" and the "MODEL Blueprint" are tools that other anesthesiology residency programs can use in developing their own Milestones-based feedback and evaluation systems prior to ACGME-required implementation. Data from our early experience with the streamlined MODEL blueprint assessment strategy showed substantially improved faculty compliance with reporting requirements. The MODEL assessment strategy provides programs with a workable assessment method for residents, and important Milestones data points to programs for ACGME reporting.

Environmental projects. Volume 5, part 1: Study of subsurface contamination. Part 2: Guide to implement environmental compliance programs

NASA Technical Reports Server (NTRS)

Bengelsdorf, I.

1988-01-01

In support of the national goal for the preservation of the environment and the protection of human health and safety, NASA, the Jet Propulsion Laboratory, and the Goldstone Deep Space Communications Complex have adopted the position that their operating installations shall maintain a high level of compliance in regard to regulations concerning environmental hazards. An investigation carried out by Engineering Science, Inc. focused on possible underground contamination that may have resulted from leaks and/or spills from storage facilities at the Goldstone Communications Complex. It also involved the cleanup of a non-hazardous waste dumpsite at the Mojave Base Site at the Goldstone complex. The report also includes details of the management duties and responsibilities needed to maintain compliance with environmental laws and regulations.

An Institutional Program to Increase Compliance with Clinicaltrials.gov Requirements.

PubMed

Kelly-Pumarol, Issis; Andrews, Joseph E

2018-01-01

Recent National Institutes of Health policy changes have expanded the number of research studies that must be registered in clinicaltrials.gov beyond the requirements of the Food and Drug Administration Amendments Act of 2007. The International Committee of Medical Journal Editors has also adopted a policy that requires registration of research in a public database. The goal was to increase the transparency of research by reporting the original endpoints of a study, and to discern whether primary endpoints were excluded in subsequent publications. Efforts to increase openness and accountability in clinical trials are likely to strengthen public trust. However, first investigators and study staff must be educated about the requirements, and staff must be prepared to offer support to researchers in navigating the clinicaltrials.gov system. For academic institutions, maintaining compliance requires continuous oversight so that problems can be identified centrally and addressed with investigators. At Wake Forest University Health Sciences, because researchers often did not realize they were out of compliance, we implemented a program to assist them and provide oversight. We introduced standard operating procedures, provided education and assistance to investigators, and engaged leadership about consequences of compliance, resulting in increased budget support for a full-time employee in this role. As a result of these changes, compliance increased from 22% to 92% over 4 months. These approaches may help other institutions become compliant with registration requirements more quickly.

Applying your corporate compliance skills to the HIPAA security standard.

PubMed

Carter, P I

2000-01-01

Compliance programs are an increasingly hot topic among healthcare providers. These programs establish policies and procedures covering billing, referrals, gifts, confidentiality of patient records, and many other areas. The purpose is to help providers prevent and detect violations of the law. These programs are voluntary, but are also simply good business practice. Any compliance program should now incorporate the Health Insurance Portability and Accountability Act (HIPAA) security standard. Several sets of guidelines for development of compliance programs have been issued by the federal government, and each is directed toward a different type of healthcare provider. These guidelines share certain key features with the HIPAA security standard. This article examines the common areas between compliance programs and the HIPAA security standard to help you to do two very important things: (1) Leverage your resources by combining compliance with the security standard with other legal and regulatory compliance efforts, and (2) apply the lessons learned in developing your corporate compliance program to developing strategies for compliance with the HIPAA security standard.

The Interventional Arm of the Flexibility In Duty-Hour Requirements for Surgical Trainees Trial: First-Year Data Show Superior Quality In-Training Initiative Outcomes.

PubMed

Mirmehdi, Issa; O'Neal, Cindy-Marie; Moon, Davis; MacNew, Heather; Senkowski, Christopher

With the implementation of strict 80-hour work week in general surgery training, serious questions have been raised concerning the quality of surgical education and the ability of newly trained general surgeons to independently operate. Programs that were randomized to the interventional arm of the Flexibility In duty-hour Requirements for Surgical Trainees (FIRST) Trial were able to decrease transitions and allow for better continuity by virtue of less constraints on duty-hour rules. Using National Surgical Quality Improvement Program Quality In-Training Initiative data along with duty-hour violations compared with old rules, it was hypothesized that quality of care would be improved and outcomes would be equivalent or better than the traditional duty-hour rules. It was also hypothesized that resident perception of compliance with duty hour would not change with implementation of new regulations based on FIRST trial. Flexible work hours were implemented on July 1, 2014. National Surgical Quality Improvement Program Quality In-Training Initiative information was reviewed from July 2014 to January 2015. Patient risk factors and outcomes were compared between institutional resident cases and the national cohort for comparison. Residents' duty-hour logs and violations during this period were compared to the 6-month period before the implementation of the FIRST trial. The annual Accreditation Council for Graduate Medical Education resident survey was used to assess the residents' perception of compliance with duty hours. With respect to the postoperative complications, the only statistically significant measures were higher prevalence of pneumonia (3.4% vs. 1.5%, p < 0.05) and lower prevalence of sepsis (0% vs. 1.5%, p < 0.05) among cases covered by residents with flexible duty hours. All other measures of postoperative surgical complications showed no difference. The total number of duty-hour violations decreased from 54 to 16. Had the institution not been part of the interventional arm of the FIRST trial, this number would have increased to 238. The residents' perception of compliance with 80-hour work week from the Accreditation Council for Graduate Medical Education survey improved from 68% to 91%. Residents with flexible work hours on the interventional arm of the FIRST trial at our institution took care of a significantly sicker cohort of patients as compared with the national dataset with equivalent outcomes. Flexible duty-hour policy under the FIRST trial has enabled the residents to have fewer work-hour violations while improving continuity of care to the patients. Additionally, the overall perception of resident compliance with the duty-hour requirements was improved. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in five intensive care units in three cities of China.

PubMed

Su, D; Hu, B; Rosenthal, V D; Li, R; Hao, C; Pan, W; Tao, L; Gao, X; Liu, K

2015-07-01

To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene (HH) Approach in three hospitals in three cities of China, and analyze predictors of poor hand hygiene compliance. A prospective before-after study from May 2009 to December 2010 in five intensive care units members of the INICC in China. The study was divided into two periods: a 3-month baseline period and a follow-up period. A Multidimensional HH Approach was implemented, which included the following elements: 1- administrative support, 2- supplies availability, 3- education and training, 4- reminders in the workplace, 5- process surveillance and 6- performance feedback. Observations were done for HH compliance in each ICU, during randomly selected 30-min periods. A total of 2079 opportunities for HH were recorded. Overall HH compliance increased from 51.5% to 80.1% (95% CI 73.2-87.8; P = 0.004). Multivariate analysis indicated that several variables were significantly associated with poor HH compliance: females vs males (64% vs 55%; 95% CI 0.81-0.94; P = 0.0005), nurses vs physicians (64% vs 57%, P = 0.004), among others. Adherence to HH was increased significantly with the INICC multidimensional approach. Specific programs directed to improve HH in variables found to be predictors of poor HH compliance should be implemented. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Impact of implementation of the World Health Organization multimodal hand hygiene improvement strategy in a teaching hospital in Taiwan.

PubMed

Chen, Jui-Kuang; Wu, Kuan-Sheng; Lee, Susan Shin-Jung; Lin, Huey-Shyan; Tsai, Hung-Chin; Li, Ching-Hsien; Chao, Hsueh-Lan; Chou, Hsueh-Chih; Chen, Yueh-Ju; Huang, Yu-Hsiu; Ke, Chin-Mei; Sy, Cheng Len; Tseng, Yu-Ting; Chen, Yao-Shen

2016-02-01

Hand hygiene (HH) is considered to be the most simple, rapid, and economic way to prevent health care-associated infection (HAI). However, poor HH compliance has been repeatedly reported. Our objective was to evaluate the impact of implementing the updated World Health Organization (WHO) multimodal HH guidelines on HH compliance and HAI in a tertiary hospital in Taiwan. We conducted a before-and-after interventional study during 2010-2011. A multimodal HH promotion campaign was initiated. Key strategies included providing alcohol-based handrub dispensers at points of care, designing educational programs tailored to the needs of different health care workers, placement of general and individual reminders in the workplace, and establishment of evaluation and feedback for HH compliance and infection rates. Overall HH compliance increased from 62.3% to 73.3% after 1 year of intervention (P < .001). The rate of overall HAI decreased from 3.7% to 3.1% (P < .05), urinary tract infection rate decreased from 1.5% to 1.2% (P < .05), and respiratory tract infection rate decreased from 0.53% to 0.35% (P < .05). This campaign saved an estimated $940,000 and 3,564 admission patient days per year. The WHO multimodal HH guidelines are feasible and effective for the promotion of HH compliance and are associated with the reduction of HAIs. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

7 CFR 772.3 - Compliance.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Compliance. 772.3 Section 772.3 Agriculture... SPECIAL PROGRAMS SERVICING MINOR PROGRAM LOANS § 772.3 Compliance. (a) Requirements. No Minor Program... will conduct a compliance review of all Minor Program borrowers, to determine if a borrower has...

7 CFR 772.3 - Compliance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Compliance. 772.3 Section 772.3 Agriculture... SPECIAL PROGRAMS SERVICING MINOR PROGRAM LOANS § 772.3 Compliance. (a) Requirements. No Minor Program... will conduct a compliance review of all Minor Program borrowers, to determine if a borrower has...

Status of SFR Codes and Methods QA Implementation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brunett, Acacia J.; Briggs, Laural L.; Fanning, Thomas H.

2017-01-31

This report details development of the SAS4A/SASSYS-1 SQA Program and describes the initial stages of Program implementation planning. The provisional Program structure, which is largely focused on the establishment of compliant SQA documentation, is outlined in detail, and Program compliance with the appropriate SQA requirements is highlighted. Additional program activities, such as improvements to testing methods and Program surveillance, are also described in this report. Given that the programmatic resources currently granted to development of the SAS4A/SASSYS-1 SQA Program framework are not sufficient to adequately address all SQA requirements (e.g. NQA-1, NUREG/BR-0167, etc.), this report also provides an overview ofmore » the gaps that remain the SQA program, and highlights recommendations on a path forward to resolution of these issues. One key finding of this effort is the identification of the need for an SQA program sustainable over multiple years within DOE annual R&D funding constraints.« less

Kaiser Permanente National Hand Hygiene Program

PubMed Central

Barnes, Sue; Barron, Dana; Becker, Linda; Canola, Teresa; Salemi, Charles

2004-01-01

Objective: Hand hygiene has historically been identified as an important intervention for preventing infection acquired in health care settings. Recently, the advent of waterless, alcohol-based skin degermer and elimination of artificial nails have been recognized as other important interventions for preventing infection. Supplied with this information, the National Infection Control Peer Group convened a KP Hand Hygiene Work Group, which, in August 2001, launched a National Hand Hygiene Program initiative titled “Infection Control: It’s In Our Hands” to increase compliance with hand hygiene throughout the Kaiser Permanente (KP) organization. Design: The infection control initiative was designed to include employee and physician education as well as to implement standard hand hygiene products (eg, alcohol degermers), eliminate use of artificial nails, and monitor outcomes. Results: From 2001 through September 2003, the National KP Hand Hygiene Work Group coordinated implementation of the Hand Hygiene initiative throughout the KP organization. To date, outcome monitoring has shown a 26% increase in compliance with hand hygiene as well as a decrease in the number of bloodstream infections and methycillin-resistant Staphylococcus aureus (MRSA) infections. As of May 2003, use of artificial nails had been reduced by 97% nationwide. Conclusions: Endorsement of this Hand Hygiene Program initiative by KP leadership has led to implementation of the initiative at all medical centers throughout the KP organization. Outcome indicators to date suggest that the initiative has been successful; final outcome monitoring will be completed in December 2003. PMID:26704605

40 CFR 52.2578 - Compliance schedules.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Wisconsin § 52.2578 Compliance schedules. (a... operator of any stationary source in the Southeast Wisconsin AQCR subject to the following emission limiting regulation in the Wisconsin implementation plan shall comply with the applicable compliance...

40 CFR 52.2578 - Compliance schedules.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Wisconsin § 52.2578 Compliance schedules. (a... operator of any stationary source in the Southeast Wisconsin AQCR subject to the following emission limiting regulation in the Wisconsin implementation plan shall comply with the applicable compliance...

40 CFR 52.2578 - Compliance schedules.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Wisconsin § 52.2578 Compliance schedules. (a... operator of any stationary source in the Southeast Wisconsin AQCR subject to the following emission limiting regulation in the Wisconsin implementation plan shall comply with the applicable compliance...

40 CFR 52.2578 - Compliance schedules.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Wisconsin § 52.2578 Compliance schedules. (a... operator of any stationary source in the Southeast Wisconsin AQCR subject to the following emission limiting regulation in the Wisconsin implementation plan shall comply with the applicable compliance...

40 CFR 52.2578 - Compliance schedules.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Wisconsin § 52.2578 Compliance schedules. (a... operator of any stationary source in the Southeast Wisconsin AQCR subject to the following emission limiting regulation in the Wisconsin implementation plan shall comply with the applicable compliance...

Y-12 Site environmental protection program implementation plan (EPPIP)

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1996-11-01

The Y-12 Plant Environmental Protection Program is conducted to: (1) protect public health and the environment from chemical and radiological releases occurring from current plant operations and past waste management and operational practices; (2) ensure compliance with federal, state, and local environmental regulations and DOE directives; (3) identify potential environmental problems; (4) evaluate existing environmental contamination and determine the need for remedial actions and mitigative measures; (5) monitor the progress of ongoing remedial actions and cleanup measures; and (6) inform the public of environmental issues relating to DOE operations. DOE Order 5400.1, General Environmental Protection Program, defines the general requirementsmore » for environmental protection programs at DOE facilities. This Environmental Protection Program Implementation Plan (EPPIP) defines the methods by which the Y-12 Plant staff will comply with the order by: (1) referencing environmental protection goals and objectives and identifying strategies and timetables for attaining them; (2) providing the overall framework for the design and implementation of the Y-12 Environmental Protection Program; and (3) assigning responsibilities for complying with the requirements of the order. The EPPIP is revised and updated annually.« less

Case outsourcing medical device reprocessing.

PubMed

Haley, Deborah

2004-04-01

IN THE INTEREST OF SAVING MONEY, many hospitals are considering extending the life of some single-use medical devices by using medical device reprocessing programs. FACILITIES OFTEN LACK the resources required to meet the US Food and Drug Administration's tough quality assurance standards. BY OUTSOURCING, hospitals can reap the benefits of medical device reprocessing without assuming additional staffing and compliance burdens. OUTSOURCING enables hospitals to implement a medical device reprocessing program quickly, with no capital investment and minimal effort.

Overcoming nursing barriers to intensive care unit early mobilisation: A quality improvement project.

PubMed

Hunter, Oluwatobi O; George, Elisabeth L; Ren, Dianxu; Morgan, Douglas; Rosenzweig, Margaret; Klinefelter Tuite, Patricia

2017-06-01

To increase adherence with intensive care unit mobility by developing and implementing a mobility training program that addresses nursing barriers to early mobilisation. An intensive care unit mobility training program was developed, implemented and evaluated with a pre-test, immediate post-test and eight-week post-test. Patient mobility was tracked before and after training. A ten bed cardiac intensive care unit. The training program's efficacy was measured by comparing pre-test, immediate post-test and 8-week post-test scores. Patient mobilisation rates before and after training were compared. Protocol compliance was measured in the post training group. Nursing knowledge increased from pre-test to immediate post-test (p<0.0001) and pre-test to 8-week post-test (p<0.0001). Mean test scores decreased by seven points from immediate post-test (80±12) to 8-week post-test (73±14). Fear significantly decreased from pre-test to immediate post-test (p=0.03), but not from pre-test to 8-week post-test (p=0.06) or immediate post-test to 8-week post-test (p=0.46). Post training patient mobility rates increased although not significantly (p=0.07). Post training protocol compliance was 78%. The project successfully increased adherence with intensive care unit mobility and indicates that a training program could improve adoption of early mobility. Copyright © 2016 Elsevier Ltd. All rights reserved.

HIPAA: update on rule revisions and compliance requirements.

PubMed

Maddox, P J

2002-01-01

Due to the highly technical requirements for HIPAA compliance and the numerous administrative and clinical functions and processes involved, guidance from experts who are knowledgeable about systems design and use to secure private data is necessary. In health care organizations, this will require individuals who are knowledgeable about clinical processes and those who understand health information technology, security, and privacy to work together to establish an entity's compliance plans and revise operations and practices accordingly. As a precondition of designing such systems, it is essential that covered entities understand the HIPAA's statutory requirements and timeline for compliance. An organization's success in preparing for HIPAA will depend upon an active program of assessment, planning, and implementation. Compliance with security and privacy standards can be expected to increase costs initially. However, greater use of EDI is expected to reduce costs and enhance revenues in the long run if processes and systems are improved. NOTE: Special protection for psychotherapy notes holds them to a higher standard of protection. Notes used only by a psychotherapist are not intended to be shared with anyone and are not considered part of the medical record.

Implementation of the Spanish ERAS program in bariatric surgery.

PubMed

Ruiz-Tovar, Jaime; Muñoz, José Luis; Royo, Pablo; Duran, Manuel; Redondo, Elisabeth; Ramirez, Jose Manuel

2018-03-08

The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish Fast Track Group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery, comparing it with a historical cohort receiving standard care. A multi-centric prospective study was performed, including 233 consecutive patients undergoing bariatric surgery during 2015 and following ERAS protocol. It was compared with a historical cohort of 286 patients, who underwent bariatric surgery at the same institutions between 2013 and 2014 and following standard care. Compliance with the protocol, morbidity, mortality, hospital stay and readmission were evaluated. Bariatric techniques performed were Roux-en-Y gastric bypass and sleeve gastrectomy. There were no significant differences in complications, mortality and readmission. Postoperative pain and hospital stay were significantly lower in the ERAS group. The total compliance to protocol was 80%. The Spanish National ERAS protocol is a safe issue, obtaining similar results to standard care in terms of complications, reoperations, mortality and readmissions. It is associated with less postoperative pain and earlier hospital discharge.

Implementation of nutrition risk screening using the Malnutrition Universal Screening Tool across a large metropolitan health service.

PubMed

Cooper, P L; Raja, R; Golder, J; Stewart, A J; Shaikh, R F; Apostolides, M; Savva, J; Sequeira, J L; Silvers, M A

2016-12-01

A standardised nutrition risk screening (NRS) programme with ongoing education is recommended for the successful implementation of NRS. This project aimed to develop and implement a standardised NRS and education process across the adult bed-based services of a large metropolitan health service and to achieve a 75% NRS compliance at 12 months post-implementation. A working party of Monash Health (MH) dietitians and a nutrition technician revised an existing NRS medical record form consisting of the Malnutrition Universal Screening Tool and nutrition management guidelines. Nursing staff across six MH hospital sites were educated in the use of this revised form and there was a formalised implementation process. Support from Executive Management, nurse educators and the Nutrition Risk Committee ensured the incorporation of NRS into nursing practice. Compliance audits were conducted pre- and post-implementation. At 12 months post-implementation, organisation-wide NRS compliance reached 34.3%. For those wards that had pre-implementation NRS performed by nursing staff, compliance increased from 7.1% to 37.9% at 12 months (P < 0.001). The improved NRS form is now incorporated into standard nursing practice and NRS is embedded in the organisation's 'Point of Care Audit', which is reported 6-monthly to the Nutrition Risk Committee and site Quality and Safety Committees. NRS compliance improved at MH with strong governance support and formalised implementation; however, the overall compliance achieved appears to have been affected by the complexity and diversity of multiple healthcare sites. Ongoing education, regular auditing and establishment of NRS routines and ward practices is recommended to further improve compliance. © 2016 The British Dietetic Association Ltd.

40 CFR 264.99 - Compliance monitoring program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... be based on a compliance monitoring program developed to meet the requirements of this section. (i... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Compliance monitoring program. 264.99... Releases From Solid Waste Management Units § 264.99 Compliance monitoring program. An owner or operator...

Drug-Free Schools and Communities Act Compliance at Michigan Community Colleges

ERIC Educational Resources Information Center

Custer, Bradley D.

2018-01-01

In 1989, Congress passed the Drug-Free Schools and Communities Act Amendments to address illegal alcohol and drug abuse on college campuses. To receive federal funding, each college must comply by implementing an alcohol and drug prevention program, but the federal government and some colleges have paid little attention to this policy. Recently,…

77 FR 15656 - Implementation of the New Source Review (NSR) Program for Particulate Matter Less Than 2.5...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-16

... for measurement of ``particulate matter emissions'' in the context of the PSD and NSR regulations there is no explicit requirement to include measurement of condensable PM. However, the condensable... 109 of the Act. See 36 FR 8186. Compliance with the original PM NAAQS was based on the measurement of...

Counterfeit Compliance with the HIPAA Security Rule: A Study of Information System Success

ERIC Educational Resources Information Center

Johnson, James R.

2013-01-01

The intent of the security standards adopted by the Department of Health and Human Services (DHS) implementing some of the requirements of the Administrative Simplification (AS) subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was to improve Federal and private health care programs and to improve the…

Coherence and Compliance of Kohler's Model for Successful Transition Planning with Classified Special Education Students

ERIC Educational Resources Information Center

Karahalis, John

2011-01-01

This researcher addresses whether transition planning with classified special education students is being implemented in accordance with the Kohler model for successful transition planning. Using archival data available from two high schools, one with a specialized on campus program and the latter as an excluded site specializing in classified…

Westinghouse Hanford Company (WHC) standards/requirements identification document (S/RID)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bennett, G.L.

1996-03-15

This Standards/Requirements Identification Document (S/RID) set forth the Environmental Safety and Health (ES&H) standards/requirements for Westinghouse Hanford Company Level Programs, where implementation and compliance is the responsibility of these organizations. These standards/requirements are adequate to ensure the protection of the health and safety of workers, the public, and the environment.

Beyond Compliance: ESL Faculty's Perspectives on Preparing General Education Faculty for ESL Infusion

ERIC Educational Resources Information Center

de Jong, Ester J.; Naranjo, Cindy; Li, Shuzhan; Ouzia, ­Aicha

2018-01-01

The trend of placing English language learners (ELLs) in mainstream classrooms has teacher education programs developing their capacity to prepare all teachers to educate ELLs. This study examined how universities in Florida implement a professional development requirement to help faculty infuse ELL content into their courses. Our findings suggest…

Comparison Between Manual Auditing and a Natural Language Process With Machine Learning Algorithm to Evaluate Faculty Use of Standardized Reports in Radiology.

PubMed

Guimaraes, Carolina V; Grzeszczuk, Robert; Bisset, George S; Donnelly, Lane F

2018-03-01

When implementing or monitoring department-sanctioned standardized radiology reports, feedback about individual faculty performance has been shown to be a useful driver of faculty compliance. Most commonly, these data are derived from manual audit, which can be both time-consuming and subject to sampling error. The purpose of this study was to evaluate whether a software program using natural language processing and machine learning could accurately audit radiologist compliance with the use of standardized reports compared with performed manual audits. Radiology reports from a 1-month period were loaded into such a software program, and faculty compliance with use of standardized reports was calculated. For that same period, manual audits were performed (25 reports audited for each of 42 faculty members). The mean compliance rates calculated by automated auditing were then compared with the confidence interval of the mean rate by manual audit. The mean compliance rate for use of standardized reports as determined by manual audit was 91.2% with a confidence interval between 89.3% and 92.8%. The mean compliance rate calculated by automated auditing was 92.0%, within that confidence interval. This study shows that by use of natural language processing and machine learning algorithms, an automated analysis can accurately define whether reports are compliant with use of standardized report templates and language, compared with manual audits. This may avoid significant labor costs related to conducting the manual auditing process. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Web-based interventions in multiple sclerosis: the potential of tele-rehabilitation

PubMed Central

Tallner, Alexander; Pfeifer, Klaus; Mäurer, Mathias

2016-01-01

The World Wide Web is increasingly used in therapeutic settings. In this regard, internet-based interventions have proven effective in ameliorating several health behaviors, amongst them physical activity behavior. Internet-delivered interventions have shown positive effects on physical activity and physical function in persons with MS (pwMS). In this review we give an overview on several online exercise programs for pwMS and discuss the advantages and drawbacks of web-based interventions. Although participants of online exercise programs reported a high acceptance and satisfaction with the intervention, decreasing compliance was a major issue. A possible remedy might be the implementation of game-design elements to increase compliance and long-term adherence to internet-delivered interventions. In addition we believe that the integration of social networks seems to be a promising strategy. PMID:27366240

Noise Control in Space Shuttle Orbiter

NASA Technical Reports Server (NTRS)

Goodman, Jerry R.

2009-01-01

Acoustic limits in habitable space enclosures are required to ensure crew safety, comfort, and habitability. Noise control is implemented to ensure compliance with the acoustic requirements. The purpose of this paper is to describe problems with establishing acoustic requirements and noise control efforts, and present examples of noise control treatments and design applications used in the Space Shuttle Orbiter. Included is the need to implement the design discipline of acoustics early in the design process, and noise control throughout a program to ensure that limits are met. The use of dedicated personnel to provide expertise and oversight of acoustic requirements and noise control implementation has shown to be of value in the Space Shuttle Orbiter program. It is concluded that to achieve acceptable and safe noise levels in the crew habitable space, early resolution of acoustic requirements and implementation of effective noise control efforts are needed. Management support of established acoustic requirements and noise control efforts is essential.

The implementation of best practice in medication administration across a health network: a multisite evidence-based audit and feedback project.

PubMed

Munn, Zachary; Scarborough, Alan; Pearce, Susanne; McArthur, Alexa; Kavanagh, Sheila; Girdler, Michelle; Stefan-Rasmus, Bernie; Breen, Helen; Farquhar, Shirley; Li, Jessie; Hutchinson, Steven; Stephenson, Matthew; McBeth, Helen; Kitson, Alison

2015-09-16

Medication errors present a significant risk to patient safety. The "rights" of medication administration represent one approach to potentially reducing this risk. The aim of this project was to implement an evidence-based audit and feedback project to improve compliance with best practice in this area across a health network. A baseline audit was conducted to determine compliance with evidence-based standards by trained observers. The results of this audit were analysed and fed back to staff. An analysis of barriers to compliance was undertaken by key staff within the organization, which was followed by the implementation of targeted strategies to improve compliance. A follow-up audit was conducted and the results compared to the baseline audit. There were improvements in the percentage of compliance across all of the eight criteria audited, with statistically significant improvements found in six of the eight. In general, compliance with the criteria was high in both the baseline and follow-up audits. This audit and feedback implementation project was successful in increasing compliance and knowledge in this area and providing future direction for sustaining evidence-based practice change. It is now planned to use this approach for rolling out future implementation projects within this health system. The Joanna Briggs Institute.

Rapid motif compliance scoring with match weight sets.

PubMed

Venezia, D; O'Hara, P J

1993-02-01

Most current implementations of motif matching in biological sequences have sacrificed the generality of weight matrix scoring for shorter runtimes. The program MOTIF incorporates a weight matrix and a rapid, backtracking tree-search algorithm to score motif compliance with greatly enhanced performance while placing no constraints on the motif. In addition, any positions within a motif can be marked as 'inviolate', thereby requiring an exact match. MOTIF allows a choice of regular expression formats and can use both motif and sequence libraries as either targets or queries. Nucleic acid sequences can optionally be translated by MOTIF in any frame(s) and used against peptide motifs.

EVMS Self-Surveillance of Remote Handled Low Level Waste (RHLLW) Project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nelson, Michael L.; Case, Kimberly; Hergesheimer, Linda

2013-07-01

DOE G 413.3-10A, Section 3.a states: “The Contractor has primary responsibility for implementing and maintaining a surveillance program to ensure continued compliance of the system with ANSI/EIA-748B. DOE O 413.3B requires the FPD to ensure the contractor conducts a Self-Surveillance annually. This annual Self-Surveillance,…should cover all 32 guidelines of the ANSI/EIA748B. Documentation of the Self-Surveillance is sent to the CO and the PMSO (copy to OECM) confirming the continued compliance of their EVMS ANSI/EIA748B...” This review, and the associated report, is deemed to satisfy this requirement.

76 FR 60837 - Federal Acquisition Regulation; Information Collection; Contractor Business Ethics Compliance...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-30

...; Information Collection; Contractor Business Ethics Compliance Program and Disclosure Requirements AGENCIES... concerning contractor business ethics compliance program and disclosure requirements. Public comments are... Collection 9000- 0164, Contractor Business Ethics Compliance Program and Disclosure Requirements, by any of...

Implementation of a Clinical Documentation Improvement Curriculum Improves Quality Metrics and Hospital Charges in an Academic Surgery Department.

PubMed

Reyes, Cynthia; Greenbaum, Alissa; Porto, Catherine; Russell, John C

2017-03-01

Accurate clinical documentation (CD) is necessary for many aspects of modern health care, including excellent communication, quality metrics reporting, and legal documentation. New requirements have mandated adoption of ICD-10-CM coding systems, adding another layer of complexity to CD. A clinical documentation improvement (CDI) and ICD-10 training program was created for health care providers in our academic surgery department. We aimed to assess the impact of our CDI curriculum by comparing quality metrics, coding, and reimbursement before and after implementation of our CDI program. A CDI/ICD-10 training curriculum was instituted in September 2014 for all members of our university surgery department. The curriculum consisted of didactic lectures, 1-on-1 provider training, case reviews, e-learning modules, and CD queries from nurse CDI staff and hospital coders. Outcomes parameters included monthly documentation completion rates, severity of illness (SOI), risk of mortality (ROM), case-mix index (CMI), all-payer refined diagnosis-related groups (APR-DRG), and Surgical Care Improvement Program (SCIP) metrics. Financial gain from responses to CDI queries was determined retrospectively. Surgery department delinquent documentation decreased by 85% after CDI implementation. Compliance with SCIP measures improved from 85% to 97%. Significant increases in surgical SOI, ROM, CMI, and APR-DRG (all p < 0.01) were found after CDI/ICD-10 training implementation. Provider responses to CDI queries resulted in an estimated $4,672,786 increase in charges. Clinical documentation improvement/ICD-10 training in an academic surgery department is an effective method to improve documentation rates, increase the hospital estimated reimbursement based on more accurate CD, and provide better compliance with surgical quality measures. Copyright © 2016 American College of Surgeons. All rights reserved.

Technical Basis for PNNL Beryllium Inventory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, Michelle Lynn

2014-07-09

The Department of Energy (DOE) issued Title 10 of the Code of Federal Regulations Part 850, “Chronic Beryllium Disease Prevention Program” (the Beryllium Rule) in 1999 and required full compliance by no later than January 7, 2002. The Beryllium Rule requires the development of a baseline beryllium inventory of the locations of beryllium operations and other locations of potential beryllium contamination at DOE facilities. The baseline beryllium inventory is also required to identify workers exposed or potentially exposed to beryllium at those locations. Prior to DOE issuing 10 CFR 850, Pacific Northwest Nuclear Laboratory (PNNL) had documented the beryllium characterizationmore » and worker exposure potential for multiple facilities in compliance with DOE’s 1997 Notice 440.1, “Interim Chronic Beryllium Disease.” After DOE’s issuance of 10 CFR 850, PNNL developed an implementation plan to be compliant by 2002. In 2014, an internal self-assessment (ITS #E-00748) of PNNL’s Chronic Beryllium Disease Prevention Program (CBDPP) identified several deficiencies. One deficiency is that the technical basis for establishing the baseline beryllium inventory when the Beryllium Rule was implemented was either not documented or not retrievable. In addition, the beryllium inventory itself had not been adequately documented and maintained since PNNL established its own CBDPP, separate from Hanford Site’s program. This document reconstructs PNNL’s baseline beryllium inventory as it would have existed when it achieved compliance with the Beryllium Rule in 2001 and provides the technical basis for the baseline beryllium inventory.« less

Applying the Analytic Hierarchy Process to Oil Sands Environmental Compliance Risk Management

NASA Astrophysics Data System (ADS)

Roux, Izak Johannes, III

Oil companies in Alberta, Canada, invested $32 billion on new oil sands projects in 2013. Despite the size of this investment, there is a demonstrable deficiency in the uniformity and understanding of environmental legislation requirements that manifest into increased project compliance risks. This descriptive study developed 2 prioritized lists of environmental regulatory compliance risks and mitigation strategies and used multi-criteria decision theory for its theoretical framework. Information from compiled lists of environmental compliance risks and mitigation strategies was used to generate a specialized pairwise survey, which was piloted by 5 subject matter experts (SMEs). The survey was validated by a sample of 16 SMEs, after which the Analytic Hierarchy Process (AHP) was used to rank a total of 33 compliance risks and 12 mitigation strategy criteria. A key finding was that the AHP is a suitable tool for ranking of compliance risks and mitigation strategies. Several working hypotheses were also tested regarding how SMEs prioritized 1 compliance risk or mitigation strategy compared to another. The AHP showed that regulatory compliance, company reputation, environmental compliance, and economics ranked the highest and that a multi criteria mitigation strategy for environmental compliance ranked the highest. The study results will inform Alberta oil sands industry leaders about the ranking and utility of specific compliance risks and mitigations strategies, enabling them to focus on actions that will generate legislative and public trust. Oil sands leaders implementing a risk management program using the risks and mitigation strategies identified in this study will contribute to environmental conservation, economic growth, and positive social change.

Revised ground-water monitoring compliance plan for the 300 area process trenches

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schalla, R.; Aaberg, R.L.; Bates, D.J.

1988-09-01

This document contains ground-water monitoring plans for process-water disposal trenches located on the Hanford Site. These trenches, designated the 300 Area Process Trenches, have been used since 1973 for disposal of water that contains small quantities of both chemicals and radionuclides. The ground-water monitoring plans contained herein represent revision and expansion of an effort initiated in June 1985. At that time, a facility-specific monitoring program was implemented at the 300 Area Process Trenches as part of a regulatory compliance effort for hazardous chemicals being conducted on the Hanford Site. This monitoring program was based on the ground-water monitoring requirements formore » interim-status facilities, which are those facilities that do not yet have final permits, but are authorized to continue interim operations while engaged in the permitting process. The applicable monitoring requirements are described in the Resource Conservation and Recovery Act (RCRA), 40 CFR 265.90 of the federal regulations, and in WAC 173-303-400 of Washington State's regulations (Washington State Department of Ecology 1986). The program implemented for the process trenches was designed to be an alternate program, which is required instead of the standard detection program when a facility is known or suspected to have contaminated the ground water in the uppermost aquifer. The plans for the program, contained in a document prepared by the US Department of Energy (USDOE) in 1985, called for monthly sampling of 14 of the 37 existing monitoring wells at the 300 Area plus the installation and sampling of 2 new wells. 27 refs., 25 figs., 15 tabs.« less

76 FR 37353 - Federal Acquisition Regulation; Submission for OMB Review; Contractor Business Ethics Compliance...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-27

...; Submission for OMB Review; Contractor Business Ethics Compliance Program and Disclosure Requirements AGENCIES... contractor business ethics compliance program and disclosure requirements. Public comments are particularly... Information Collection 9000- 0164, Contractor Business Ethics Compliance Program and Disclosure Requirements...

Balancing entrepreneurship and business practices for e-collaboration: responsible information sharing in academic research.

PubMed

Porter, Mark W; Porter, Mark William; Milley, David; Oliveti, Kristyn; Ladd, Allen; O'Hara, Ryan J; Desai, Bimal R; White, Peter S

2008-11-06

Flexible, highly accessible collaboration tools can inherently conflict with controls placed on information sharing by offices charged with privacy protection, compliance, and maintenance of the general business environment. Our implementation of a commercial enterprise wiki within the academic research environment addresses concerns of all involved through the development of a robust user training program, a suite of software customizations that enhance security elements, a robust auditing program, allowance for inter-institutional wiki collaboration, and wiki-specific governance.

Applying Positive Deviance for Improving Compliance to Adolescent Anemia Control Program in Tribal Communities of India.

PubMed

Sethi, Vani; Sternin, Monique; Sharma, Deepika; Bhanot, Arti; Mebrahtu, Saba

2017-09-01

Positive deviance (PD) is an asset-based social and behavior change communication strategy, utilizing successful outliers within a specific context. It has been applied to tackling major public health problems but not adolescent anemia. The study, first of its kind, used PD to improve compliance to adolescent anemia control program in Jharkhand, India, where anemia prevalence in adolescent girls is 70%, and program compliance is low. With leadership of state government, the study was designed and implemented by a multidisciplinary 42 member PD team, in Khunti district, in 2014. Participatory appraisals were undertaken with 434 adolescent girls, 18 frontline workers, 15 teachers, and 751 community leaders/parents/relatives. Stakeholders were interviewed to identify positive deviants and PD determinants across 17 villages. Perceived benefits of iron folic acid tablet and nutritional care during adolescence are low. Positive deviants exist among adolescent girls (26 of 434), villages (2 of 17), and schools (2 of 17). Positive deviant adolescent girls consumed variety of iron-rich foods and in higher frequency, consumed iron folic acid tablets, and practiced recommended personal hygiene behaviors. Deviant practices in schools included supervision of students during tablet distribution among others. Government-led PD approach uncovered local solutions and provided a forum for government functionaries to listen to and dialogue with, and an opportunity to adapt the program according to the needs of the affected communities, who are missing partners in program design and management.

Building an effective corporate compliance plan.

PubMed

Ryan, E

1997-09-01

Corporate compliance plans are essential for healthcare organizations to cope with, and perhaps even stave off, investigations arising from allegations of illegal business practices. Initial development and implementation of a corporate compliance plan can be facilitated through four steps: determining the content of the code of conduct, determining how the code will be distributed, assigning responsibility for implementing the plan, and appointing a compliance task force to guide the implementation process. Special attention should be paid to education requirements of the United States Sentencing Guidelines to see that all employees understand and can apply provisions of the plan.

Lessons learned from the scaling-up of a weekly multimicronutrient supplementation program in the integrated food security program (PISA).

PubMed

Lechtig, Aarón; Gross, Rainer; Vivanco, Oscar Aquino; Gross, Ursula; López de Romaña, Daniel

2006-01-01

Weekly multimicronutrient supplementation was initiated as an appropriate intervention to protect poor urban populations from anemia. To identify the lessons learned from the Integrated Food Security Program (Programa Integrado de Seguridad Alimentaria [PISA]) weekly multimicronutrient supplementation program implemented in poor urban populations of Chiclayo, Peru. Data were collected from a 12-week program in which multimicronutrient supplements were provided weekly to women and adolescent girls 12 through 44 years of age and children under 5 years of age. A baseline survey was first conducted. Within the weekly multimicronutrient supplementation program, information was collected on supplement distribution, compliance, biological effectiveness, and cost. Supplementation, fortification, and dietary strategies can be integrated synergistically within a micronutrient intervention program. To ensure high cost-effectiveness of a weekly multimicronutrient supplementation program, the following conditions need to be met: the program should be implemented twice a year for 4 months; the program should be simultaneously implemented at the household (micro), community (meso), and national (macro) levels; there should be governmental participation from health and other sectors; and there should be community and private sector participation. Weekly multimicronutrient supplementation programs are cost effective options in urban areas with populations at low risk of energy deficiency and high risk of micronutrient deficiencies.

Improvement in safety monitoring of biologic response modifiers after the implementation of clinical care guidelines by a specialty.

PubMed

Hanson, Rebekah L; Gannon, Michael J; Khamo, Nehrin; Sodhi, Monsheel; Orr, Alexander M; Stubbings, JoAnn

2013-01-01

Tumor necrosis factor (TNF)-alpha inhibitors and other biologic response modifiers (BRMs) are frequently used to treat a variety of inflammatory diseases. Use of these agents may increase risk of serious infections, malignancies, and other complications such as worsening symptoms of heart failure or demyelinating disease. Because of these risks, a baseline assessment and routine monitoring have been recommended, but standardized guidelines for monitoring have yet to be established. To measure the compliance with the recommended safety monitoring in the Clinical Care Guidelines for BRMs at the University of Illinois Hospitals and Health Sciences System (UI Health). The Clinical Care Guidelines for BRMs was developed by a committee of pharmacists, nurses, and physicians based on an assessment of published literature and medication labeling. The guidelines included recommendations for safety monitoring prior to BRM therapy, such as the tuberculosis (TB) test, Hepatitis B surface Antigen (HBsAg) test, liver function test (LFT), complete blood count (CBC), up-to-date vaccinations, risk assessment for cancer, pregnancy testing, monitoring for contraindications with concomitant medications, concomitant disease state risk assessment, and patient education. The guidelines were introduced to UI Health in February 2012 by a systemwide email and by in-services given by the health system's Specialty Pharmacy Service. In-services were given in the clinics known to generate large numbers of BRM orders (e.g., gastroenterology and rheumatology) and at the outpatient center for infused therapies. The purpose of the in-services was to introduce providers to the guidelines and encourage their compliance. To ensure that guideline requirements were met when BRMs were ordered, a process was established to identify BRM orders, assess the orders for compliance with 4 of the safety monitoring tests from the guidelines (TB, HBsAg, LFT, and CBC), and make interventions. When necessary, Specialty Pharmacy Services coordinated with the pharmacists and other providers in the clinic to order lab tests and ensure they were completed prior to the start of therapy. Feedback was provided during the study to proactively improve compliance with the guidelines. After completion of the study, a report containing outpatient prescription orders for BRMs (abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, and tocilizumab) from August 2011 through July 2012 was generated from the electronic medical record. Retrospective analyses of completion of safety monitoring were conducted for patients administered BRM treatment. Completion rates were compared before and after implementation of guidelines in February 2012. Completion was considered to have occurred when all 4 safety monitoring tests had been conducted -TB (unless known to be positive from a previous test), HBsAg, LFT, and CBC. Completion data from August 2011 through January 2012 were before the guidelines were implemented, and data from February 2012 through July 2012 were after the guidelines. Chi square analyses were performed on completion frequencies in the patients before and after the guidelines were implemented. Of the 320 unique patient BRM orders evaluated in this study, 195 (61%) were generated in the Rheumatology clinic, 99 (31%) in the Gastroenterology clinic, 21 (6.5%) in the Dermatology clinic, and 5 (1.5%) in the Transplant clinic. Before the guidelines were implemented, 54 ( 31%) of 173 patient orders complied with the safety monitoring by having all 4 clinical tests performed at the appropriate time points. After guideline implementation, 88 (60%) of 147 patient orders were compliant and had all 4 clinical tests conducted, which represents a statistically significant improvement in the rate of compliance (Pearson chi square = 26.43, degrees of freedom (df) = 1, P  less than  0.0001). This significant improvement in compliance rates after guideline implementation was observed in both the new patient group and the patients with continuing prescription orders/treatment changes. There was also an improvement in patients whose prescriptions were dispensed by UI Health and to a lesser degree those whose prescriptions were dispensed by an outside pharmacy. When the new patient group was analyzed separately (n = 92), 50 patients were treated before the guidelines were implemented, and 42 patients were treated after the guidelines were implemented. Compliance rates with safety monitoring in these 2 groups were 52% pre-implementation and 83% post-implementation, which represented a statistically significant improvement in compliance (Pearson chi square = 10.03, df=1, P = 0.0015). Similar results were observed in the second patient subgroup with continuing prescription orders/treatment change (n = 228). A total of 123 patients were treated before the guidelines were implemented, and 105 were treated after the guidelines were implemented. Compliance rates were 23% pre-implementation compared with 50% post-implementation, which represented a statistically significant improvement in compliance (Pearson chi square = 18.99, df = 1, P  less than  0.0001). Given the widespread and long-term use of BRMs, safety monitoring and management should be an important part of a comprehensive medication management program for their use. A coordinated effort may have a significant impact on compliance with safety monitoring guidelines.

Regulatory basis for the Waste Isolation Pilot Plant performance assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

HOWARD,BRYAN A.; CRAWFORD,M.B.; GALSON,D.A.

2000-05-22

The Waste Isolation Pilot Plant (WIPP) is the first operational repository designed for the safe disposal of transuranic (TRU) radioactive waste from the defense programs of the US Department of Energy (DOE). The US Environmental Protection Agency (EPA) is responsible for certifications and regulation of the WIPP facility for the radioactive components of the waste. The EPA has promulgated general radioactive waste disposal standards at 40 CFR Part 191. and WIPP-specific criteria to implement and interpret the generic disposal standards at 40 CFR Part 194. In October 1996. the DOE submitted its Compliance Certification Application (CCA) to the EPA tomore » demonstrate compliance with the disposal standards at Subparts B and C of 40 CFR Part 191. This paper summarizes the development of the overall legal framework for radioactive waste disposal at the WIPP, the parallel development of the WIPP performance assessment (PA), and how the EPA disposal standards and implementing criteria formed the basis for the CCA WIPP PA. The CCA resulted in a certification in May 1998 by the EPA of the WIPP'S compliance with the EPA's disposal standard, thus enabling the WIPP to begin radioactive waste disposal.« less

Effectiveness of an occupational health intervention program to reduce whole body vibration exposure: an evaluation study with a controlled pretest-post-test design.

PubMed

Tiemessen, Ivo J H; Hulshof, Carel T J; Frings-Dresen, Monique H W

2009-12-01

An effective intervention program aiming to reduce whole body vibration (WBV) exposure at work will reduce the number of low back complaints in the near future. An evaluation study with a controlled pretest-post-test design. Nine companies and 126 drivers were included in the study. Cluster randomization on company level divided the drivers and their employers in an intervention group and a "care-as-usual" group. At baseline (T0) and intervention program was implemented and evaluated after 7 months (T1). The main outcome measure was WBV exposure. Process measures included knowledge, attitude, and (intended) behavior towards reduction of WBV exposure for the drivers and knowledge and WBV policy for the employers. At T1, no significant reduction was found in WBV exposure within both groups compared with T0. Probably due to poor to moderate compliance, the intervention program was not effective in reducing the WBV exposure on group level but small reductions in WBV exposure are possible when intervention compliance is high. Copyright 2009 Wiley-Liss, Inc.

Watershed monitoring and modelling and USA regulatory compliance.

PubMed

Turner, B G; Boner, M C

2004-01-01

The aim of the Columbus program was to implement a comprehensive watershed monitoring-network including water chemistry, aquatic biology and alternative sensors to establish water environment health and methods for determining future restoration progress and early warning for protection of drinking water supplies. The program was implemented to comply with USA regulatory requirements including Total Maximum Daily Load (TMDL) rules of the Clean Water Act (CWA) and Source Water Assessment and Protection (SWAP) rules under the Safe Drinking Water Act (SDWA). The USEPA Office of Research and Development and the Water Environment Research Foundation provided quality assurance oversight. The results obtained demonstrated that significant wet weather data is necessary to establish relationships between land use, water chemistry, aquatic biology and sensor data. These measurements and relationships formed the basis for calibrating the US EPA BASINS Model, prioritizing watershed health and determination of compliance with water quality standards. Conclusions specify priorities of cost-effective drainage system controls that attenuate stormwater flows and capture flushed pollutants. A network of permanent long-term real-time monitoring using combination of continuous sensor measurements, water column sampling and aquatic biology surveys and a regional organization is prescribed to protect drinking water supplies and measure progress towards water quality targets.

One Rural Hospital's Experience Implementing the Society for Healthcare Epidemiology of America Guidelines to Decrease Central Line Infections.

PubMed

Curlej, Maria H; Katrancha, Elizabeth

2016-01-01

In an effort to take advantage of the Highmark Quality Blue Initiative () requiring information from hospitals detailing their central line-associated blood stream infections (CLABSIs) surveillance system, quality improvement program, and statistics regarding the CLABSI events, this institution investigated the latest evidence-based recommendations to reduce CLABSIs. Recognizing the baseline rate of 2.4 CLABSIs per 1,000 central line days and its effect on patient outcomes and medical costs, this hospital made a commitment to improve their CLABSI outcomes. As a result, the facility adopted the Society for Healthcare Epidemiology of America (SHEA) guidelines. The purpose of this article is to review the CLABSI rates and examine the prevention strategies following implementation of the SHEA guidelines. A quantitative, descriptive retrospective program evaluation examined the hospital's pre- and post-SHEA implementation methods of decreasing CLABSIs and the subsequent CLABSI rates over 3 time periods. Any patient with a CLABSI infection admitted to this hospital July 2007 to June 2010 (N = 78). CLABSI rates decreased from 1.9 to 1.3 over the study period. Compliance with specific SHEA guidelines was evaluated and measures were put into place to increase compliance where necessary. CLABSI rates at this facility remain below the baseline of 2.4 for calendar year 2013 (0.79), 2014 (0.07), and 2015 (0.33).

How Compliance Measures, Behavior Modification, and Continuous Quality Improvement Led to Routine HIV Screening in an Emergency Department in Brooklyn, New York.

PubMed

Isaac, Jermel Kyri; Sanchez, Travis H; Brown, Emily H; Thompson, Gina; Sanchez, Christina; Fils-Aime, Stephany; Maria, Jose

2016-01-01

New York State adopted a new HIV testing law in 2010 requiring medical providers to offer an HIV test to all eligible patients aged 13-64 years during emergency room or ambulatory care visits. Since then, Wyckoff Heights Medical Center (WHMC) in Brooklyn, New York, began implementing routine HIV screening organization-wide using a compliance, behavior-modification, and continuous quality-improvement process. WHMC first implemented HIV screening in the emergency department (ED) and evaluated progress with the following monthly indicators: HIV tests offered, HIV tests accepted, HIV tests ordered (starting in December 2013), HIV tests administered, positive HIV tests, and linkage to HIV care. Compliance with the delivery of HIV testing was determined by the proportion of patients who, after accepting a test, received one. During August 2013 through July 2014, of 57,852 eligible patients seen in the WHMC ED, a total of 31,423 (54.3%) were offered an HIV test. Of those, 8,229 (26.2%) patients accepted a test. Of those, 6,114 (74.3%) underwent a test. A total of 26 of the 6,114 patients tested (0.4%) had a positive test, and 24 of the 26 HIV-positive patients were linked to HIV medical care. By July 2014, the monthly proportion of patients offered a test was 62%; the proportion of those offered a test who had a test ordered was 98%, and the proportion of those with a test ordered who were tested was 81%. Testing compliance increased substantially at the WHMC ED, from 77% in December 2013 to >98% in July 2014. Using compliance-monitoring, behavior-modification, and continuous quality-improvement processes produced substantial increases in offers and HIV test completion. WHMC is replicating this approach across departments, and other hospitals implementing routine HIV screening programs should consider this approach as well.

Safety and compliance-related hazards in the medical practice: Part one.

PubMed

Calway, R C

2001-01-01

Safety and risk management hazards are a fact of life for the medical practice, and the costs of these incidents can place the group at significant risk of liability. Good compliance and risk management programs help minimize these incidents, improve staff morale, increase a practice's visibility in the community, and positively affect the practice's financial and operational bottom line performance. Medical practices that implement effective safety and risk management programs can realize savings in staffing costs, operational efficiency, morale, insurance premiums, and improved third-party relationships while at the same time avoiding embarrassing risks, fines, and liability. This article outlines some of the most common safety and risk management-related deficiencies seen in medical practices today. The author explains how to remedy these deficiencies and provides a self-test tool to enable the reader to assess areas within his or her own practice in need of attention.

GUIDANCE DOCUMENT ON IMPLEMENTATION OF THE ...

EPA Pesticide Factsheets

The Agreement in Principle for the Stage 2 M-DBP Federal Advisory Committee contains a list of treatment processes and management practices for water systems to use in meeting additional Cryptosporidium treatment requirements under the LT2ESWTR. This list, termed the microbial toolbox, includes watershed control programs, alternative intake locations, pretreatment processes, additional filtration barriers, inactivation technologies, and enhanced plant performance. The intent of the microbial toolbox is to provide water systems with broad flexibility in selecting cost-effective LT2ESWTR compliance strategies. Moreover, the toolbox allows systems that currently provide additional pathogen barriers or that can demonstrate enhanced performance to receive additional Cryptosporidium treatment credit. Provide guidance to utilities with surface water supplies and to state drinking water programs on the use of different treatment technologies to reduce the level of Cryptosporidium in drinking water. Technologies included in the guidance manual may be used to achieve compliance with the requirements of the LT2ESWTR.

A novel Web-based graduate medical education management system including ACGME compliance algorithms.

PubMed

Gauger, Paul G; Davis, Janice W; Orr, Peter J

2002-09-01

Administration of graduate medical education programs has become more difficult as compliance with ACGME work guidelines has assumed increased importance. These guidelines have caused many changes in the resident work environment, including the emergence of complicated cross-cover arrangements. Many participating residents (each with his or her own individual scheduling requirements) usually generate these schedules. Accordingly, schedules are often not submitted in a timely fashion and they may not be in compliance with the ACGME guidelines for maximum on-call assignments and mandatory days off. Our objective was the establishment of a Web-based system that guides residents in creating on-call schedules that follow ACGME guidelines while still allowing maximum flexibility -- thus allowing each resident to maintain an internal locus of control. A versatile and scalable system with password-protected user (resident) and administrator interfaces was created. An entire academic year is included, and past months and years are automatically archived. The residents log on within the first 15 days of the preceding month and choose their positions in a schedule template. They then make adjustments while receiving immediate summary feedback on compliance with ACGME guidelines. The schedule is electronically submitted to the educational administrator for final approval. If a cross-cover system is required, the program automatically generates an optimal schedule using both of the approved participating service schedules. The residents then have an additional five-day period to make adjustments in the cross-cover schedule while still receiving compliance feedback. The administrator again provides final approval electronically. The communication interface automatically pages or e-mails the residents when schedules are updated or approved. Since the information exists in a relational database, simple reporting tools are included to extract the information necessary to generate records for institutional GME management. Implementation of this program has been met with great enthusiasm from the institutional stakeholders. Specifically, residents have embraced the ability to directly control their schedules and have gained appreciation for the regulatory matrix in which they function. Institutional administrators have praised the improvement in compliance and the ease of documentation. We anticipate that the system will also meet with approval from reviewing regulatory bodies, as it generates and stores accurate information about the resident work environment. This program is robust and versatile enough to be modified for any GME training program in the country.

Environmental Compliance Assessment Management Program (ECAMP) - U.S. Fish and Wildlife Service (FWS)

DTIC Science & Technology

1994-06-01

and Wildlife Service, began research on the Environmental Compliance Assessment and Management Program (ECAMP). The concept was to combine Code of ... The number of environmental laws and regulations have continued to grow in the United States and worldwide, making compliance with these regulations...Service has adopted an environmental compliance program that identifies compliance problems before they are cited as violations by the U.S

Measuring User Compliance and Cost Effectiveness of Safe Drinking Water Programs: A Cluster-Randomized Study of Household Ultraviolet Disinfection in Rural Mexico.

PubMed

Reygadas, Fermín; Gruber, Joshua S; Dreizler, Lindsay; Nelson, Kara L; Ray, Isha

2018-03-01

Low adoption and compliance levels for household water treatment and safe storage (HWTS) technologies have made it challenging for these systems to achieve measurable health benefits in the developing world. User compliance remains an inconsistently defined and poorly understood feature of HWTS programs. In this article, we develop a comprehensive approach to understanding HWTS compliance. First, our Safe Drinking Water Compliance Framework disaggregates and measures the components of compliance from initial adoption of the HWTS to exclusive consumption of treated water. We apply this framework to an ultraviolet (UV)-based safe water system in a cluster-randomized controlled trial in rural Mexico. Second, we evaluate a no-frills (or "Basic") variant of the program as well as an improved (or "Enhanced") variant, to test if subtle changes in the user interface of HWTS programs could improve compliance. Finally, we perform a full-cost analysis of both variants to assess their cost effectiveness (CE) in achieving compliance. We define "compliance" strictly as the habit of consuming safe water. We find that compliance was significantly higher in the groups where the UV program variants were rolled out than in the control groups. The Enhanced variant performed better immediately postintervention than the Basic, but compliance (and thus CE) degraded with time such that no effective difference remained between the two versions of the program.

75 FR 1099 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-08

... Laundering Compliance Program) and adopt new Rule 3310--NYSE Amex Equities (Anti-Money Laundering Compliance... amendments, NASD Rule 3011 (Anti- Money Laundering Compliance Program) and related Interpretive Material NASD IM-3011-1 and 3011-2 as consolidated FINRA Rule 3310 (Anti-Money Laundering Compliance Program), and...

78 FR 57857 - Medicare and Medicaid Programs; Application from the Compliance Team for Initial CMS-Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-20

...] Medicare and Medicaid Programs; Application from the Compliance Team for Initial CMS-Approval of its Rural... Compliance Team for initial recognition as a national accrediting organization for rural health clinics (RHCs... Compliance Team's request for initial CMS approval of its RHC accreditation program. This notice also...

Nevada National Security Site Radiation Protection Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

none,

2013-04-30

Title 10 Code of Federal Regulations (CFR) Part 835, “Occupational Radiation Protection,” establishes radiation protection standards, limits, and program requirements for protecting individuals from ionizing radiation resulting from the conduct of U.S. Department of Energy (DOE) activities. 10 CFR 835.101(a) mandates that DOE activities be conducted in compliance with a documented Radiation Protection Program (RPP) as approved by DOE. This document promulgates the RPP for the Nevada National Security Site (NNSS), related (on-site or off-site) U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) operations, and environmental restoration off-site projects. This RPP section consists of general statementsmore » that are applicable to the NNSS as a whole. The RPP also includes a series of appendices which provide supporting detail for the associated NNSS Tennant Organizations (TOs). Appendix H, “Compliance Demonstration Table,” contains a cross-walk for the implementation of 10 CFR 835 requirements. This RPP does not contain any exemptions from the established 10 CFR 835 requirements. The RSPC and TOs are fully compliant with 10 CFR 835 and no additional funding is required in order to meet RPP commitments. No new programs or activities are needed to meet 10 CFR 835 requirements and there are no anticipated impacts to programs or activities that are not included in the RPP. There are no known constraints to implementing the RPP. No guides or technical standards are adopted in this RPP as a means to meet the requirements of 10 CFR 835.« less

Characteristics of Inpatient Units Associated With Sustained Hand Hygiene Compliance.

PubMed

Wolfe, Jonathan D; Domenico, Henry J; Hickson, Gerald B; Wang, Deede; Dubree, Marilyn; Feistritzer, Nancye; Wells, Nancy; Talbot, Thomas R

2018-04-20

Following institution of a hand hygiene (HH) program at an academic medical center, HH compliance increased from 58% to 92% for 3 years. Some inpatient units modeled early, sustained increases, and others exhibited protracted improvement rates. We examined the association between patterns of HH compliance improvement and unit characteristics. Adult inpatient units (N = 35) were categorized into the following three tiers based on their pattern of HH compliance: early adopters, nonsustained and late adopters, and laggards. Unit-based culture measures were collected, including nursing practice environment scores (National Database of Nursing Quality Indicators [NDNQI]), patient rated quality and teamwork (Hospital Consumer Assessment of Healthcare Provider and Systems), patient complaint rates, case mix index, staff turnover rates, and patient volume. Associations between variables and the binary outcome of laggard (n = 18) versus nonlaggard (n = 17) were tested using a Mann-Whitney U test. Multivariate analysis was performed using an ordinal regression model. In direct comparison, laggard units had clinically relevant differences in NDNQI scores, Hospital Consumer Assessment of Healthcare Provider and Systems scores, case mix index, patient complaints, patient volume, and staff turnover. The results were not statistically significant. In the multivariate model, the predictor variables explained a significant proportion of the variability associated with laggard status, (R = 0.35, P = 0.0481) and identified NDNQI scores and patient complaints as statistically significant. Uptake of an HH program was associated with factors related to a unit's safety culture. In particular, NDNQI scores and patient complaint rates might be used to assist in identifying units that may require additional attention during implementation of an HH quality improvement program.

Energy Management Programs at the John F. Kennedy Space Center

NASA Technical Reports Server (NTRS)

Huang, Jeffrey H.

2011-01-01

The Energy Management internship over the summer of 2011 involved a series of projects related to energy management on the John. F. Kennedy Space Center (KSC). This internship saved KSC $14.3 million through budgetary projections, saved KSC $400,000 through implementation of the recycling program, updated KSC Environmental Management System's (EMS) water and energy-related List of Requirements (LoR) which changed 25.7% of the list, provided a incorporated a 45% design review of the Ordnance Operations Facility (OOF) which noted six errors within the design plans, created a certification system and timeline for implementation regarding compliance to the federal Guiding Principles, and gave off-shore wind as the preferred alternative to on-site renewable energy generation.

78 FR 60700 - Source Specific Federal Implementation Plan for Implementing Best Available Retrofit Technology...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-02

... operator of FCPP must notify EPA of its selected BART compliance strategy. On June 19, 2013, APS requested... related to the potential deregulation of the retail electricity market in Arizona that complicate its... one of two strategies for BART compliance: (1) Compliance with a facility-wide BART emission limit for...

Determining Childhood Blood Lead Level Screening Compliance Among Physicians.

PubMed

Haboush-Deloye, Amanda; Marquez, Erika R; Gerstenberger, Shawn L

2017-08-01

Childhood Lead Poisoning Prevention Programs throughout the U.S. have addressed childhood lead poisoning by implementing primary and secondary prevention efforts. While many programs have helped increase screening rates, in some states children under the age of six still have not been tested for lead. This study aims to identify the barriers to childhood blood lead testing and develop a strategy to increase the number of children tested. Clark County physicians who work with children six and under were surveyed about blood lead level (BLL) testing practices, particularly, adherence to Centers for Disease Control and Prevention (CDC) guidelines, and parental compliance with orders to have their children tested to determine their blood lead levels. In addition, select in-person interviews were conducted with physicians who reported high parental compliance to identify best practices and barriers. Of the 77 physicians that provided data, 48% indicated they did not follow CDC guideline compared to 52% who follow guidelines. 18 of the 30 (or 60%) physicians reported more than 80% of parents complied with doctor recommended BLL testing. Twelve physicians identified cost, lack of insurance, and absence of symptomology as persistent barriers to lead screening. This study identified barriers to childhood lead screening including inadequate parental adherence to physician-ordered screenings and physician non-compliance with screening recommendations are two primary contributors. Addressing these issues could increase screening in children and reduce the risk of lead poisoning.

Compliance in 2017 With Federal Calorie Labeling in 90 Chain Restaurants and 10 Retail Food Outlets Prior to Required Implementation.

PubMed

Cleveland, Lauren P; Simon, Denise; Block, Jason P

2018-06-21

To examine early compliance with the delayed federal calorie labeling regulation that requires posting calories on menus and menu boards at retail food chains with 20 or more establishments nationally. We explored implementation of calorie labeling at 90 of the largest US chain restaurants and the 10 highest-grossing supermarket chains from May to December 2017. We contacted corporate offices and at least 2 locations for each chain, made site visits when possible, and supplemented these efforts with targeted Internet searches. Overall, 71 (79%) restaurant chains partially or fully implemented labeling, as did 9 (90%) supermarket chains. Fast-food and fast-casual restaurants fully implemented labeling at a modestly higher rate than did full-service restaurants. Most of the retail food chains we assessed implemented calorie labeling policies in advance of the May 2018 compliance date. Public Health Implications. Although implementation of federal calorie labeling has been delayed repeatedly in the 8 years since the passage of the legislation, retail food chains have demonstrated a high rate of compliance with calorie labeling in advance of the required May 2018 implementation date. Despite reports from some retail food industries that compliance will be difficult, current implementation shows the feasibility of complying. (Am J Public Health. Published online ahead of print June 21, 2018: e1-e4. doi:10.2105/AJPH.2018.304513).

Development, implementation, and evaluation of a community- and hospital-based respiratory syncytial virus prophylaxis program.

PubMed

Bracht, Marianne; Heffer, Michael; O'Brien, Karel

2005-02-01

To implement and deliver a respiratory syncytial virus prophylaxis (RSVP) program in response to the Canadian Pediatric Society recommendations. A novel program was designed to provide inpatient RSVP for at-risk infants cared for in 1 tertiary care newborn intensive care unit (NICU). This inpatient program was part of a coordinated approach to RSVP, designed and implemented by 3 hospitals. An RSVP program logic model was created and used by a multidisciplinary team to evaluate the in-house program and identify areas of program activity requiring improvement. Following the 2000 to 2001 RSV season, a compliance and outcomes audit was performed in the tertiary center; 193 infants were enrolled in the RSVP program and 162 infants had received RSVP in the NICU [Mean = 1.64 doses]. Telephone follow-up with the parents of discharged infants identified that 159 infants (98%) had successfully completed their full course of RSVP. Using the RSVP program logic model, 5 areas for program improvement were identified including infant recruitment, patient transfer/discharge processes, product procurement, preparation/distribution/administration of doses, and healthcare team communication. Interdisciplinary collaboration is an important factor in the success of the RSVP program and has supported a consistent model of care for the delivery of RSVP. The program logic model provided a useful structure to systematically review the RSVP program in this organization.

Evaluation of the Defense Agencies Law Enforcement Divisions Compliance with the Lautenberg Amendment Requirements and Implementing Guidance

DTIC Science & Technology

2016-02-23

Coverage During the last 5 years, the DoD Inspector General (IG) issued one report discussing the Lautenberg Amendment . Unrestricted DoD IG reports can be...Enforcement Divisions’ Compliance with the Lautenberg Amendment Requirements and Implementing Guidance I N T E G R I T Y  E F F I C I E N C Y...Evaluation of the Defense Agencies’ Law Enforcement Divisions’ Compliance with the Lautenberg Amendment Requirements and Implementing Guidance February 23

Introducing an enhanced recovery after surgery program in colorectal surgery: A single center experience

PubMed Central

Bona, Stefano; Molteni, Mattia; Rosati, Riccardo; Elmore, Ugo; Bagnoli, Pietro; Monzani, Roberta; Caravaca, Monica; Montorsi, Marco

2014-01-01

AIM: To study the implementation of an enhanced recovery after surgery (ERAS) program at a large University Hospital from “pilot study” to “standard of care”. METHODS: The study was designed as a prospective single centre cohort study. A prospective evaluation of compliance to a protocol based on full application of all ERAS principles, through the progressive steps of its implementation, was performed. Results achieved in the initial pilot study conducted by a dedicated team (n = 47) were compared to those achieved in the shared protocol phase (n = 143) three years later. Outcomes were length of postoperative hospital stay, readmission rate, compliance to the protocol and morbidity. Primary endpoint was the description of the results and the identification of critical issues of large scale implementation of an ERAS program in colorectal surgery emerged in the experience of a single center. Secondary endpoint was the identification of interventions that have been proven to be effective for facilitating the transition from traditional care pathways to a multimodal management protocol according to ERAS principles in colorectal surgery at a single center. RESULTS: During the initial pilot study (March 2009 to December 2010; 47 patients) conducted by a dedicated multidisciplinary team, compliance to the items of ERAS protocol was 93%, with a median length of hospital stay (LOS) of 3 d. Early anastomotic fistulas were observed in 2 cases (4.2%), which required reoperation (Clavien-Dindo grade IIIb). None of the patients had been discharged before the onset of the complication, which could therefore receive prompt treatment. There were also four (8.5%) minor complications (Clavien-Dindo grade II). Thirty days readmission rate was 4%. Perioperative mortality was nil. After implementation of the protocol throughout the Hospital in unselected patients (May 2012 to December 2012; 147 patients) compliance was 74%, with a median LOS of 6 d. Early anastomotic fistulas were observed in 11 cases (7.7%), 5 (3.5%) of which required reoperation (Clavien-Dindo grade IIIb). Two early anastomotic fistulas were treated by radiologic/endoscopic manoeuvres and 4 were treated conservatively. There were also 36 (25.2%) minor complications, 21 (14.7%) of which were Clavien-Dindo grade II and 15 (10.5%) of which were Clavien-Dindo grade I. Only two patients whose course was adversely affected by the development of an anastomotic leak had been discharged before the onset of the complication itself, requiring readmission. Readmission rate within 30 d was 4%. Perioperative mortality was 1%. CONCLUSION: Our results confirm that introduction of an ERAS protocol for colorectal surgery allows quicker postoperative recovery and shortens the length of stay compared to historical series. PMID:25516673

Process improvement program evolves into compliance program at an integrated delivery system.

PubMed

Tyk, R C; Hylton, P G

1998-09-01

An integrated delivery system discovered questionable practices when it undertook a process-improvement initiative for its revenue-to-cash cycle. These discoveries served as a wake-up call to the organization that it needed to develop a comprehensive corporate compliance program. The organization engaged legal counsel to help it establish such a program. A corporate compliance officer was hired, and a compliance committee was set up. They worked with counsel to develop the structure and substance of the program and establish a corporate code of conduct that became a part of the organization's policies and procedures. Teams were formed in various areas of the organization to review compliance-related activities and suggest improvements. Clinical and nonclinical staff attended mandatory educational sessions about the program. By approaching compliance systematically, the organization has put itself in an excellent position to avoid fraudulent and abusive activities- and the government scrutiny they invite.

[Use the Markov-decision tree model to optimize vaccination strategies of hepatitis E among women aged 15 to 49].

PubMed

Chen, Z M; Ji, S B; Shi, X L; Zhao, Y Y; Zhang, X F; Jin, H

2017-02-10

Objective: To evaluate the cost-utility of different hepatitis E vaccination strategies in women aged 15 to 49. Methods: The Markov-decision tree model was constructed to evaluate the cost-utility of three hepatitis E virus vaccination strategies. Parameters of the models were estimated on the basis of published studies and experience of experts. Both methods on sensitivity and threshold analysis were used to evaluate the uncertainties of the model. Results: Compared with non-vaccination group, strategy on post-screening vaccination with rate as 100%, could save 0.10 quality-adjusted life years per capital in the women from the societal perspectives. After implementation of screening program and with the vaccination rate reaching 100%, the incremental cost utility ratio (ICUR) of vaccination appeared as 5 651.89 and 6 385.33 Yuan/QALY, respectively. Vaccination post to the implementation of a screening program, the result showed better benefit than the vaccination rate of 100%. Results from the sensitivity analysis showed that both the cost of hepatitis E vaccine and the inoculation compliance rate presented significant effects. If the cost were lower than 191.56 Yuan (RMB) or the inoculation compliance rate lower than 0.23, the vaccination rate of 100% strategy was better than the post-screening vaccination strategy, otherwise the post-screening vaccination strategy appeared the optimal strategy. Conclusion: Post-screening vaccination for women aged 15 to 49 from social perspectives seemed the optimal one but it had to depend on the change of vaccine cost and the rate of inoculation compliance.

Attitudes of Canadian dairy farmers toward a voluntary Johne's disease control program.

PubMed

Sorge, U; Kelton, D; Lissemore, K; Godkin, A; Hendrick, S; Wells, S

2010-04-01

The success of Johne's disease (JD) control programs based on risk assessment (RA) depends on producers' compliance with suggested management practices. One objective of this study was to describe the perception of participating Canadian dairy farmers of the impact of JD, the RA process, and suggested management strategies. The second objective was to describe the cost of changes in management practices following the RA. A telephone survey was conducted with 238 dairy farmers in Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia. The producers agreed to participate in this follow-up study after they had been enrolled in an RA-based voluntary JD control program and had tested their herd with the JD milk ELISA test in 2005 to 2007. The majority of farms had no JD test-positive cows and, although some producers thought they had experienced the economic impact of JD, many did not see JD as a current problem for their herd. The majority of producers enrolled in this program because they were concerned that Mycobacterium avium ssp. paratuberculosis could be perceived by consumers as a cause for Crohn's disease in humans, which could lead to altered purchasing behavior of milk and milk products. Fifty-two farm-specific recommendations had been made after the initial RA. Although the producers generally liked the program and found the recommendations reasonable and feasible, on average only 2 of 6 suggestions made specifically to them were implemented. The recommendation with the highest compliance was culling of JD test-positive cows. The main reasons for noncompliance were that the dairy producer did not believe a change of management practices was necessary or the available barn setting or space did not allow the change. Producers were generally uncomfortable estimating time and monetary expenses for management changes, but found that several suggested management practices actually saved time and money. In addition, 39% of the producers that implemented at least 1 recommendation thought their calf and herd health had improved subsequently. This indicates that the communication of associated benefits needs to be improved to increase the compliance of producers with recommended management practices. Copyright (c) 2010 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Debris control design achievements of the booster separation motors

NASA Technical Reports Server (NTRS)

Smith, G. W.; Chase, C. A.

1985-01-01

The stringent debris control requirements imposed on the design of the Space Shuttle booster separation motor are described along with the verification program implemented to ensure compliance with debris control objectives. The principal areas emphasized in the design and development of the Booster Separation Motor (BSM) relative to debris control were the propellant formulation and nozzle closures which protect the motors from aerodynamic heating and moisture. A description of the motor design requirements, the propellant formulation and verification program, and the nozzle closures design and verification are presented.

Continuous Certification Within Residency: An Educational Model.

PubMed

Rachlin, Susan; Schonberger, Alison; Nocera, Nicole; Acharya, Jay; Shah, Nidhi; Henkel, Jacqueline

2015-10-01

Given that maintaining compliance with Maintenance of Certification is necessary for maintaining licensure to practice as a radiologist and provide quality patient care, it is important for radiology residents to practice fulfilling each part of the program during their training not only to prepare for success after graduation but also to adequately learn best practices from the beginning of their professional careers. This article discusses ways to implement continuous certification (called Continuous Residency Certification) as an educational model within the residency training program. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

Frequency and Severity of Parenteral Nutrition Medication Errors at a Large Children's Hospital After Implementation of Electronic Ordering and Compounding.

PubMed

MacKay, Mark; Anderson, Collin; Boehme, Sabrina; Cash, Jared; Zobell, Jeffery

2016-04-01

The Institute for Safe Medication Practices has stated that parenteral nutrition (PN) is considered a high-risk medication and has the potential of causing harm. Three organizations--American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), American Society of Health-System Pharmacists, and National Advisory Group--have published guidelines for ordering, transcribing, compounding and administering PN. These national organizations have published data on compliance to the guidelines and the risk of errors. The purpose of this article is to compare total compliance with ordering, transcription, compounding, administration, and error rate with a large pediatric institution. A computerized prescriber order entry (CPOE) program was developed that incorporates dosing with soft and hard stop recommendations and simultaneously eliminating the need for paper transcription. A CPOE team prioritized and identified issues, then developed solutions and integrated innovative CPOE and automated compounding device (ACD) technologies and practice changes to minimize opportunities for medication errors in PN prescription, transcription, preparation, and administration. Thirty developmental processes were identified and integrated in the CPOE program, resulting in practices that were compliant with A.S.P.E.N. safety consensus recommendations. Data from 7 years of development and implementation were analyzed and compared with published literature comparing error, harm rates, and cost reductions to determine if our process showed lower error rates compared with national outcomes. The CPOE program developed was in total compliance with the A.S.P.E.N. guidelines for PN. The frequency of PN medication errors at our hospital over the 7 years was 230 errors/84,503 PN prescriptions, or 0.27% compared with national data that determined that 74 of 4730 (1.6%) of prescriptions over 1.5 years were associated with a medication error. Errors were categorized by steps in the PN process: prescribing, transcription, preparation, and administration. There were no transcription errors, and most (95%) errors occurred during administration. We conclude that PN practices that conferred a meaningful cost reduction and a lower error rate (2.7/1000 PN) than reported in the literature (15.6/1000 PN) were ascribed to the development and implementation of practices that conform to national PN guidelines and recommendations. Electronic ordering and compounding programs eliminated all transcription and related opportunities for errors. © 2015 American Society for Parenteral and Enteral Nutrition.

Impact of a mobile health aplication in the nursing care plan compliance of a home care service in Belo Horizonte, Minas Gerais, Brazil.

PubMed

de Britto, Felipe A; Martins, Tatiana B; Landsberg, Gustavo A P

2015-01-01

To assess impact of a mobile health solution in the nursing care plan compliance of a home care service. A retrospective cohort study was performed with 3,036 patients. Compliance rates before and after the implementation were compared. After the implementation of a mobile health aplication, compliance with the nursing care plan increased from 53% to 94%. The system reduced IT spending, increased the nursing team efficiency and prevented planned hiring. The use of a mobile health solution with geolocating feature by a nursing home care team increased compliance to the care plan.

13 CFR 120.180 - Lender and CDC compliance with Loan Program Requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false Lender and CDC compliance with... Program Requirements § 120.180 Lender and CDC compliance with Loan Program Requirements. Lenders must... are revised from time to time. CDCs must comply and maintain familiarity with Loan Program...

13 CFR 120.180 - Lender and CDC compliance with Loan Program Requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Lender and CDC compliance with... Program Requirements § 120.180 Lender and CDC compliance with Loan Program Requirements. Lenders must... are revised from time to time. CDCs must comply and maintain familiarity with Loan Program...

13 CFR 120.180 - Lender and CDC compliance with Loan Program Requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false Lender and CDC compliance with... Program Requirements § 120.180 Lender and CDC compliance with Loan Program Requirements. Lenders must... are revised from time to time. CDCs must comply and maintain familiarity with Loan Program...

13 CFR 120.180 - Lender and CDC compliance with Loan Program Requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false Lender and CDC compliance with... Program Requirements § 120.180 Lender and CDC compliance with Loan Program Requirements. Lenders must... are revised from time to time. CDCs must comply and maintain familiarity with Loan Program...

13 CFR 120.180 - Lender and CDC compliance with Loan Program Requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Lender and CDC compliance with... Program Requirements § 120.180 Lender and CDC compliance with Loan Program Requirements. Lenders must... are revised from time to time. CDCs must comply and maintain familiarity with Loan Program...

Practice-based research networks add value to evidence-based quality improvement.

PubMed

Goldstein, Karen M; Vogt, Dawne; Hamilton, Alison; Frayne, Susan M; Gierisch, Jennifer; Blakeney, Jill; Sadler, Anne; Bean-Mayberry, Bevanne M; Carney, Diane; DiLeone, Brooke; Fox, Annie B; Klap, Ruth; Yee, Ellen; Romodan, Yasmin; Strehlow, Holly; Yosef, Julia; Yano, Elizabeth M

2018-06-01

This study evaluated the Implementation of Essential Health Care Program (EHCP) in the Department of Education - Schools Division of Tarlac Province during the School Year 2014-2015 in partnership with the Provincial Government of Tarlac (PGT). The Context Input Process Product (CIPP) evaluation model was used in the study. The questionnaire, documentary analysis, interview and observation were used in the data gathering. Documents that were available such as records and DepED memoranda and orders were used as sources of data. Tables were utilized to analyze the data. The study found that the implementation of the EHCP was outstanding in its administration and personnel while very satisfactory in its strategies. The supplies were very adequate and adequate in its financial resources and facilities. The extent/level of the attainment of implementation of its component was fully attained/implemented in the daily handwashing with soap, toothbrushing with fluoride toothpaste and bi-annual deworming while on the additional dental services incorporated to the EHCP were fully attained/implemented on fluoride application, atraumatic restorative treatment (ART) and pits and fissure sealant. The successful implementation of the were attributed to the full implementation of the activities in each component in compliance with the DepED memoranda and orders, supervision of School Health and Nutrition Section and support of the program administrators and program implementers, cooperation and participation of the program beneficiaries and the full support of the Provincial Government of Tarlac. The EHCP has been successfully implemented however there are problems that are seldom encountered and action plan was proposed to address the said problems. Published by Elsevier Inc.

10 CFR 1040.101 - Compliance reviews.

Code of Federal Regulations, 2011 CFR

2011-01-01

... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.101 Compliance reviews. (a) The Director shall periodically conduct compliance... of: (1) The practices to be reviewed; (2) The programs or activities affected by the review; (3) The...

10 CFR 1040.101 - Compliance reviews.

Code of Federal Regulations, 2013 CFR

2013-01-01

... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.101 Compliance reviews. (a) The Director shall periodically conduct compliance... of: (1) The practices to be reviewed; (2) The programs or activities affected by the review; (3) The...

10 CFR 1040.101 - Compliance reviews.

Code of Federal Regulations, 2012 CFR

2012-01-01

... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.101 Compliance reviews. (a) The Director shall periodically conduct compliance... of: (1) The practices to be reviewed; (2) The programs or activities affected by the review; (3) The...

10 CFR 1040.101 - Compliance reviews.

Code of Federal Regulations, 2014 CFR

2014-01-01

... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.101 Compliance reviews. (a) The Director shall periodically conduct compliance... of: (1) The practices to be reviewed; (2) The programs or activities affected by the review; (3) The...

10 CFR 1040.101 - Compliance reviews.

Code of Federal Regulations, 2010 CFR

2010-01-01

... DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.101 Compliance reviews. (a) The Director shall periodically conduct compliance... of: (1) The practices to be reviewed; (2) The programs or activities affected by the review; (3) The...

Digital retinal imaging in a residency-based patient-centered medical home.

PubMed

Newman, Robert; Cummings, Doyle M; Doherty, Lisa; Patel, Nick R

2012-03-01

Diabetic retinopathy is the leading cause of blindness in adults in the United States, and early screening/treatment may preserve vision. This study examined the feasibility of using non-mydriatic digital retinal imaging (DRI) for retinopathy screening in a busy family medicine residency program at the point of care using a nurse-driven protocol. We compared the number of diabetics screened during a 1-year period before and after DRI protocol implementation. We also determined the prevalence of retinopathy, assessed patient satisfaction with the alternative screening process, and tracked ophthalmologic appointment compliance for patients referred because of abnormal screening results. Screening approximately doubled from 161 patients/year before the protocol to 330 patients/year after protocol implementation. However, DRI screening had no impact on ophthalmologic appointment compliance; only 58% of 153 patients referred for ophthalmologic evaluation because of positive screening findings completed their referral appointment. Seven cases needing urgent ophthalmologic treatment were identified. Satisfaction with primary care retinopathy screening was high. Use of a nurse-driven protocol for digital retinal imaging at the point of care dramatically improves rates of annual retinopathy screening in academic family medicine practice and can identify patients who require subspecialty referral. However, DRI screening does not improve visit compliance rates with ophthalmologists for evaluation and management.

76 FR 69333 - Derivatives Clearing Organization General Provisions and Core Principles

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

...The Commodity Futures Trading Commission (Commission) is adopting final regulations to implement certain provisions of Title VII and Title VIII of the Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank Act) governing derivatives clearing organization (DCO) activities. More specifically, the regulations establish the regulatory standards for compliance with DCO Core Principles A (Compliance), B (Financial Resources), C (Participant and Product Eligibility), D (Risk Management), E (Settlement Procedures), F (Treatment of Funds), G (Default Rules and Procedures), H (Rule Enforcement), I (System Safeguards), J (Reporting), K (Recordkeeping), L (Public Information), M (Information Sharing), N (Antitrust Considerations), and R (Legal Risk) set forth in Section 5b of the Commodity Exchange Act (CEA). The Commission also is updating and adding related definitions; adopting implementing rules for DCO chief compliance officers (CCOs); revising procedures for DCO applications including the required use of a new Form DCO; adopting procedural rules applicable to the transfer of a DCO registration; and adding requirements for approval of DCO rules establishing a portfolio margining program for customer accounts carried by a futures commission merchant (FCM) that is also registered as a securities broker-dealer (FCM/BD). In addition, the Commission is adopting certain technical amendments to parts 21 and 39, and is adopting certain delegation provisions under part 140.

Implementation of a low-cost Interim 21CFR11 compliance solution for laboratory environments.

PubMed

Greene, Jack E

2003-01-01

In the recent past, compliance with 21CFR11 has become a major buzzword within the pharmaceutical and biotechnology industries. While commercial solutions exist, implementation and validation are expensive and cumbersome. Frequent implementation of new features via point releases further complicates purchasing decisions by making it difficult to weigh the risk of non-compliance against the costs of too frequent upgrades. This presentation discusses a low-cost interim solution to the problem. While this solution does not address 100% of the issues raised by 21CFR11, it does implement and validate: (1) computer system security; (2) backup and restore ability on the electronic records store; and (3) an automated audit trail mechanism that captures the date, time and user identification whenever electronic records are created, modified or deleted. When coupled with enhanced procedural controls, this solution provides an acceptable level of compliance at extremely low cost.

Implementing Evidenced Based Oral Care for Critically Ill Patients

DTIC Science & Technology

2016-02-28

Tacoma, WA 98402 N/A 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) TriService Nursing Research...determined if an evidence-based oral care program resulted in increased nurses ’ knowledge and improved oral care practices compliance. Design: The project...critical care nursing education was conducted over a two-week period using the conceptual underpinning of the Iowa Model, the Diffusion of Innovation

Improving adherence to the Epic Beacon ambulatory workflow.

PubMed

Chackunkal, Ellen; Dhanapal Vogel, Vishnuprabha; Grycki, Meredith; Kostoff, Diana

2017-06-01

Computerized physician order entry has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Epic's Beacon Oncology Information System of computerized physician order entry and electronic medication administration was implemented in Henry Ford Health System's ambulatory oncology infusion centers on 9 November 2013. Since that time, compliance to the infusion workflow had not been assessed. The objective of this study was to optimize the current workflow and improve the compliance to this workflow in the ambulatory oncology setting. This study was a retrospective, quasi-experimental study which analyzed the composite workflow compliance rate of patient encounters from 9 to 23 November 2014. Based on this analysis, an intervention was identified and implemented in February 2015 to improve workflow compliance. The primary endpoint was to compare the composite compliance rate to the Beacon workflow before and after a pharmacy-initiated intervention. The intervention, which was education of infusion center staff, was initiated by ambulatory-based, oncology pharmacists and implemented by a multi-disciplinary team of pharmacists and nurses. The composite compliance rate was then reassessed for patient encounters from 2 to 13 March 2015 in order to analyze the effects of the determined intervention on compliance. The initial analysis in November 2014 revealed a composite compliance rate of 38%, and data analysis after the intervention revealed a statistically significant increase in the composite compliance rate to 83% ( p < 0.001). This study supports a pharmacist-initiated educational intervention can improve compliance to an ambulatory, oncology infusion workflow.

75 FR 57410 - Energy Conservation Program: Certification, Compliance, and Enforcement for Consumer Products and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-21

..., regarding the Energy Conservation Program: Certification, Compliance, and Enforcement for Consumer Products... [Docket No. EERE-2010-BT-CE-0014] RIN 1904-AC23 Energy Conservation Program: Certification, Compliance, and Enforcement for Consumer Products and Commercial and Industrial Equipment; Correction AGENCY...

75 FR 27182 - Energy Conservation Program: Web-Based Compliance and Certification Management System

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-14

... Conservation Program: Web-Based Compliance and Certification Management System AGENCY: Office of Energy... certification reports to the Department of Energy (DOE) through an electronic Web-based tool, the Compliance and... following means: 1. Compliance and Certification Management System (CCMS)--via the Web portal: http...

30 CFR 773.11 - Review of compliance history.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 3 2013-07-01 2013-07-01 false Review of compliance history. 773.11 Section... REGULATORY PROGRAMS REQUIREMENTS FOR PERMITS AND PERMIT PROCESSING § 773.11 Review of compliance history. (a... histories of compliance with the Act or the applicable State regulatory program, and any other applicable...

30 CFR 773.11 - Review of compliance history.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 3 2014-07-01 2014-07-01 false Review of compliance history. 773.11 Section... REGULATORY PROGRAMS REQUIREMENTS FOR PERMITS AND PERMIT PROCESSING § 773.11 Review of compliance history. (a... histories of compliance with the Act or the applicable State regulatory program, and any other applicable...

30 CFR 773.11 - Review of compliance history.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 3 2012-07-01 2012-07-01 false Review of compliance history. 773.11 Section... REGULATORY PROGRAMS REQUIREMENTS FOR PERMITS AND PERMIT PROCESSING § 773.11 Review of compliance history. (a... histories of compliance with the Act or the applicable State regulatory program, and any other applicable...

30 CFR 773.11 - Review of compliance history.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Review of compliance history. 773.11 Section... REGULATORY PROGRAMS REQUIREMENTS FOR PERMITS AND PERMIT PROCESSING § 773.11 Review of compliance history. (a... histories of compliance with the Act or the applicable State regulatory program, and any other applicable...

30 CFR 773.11 - Review of compliance history.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Review of compliance history. 773.11 Section... REGULATORY PROGRAMS REQUIREMENTS FOR PERMITS AND PERMIT PROCESSING § 773.11 Review of compliance history. (a... histories of compliance with the Act or the applicable State regulatory program, and any other applicable...

40 CFR 68.58 - Compliance audits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Compliance audits. 68.58 Section 68.58... ACCIDENT PREVENTION PROVISIONS Program 2 Prevention Program § 68.58 Compliance audits. (a) The owner or... are being followed. (b) The compliance audit shall be conducted by at least one person knowledgeable...

40 CFR 68.79 - Compliance audits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Compliance audits. 68.79 Section 68.79... ACCIDENT PREVENTION PROVISIONS Program 3 Prevention Program § 68.79 Compliance audits. (a) The owner or... are being followed. (b) The compliance audit shall be conducted by at least one person knowledgeable...

10 CFR 851.13 - Compliance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Compliance. 851.13 Section 851.13 Energy DEPARTMENT OF ENERGY WORKER SAFETY AND HEALTH PROGRAM Program Requirements § 851.13 Compliance. (a) Contractors must achieve compliance with all the requirements of Subpart C of this part, and their approved worker safety...

FMCSA safety program effectiveness measurement compliance review effectiveness model results for carriers with compliance reviews in fiscal year 2009 : [analysis brief].

DOT National Transportation Integrated Search

2014-04-01

This Analysis Brief documents the methodology and results from the Compliance Review Effectiveness Model (CREM) for carriers receiving CRs in fiscal year (FY) 2009. The model measures the effectiveness of the compliance review (CR) program, one of th...

10 CFR 851.13 - Compliance.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Compliance. 851.13 Section 851.13 Energy DEPARTMENT OF ENERGY WORKER SAFETY AND HEALTH PROGRAM Program Requirements § 851.13 Compliance. (a) Contractors must achieve compliance with all the requirements of Subpart C of this part, and their approved worker safety...

40 CFR 52.1175 - Compliance schedules.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 4 2011-07-01 2011-07-01 false Compliance schedules. 52.1175 Section...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Michigan § 52.1175 Compliance schedules. (a... Rule 336.49 of the Michigan Air Pollution Control Commission provides for individual compliance...

Utilizing Quality Improvement Methods to Improve Patient Care Outcomes in a Pediatric Residency Program

PubMed Central

Akins, Ralitsa B.; Handal, Gilbert A.

2009-01-01

Objective Although there is an expectation for outcomes-oriented training in residency programs, the reality is that few guidelines and examples exist as to how to provide this type of education and training. We aimed to improve patient care outcomes in our pediatric residency program by using quality improvement (QI) methods, tools, and approaches. Methods A series of QI projects were implemented over a 3-year period in a pediatric residency program to improve patient care outcomes and teach the residents how to use QI methods, tools, and approaches. Residents experienced practice-based learning and systems-based assessment through group projects and review of their own patient outcomes. Resident QI experiences were reviewed quarterly by the program director and were a mandatory part of resident training portfolios. Results Using QI methodology, we were able to improve management of children with obesity, to achieve high compliance with the national patient safety goals, improve the pediatric hotline service, and implement better patient flow in resident continuity clinic. Conclusion Based on our experiences, we conclude that to successfully implement QI projects in residency programs, QI techniques must be formally taught, the opportunities for resident participation must be multiple and diverse, and QI outcomes should be incorporated in resident training and assessment so that they experience the benefits of the QI intervention. The lessons learned from our experiences, as well as the projects we describe, can be easily deployed and implemented in other residency programs. PMID:21975995

Requirements, Verification, and Compliance (RVC) Database Tool

NASA Technical Reports Server (NTRS)

Rainwater, Neil E., II; McDuffee, Patrick B.; Thomas, L. Dale

2001-01-01

This paper describes the development, design, and implementation of the Requirements, Verification, and Compliance (RVC) database used on the International Space Welding Experiment (ISWE) project managed at Marshall Space Flight Center. The RVC is a systems engineer's tool for automating and managing the following information: requirements; requirements traceability; verification requirements; verification planning; verification success criteria; and compliance status. This information normally contained within documents (e.g. specifications, plans) is contained in an electronic database that allows the project team members to access, query, and status the requirements, verification, and compliance information from their individual desktop computers. Using commercial-off-the-shelf (COTS) database software that contains networking capabilities, the RVC was developed not only with cost savings in mind but primarily for the purpose of providing a more efficient and effective automated method of maintaining and distributing the systems engineering information. In addition, the RVC approach provides the systems engineer the capability to develop and tailor various reports containing the requirements, verification, and compliance information that meets the needs of the project team members. The automated approach of the RVC for capturing and distributing the information improves the productivity of the systems engineer by allowing that person to concentrate more on the job of developing good requirements and verification programs and not on the effort of being a "document developer".

Stethoscope disinfection campaign in a Nigerian teaching hospital:results of a before-and-after study.

PubMed

Uneke, Chigozie J; Ndukwe, Chinwendu D; Nwakpu, Kingsley O; Nnabu, Richard C; Ugwuoru, Cletus D; Prasopa-Plaizier, Nittita

2014-01-15

This study aimed to assess the impact of a stethoscope disinfection sensitization campaign among doctors and nurses in a Nigerian teaching hospital. The design was a before-and-after study. Pre-program measurements were used to provide a baseline against which the post-program results were compared. Interventions that promoted compliance with stethoscope disinfection practice that were implemented included training and education on stethoscope disinfection and introduction of 70% isopropyl alcohol disinfectant at points-of-care places. Microbiological assessment of stethoscopes used by health workers was conducted after the intervention and the outcome was compared with the pilot study results. After the intervention, of the 89 stethoscopes screened, 18 (20.2%) were contaminated with bacterial agents. A higher prevalence of stethoscope contamination was observed among stethoscopes from the intensive care unit (66.7%), the VIP unit (50%), and the antenatal unit (37.5%). The main isolates were Staphylococcus aureus (44.4%) and Escherichia coli (50%). The antibiotic sensitivity assessment indicated that the bacterial isolates were resistant to nearly all the antibiotics tested. All the 89 health workers whose stethoscopes were screened after the intervention admitted to cleaning their stethoscopes after seeing each patient, representing a compliance rate of 100%, unlike the 15% compliance at the pilot phase. The baseline stethoscope contamination rate was 78.5% versus 20.2% post-intervention. Training and education and introduction of alcohol-based disinfectants inexpensive but very effective methods to improve stethoscope disinfection compliance among health workers in low-income settings.

Medicare program; inpatient rehabilitation facility prospective payment system for federal fiscal year 2015.

PubMed

2014-08-06

This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2015 as required by the statute. This final rule finalizes a policy to collect data on the amount and mode (that is, Individual, Concurrent, Group, and Co-Treatment) of therapy provided in the IRF setting according to therapy discipline, revises the list of diagnosis and impairment group codes that presumptively meet the "60 percent rule'' compliance criteria, provides a way for IRFs to indicate on the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) form whether the prior treatment and severity requirements have been met for arthritis cases to presumptively meet the "60 percent rule'' compliance criteria, and revises and updates quality measures and reporting requirements under the IRF quality reporting program (QRP). This rule also delays the effective date for the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the "60 percent rule'' that were finalized in FY 2014 IRF PPS final rule and adopts the revisions to the list of diagnosis codes that are used to determine presumptive compliance under the "60 percent rule'' that are finalized in this rule. This final rule also addresses the implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), for the IRF prospective payment system (PPS), which will be effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF-PAI submissions.

76 FR 24761 - Energy Conservation Program: Certification, Compliance, and Enforcement for Consumer Products and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-02

... Conservation Program: Certification, Compliance, and Enforcement for Consumer Products and Commercial and...) Certification. Each manufacturer, before distributing in commerce any basic model of a covered product or.... EERE-2010-BT-CE-0014] RIN 1904-AC23 Energy Conservation Program: Certification, Compliance, and...

Waste Isolation Pilot Plant site environmental report, for calendar year 1995

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

The U.S. Department of Energy (DOE) Order 5400.1 General Environmental Protection Program, requires DOE facilities, that conduct environmental protection programs, to annually prepare a Site Environmental Report (SER). The purpose of the SER is to provide an abstract of environmental assessments conducted in order to characterize site environmental management performance, to confirm compliance with environmental standards and requirements, and to highlight significant programs and efforts of environmental merit. The content of this SER is not restricted to a synopsis of the required data, in addition, information pertaining to new and continued monitoring and compliance activities during the 1995 calendar yearmore » are also included. Data contained in this report are derived from those monitoring programs directed by the Waste Isolation Pilot Plant (WIPP) Environmental Monitoring Plan (EMP). The EMP provides inclusive guidelines implemented to detect potential impacts to the environment and to establish baseline measurements for future environmental evaluations. Surface water, groundwater. air, soil, and biotic matrices are monitored for an array of radiological and nonradiological factors. The baseline radiological surveillance program encompasses a broader geographic area that includes nearby ranches, villages, and cities. Most elements of nonradiological assessments are conducted within the geographic vicinity of the WIPP site.« less

40 CFR 52.1425 - Compliance schedules.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 4 2011-07-01 2011-07-01 false Compliance schedules. 52.1425 Section...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Nebraska § 52.1425 Compliance schedules. (a) The compliance schedules for the sources identified below are approved as revisions to the plan...

Effects of the Family Schizophrenia Psychoeducation Program for Individuals with Recent Onset Schizophrenia in Viet Nam

PubMed Central

Ngoc, T. N.; Weiss, B.; Trung, L. T.

2016-01-01

Objective Although psychoeducation has been found effective for improving the life functioning of patients with schizophrenia in high income countries, there have been relatively few studies of schizophrenia psychoeducation adapted for low and middle-income countries (LMIC), particularly in Southeast Asia. The present study assessed effects of the Family Schizophrenia Psychoeducation Program (FSPP) among Vietnamese patients and their families on the patients’ (1) quality of life and (2) medication non-compliance, and the family and patients’ (3) stigma towards schizophrenia, and (4) consumer satisfaction. Method This intervention study involved 59 patients, and their families, from the Da Nang Psychiatric Hospital, randomly assigned to treatment (n=30) or control (n=29) conditions. Control subjects received services as usual (antipsychotic medication); treatment group subjects received the FSPP as well. Blind-rater assessments were conducted at T1 immediately after project enrollment (prior to participating in the FSPP) and at T2 six months later. Results There were significant treatment effects on: (1) quality of life, (2) stigma, (3) medication compliance, and (4) consumer satisfaction, with all effects favoring the treatment group. Effect sizes were moderate to large. Conclusions This psychoeducation program appears to reduce stigma, improve quality of life and medication compliance, and increase consumer satisfaction of Vietnamese patients with schizophrenia and their families, beyond the effects of antipsychotic medication. It involves relatively little cost, and it may be useful for it or equivalent programs to be implemented in other hospitals in Viet Nam, and potentially other low-income Asian countries to improve the lives of patients with schizophrenia. PMID:27520922

Effects of the family schizophrenia psychoeducation program for individuals with recent onset schizophrenia in Viet Nam.

PubMed

Ngoc, T N; Weiss, B; Trung, L T

2016-08-01

Although psychoeducation has been found effective for improving the life functioning of patients with schizophrenia in high income countries, there have been relatively few studies of schizophrenia psychoeducation adapted for low and middle-income countries (LMIC), particularly in Southeast Asia. The present study assessed effects of the Family Schizophrenia Psychoeducation Program (FSPP) among Vietnamese patients and their families on the patients' (1) quality of life and (2) medication non-compliance, and the family and patients' (3) stigma towards schizophrenia, and (4) consumer satisfaction. This intervention study involved 59 patients, and their families, from the Da Nang Psychiatric Hospital, randomly assigned to treatment (n=30) or control (n=29) conditions. Control subjects received services as usual (antipsychotic medication); treatment group subjects received the FSPP as well. Blind-rater assessments were conducted at T1 immediately after project enrollment (prior to participating in the FSPP) and at T2 six months later. There were significant treatment effects on: (1) quality of life, (2) stigma, (3) medication compliance, and (4) consumer satisfaction, with all effects favoring the treatment group. Effect sizes were moderate to large. This psychoeducation program appears to reduce stigma, improve quality of life and medication compliance, and increase consumer satisfaction of Vietnamese patients with schizophrenia and their families, beyond the effects of antipsychotic medication. It involves relatively little cost, and it may be useful for it or equivalent programs to be implemented in other hospitals in Viet Nam, and potentially other low-income Asian countries to improve the lives of patients with schizophrenia. Copyright © 2016 Elsevier B.V. All rights reserved.

Waste Isolation Pilot Plant Site Environmental Report for 1998

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hooda, Balwan S.; Allen, Vivian L.

This 1998 annual Site Environmental Report (SER) was prepared in accordance with U.S. Department of Energy (DOE) Order 5400.1, ''General Environmental Protection Program''; DOE Order 231.1, ''Environmental Safety and Health Reporting''; the ''Environmental Regulatory Guide for Radiological Effluent Monitoring and Environmental Surveillance'' (DOE/EH-0173T); and the Environmental Protection Implementation Plan (DOE/WIPP 96-2199). The above orders and guidance documents require that DOE facilities submit an SER to DOE Headquarters, Office of the Assistant Secretary for Environment, Safety, and Health. The purpose of the SER is to provide a comprehensive description of operational environmental monitoring activities, an abstract of environmental activities conducted tomore » characterize site environmental management performance, to confirm compliance with environmental standards and requirements, and to highlight significant programs and efforts of environmental merit at WIPP during calendar year ( CY) 1998. The content of this SER is not restricted to a synopsis of the required data. Information pertaining to new and continued monitoring and compliance activities during CY 1998 are also included.« less

7 CFR Exhibit A to Subpart E of... - Civil Rights Compliance Reviews

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 12 2012-01-01 2012-01-01 false Civil Rights Compliance Reviews A Exhibit A to... OF AGRICULTURE PROGRAM REGULATIONS PROGRAM-RELATED INSTRUCTIONS Civil Rights Compliance Requirements Pt. 1901, Subpt. E, Exh. A Exhibit A to Subpart E of Part 1901—Civil Rights Compliance Reviews To...

7 CFR 1484.74 - How is Cooperator program compliance monitored?

Code of Federal Regulations, 2011 CFR

2011-01-01

... is Cooperator program compliance monitored? (a) The Compliance Review Staff (CRS), FAS, performs... pursuant to § 1550.20(a)(14), FAS will consider the Cooperator's overall marketing budget from year to year...

Evaluation of a continual compliance monitoring program for dapsone in an outpatient Hansen's disease clinic.

PubMed

Fischer, J H; West, D P; Worobec, S M

1986-12-01

Guidelines for the assessment of patient compliance to dapsone were developed and evaluated. The urinary dapsone-to-creatinine (D/C) ratio following standardization by dose, ideal body weight, and time since last dose was used for assessment of compliance. Compliance standards were established in 12 patients of known compliance and confirmed prospectively in nine inpatients on 14 occasions. Compliance increased significantly among outpatients (N = 30) attending the University of Illinois Hansen's Disease Clinic from 47% at base line to 73% at 6 months and 80% at 18 months after establishing the monitoring program. In a subgroup of 18 patients, a similar increase in compliance was observed from 50% to 80%. A good therapeutic response was seen in the subgroup patients who were compliant. A poor therapeutic response was seen in the consistently noncompliant patients. These results demonstrate that use of a continual compliance monitoring program can improve patient drug compliance in an outpatient Hansen's disease clinic.

40 CFR 52.1335 - Compliance schedules.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 4 2011-07-01 2011-07-01 false Compliance schedules. 52.1335 Section...) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Missouri § 52.1335 Compliance schedules. (a) The compliance schedule for the source identified below is approved as a revision to the plan pursuant...

40 CFR 80.1334 - What are the requirements for early compliance with the gasoline benzene program?

Code of Federal Regulations, 2011 CFR

2011-07-01

... compliance with the gasoline benzene program? 80.1334 Section 80.1334 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Benzene Hardship Provisions § 80.1334 What are the requirements for early compliance with the gasoline...

40 CFR 80.1334 - What are the requirements for early compliance with the gasoline benzene program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... compliance with the gasoline benzene program? 80.1334 Section 80.1334 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Benzene Hardship Provisions § 80.1334 What are the requirements for early compliance with the gasoline...

40 CFR 80.1334 - What are the requirements for early compliance with the gasoline benzene program?

Code of Federal Regulations, 2013 CFR

2013-07-01

... compliance with the gasoline benzene program? 80.1334 Section 80.1334 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Benzene Hardship Provisions § 80.1334 What are the requirements for early compliance with the gasoline...

40 CFR 80.1334 - What are the requirements for early compliance with the gasoline benzene program?

Code of Federal Regulations, 2012 CFR

2012-07-01

... compliance with the gasoline benzene program? 80.1334 Section 80.1334 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Benzene Hardship Provisions § 80.1334 What are the requirements for early compliance with the gasoline...

40 CFR 80.1334 - What are the requirements for early compliance with the gasoline benzene program?

Code of Federal Regulations, 2014 CFR

2014-07-01

... compliance with the gasoline benzene program? 80.1334 Section 80.1334 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Gasoline Benzene Hardship Provisions § 80.1334 What are the requirements for early compliance with the gasoline...

29 CFR 1608.5 - Affirmative action compliance programs under Executive Order No. 11246, as amended.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 4 2011-07-01 2011-07-01 false Affirmative action compliance programs under Executive... EMPLOYMENT OPPORTUNITY COMMISSION AFFIRMATIVE ACTION APPROPRIATE UNDER TITLE VII OF THE CIVIL RIGHTS ACT OF 1964, AS AMENDED § 1608.5 Affirmative action compliance programs under Executive Order No. 11246, as...

29 CFR 1608.5 - Affirmative action compliance programs under Executive Order No. 11246, as amended.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 4 2010-07-01 2010-07-01 false Affirmative action compliance programs under Executive... EMPLOYMENT OPPORTUNITY COMMISSION AFFIRMATIVE ACTION APPROPRIATE UNDER TITLE VII OF THE CIVIL RIGHTS ACT OF 1964, AS AMENDED § 1608.5 Affirmative action compliance programs under Executive Order No. 11246, as...

40 CFR 97.254 - Compliance with CAIR SO2 emissions limitation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Compliance with CAIR SO2 emissions... PROGRAMS (CONTINUED) FEDERAL NOX BUDGET TRADING PROGRAM AND CAIR NOX AND SO2 TRADING PROGRAMS CAIR SO2 Allowance Tracking System § 97.254 Compliance with CAIR SO2 emissions limitation. (a) Allowance transfer...

40 CFR 745.327 - State or Indian Tribal lead-based paint compliance and enforcement programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 30 2010-07-01 2010-07-01 false State or Indian Tribal lead-based paint compliance and enforcement programs. 745.327 Section 745.327 Protection of Environment... Tribal lead-based paint compliance and enforcement program must have the technological capability to...

40 CFR 745.327 - State or Indian Tribal lead-based paint compliance and enforcement programs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 31 2011-07-01 2011-07-01 false State or Indian Tribal lead-based paint compliance and enforcement programs. 745.327 Section 745.327 Protection of Environment... Tribal lead-based paint compliance and enforcement program must have the technological capability to...

Discharge planning for acute coronary syndrome patients in a tertiary hospital: a best practice implementation project.

PubMed

Lu, Minmin; Tang, Jun; Wu, Jianjin; Yang, Jie; Yu, Jiangyue

2015-08-14

Acute coronary syndromes threaten the lives of patients, and pose a high risk for morbidity and mortality despite advances in treatment. Evidence highlights that effective discharge planning is associated with long-term prognosis of patients. The aim of this project was to improve local practice in discharge planning for acute coronary syndrome patients in Huadong Hospital, Shanghai. Five criteria identified by the Joanna Briggs Institute were used to conduct an audit in the Cardiovascular Ward and Coronary Care Unit of Huadong Hospital, Shanghai. Forty-two nurses and 65 patients were involved. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in health practice were used to ascertain compliance with the criteria before and after the implementation of best practice. The program included three phases and was conducted over five months. The project showed that the compliance rates of in-house education, advice on lifestyle changes, education on discharge medication and left ventricular assessment reached 100%. Psychological screening also attained 97% compliance. There were improvements in the compliance rates of four criteria from 38% to 100%, excluding in-house education which was already 100% compliant. The project achieved significant improvements in establishing evidence-based practice of discharge planning for acute coronary syndrome patients in the Cardiovascular Ward and Coronary Care Unit. Strategies for sustaining best practice will continue to be developed in the future. The Joanna Briggs Institute.

A statewide nurse training program for a hospital based infant abusive head trauma prevention program.

PubMed

Nocera, Maryalice; Shanahan, Meghan; Murphy, Robert A; Sullivan, Kelly M; Barr, Marilyn; Price, Julie; Zolotor, Adam

2016-01-01

Successful implementation of universal patient education programs requires training large numbers of nursing staff in new content and procedures and maintaining fidelity to program standards. In preparation for statewide adoption of a hospital based universal education program, nursing staff at 85 hospitals and 1 birthing center in North Carolina received standardized training. This article describes the training program and reports findings from the process, outcome and impact evaluations of this training. Evaluation strategies were designed to query nurse satisfaction with training and course content; determine if training conveyed new information, and assess if nurses applied lessons from the training sessions to deliver the program as designed. Trainings were conducted during April 2008-February 2010. Evaluations were received from 4358 attendees. Information was obtained about training type, participants' perceptions of newness and usefulness of information and how the program compared to other education materials. Program fidelity data were collected using telephone surveys about compliance to delivery of teaching points and teaching behaviors. Results demonstrate high levels of satisfaction and perceptions of program utility as well as adherence to program model. These findings support the feasibility of implementing a universal patient education programs with strong uptake utilizing large scale systematic training programs. Copyright © 2015 Elsevier Ltd. All rights reserved.

23 CFR 230.401 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Purpose. 230.401 Section 230.401 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CIVIL RIGHTS EXTERNAL PROGRAMS Construction Contract... contract compliance program, including compliance reviews, consolidated compliance reviews, and the...

Foodservice employees benefit from interventions targeting barriers to food safety.

PubMed

York, Valerie K; Brannon, Laura A; Shanklin, Carol W; Roberts, Kevin R; Howells, Amber D; Barrett, Elizabeth B

2009-09-01

The number of foodborne illnesses traced to improper food handling in restaurants indicates a need for research to improve food safety in these establishments. Therefore, this 2-year longitudinal study investigated the effectiveness of traditional ServSafe (National Restaurant Association Educational Foundation, Chicago, IL) food-safety training and a Theory of Planned Behavior intervention program targeting employees' perceived barriers and attitudes toward important food-safety behaviors. The effectiveness of the training and intervention was measured by knowledge scores and observed behavioral compliance rates related to food-safety practices. Employees were observed for handwashing, thermometer usage, and proper handling of work surfaces at baseline, after receiving ServSafe training, and again after exposure to the intervention targeting barriers and negative attitudes about food-safety practices. Repeated-measures analyses of variance indicated training improved handwashing knowledge, but the intervention was necessary to improve overall behavioral compliance and handwashing compliance. Results suggest that registered dietitians; dietetic technicians, registered; and foodservice managers should implement a combination of training and intervention to improve knowledge and compliance with food-safety behaviors, rather than relying on training alone. Challenges encountered while conducting this research are discussed, and recommendations are provided for researchers interested in conducting this type of research in the future.

Internship - practical education

DOE Office of Scientific and Technical Information (OSTI.GOV)

Porell, A.L.; Bauman, H.F.

1989-01-01

The current emphasis on regulatory compliance with environmental laws has depleted the availability of experienced environmental scientists and engineers needed to initiate critical environmental projects. Further, projects of short duration and long-term commitments to employment situations are considered a high risk for both the employer and the employee. Martin Marietta Energy Systems, Inc., has met this challenge for federal agencies through the US Department of Energy's (DOE's) Hazardous Waste Remedial Actions Program (HAZWRAP). Through unique interdepartmental agency agreements between the DOE and the Department of Defense (DOD) and contractual arrangements between Energy Systems, DOE, and the University of Tennessee's (UT's)more » Waste Management Institute (WMI), an intern program was formulated. HAZWRAP is a DOE headquarters' program for addressing hazardous-waste issues at all DOE facilities. Energy Systems is the support contractor office responsible for developing policies and implementing plans for this program. Under this charter, HAZWRAP assembled a large staff of experienced project managers for developing remedial actions plans, while providing other federal agencies assistance in implementing their remedial actions programs. HAZWRAP project managers are currently managing remedial investigations and feasibility studies at 130 federal facilities located throughout the DOD.« less

NTS American Indian Religious Freedom Act Compliance Program complying with AIRFA: A literature review and evaluation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pippin, L.C.

The First Amendment to the United States Constitution guarantees the inherent right of all Americans to freedom of religion. However, since the religious practices of Native Americans are significantly different from those of the majority of Americans, their religious freedom has often restricted. Section 2 of the American Indian Religious Freedom Act (AIRFA) of 1978 (Public Law 95-341) directs federal agencies to consult with Native Americans to determine appropriate procedures to protect the inherent rights of Native Americans to believe, express, and exercise their traditional religions including, but not limited to access to sites, use and possession of sacred objects,more » and freedom to worship through ceremonials and traditional rites. The NTS AIRFA Compliance Program was initiated in October 1989 to assist DOE in expanding its compliance with AIRFA to incorporate all weapons testing activities on the NTS. It is directed at the development and implementation of a consultation plan designed to solicit, on behalf of DOE, Native American comments regarding the effects of the DOE's nuclear testing activities on historic properties of Native American origin and the expression and exercise of traditional Native American religions. The program has been developed around a phased approach that includes; (1) literature review and evaluation, (2) preparation of a baseline document, (3) preparation of a study design, (4) consultation with Native Americans, (5) preparation of a draft report, (6) Native American and State consultation and review, and (7) preparation of a final report.« less

NTS American Indian Religious Freedom Act Compliance Program complying with AIRFA: A literature review and evaluation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pippin, L.C.

The First Amendment to the United States Constitution guarantees the inherent right of all Americans to freedom of religion. However, since the religious practices of Native Americans are significantly different from those of the majority of Americans, their religious freedom has often restricted. Section 2 of the American Indian Religious Freedom Act (AIRFA) of 1978 (Public Law 95-341) directs federal agencies to consult with Native Americans to determine appropriate procedures to protect the inherent rights of Native Americans to believe, express, and exercise their traditional religions including, but not limited to access to sites, use and possession of sacred objects,more » and freedom to worship through ceremonials and traditional rites. The NTS AIRFA Compliance Program was initiated in October 1989 to assist DOE in expanding its compliance with AIRFA to incorporate all weapons testing activities on the NTS. It is directed at the development and implementation of a consultation plan designed to solicit, on behalf of DOE, Native American comments regarding the effects of the DOE`s nuclear testing activities on historic properties of Native American origin and the expression and exercise of traditional Native American religions. The program has been developed around a phased approach that includes; (1) literature review and evaluation, (2) preparation of a baseline document, (3) preparation of a study design, (4) consultation with Native Americans, (5) preparation of a draft report, (6) Native American and State consultation and review, and (7) preparation of a final report.« less

Harmonization of European laboratory response networks by implementing CWA 15793: use of a gap analysis and an "insider" exercise as tools.

PubMed

Sundqvist, Bo; Bengtsson, Ulrika Allard; Wisselink, Henk J; Peeters, Ben P H; van Rotterdam, Bart; Kampert, Evelien; Bereczky, Sándor; Johan Olsson, N G; Szekely Björndal, Asa; Zini, Sylvie; Allix, Sébastien; Knutsson, Rickard

2013-09-01

Laboratory response networks (LRNs) have been established for security reasons in several countries including the Netherlands, France, and Sweden. LRNs function in these countries as a preparedness measure for a coordinated diagnostic response capability in case of a bioterrorism incident or other biocrimes. Generally, these LRNs are organized on a national level. The EU project AniBioThreat has identified the need for an integrated European LRN to strengthen preparedness against animal bioterrorism. One task of the AniBioThreat project is to suggest a plan to implement laboratory biorisk management CWA 15793:2011 (CWA 15793), a management system built on the principle of continual improvement through the Plan-Do-Check-Act (PDCA) cycle. The implementation of CWA 15793 can facilitate trust and credibility in a future European LRN and is an assurance that the work done at the laboratories is performed in a structured way with continuous improvements. As a first step, a gap analysis was performed to establish the current compliance status of biosafety and laboratory biosecurity management with CWA 15793 in 5 AniBioThreat partner institutes in France (ANSES), the Netherlands (CVI and RIVM), and Sweden (SMI and SVA). All 5 partners are national and/or international laboratory reference institutes in the field of public or animal health and possess high-containment laboratories and animal facilities. The gap analysis showed that the participating institutes already have robust biorisk management programs in place, but several gaps were identified that need to be addressed. Despite differences between the participating institutes in their compliance status, these variations are not significant. Biorisk management exercises also have been identified as a useful tool to control compliance status and thereby implementation of CWA 15793. An exercise concerning an insider threat and loss of a biological agent was performed at SVA in the AniBioThreat project to evaluate implementation of the contingency plans and as an activity in the implementation process of CWA 15793. The outcome of the exercise was perceived as very useful, and improvements to enhance biorisk preparedness were identified. Gap analyses and exercises are important, useful activities to facilitate implementation of CWA 15793. The PDCA cycle will enforce a structured way to work, with continual improvements concerning biorisk management activities. Based on the activities in the AniBioThreat project, the following requirements are suggested to promote implementation: support from the top management of the organizations, knowledge about CWA 15793, a compliance audit checklist and gap analysis, training and exercises, networking in LRNs and other networks, and interinstitutional audits. Implementation of CWA 15793 at each institute would strengthen the European animal bioterrorism response capabilities by establishing a well-prepared LRN.

Design sensitivity analysis with Applicon IFAD using the adjoint variable method

NASA Technical Reports Server (NTRS)

Frederick, Marjorie C.; Choi, Kyung K.

1984-01-01

A numerical method is presented to implement structural design sensitivity analysis using the versatility and convenience of existing finite element structural analysis program and the theoretical foundation in structural design sensitivity analysis. Conventional design variables, such as thickness and cross-sectional areas, are considered. Structural performance functionals considered include compliance, displacement, and stress. It is shown that calculations can be carried out outside existing finite element codes, using postprocessing data only. That is, design sensitivity analysis software does not have to be imbedded in an existing finite element code. The finite element structural analysis program used in the implementation presented is IFAD. Feasibility of the method is shown through analysis of several problems, including built-up structures. Accurate design sensitivity results are obtained without the uncertainty of numerical accuracy associated with selection of a finite difference perturbation.

Evaluation of automated decisionmaking methodologies and development of an integrated robotic system simulation, appendix A

NASA Technical Reports Server (NTRS)

Haley, D. C.; Almand, B. J.; Thomas, M. M.; Krauze, L. D.; Gremban, K. D.; Sanborn, J. C.; Kelly, J. H.; Depkovich, T. M.

1984-01-01

A generic computer simulation for manipulator systems (ROBSIM) was implemented and the specific technologies necessary to increase the role of automation in various missions were developed. The specific items developed were: (1) Capability for definition of a manipulator system consisting of multiple arms, load objects, and an environment; (2) Capability for kinematic analysis, requirements analysis, and response simulation of manipulator motion; (3) Postprocessing options such as graphic replay of simulated motion and manipulator parameter plotting; (4) Investigation and simulation of various control methods including manual force/torque and active compliance control; (5) Evaluation and implementation of three obstacle avoidance methods; (6) Video simulation and edge detection; and (7) Software simulation validation. This appendix is the user's guide and includes examples of program runs and outputs as well as instructions for program use.

Implementing effective policy in a national mental health re-engagement program for Veterans

PubMed Central

Smith, Shawna N.; Lai, Zongshan; Almirall, Daniel; Goodrich, David E.; Abraham, Kristen M.; Nord, Kristina M.; Kilbourne, Amy M.

2016-01-01

Policy is a powerful motivator of clinical change, but implementation success can depend on organizational characteristics. This paper used validated measures of organizational resources, culture and climate to predict uptake of a nationwide VA policy aimed at implementing Re-Engage, a brief care management program that re-establishes contact with Veterans with serious mental illness lost to care. Patient care databases were used to identify 2,738 Veterans lost to care. Local Recovery Coordinators (LRCs) were to update disposition for 2,738 Veterans at 158 VA facilities and, as appropriate, facilitate a return to care. Multivariable regression assessed organizational culture and climate as predictors of early policy compliance (via LRC presence) and uptake at six months. Higher composite climate and culture scores were associated with higher odds of having a designated LRC, but were not predictive of higher uptake. Sites with LRCs had significantly higher rates of updated documentation than sites without LRCs. PMID:27668352

Implementation of project based learning on the Prakerin subject of vocational high school students of the building engineering to enhance employment skill readiness of graduates in the construction services field

NASA Astrophysics Data System (ADS)

Sugandi, Machmud

2017-09-01

Implementation of the Prakerin subject in the field of Building Engineering study program in vocational high school (VHS) are facing many issues associated to non-compliance unit of work in the industry and the expected competencies in learning at school. Project Based Learning (PBL) is an appropriate model learning used for Prakerin subject to increase student competence as the extension of the Prakerin implementation in the construction industry services. Assignments based on the selected project during their practical industry work were given to be completed by student. VHS students in particular field of Building Engineering study program who has been completed Prakerin subject will have a better job readiness, and therefore they will have an understanding on the knowledge, skills, and attitudes and good vision on the construction project in accordance with their experience during Prakerin work in the industry.

10 CFR 1040.102 - Compliance information.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Compliance information. 1040.102 Section 1040.102 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.102 Compliance information. (a) Cooperation and assistance. Each responsible...

10 CFR 1040.102 - Compliance information.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Compliance information. 1040.102 Section 1040.102 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.102 Compliance information. (a) Cooperation and assistance. Each responsible...

10 CFR 1040.102 - Compliance information.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Compliance information. 1040.102 Section 1040.102 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.102 Compliance information. (a) Cooperation and assistance. Each responsible...

10 CFR 1040.102 - Compliance information.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Compliance information. 1040.102 Section 1040.102 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION IN FEDERALLY ASSISTED PROGRAMS OR ACTIVITIES Program Monitoring § 1040.102 Compliance information. (a) Cooperation and assistance. Each responsible...

Evaluating the impact of Getting To Outcomes-Underage Drinking on prevention capacity and alcohol merchant attitudes and selling behaviors

PubMed Central

Chinman, Matthew; Ebener, Patricia; Burkhart, Q; Osilla, Karen Chan; Imm, Pamela; Paddock, Susan M.; Wright, Patricia Ann

2017-01-01

Underage drinking is a significant problem facing US communities. Several environmental alcohol prevention (EAP) strategies (laws, regulations, responsible beverage service training and practices) successfully address underage drinking. Communities, however, face challenges carrying out these EAP strategies effectively. This small-scale, three-year, randomized controlled trial assessed whether providing prevention coalitions with Getting To Outcomes-Underage Drinking (GTO-UD), a tool kit and implementation support intervention, helped improve implementation of two common EAP strategies, responsible beverage service training (RBS) and Compliance Checks. Three coalitions in South Carolina and their RBS and Compliance Check programs received the 16 month GTO-UD intervention, including the GTO-UD manual, training, and onsite technical assistance, while another three in South Carolina maintained routine operations. The measures, collected at baseline and after the intervention, were a structured interview assessing how well coalitions carried out their work and a survey of merchant attitudes and practices in the six counties served by the participating coalitions. Over time, the quality of some RBS and Compliance Check activities improved more in GTO-UD coalitions than in the control sites. No changes in merchant practices or attitudes significantly differed between the GTO-UD and control groups, although merchants in the GTO-UD counties did significantly improve on refusing sales to minors while control merchants did not. PMID:23564504

Impact of a multi-faceted training intervention on the improvement of hand hygiene and gloving practices in four healthcare settings including nursing homes, acute-care geriatric wards and physical rehabilitation units.

PubMed

Eveillard, Matthieu; Raymond, Françoise; Guilloteau, Véronique; Pradelle, Marie-Thérèse; Kempf, Marie; Zilli-Dewaele, Marina; Joly-Guillou, Marie-Laure; Brunel, Patrick

2011-10-01

To assess the impact of a multi-faceted training program on the compliance with hand hygiene and gloving practices. Hand hygiene is considered as the cornerstone of the prevention of hospital-acquired infections. Several studies have enhanced the poor effectiveness of training programs in improving hand hygiene compliance. A before-after evaluation study. The study was conducted in four healthcare settings before and after an intervention program which included the performance feedback of the first evaluation phase, three six-h training sessions, the assessment of hand hygiene performance with teaching boxes and the organisation of one full-day session devoted to institutional communication around hand hygiene in each setting. Hand hygiene compliance and quality of hand rubbing were evaluated. Hand hygiene opportunities were differentiated into extra-series opportunities (before or after a single contact and before the first contact or after the last contact of a series of consecutive contacts) and intra-series opportunities (from the opportunity following the first contact to the opportunity preceding the last in the same series). Overall, 969 contacts corresponding to 1,470 hand hygiene opportunities (760 during the first phase and 710 during the second) were observed. A significant improvement of observed practices was recorded for the hand hygiene compliance in intra-series opportunities (39·0% vs. 19·0%; p < 10(-5) ), the proportion of gloves worn if indicated (71·4% vs. 52·0%; p < 0·001) and the quality of hand rubbing (85·0% vs. 71·9%; p < 10(-5) ). Some of the performances measured for both hand hygiene and gloving practices were improved. We plan to extend this investigation by performing a qualitative study with experts in behavioural sciences to try improving practices for which adherence was still weak after the training program such as hand hygiene in intra-series opportunities. This study underscored the usefulness of implementing contextualised training programs, while more traditional courses have shown little impact. © 2011 Blackwell Publishing Ltd.

Implementation of an Educational Cartoon ("the Patchbook") and Other Compliance-Enhancing Measures by Orthoptists in Occlusion Treatment of Amblyopia.

PubMed

Tjiam, A M; Asjes-Tydeman, W L; Holtslag, G; Vukovic, E; Sinoo, M M; Loudon, S E; Passchier, J; de Koning, H J; Simonsz, H J

2016-09-01

This implementation study evaluated orthoptists' use of an educational cartoon ("the Patchbook") and other measures to improve compliance with occlusion therapy for amblyopia. Participating orthoptists provided standard orthoptic care for one year, adding the Patchbook in the second year. They attended courses on compliance and intercultural communication by communication skills training. Many other compliance-enhancing measures were initiated. Orthoptists' awareness, attitude, and activities regarding noncompliance were assessed through interviews, questionnaires, and observations. Their use of the Patchbook was measured. The study was performed in low socio-economic status (SES) areas and in other areas in the Netherlands. It was attempted to integrate education on compliance into basic and continuing orthoptic training. The Patchbook was used by all 9 orthoptists who participated in low-SES areas and 17 of 23 orthoptists in other areas. Courses changed awareness and attitude about compliance, but this was not sustained. Although orthoptists estimated compliance during patching at 70%, three-quarters never suspected noncompliance during a full day of observation in any of their patients. Explanations to parents who spoke Dutch poorly were short. In the second year, explanations to children were longer. Implementation of all 7 additional compliance-enhancing measures failed. Education on compliance was not integrated into orthoptists' training. Almost all orthoptists used the Patchbook and, as another study demonstrated, it proved to be very effective, especially in low-SES areas. Duration of explanation was inversely proportional to parents' fluency in Dutch. Noncompliance was rarely suspected by orthoptists. Although 7 additional compliance-enhancing measures had been conceived and planned with the best intentions, they were not realized. These required extra, unpaid time from the orthoptists, which is especially scarce in hospitals in low-SES areas where the educational cartoon is most needed.

24 CFR 266.520 - Program monitoring and compliance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.520 Program monitoring and compliance. HUD will monitor the...

24 CFR 266.520 - Program monitoring and compliance.

Code of Federal Regulations, 2012 CFR

2012-04-01

... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.520 Program monitoring and compliance. HUD will monitor the...

24 CFR 266.520 - Program monitoring and compliance.

Code of Federal Regulations, 2011 CFR

2011-04-01

... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.520 Program monitoring and compliance. HUD will monitor the...

24 CFR 266.520 - Program monitoring and compliance.

Code of Federal Regulations, 2013 CFR

2013-04-01

... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.520 Program monitoring and compliance. HUD will monitor the...

24 CFR 266.520 - Program monitoring and compliance.

Code of Federal Regulations, 2014 CFR

2014-04-01

... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.520 Program monitoring and compliance. HUD will monitor the...

7 CFR 773.9 - Environmental compliance.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 7 2014-01-01 2014-01-01 false Environmental compliance. 773.9 Section 773.9 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS SPECIAL APPLE LOAN PROGRAM § 773.9 Environmental compliance. (a) Except as...

7 CFR 773.9 - Environmental compliance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Environmental compliance. 773.9 Section 773.9 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS SPECIAL APPLE LOAN PROGRAM § 773.9 Environmental compliance. (a) Except as...

7 CFR 773.9 - Environmental compliance.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Environmental compliance. 773.9 Section 773.9 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS SPECIAL APPLE LOAN PROGRAM § 773.9 Environmental compliance. (a) Except as...

75 FR 4474 - Energy Conservation Program: Certification, Compliance, and Enforcement Requirements for Certain...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-28

... titled ``Certification, Compliance, and Enforcement Requirements for Certain Consumer Products and...-AA96 and 1904-AB53 Energy Conservation Program: Certification, Compliance, and Enforcement Requirements for Certain Consumer Products and Commercial and Industrial Equipment; Correction AGENCY: Office of...

45 CFR 164.534 - Compliance dates for initial implementation of the privacy standards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... privacy standards. 164.534 Section 164.534 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS SECURITY AND PRIVACY Privacy of Individually Identifiable Health Information § 164.534 Compliance dates for initial implementation of the privacy standards. (a...

45 CFR 164.534 - Compliance dates for initial implementation of the privacy standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... privacy standards. 164.534 Section 164.534 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS SECURITY AND PRIVACY Privacy of Individually Identifiable Health Information § 164.534 Compliance dates for initial implementation of the privacy standards. (a...

45 CFR 164.534 - Compliance dates for initial implementation of the privacy standards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... privacy standards. 164.534 Section 164.534 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS SECURITY AND PRIVACY Privacy of Individually Identifiable Health Information § 164.534 Compliance dates for initial implementation of the privacy standards. (a...

49 CFR Appendix B to Part 224 - Reflectorization Implementation Compliance Report

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Reflectorization Implementation Compliance Report B Appendix B to Part 224 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. B Appendix B to Part 224...

An Effective Health and Medical Technical Authority

NASA Technical Reports Server (NTRS)

Fogarty, Jennifer A.

2009-01-01

The NASA Governance model directed the formation of three Technical Authorities, Engineering; Safety and Mission Assurance; and Health and Medical, to ensure that risks are identified and adjudicated efficiently and transparently in concert with the spaceflight programs and projects. The Health and Medical Technical Authority (HMTA) has been implemented at the Johnson Space Center (JSC) and consists of the Chief Medical Office (CMO), the Deputy CMO, and HMTA Delegates. The JSC HMTA achieves the goals of risk identification and adjudication through the discharge of the appropriate technical expertise to human space flight programs and projects and the escalation of issues within program and technical authority boards. The JSC HMTA relies on subject matter experts (SMEs) in the Space Life Sciences Directorate at JSC as well as experts from other Centers to work crew health and performance issues at the technical level, develop requirements, oversee implementation and validation of requirements, and identify risks and non-compliances. Once a risk or potential noncompliance has been identified and reported to the programs or projects, the JSC HMTA begins to track it and closely monitor the program's or project's response. As a risk is developed or a non-compliance negotiated, positions from various levels of decision makers are sought at the program and project control boards. The HMTA may support a program or project position if it is satisfied with the decision making and vetting processes (ex. the subject matter expert voiced his/her concerns and all dissenting opinions were documented) and finds that the position both acknowledges the risk and cost of the mitigation and resolves the issue without changing NASA risk posture. The HMTA may disagree with a program or project position if the NASA risk posture has been elevated or obfuscated. If the HMTA does disagree with the program or project position, it will appeal to successively higher levels of authority so that risk acceptance and risk trades will be acknowledged and sanctioned at the highest appropriate level; this includes Program Managers, Mission Directorate Associate Administrators and the Agency Administrator.

75 FR 49029 - Medicare Program; End-Stage Renal Disease Prospective Payment System

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

...This final rule implements a case-mix adjusted bundled prospective payment system (PPS) for Medicare outpatient end-stage renal disease (ESRD) dialysis facilities beginning January 1, 2011 (ESRD PPS), in compliance with the statutory requirement of the Medicare Improvements for Patients and Providers Act (MIPPA), enacted July 15, 2008. This ESRD PPS also replaces the current basic case-mix adjusted composite payment system and the methodologies for the reimbursement of separately billable outpatient ESRD services.

Impact of an Antimicrobial Stewardship Care Bundle to Improve the Management of Patients with Suspected or Confirmed Urinary Tract Infection.

PubMed

Collins, Curtis D; Kabara, Jared J; Michienzi, Sarah M; Malani, Anurag N

2016-12-01

Implementation of an antimicrobial stewardship program bundle for urinary tract infections among 92 patients led to a higher rate of discontinuation of therapy for asymptomatic bacteriuria (52.4% vs 12.5%; P =.004), more appropriate durations of therapy (88.7% vs 63.6%; P =.001), and significantly higher overall bundle compliance (75% vs 38.2%; P < .001). Infect Control Hosp Epidemiol 2016;1499-1501.

Cost reduction with successful implementation of an antibiotic prophylaxis program in a private hospital in Ribeirão Preto, Brazil.

PubMed

Fonseca, S N; Melon Kunzle, S R; Barbosa Silva, S A; Schmidt, J G; Mele, R R

1999-01-01

To describe the implementation and results of a perioperative antibiotic prophylaxis (PAP) program. A protocol for correct use of PAP was implemented in December 1994. For selected months we measured the PAP protocol compliance of a random sample of clean and clean-contaminated procedures and calculated the cost of incorrect use of PAP. SELLING: A 180-bed general hospital in Ribeirão Preto, Brazil. The cost of unnecessary PAP in the obstetric and gynecologic, cardiothoracic, and orthopedic services dropped from $4,224.54 ($23.47/procedure) in November 1994 to $1,147.24 ($6.17/procedure, January 1995), $544.42 ($3.58/procedure, May 1995), $99.06 ($0.50/procedure, August 1995), and $30 ($0.12/procedure, March 1996). In November 1994, only 13.6% of all surgical procedures were done with correct use of PAP, compared to 59% in January 1995, 73% in August 1995, 78% in March 1996, 92% in November 1996, and 98% in May 1997. Incorrect PAP use wastes resources, which is a particular problem in developing countries. Our program is simple and can be implemented without the use of computers and now is being adopted in other hospitals in our region. We credit the success of our program to the commitment of all participants and to the strong support of the hospital directors.

Water Management Planning: A Case Study at Blue Grass Army Depot

DOE Office of Scientific and Technical Information (OSTI.GOV)

Solana, Amy E.; Mcmordie, Katherine

2006-04-03

Executive Order 13123, Greening the Government Through Efficient Energy Management, mandates an aggressive policy for reducing potable water consumption at federal facilities. Implementation guid¬ance from the U.S. Department of Energy (DOE) set a requirement for each federal agency to “reduce potable water usage by implementing life cycle, cost-effective water efficiency programs that include a water management plan, and not less than four Federal Energy Management Program (FEMP) Best Manage¬ment Practices (BMPs).” The objective of this plan is to gain full compliance with Executive Order 13123 and associated DOE implementation guidance on behalf of Blue Grass Army Depot (BGAD), Richmond, Kentucky.more » In accordance with this plan, BGAD must: • Incorporate the plan as a component of the Installation energy conservation plan • Investigate the water savings potential and life-cycle cost effectiveness of the Operations and Maintenance (O&M) and retrofit/replacement options associated with the ten FEMP BMPs • Put into practice all applicable O&M options • Identify retrofit/replacement options appropriate for implementation (based upon calculation of the simple payback periods) • Establish a schedule for implementation of applicable and cost-effective retrofit/replacement options.« less

Monitoring Compliance to Promote Quality Assurance: Development of a Mental Health Clinical Chart Audit Tool in Belize, 2013.

PubMed

Winer, Rachel A; Bennett, Eleanor; Murillo, Illouise; Schuetz-Mueller, Jan; Katz, Craig L

2015-09-01

Belize trained psychiatric nurse practitioners (PNPs) in the early 1990s to provide mental health services throughout the country. Despite overwhelming success, the program is limited by lack of monitoring, evaluation, and surveillance. To promote quality assurance, we developed a chart audit tool to monitor mental healthcare delivery compliance for initial psychiatric assessment notes completed by PNPs. After reviewing the Belize Health Information System electronic medical record system, we developed a clinical audit tool to capture 20 essential components for initial assessment clinical notes. The audit tool was then piloted for initial assessment notes completed during July through September of 2013. One hundred and thirty-four initial psychiatric interviews were audited. The average chart score among all PNPs was 9.57, ranging from 3 to 15. Twenty-three charts-or 17.2%-had a score of 14 or higher and met a 70% compliance benchmark goal. Among indicators most frequently omitted included labs ordered and named (15.7%) and psychiatric diagnosis (21.6%). Explicit statement of medications initiated with dose and frequency occurred in 47.0% of charts. Our findings provide direction for training and improvement, such as emphasizing the importance of naming labs ordered, medications and doses prescribed, and psychiatric diagnoses in initial assessment clinical notes. We hope this initial assessment helps enhance mental health delivery compliance by prompting creation of BHIS templates, development of audits tools for revisit follow-up visits, and establishment of corrective actions for low-scoring practitioners. These efforts may serve as a model for implementing quality assurance programming in other low resource settings.

Advance care planning for residents in aged care facilities: what is best practice and how can evidence-based guidelines be implemented?

PubMed

Lyon, Cheryl

2007-12-01

Background  Advance care planning in a residential care setting aims to assist residents to make decisions about future healthcare and to improve end-of-life care through medical and care staff knowing and respecting the wishes of the resident. The process enables individuals and others who are important to them, to reflect on what is important to the resident including their beliefs/values and preferences about care when they are dying. This paper describes a project conducted as part of the Joanna Briggs Institute Clinical Aged Care Fellowship Program implemented at the Manningham Centre in metropolitan Melbourne in a unit providing services for 46 low and high care residents. Objectives  The objectives of the study were to document implementation of best practice in advance care planning in a residential aged care facility using a cycle of audit, feedback and re-audit cycle audit with a clinical audit software program, the Practical Application of Clinical Evidence System. The evidence-based guidelines found in 'Guidelines for a Palliative Approach in Residential Aged Care' were used to inform the process of clinical practice review and to develop a program to implement advance care planning. Results  The pre-implementation audit results showed that advance care planning practice was not based on high level evidence as initial compliance with five audit criteria was 0%. The barriers to implementation that became apparent during the feedback stage included the challenge of creating a culture where advance care planning policy, protocols and guidelines could be implemented, and advance care planning discussions held, by adequately prepared health professionals and carers. Opportunities were made to equip the resident to discuss their wishes with family, friends and healthcare staff. Some residents made the decision to take steps to formally document those wishes and/or appoint a Medical Enduring Power of Attorney to act on behalf of the resident when they are unable to communicate wishes. The post-implementation audit showed a clear improvement as compliance ranged from 15-100% for the five audit criteria. Strong leadership by the project team was effective in engaging staff in this quality improvement program. Conclusion  The outcomes of the project were extremely positive and demonstrate a genuine improvement in practice. All audit criteria indicate that the Manningham Centre is now positively working towards improved practice based on the best available evidence. It is hoped that as the expertise developed during this project is shared, other areas of gerontological practice will be similarly improved and more facilities caring for the older person will embrace evidence-based practice.

40 CFR 76.13 - Compliance and excess emissions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 16 2011-07-01 2011-07-01 false Compliance and excess emissions. 76.13 Section 76.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) ACID RAIN NITROGEN OXIDES EMISSION REDUCTION PROGRAM § 76.13 Compliance and excess emissions...

40 CFR 76.13 - Compliance and excess emissions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Compliance and excess emissions. 76.13 Section 76.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) ACID RAIN NITROGEN OXIDES EMISSION REDUCTION PROGRAM § 76.13 Compliance and excess emissions...

40 CFR 76.13 - Compliance and excess emissions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Compliance and excess emissions. 76.13 Section 76.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) ACID RAIN NITROGEN OXIDES EMISSION REDUCTION PROGRAM § 76.13 Compliance and excess emissions...

40 CFR 76.13 - Compliance and excess emissions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 17 2013-07-01 2013-07-01 false Compliance and excess emissions. 76.13 Section 76.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) ACID RAIN NITROGEN OXIDES EMISSION REDUCTION PROGRAM § 76.13 Compliance and excess emissions...

40 CFR 76.13 - Compliance and excess emissions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 17 2014-07-01 2014-07-01 false Compliance and excess emissions. 76.13 Section 76.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) ACID RAIN NITROGEN OXIDES EMISSION REDUCTION PROGRAM § 76.13 Compliance and excess emissions...

Improving resident engagement in quality improvement and patient safety initiatives at the bedside: the Advocate for Clinical Education (ACE).

PubMed

Schleyer, Anneliese M; Best, Jennifer A; McIntyre, Lisa K; Ehrmantraut, Ross; Calver, Patty; Goss, J Richard

2013-01-01

Quality improvement (QI) and patient safety (PS) are essential competencies in residency training; however, the most effective means to engage physicians remains unclear. The authors surveyed all medicine and surgery physicians at their institution to describe QI/PS practices and concurrently implemented the Advocate for Clinical Education (ACE) program to determine if a physician-centered program in the context of educational structures and at the point of care improved performance. The ACE rounded with medicine and surgery teams and provided individual and team-level education and feedback targeting 4 domains: professionalism, infection control, interpreter use, and pain assessment. In a pilot, the ACE observed 2862 physician-patient interactions and 178 physicians. Self-reported compliance often was greater than the behaviors observed. Following ACE implementation, observed professionalism behaviors trended toward improvement; infection control also improved. Physicians were highly satisfied with the program. The ACE initiative is one coaching/feedback model for engaging residents in QI/PS that may warrant further study.

Impact of Educational Program on the Management of Chronic Suppurative Otitis Media among Children.

PubMed

Elsayed Yousef, Yousseria; Abo El-Magd, Essam A; El-Asheer, Osama M; Kotb, Safaa

2015-01-01

Background. Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide, affecting diverse racial and cultural groups in both developing and industrialized countries. Aim of the Study. This study aimed to assess the impact of educational program on the management of children with CSOM. Subjects and Methods. An experimental study design was used. This study included 100 children of both sexes of 2 years and less of age with CSOM. Those children were divided into 3 groups: group I: it involved 50 children with CSOM (naive) who received the designed educational program; control group: it involved 50 children who were under the traditional treatment and failed to respond; group II: those children in the control group were given the educational program and followed up in the same way as group I and considered as group II. Tools of the Study. Tool I is a structured questionnaire interview sheet for mothers. It consists of four parts: (1) personal and sociodemographic characteristics of child and (2) data about risk factors of otitis media (3) assessment of maternal practice about care of children with suppurative otitis medi (4) diagnostic criteria for suppurative otitis media. Tool II is the educational program: an educational program was developed by the researchers based on the knowledge and practices needs. This study was carried out through a period of 9 months starting from September 2013 to May 2014. The educational program was implemented for mothers of children with CSOM in the form of 5 scheduled sessions at the time of diagnosis, after one week, 1, 3, and 6 months. Results. There were significant differences between children who received the educational program and control group regarding the response to treatment after one and 3 months. The percentages of complete cure increased progressively 32%, 60%, and 84% after 1, 3, and 6 months in group I while they were 24%, 44%, and 64% in group II, respectively. Cure (dry perforation) was 64%, 36%, and 12% among children of group I after 1, 3, and 6 months while it was 64%, 44%, and 24% in group II, respectively. The percentages of compliance to the educational program improved with time in both groups: 44%, 64%, and 80% in group I and 32%, 48%, and 56% in group II after 1, 3, and 6 months, respectively. The percentages of cure were statistically significantly higher among children with complete compliance with the educational program in both groups in comparison to those with incomplete compliance (P = 0.000 for both). Conclusions. From this study we can conclude that the majority of children with CSOM had one or more risk factors for occurrence of the disease; the educational program is effective for management of CSOM (whether cure or complete cure); the higher the compliance of mothers with the program the higher the response rate; regular followup and explanation of the importance of the program played an important role in the compliance with the program.

The "TRAUMA LIFE" initiative: The impact of a multidisciplinary checklist process on outcomes and communication in a Trauma Intensive Care Unit.

PubMed

Joseph, Kimberly; Gupta, Sameer; Yon, James; Partida, Renee; Cartagena, Lee; Kubasiak, John; Buie, Vanessa; Miller, Jared; Wiley, Dorion; Nagy, Kimberly; Starr, Frederic; Dennis, Andrew; Kaminsky, Matthew; Bokhari, Faran

2018-03-09

Checklists have been advocated to improve quality outcomes/communication in the critical care setting, but results have been mixed. A new checklist process, "TRAUMA LIFE", was implemented in our Trauma Intensive Care Unit (TICU) to replace prior checklists. The purpose of this study was to evaluate the impact of the "TRAUMA LIFE" process implementation on quality metrics and on patient/family communication in the TICU. "TRAUMA LIFE" was considered maturely implemented by 2016. Multiple quality metrics, including restraint order compliance, were compared between 2013 and 2016 (pre- and post-implementation). Compliance with the "Family Message" (FM), a part of the "TRAUMA LIFE" communication process, was analyzed in 2016. Improvement was seen in CAUTI, VAE, and IUCU; CLABSI rates increased. Restraint order compliance increased significantly. FM delivery compliance was inconsistent; improvement was noted in concordance between update content and FM documented in Electronic Medical Record. Implementation of "TRAUMA LIFE" was well integrated into the rounding process and was associated with some improvement in quality metrics and communication. Additional evaluation is required to assess sustainability. Copyright © 2018 Elsevier Inc. All rights reserved.

Quality consciousness...auditing for HIPAA Privacy Compliance.

PubMed

LePar, Kathleen

2004-01-01

The Health Insurance Portability and Accountability Act (HIPAA) privacy deadline has passed. Now it is essential to comply with the regulations. The stakes are high; therefore, a HIPAA Privacy Compliance Program must be part of an organization's quality initiatives. This article provides guidelines for the challenges of continual program improvement, successful cultural change, and effective monitoring of the existing program. Healthcare organizations will attain compliance goals through internal audits on the processes, policies, and training efforts of their HIPAA program.

Convention on the rights of persons with disabilities, assistive technology and information and communication technology requirements: where do we stand on implementation?

PubMed

Gould, Martin; Leblois, Axel; Cesa Bianchi, Francesca; Montenegro, Viviana

2015-07-01

This article presents 2013 data from a survey provided by G3ict and Disabled Peoples International (DPI). The Progress Report identifies the degree that each of the CRPD dispositions on ATs and ICTs accessibility are enacted in local laws, policies and regulations and their impacts. The initial methodology used to develop the survey involved several steps. First, a systematic review of CRPD AT and ICT technology requirements was conducted. Second, 57 variables were identified. Third, variables were grouped into three clusters representing countries': (a) legal, regulatory and programmatic commitments; (b) capacity to implement; and (c) actual implementation results. Surveys were completed by experts in a total of 74 countries. With respect to select CRPD AT and ICT dispositions, respondent countries report an: (a) average degree of compliance within their general legal and regulatory framework at 66%; (b) average 29% of the capacity to implement; and (c) average degree of implementation and impact of 42%. Implications for Rehabilitation Survey results reflect low levels of ratifying countries implementation of laws, policies or programs that promote awareness-raising and training programs about the CRPD and its AT and ICT technology requirements. Implication 1: CRPD ratifying countries need to promote disability-inclusive AT and ICT policies and programs identified as priority areas by key stakeholders Implication 2: Government leaders and key policymakers need to address gaps in capacity building such as professional training of professionals in the areas of AT and ICT accessibility and programming through disability-inclusive cooperative development practices.

Effective health care corporate compliance.

PubMed

Saum, T B; Byassee, J

2000-01-01

The pace and intensity of oversight and investigation of health care organizations has greatly increased at all levels. Well run organizations with ethical management committed to following all laws and regulations are still at risk for compliance violations and punitive penalties. Under the Federal Sentencing Guidelines, organizations with an "effective" corporate compliance program may receive reduced penalties. The seven components of an effective program as defined in the guidelines are: (1) Standards and procedures; (2) oversight responsibilities; (3) employee training; (4) monitoring and auditing; (5) reporting systems; (6) enforcement and discipline; and (7) response and prevention. Lack of a compliance program needlessly exposes the organization to an avoidable risk of damage from non-compliance--whether intentional or not. Moreover, an effective program can contribute to the efficient operation of the organization and be a key piece of its corporate culture.

National School Lunch Program and School Breakfast Program: Nutrition Standards for All Foods Sold in School as Required by the Healthy, Hunger-Free Kids Act of 2010. Final rule and interim final rule.

PubMed

2016-07-29

This rule adopts as final, with some modifications, the National School Lunch Program and School Breakfast Program regulations set forth in the interim final rule published in the Federal Register on June 28, 2013. The requirements addressed in this rule conform to the provisions in the Healthy, Hunger-Free Kids Act of 2010 regarding nutrition standards for all foods sold in schools, other than food sold under the lunch and breakfast programs. Most provisions of this final rule were implemented on July 1, 2014, a full year subsequent to publication of the interim final rule. This was in compliance with section 208 of the Healthy, Hunger-Free Kids Act of 2010, which required that State and local educational agencies have at least one full school year from the date of publication of the interim final rule to implement the competitive food provisions. Based on comments received on the interim final rule and implementation experience, this final rule makes a few modifications to the nutrition standards for all foods sold in schools implemented on July 1, 2014. In addition, this final rule codifies specific policy guidance issued after publication of the interim rule. Finally, this rule retains the provision related to the standard for total fat as interim and requests further comment on this single standard.

Implementation of a Goal-Directed Mechanical Ventilation Order Set Driven by Respiratory Therapists Improves Compliance With Best Practices for Mechanical Ventilation.

PubMed

Radosevich, Misty A; Wanta, Brendan T; Meyer, Todd J; Weber, Verlin W; Brown, Daniel R; Smischney, Nathan J; Diedrich, Daniel A

2017-01-01

Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice. We evaluated 1302 patients undergoing invasive mechanical ventilation (1693 separate episodes of invasive mechanical ventilation) prior to and after institution of a standardized, goal-directed mechanical ventilation order set using a controlled before-and-after study design. Patient-specific goals for oxygenation partial pressure of oxygen in arterial blood (Pao 2 ), ARDS Network [Net] positive end-expiratory pressure [PEEP]/fraction of inspired oxygen [Fio 2 ] table use) and ventilation (pH, partial pressure of carbon dioxide) were selected by prescribers and implemented by RTs. Compliance with the new mechanical ventilation order set was high: 88.2% compliance versus 3.8% before implementation of the order set ( P < .001). Adherence to the PEEP/Fio 2 table after implementation of the order set was significantly greater (86.0% after vs 82.9% before, P = .02). There was no difference in duration of mechanical ventilation, intensive care unit (ICU) length of stay, and in-hospital or ICU mortality. A standardized best practice mechanical ventilation order set can be implemented by a multidisciplinary team and is associated with improved compliance to written orders and adherence to the ARDSNet PEEP/Fio 2 table.

Developing and Implementing a Quality Assurance Strategy for Electroconvulsive Therapy.

PubMed

Hollingsworth, Jessa; Baliko, Beverly; McKinney, Selina; Rosenquist, Peter

2018-04-17

The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care; however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT. The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy. An audit tool was developed utilizing quality criteria derived from a systematic review of ECT practice guidelines, peer review, and facility policy. All ECT procedures occurring over a 2-month period of May to June 2017 were retrospectively audited and compared against target compliance rates set for the facility's ECT program. Facility policy was adapted to reflect quality standards, and audit findings were used to inform possible practice change initiatives, were used to create benchmarks for continuous quality monitoring, and were integrated into regular hospital quality meetings. Clarification on standards of care and the use of clinical auditing in ECT was an effective starting point in the development of a quality assurance strategy. Audit findings were successfully integrated into the hospital's overall quality program, and recognition of practice compliance informed areas for future quality development and policy revision in this small community-based hospital in the southeastern United States. This project sets the foundation for a quality assurance strategy that can be used to help monitor procedural safety and guide future improvement efforts in delivering ECT. Although it is just the first step in creating meaningful quality improvement, setting clear standards and identifying areas of greatest clinical need were crucial beginning for this hospital's growing program.

Determinants of success and sustainability of the WHO multimodal hand hygiene promotion campaign, Italy, 2007–2008 and 2014

PubMed Central

Moro, Maria Luisa; Morsillo, Filomena; Nascetti, Simona; Parenti, Mita; Allegranzi, Benedetta; Pompa, Maria Grazia; Pittet, Didier

2017-01-01

A national hand hygiene promotion campaign based on the World Health Organization (WHO) multimodal, Clean Care is Safer Care campaign was launched in Italy in 2007. One hundred seventy-five hospitals from 14 of 20 Italian regions participated. Data were collected using methods and tools provided by the WHO campaign, translated into Italian. Hand hygiene compliance, ward infrastructure, and healthcare workers’ knowledge and perception of healthcare-associated infections and hand hygiene were evaluated before and after campaign implementation. Compliance data from the 65 hospitals returning complete data for all implementation tools were analysed using a multilevel approach. Overall, hand hygiene compliance increased in the 65 hospitals from 40% to 63% (absolute increase: 23%, 95% confidence interval: 22–24%). A wide variation in hand hygiene compliance among wards was observed; inter-ward variability significantly decreased after campaign implementation and the level of perception was the only item associated with this. Long-term sustainability in 48 of these 65 hospitals was assessed in 2014 using the WHO Hand Hygiene Self-Assessment Framework tool. Of the 48 hospitals, 44 scored in the advanced/intermediate categories of hand hygiene implementation progress. The median hand hygiene compliance achieved at the end of the 2007–2008 campaign appeared to be sustained in 2014. PMID:28661390

Exploring implementation of the 2010 Institute of Medicine’s Child and Adult Food Care Program recommendations for after-school snacks

PubMed Central

Nanney, Marilyn S; Glatt, Carissa

2012-01-01

Objective The aim of the present study was to explore the implementation of nutrition recommendations made in the 2010 Institute of Medicine (IOM) report, Child and Adult Care Food Program: Aligning Dietary Guidance for All, in school-based after-school snack programmes. Design A descriptive study. Setting One large suburban school district in Minneapolis, Minnesota, USA. Subjects None. Results Major challenges to implementation included limited access to product labelling and specifications inconsistent with the IOM’s Child and Adult Care Food Program (CACFP) recommendations, limited access to healthier foods due to current school district buying consortium agreement, and increased costs of wholegrain and lower-sodium foods and pre-packaged fruits and vegetables. Conclusions Opportunities for government and industry policy development and partnerships to support schools in their efforts to promote healthy after-school food environments remain. Several federal, state and industry leadership opportunities are proposed: provide product labelling that makes identifying snacks which comply with the 2010 IOM CACFP recommended standards easy; encourage compliance with recommendations by providing incentives to programmes; prioritize the implementation of paperwork and technology that simplifies enrolment and accountability systems; and provide support for food safety training and/or certification for non-food service personnel. PMID:22050891

Implementation of a real-time compliance dashboard to help reduce SICU ventilator-associated pneumonia with the ventilator bundle.

PubMed

Zaydfudim, Victor; Dossett, Lesly A; Starmer, John M; Arbogast, Patrick G; Feurer, Irene D; Ray, Wayne A; May, Addison K; Pinson, C Wright

2009-07-01

Ventilator-associated pneumonia (VAP) causes significant morbidity and mortality in critically ill surgical patients. Recent studies suggest that the success of preventive measures is dependent on compliance with ventilator bundle parameters. Implementation of an electronic dashboard will improve compliance with the bundle parameters and reduce rates of VAP in our surgical intensive care unit (SICU). Time series analysis of VAP rates between January 2005 and July 2008, with dashboard implementation in July 2007. Multidisciplinary SICU at a tertiary-care referral center with a stable case mix during the study period. Patients admitted to the SICU between January 2005 and July 2008. Infection control data were used to establish rates of VAP and total ventilator days. For the time series analysis, VAP rates were calculated as quarterly VAP events per 1000 ventilator days. Ventilator bundle compliance was analyzed after dashboard implementation. Differences between expected and observed VAP rates based on time series analysis were used to estimate the effect of intervention. Average compliance with the ventilator bundle improved from 39% in August 2007 to 89% in July 2008 (P < .001). Rates of VAP decreased from a mean (SD) of 15.2 (7.0) to 9.3 (4.9) events per 1000 ventilator days after introduction of the dashboard (P = .01). Quarterly VAP rates were significantly reduced in the November 2007 through January 2008 and February through April 2008 periods (P < .05). For the August through October 2007 and May through July 2008 quarters, the observed rate reduction was not statistically significant. Implementation of an electronic dashboard improved compliance with ventilator bundle measures and is associated with reduced rates of VAP in our SICU.

The Feedback Intervention Trial (FIT) — Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial

PubMed Central

Fuller, Christopher; Michie, Susan; Savage, Joanne; McAteer, John; Besser, Sarah; Charlett, Andre; Hayward, Andrew; Cookson, Barry D.; Cooper, Ben S.; Duckworth, Georgia; Jeanes, Annette; Roberts, Jenny; Teare, Louise; Stone, Sheldon

2012-01-01

Introduction Achieving a sustained improvement in hand-hygiene compliance is the WHO’s first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness. Methods Three year stepped wedge cluster RCT of a feedback intervention testing hypothesis that the intervention was more effective than routine practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU]; 44 Acute Care of the Elderly [ACE] wards) routinely implementing a national cleanyourhands campaign). Intervention-based on Goal & Control theories. Repeating 4 week cycle (20 mins/week) of observation, feedback and personalised action planning, recorded on forms. Computer-generated stepwise entry of all hospitals to intervention. Hospitals aware only of own allocation. Primary outcome: direct blinded hand hygiene compliance (%). Results All 16 trusts (60 wards) randomised, 33 wards implemented intervention (11 ITU, 22 ACE). Mixed effects regression analysis (all wards) accounting for confounders, temporal trends, ward type and fidelity to intervention (forms/month used). Intention to Treat Analysis Estimated odds ratio (OR) for hand hygiene compliance rose post randomisation (1.44; 95% CI 1.18, 1.76;p<0.001) in ITUs but not ACE wards, equivalent to 7–9% absolute increase in compliance. Per-Protocol Analysis for Implementing Wards OR for compliance rose for both ACE (1.67 [1.28–2.22]; p<0.001) & ITUs (2.09 [1.55–2.81];p<0.001) equating to absolute increases of 10–13% and 13–18% respectively. Fidelity to intervention closely related to compliance on ITUs (OR 1.12 [1.04, 1.20];p = 0.003 per completed form) but not ACE wards. Conclusion Despite difficulties in implementation, intention-to-treat, per-protocol and fidelity to intervention, analyses showed an intervention coupling feedback to personalised action planning produced moderate but significant sustained improvements in hand-hygiene compliance, in wards implementing a national hand-hygiene campaign. Further implementation studies are needed to maximise the intervention’s effect in different settings. Trial Registration Controlled-Trials.com ISRCTN65246961 PMID:23110040

45 CFR 164.318 - Compliance dates for the initial implementation of the security standards.

Code of Federal Regulations, 2013 CFR

2013-10-01

... of Electronic Protected Health Information § 164.318 Compliance dates for the initial implementation of the security standards. (a) Health plan. (1) A health plan that is not a small health plan must... the security standards. 164.318 Section 164.318 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES...

45 CFR 164.318 - Compliance dates for the initial implementation of the security standards.

Code of Federal Regulations, 2012 CFR

2012-10-01

... of Electronic Protected Health Information § 164.318 Compliance dates for the initial implementation of the security standards. (a) Health plan. (1) A health plan that is not a small health plan must... the security standards. 164.318 Section 164.318 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES...

49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations... REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. C Appendix C to Part 224—Guidelines for Electronic...

45 CFR 164.318 - Compliance dates for the initial implementation of the security standards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Compliance dates for the initial implementation of the security standards. 164.318 Section 164.318 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS SECURITY AND PRIVACY Security Standards for the Protection...

45 CFR 164.318 - Compliance dates for the initial implementation of the security standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Compliance dates for the initial implementation of the security standards. 164.318 Section 164.318 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS SECURITY AND PRIVACY Security Standards for the Protection...

Examining the Extent of Environmental Compliance Requirements on Mechatronic Products and Their Implementation through Product Lifecycle Management

ERIC Educational Resources Information Center

Jovanovic, Vukica

2010-01-01

The present mixed-methods study examined the opinions of industry practitioners related to the implementation of environmental compliance requirements into design and manufacturing processes of mechatronic and electromechanical products. It focused on the environmental standards for mechatronic and electromechanical products and how Product…

49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations... REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. C Appendix C to Part 224—Guidelines for Electronic...

49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations... REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. C Appendix C to Part 224—Guidelines for Electronic...

49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD ADMINISTRATION, DEPARTMENT OF TRANSPORTATION REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt...

49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations... REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. C Appendix C to Part 224—Guidelines for Electronic...

28 CFR 42.723 - Compliance information.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Compliance information. 42.723 Section 42.723 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT OPPORTUNITY...; Implementation of the Age Discrimination Act of 1975 Duties of Recipients § 42.723 Compliance information. (a...

48 CFR 1852.234-2 - Earned Value Management System.

Code of Federal Regulations, 2013 CFR

2013-10-01

... compliance/validation. The Contractor shall follow and implement the approved compliance/validation plan in a... process. (f) The Contractor shall be responsible for ensuring that its subcontractors, identified below... compliance/validation. (Contracting Officer to insert names of subcontractors or subcontracted effort.) (g...

48 CFR 1852.234-2 - Earned Value Management System.

Code of Federal Regulations, 2012 CFR

2012-10-01

... compliance/validation. The Contractor shall follow and implement the approved compliance/validation plan in a... process. (f) The Contractor shall be responsible for ensuring that its subcontractors, identified below... compliance/validation. (Contracting Officer to insert names of subcontractors or subcontracted effort.) (g...

48 CFR 1852.234-2 - Earned Value Management System.

Code of Federal Regulations, 2014 CFR

2014-10-01

... compliance/validation. The Contractor shall follow and implement the approved compliance/validation plan in a... process. (f) The Contractor shall be responsible for ensuring that its subcontractors, identified below... compliance/validation. (Contracting Officer to insert names of subcontractors or subcontracted effort.) (g...

Lessons from an evaluation of a provincial-level smoking control policy in Shanghai, China.

PubMed

Li, Xiang; Gao, Junling; Zhang, Zhixing; Wei, Minqi; Zheng, Pinpin; Nehl, Eric J; Wong, Frank Y; Berg, Carla J

2013-01-01

The Shanghai Public Places Smoking Control Legislation was implemented in March 2010 as the first provincial-level legislation promoting smoke-free public places in China. To evaluate the compliance with this policy as well as its impact on exposure to secondhand smoke (SHS), respiratory symptoms, and related attitudes among employees in five kinds of workplaces (schools, kindergartens, hospitals, hotels, and shopping malls). A cross-sectional survey was conducted six months before and then six months after the policy was implemented. Five types of occupational employees from 52 work settings were surveyed anonymously using multistage stratified cluster sampling. Six months after implementation, 82% of the participants agreed that "legislation is enforced most of the time". The percentage of self-reported exposure to secondhand smoke declined from round up to 49% to 36%. High compliance rates were achieved in schools and kindergartens (above 90%), with less compliance in hotels and shopping malls (about 70%). Accordingly, prevalence of exposure to SHS was low in schools and kindergartens (less than 10%) and high in hotels and shopping malls (40% and above). The prevalence of respiratory and sensory symptoms (e.g., red or irritated eyes) among employees decreased from 83% to 67%. Initial positive effects were achieved after the implementation of Shanghai Smoking Control legislation including decreased exposure to SHS. However, compliance with the policies was a considerable problem in some settings. Further evaluation of such policy implementation should be conducted to inform strategies for increasing compliance in the future.

Waiver Culture: The Unintended Consequence of Ethics Compliance

ERIC Educational Resources Information Center

Genova, Gina L.

2008-01-01

The passage of the U.S. Sarbanes-Oxley Act (2002) spawned a series of compliance and ethics programs --the revised Principles of Federal Prosecution of Business Organizations known as the Thompson Memo (Thompson, 2003), the revised Federal Sentencing Guidelines that included the Effective Compliance and Ethics Program and the corporate…

Task force on compliance and enforcement. Final report. Volume 2

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1978-03-01

Recommendations for measures to strengthen the FEA enforcement program in the area of petroleum price regulation are presented. Results of task force efforts are presented in report and recommendations sections concerned with pending cases, compliance program organization, enforcement powers, compliance strategy, and audit staffing and techniques. (JRD)

78 FR 62488 - Energy Conservation Program: Compliance Date for the Dehumidifier Test Procedure

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-22

... Conservation Program: Compliance Date for the Dehumidifier Test Procedure AGENCY: Office of Energy Efficiency.... Department of Energy (DOE) proposes to revise the compliance date for the dehumidifier test procedures... manufacturers to test using only the active mode provisions in the test procedure for dehumidifiers currently...

76 FR 5415 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Order Approving...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-31

... Rule Change Regarding Rule 4.20--Anti-Money Laundering Compliance Program January 25, 2011. I... Rule 4.20, Anti-Money Laundering Compliance Program, to require all Trading Permit Holders or TPH... or TPH organization's existence to ensure anti-money laundering compliance is in place and...

40 CFR 72.90 - Annual compliance certification report.

Code of Federal Regulations, 2014 CFR

2014-07-01

... is subject to the Acid Rain emissions limitations, the designated representative of the source at... the source and the affected units at the source in compliance with the Acid Rain Program, whether each... covered by the report in compliance with the requirements of the Acid Rain Program applicable to the unit...

40 CFR 72.90 - Annual compliance certification report.

Code of Federal Regulations, 2011 CFR

2011-07-01

... is subject to the Acid Rain emissions limitations, the designated representative of the source at... the source and the affected units at the source in compliance with the Acid Rain Program, whether each... covered by the report in compliance with the requirements of the Acid Rain Program applicable to the unit...

40 CFR 72.90 - Annual compliance certification report.

Code of Federal Regulations, 2012 CFR

2012-07-01

... is subject to the Acid Rain emissions limitations, the designated representative of the source at... the source and the affected units at the source in compliance with the Acid Rain Program, whether each... covered by the report in compliance with the requirements of the Acid Rain Program applicable to the unit...

40 CFR 72.90 - Annual compliance certification report.

Code of Federal Regulations, 2013 CFR

2013-07-01

... is subject to the Acid Rain emissions limitations, the designated representative of the source at... the source and the affected units at the source in compliance with the Acid Rain Program, whether each... covered by the report in compliance with the requirements of the Acid Rain Program applicable to the unit...

78 FR 35631 - Proposed Information Collection Request; Comment Request; 40 CFR Part 64 Compliance Assurance...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-13

... the fact that most facilities are now using electronic monitoring to conduct their recording, thus... Request; Comment Request; 40 CFR Part 64 Compliance Assurance Monitoring Program AGENCY: Environmental... an information collection request, ``40 CFR Part 64 Compliance Assurance Monitoring Program'' (EPA...

40 CFR 52.744 - Small business stationary source technical and environmental compliance assistance program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Small business stationary source technical and environmental compliance assistance program. 52.744 Section 52.744 Protection of Environment... PLANS Illinois> § 52.744 Small business stationary source technical and environmental compliance...

40 CFR 52.798 - Small business stationary source technical and environmental compliance assistance program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Small business stationary source technical and environmental compliance assistance program. 52.798 Section 52.798 Protection of Environment... PLANS Indiana § 52.798 Small business stationary source technical and environmental compliance...

Compliance and Practices in Transition Planning: A Review of Individualized Education Program Documents

ERIC Educational Resources Information Center

Landmark, Leena Jo; Zhang, Dalun

2013-01-01

This study examined the extent to which transition components of students’ Individualized Education Programs (IEPs) were compliant with IDEIA 2004; the extent to which transition components provided evidence of best practices; the association among disability, ethnicity, compliance, and practices; and the relationship between compliance and best…

Overcoming the Challenges in Implementing Type 2 Diabetes Mellitus Prevention Programs Can Decrease the Burden on Healthcare Costs in the United States.

PubMed

Subramanian, Kritika; Midha, Inuka; Chellapilla, Vijaya

2017-01-01

Theoretically, identifying prediabetics would reduce the diabetic burden on the American healthcare system. As we expect the prevalence rate of prediabetes to continue increasing, we wonder if there is a better way of managing prediabetics and reducing the economic cost on the healthcare system. To do so, understanding the demographics and behavioral factors of known prediabetics was important. For this purpose, responses of prediabetic/borderline diabetes patients from the most recent publicly available 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed. The findings showed that there was a correlation between household income, geographic residence in the US, and risk for developing diabetes mellitus type 2, aside from the accepted risk factors such as high BMI. In conclusion, implementation of the National Diabetes Prevention Program is a rational way of reducing the burden of DM on the healthcare system both economically and by prevalence. However, difficulties arise in ensuring patient compliance to the program and providing access to all regions and communities of the United States. Technology incorporation in the NDPP program would maintain a low-cost implementation by the healthcare system, be affordable and accessible for all participants, and decrease economic burden attributed to diabetes mellitus.

40 CFR 501.16 - Requirements for compliance evaluation programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Requirements for compliance evaluation programs. 501.16 Section 501.16 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STATE SLUDGE MANAGEMENT PROGRAM REGULATIONS Development and Submission of State Programs...

76 FR 14896 - Multi-Agency Informational Meeting Concerning Compliance With the Federal Select Agent Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-18

...] Multi-Agency Informational Meeting Concerning Compliance With the Federal Select Agent Program; Public... specific regulatory guidance related to the Federal Select Agent Program established under the Public.... Sarah Kwiatkowski, Veterinary Program Assistant, APHIS Select Agent Program, APHIS, 4700 River Road Unit...

76 FR 17617 - Multi-Agency Informational Meeting Concerning Compliance With the Federal Select Agent Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-30

...] Multi-Agency Informational Meeting Concerning Compliance With the Federal Select Agent Program; Public... specific regulatory guidance related to the Federal Select Agent Program established under the Public.... Sarah Kwiatkowski, Veterinary Program Assistant, APHIS Select Agent Program, APHIS, 4700 River Road Unit...

Strengthening organizations to implement evidence-based clinical practices.

PubMed

VanDeusen Lukas, Carol; Engle, Ryann L; Holmes, Sally K; Parker, Victoria A; Petzel, Robert A; Nealon Seibert, Marjorie; Shwartz, Michael; Sullivan, Jennifer L

2010-01-01

Despite recognition that implementation of evidence-based clinical practices (EBPs) usually depends on the structure and processes of the larger health care organizational context, the dynamics of implementation are not well understood. This project's aim was to deepen that understanding by implementing and evaluating an organizational model hypothesized to strengthen the ability of health care organizations to facilitate EBPs. CONCEPTUAL MODEL: The model posits that implementation of EBPs will be enhanced through the presence of three interacting components: active leadership commitment to quality, robust clinical process redesign incorporating EBPs into routine operations, and use of management structures and processes to support and align redesign. In a mixed-methods longitudinal comparative case study design, seven medical centers in one network in the Department of Veterans Affairs participated in an intervention to implement the organizational model over 3 years. The network was selected randomly from three interested in using the model. The target EBP was hand-hygiene compliance. Measures included ratings of implementation fidelity, observed hand-hygiene compliance, and factors affecting model implementation drawn from interviews. Analyses support the hypothesis that greater fidelity to the organizational model was associated with higher compliance with hand-hygiene guidelines. High-fidelity sites showed larger effect sizes for improvement in hand-hygiene compliance than lower-fidelity sites. Adherence to the organizational model was in turn affected by factors in three categories: urgency to improve, organizational environment, and improvement climate. Implementation of EBPs, particularly those that cut across multiple processes of care, is a complex process with many possibilities for failure. The results provide the basis for a refined understanding of relationships among components of the organizational model and factors in the organizational context affecting them. This understanding suggests practical lessons for future implementation efforts and contributes to theoretical understanding of the dynamics of the implementation of EBPs.

The road to JCAHO disease-specific care certification: a step-by-step process log.

PubMed

Morrison, Kathy

2005-01-01

In 2002, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) implemented Disease-Specific Care (DSC) certification. This is a voluntary program in which organizations have their disease management program evaluated by this regulatory agency. Some of the DSC categories are stroke, heart failure, acute MI, diabetes, and pneumonia. The criteria for any disease management program certification are: compliance with consensus-based national standards, effective use of established clinical practice guidelines to manage and optimize care, and an organized approach to performance measurement and improvement activities. Successful accomplishment of DSC certification defines organizations as Centers of Excellence in management of that particular disease. This article will review general guidelines for DSC certification with an emphasis on Primary Stroke Center certification.

Compliance hotlines: practical advice for implementing a reporting mechanism.

PubMed

Pastin, M J

1999-01-01

No element of a corporate compliance program in healthcare facilities generates more controversy than the hotline established for employees who wish to raise a concern. Healthcare organizations are adopting hotlines but with reluctance, mainly because of limited staff available to answer calls and because of limited support from upper management. Those that have committed to the hotline will tell you they can't imagine not having it. Running a good hotline means first answering such questions as whether it will be answered in-house, outsourced or handled through a combination of both means. The best organizations treat the hotline as a resource for employees, managers and physicians. If employees receive advice about policies over the hotline, however, it must be answered in-house. If multiple call answers are used, a secure file-sharing system, either paper or online, must be in use to track caller concerns. Most calls are routine, but one where the caller is reporting a serious infraction can save an organization millions of dollars by forestalling a false claim or allowing for voluntary resolution of a problem. If your company has run a hotline unsuccessfully and earned a poor reputation with employees, outsourcing may be the best option. A hotline that is not supported by management may prove to be an insurmountable problem for anyone who attempts to operate it. Your approach to hotline call intake will set the tone for your compliance program.

Does competitive food and beverage legislation hurt meal participation or revenues in high schools?

PubMed

Peart, Tasha; Kao, Janice; Crawford, Patricia B; Samuels, Sarah E; Craypo, Lisa; Woodward-Lopez, Gail

2012-08-01

There is limited evidence to evaluate the influence of competitive food and beverage legislation on school meal program participation and revenues. A representative sample of 56 California high schools was recruited to collect school-level data before (2006–2007) and the year after (2007–2008) policies regarding limiting competitive foods and beverages were required to be implemented. Data were obtained from school records, observations, and questionnaires. Paired t-tests assessed significance of change between the two time points. Average participation in lunch increased from 21.7% to 25.3% (p < 0.001), representing a 17.0% increase, while average participation in breakfast increased from 8.9% to 10.3% (p = 0.02), representing a 16.0% increase. There was a significant (23.0%) increase in average meal revenue, from $0.70 to $0.86 (per student per day) (p < 0.001). There was a nonsignificant decrease (18.0%) in average sales from à la carte foods, from $0.45 to $0.37 (per student per day). Compliance with food and beverage standards also increased significantly. At end point, compliance with beverage standards was higher (71.0%) than compliance with food standards (65.7%). Competitive food and beverage legislation can increase food service revenues when accompanied by increased rates of participation in the meal program. Future studies collecting expense data will be needed to determine impact on net revenues.

Impact on clinical practice of the implementation of guidelines for the toxicity management of targeted therapies in kidney cancer. The protect-2 study.

PubMed

Lainez, Nuria; García-Donas, Jesús; Esteban, Emilio; Puente, Javier; Sáez, M Isabel; Gallardo, Enrique; Pinto-Marín, Álvaro; Vázquez-Estévez, Sergio; León, Luis; García-Carbonero, Icíar; Suárez-Rodríguez, Cristina; Molins, Carmen; Climent-Duran, Miguel A; Lázaro-Quintela, Martín; González Del Alba, Aranzazu; Méndez-Vidal, María José; Chirivella, Isabel; Afonso, Francisco J; López-Brea, Marta; Sala-González, Nuria; Domenech, Montserrat; Basterretxea, Laura; Santander-Lobera, Carmen; Gil-Arnáiz, Irene; Fernández, Ovidio; Caballero-Díaz, Cristina; Mellado, Begoña; Marrupe, David; García-Sánchez, José; Sánchez-Escribano, Ricardo; Fernández Parra, Eva; Villa Guzmán, José C; Martínez-Ortega, Esther; Belén González, María; Morán, Marina; Suarez-Paniagua, Beatriz; Lecumberri, María J; Castellano, Daniel

2016-02-22

The impact of such recommendations after their implementation of guidelines has not usually been evaluated. Herein, we assessed the impact and compliance with the Spanish Oncology Genitourinary Group (SOGUG) Guidelines for toxicity management of targeted therapies in metastatic renal cell carcinoma (mRCC) in daily clinical practice. Data on 407 mRCC patients who initiated first-line targeted therapy during the year before and the year after publication and implementation of the SOGUG guideline program were available from 34 Spanish Hospitals. Adherence to SOGUG Guidelines was assessed in every cycle. Adverse event (AE) management was consistent with the Guidelines as a whole for 28.7% out of 966 post-implementation cycles compared with 23.1% out of 892 pre-implementation cycles (p = 0.006). Analysis of adherence by AE in non-compliant cycles showed significant changes in appropriate management of hypertension (33% pre-implementation vs. 44.5% post-implementation cycles; p < 0.0001), diarrhea (74.0% vs. 80.5%; p = 0.011) and dyslipemia (25.0% vs. 44.6%; p < 0.001). Slight but significant improvements in AE management were detected following the implementation of SOGUG recommendations. However, room for improvement in the management of AEs due to targeted agents still remains and could be the focus for further programs in this direction.

An Evidence-Based Project Demonstrating Increased School Immunization Compliance Following a School Nurse-Initiated Vaccine Compliance Strategy

ERIC Educational Resources Information Center

Swallow, Wendy; Roberts, Jill C.

2016-01-01

During the 2012-2013 school year, only 66% of students at a Northern Indiana High School were in compliance with school immunization requirements. We report here successful implementation of evidence-based, time, and cost-effective methods aimed at increasing school immunization compliance. A three-stage strategy initiated by the school nurse was…

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients.

PubMed

Woodward, Cathy; Taylor, Richard; Son, Minnette; Taeed, Roozbeh; Jacobs, Marshall L; Kane, Lauren; Jacobs, Jeffrey P; Husain, S Adil

2017-07-01

Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

28 CFR 42.725 - Assurance of compliance.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Assurance of compliance. 42.725 Section 42.725 Judicial Administration DEPARTMENT OF JUSTICE NONDISCRIMINATION; EQUAL EMPLOYMENT OPPORTUNITY...; Implementation of the Age Discrimination Act of 1975 Duties of Recipients § 42.725 Assurance of compliance. Each...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

This article describes how Broward County, Florida and Browning-Ferris Industries (Houston, Texas) implemented a highly accelerated recycling project that had a county-wide recycling system fully operational in 180 days. The program is a strong step toward speeding compliance with Florida's mandated 30 percent recycling goal. The 1.2 million citizens in Broward County began recycling materials in dual curbside bins October 1, 1993. Previously, the participating communities all acted autonomously. Minimal volumes of newspaper, aluminum, clear glass, and some plastic were collected by curbsort vehicles and processed at small local recycling centers.

36 CFR 1154.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TRANSPORTATION BARRIERS COMPLIANCE BOARD ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD § 1154.150 Program accessibility: Existing facilities. (a) General. The agency shall operate each program or activity so that the...

Compliance of the Savannah River Site D-Area cooling system with environmental regulations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Specht, W.L.; Mackey, H.E.; Paller, M.H.

1990-08-01

This document presents information relating to a demonstration under Section 316(a) of the Clean Water Act for the 400-D Area cooling system at the Savannah River Site (SRS) near Aiken, South Carolina. The demonstration was mandated because the National Pollution Discharge Elimination System (NPDES) permit for SRS (SC0000175), granted on January 1, 1984, specified in-stream temperature limits in SRS streams of 32.2{degree}C and a {Delta}T limit of 2.8{degree}C above ambient. To achieve compliance with in-stream temperature limits, the Department of Energy (DOE) and the South Carolina Department of Health and Environmental Control (SCDHEC) entered into a Consent Order (84-4-W) whichmore » temporarily superseded the temperature requirements and identified a process for attaining compliance. The preferred option for achieving thermal compliance in Beaver Dam Creek consisted of increased flow, with mixing of the raw water basin overflow with the cooling water discharge during the summer months. Although this action can achieve instream temperatures of less than 32.2{degree}C, {Delta}T's still exceed 2.8{degree}C. Therefore, a 316 (a) Demonstration was initiated to determine whether a balanced indigenous biological community can be supported in the receiving stream with {Delta}T's in excess of 2.8{degree}C. A Biological Monitoring Program for Beaver Dam Creek was approved by SCDHEC in June 1988 and implemented in September 1988. The program monitored the water quality, habitat formers, zooplankton, macroinvertebrates, fish, other vertebrate wildlife and threatened and endangered species in Beaver Dam Creek for an 18-month period (September 1988-February 1990). This document summarizes information collected during the monitoring program and evaluates the data to determine whether Beaver Dam Creek presently supports a balanced indigenous biological community. 97 refs., 32 figs., 51 tabs.« less

Regulatory Monitoring of Fortified Foods: Identifying Barriers and Good Practices

PubMed Central

Rowe, Laura A; Vossenaar, Marieke; Garrett, Greg S

2015-01-01

While fortification of staple foods and condiments has gained enormous global traction, poor performance persists throughout many aspects of implementation, most notably around the critical element of regulatory monitoring, which is essential for ensuring foods meet national fortification standards. Where coverage of fortified foods is high, limited nutritional impact of fortification programs largely exists due to regulatory monitoring that insufficiently identifies and holds producers accountable for underfortified products. Based on quality assurance data from 20 national fortification programs in 12 countries, we estimate that less than half of the samples are adequately fortified against relevant national standards. In this paper, we outline key findings from a literature review, key informant interviews with 11 fortification experts, and semi-quantitative surveys with 39 individuals from regulatory agencies and the food fortification industry in 17 countries on the perceived effectiveness of regulatory monitoring systems and barriers to compliance against national fortification standards. Findings highlight that regulatory agencies and industry disagree on the value that enforcement mechanisms have in ensuring compliance against standards. Perceived political risk of enforcement and poorly resourced inspectorate capacity appear to adversely reinforce each other within an environment of unclear legislation to create a major hurdle for improving overall compliance of fortification programs against national standards. Budget constraints affect the ability of regulatory agencies to create a well-trained inspector cadre and improve the detection and enforcement of non-compliant and underfortified products. Recommendations to improve fortification compliance include improving technical capacity; ensuring sustained leadership, accountability, and funding in both the private and the public sectors; and removing political barriers to ensure consistent detection of underfortified products and enforcement of applicable fortification standards. Only by taking concrete steps to improve the entire regulatory system that is built on a cooperative working relationship between regulatory agencies and food producers will a nutrition strategy that uses fortification see its intended health effects. PMID:26374804

From Policy to Compliance: Federal Energy Efficient Product Procurement

DOE Office of Scientific and Technical Information (OSTI.GOV)

DeMates, Laurèn; Scodel, Anna

Federal buyers are required to purchase energy-efficient products in an effort to minimize energy use in the federal sector, save the federal government money, and spur market development of efficient products. The Federal Energy Management Program (FEMP)’s Energy Efficient Product Procurement (EEPP) Program helps federal agencies comply with the requirement to purchase energy-efficient products by providing technical assistance and guidance and setting efficiency requirements for certain product categories. Past studies have estimated the savings potential of purchasing energy-efficient products at over $500 million per year in energy costs across federal agencies.1 Despite the strong policy support for EEPP and resourcesmore » available, energy-efficient product purchasing operates within complex decision-making processes and operational structures; implementation challenges exist that may hinder agencies’ ability to comply with purchasing requirements. The shift to purchasing green products, including energy-efficient products, relies on “buy in” from a variety of potential actors throughout different purchasing pathways. Challenges may be especially high for EEPP relative to other sustainable acquisition programs given that efficient products frequently have a higher first cost than non-efficient ones, which may be perceived as a conflict with fiscal responsibility, or more simply problematic for agency personnel trying to stretch limited budgets. Federal buyers may also face challenges in determining whether a given product is subject to EEPP requirements. Previous analysis on agency compliance with EEPP, conducted by the Alliance to Save Energy (ASE), shows that federal agencies are getting better at purchasing energy-efficient products. ASE conducted two reviews of relevant solicitations for product and service contracts listed on Federal Business Opportunities (FBO), the centralized website where federal agencies are required to post procurements greater than $25,000. In 2010, ASE estimated a compliance rate of 46% in 2010, up from an estimate of 12% in 2008. Our work updates and expands on ASE’s 2010 analysis to gauge agency compliance with EEPP requirements.« less

Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department.

PubMed

Arntz, P R H; Hopman, J; Nillesen, M; Yalcin, E; Bleeker-Rovers, C P; Voss, A; Edwards, M; Wei, A

2016-11-01

Hand hygiene (HH) is essential in preventing nosocomial infection. The emergency department (ED) is an open portal of entry for pathogens into the hospital system, hence the important sentinel function of the ED personnel. The main objective of this study was to assess the effect of a multimodal improvement strategy on hand hygiene compliance in the ED. Our study was a prospective before-and-after study to determine the effect of a multimodal improvement strategy on the compliance of HH in the ED according to the My 5 Moments of Hand Hygiene defined by the World Health Organization. Interventions such as education, reminders, and regular feedback on HH performance and role models were planned during the 3 intervention weeks. In total, 57 ED nurses and ED physicians were observed in this study, and approximately 1,000 opportunities for handrubs were evaluated during the 3 intervention periods. HH compliance increased significantly from baseline from 18% (74/407) to 41% (77/190) after the first intervention and stabilized to 50% (99/200) and 46% (96/210) after the second and third interventions, respectively. Implementing a multimodal HH improvement program significantly improved the HH compliance of ED personnel. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Integrating Genomic Resources with Electronic Health Records using the HL7 Infobutton Standard

PubMed Central

Overby, Casey Lynnette; Del Fiol, Guilherme; Rubinstein, Wendy S.; Maglott, Donna R.; Nelson, Tristan H.; Milosavljevic, Aleksandar; Martin, Christa L.; Goehringer, Scott R.; Freimuth, Robert R.; Williams, Marc S.

2016-01-01

Summary Background The Clinical Genome Resource (ClinGen) Electronic Health Record (EHR) Workgroup aims to integrate ClinGen resources with EHRs. A promising option to enable this integration is through the Health Level Seven (HL7) Infobutton Standard. EHR systems that are certified according to the US Meaningful Use program provide HL7-compliant infobutton capabilities, which can be leveraged to support clinical decision-making in genomics. Objectives To integrate genomic knowledge resources using the HL7 infobutton standard. Two tactics to achieve this objective were: (1) creating an HL7-compliant search interface for ClinGen, and (2) proposing guidance for genomic resources on achieving HL7 Infobutton standard accessibility and compliance. Methods We built a search interface utilizing OpenInfobutton, an open source reference implementation of the HL7 Infobutton standard. ClinGen resources were assessed for readiness towards HL7 compliance. Finally, based upon our experiences we provide recommendations for publishers seeking to achieve HL7 compliance. Results Eight genomic resources and two sub-resources were integrated with the ClinGen search engine via OpenInfobutton and the HL7 infobutton standard. Resources we assessed have varying levels of readiness towards HL7-compliance. Furthermore, we found that adoption of standard terminologies used by EHR systems is the main gap to achieve compliance. Conclusion Genomic resources can be integrated with EHR systems via the HL7 Infobutton standard using OpenInfobutton. Full compliance of genomic resources with the Infobutton standard would further enhance interoperability with EHR systems. PMID:27579472

77 FR 51619 - Source Specific Federal Implementation Plan for Implementing Best Available Retrofit Technology...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-24

... Energy and Non-Air Quality Environmental Impacts C. Comments on Factor Three--Existing Controls at FCPP D... compliance, (2) the energy and non-air quality environmental impacts of compliance, (3) any pollution control... installing and operating any of several equivalent controls on Units 1- 3, and through proper operation of...

Compliance with Prevention Practices and their Association with Central Line-Associated Blood Stream Infections in Neonatal Intensive Care Units

PubMed Central

Zachariah, Philip; Furuya, E. Yoko; Edwards, Jeffrey; Dick, Andrew; Liu, Hangsheng; Herzig, Carolyn; Pogorzelska-Maziarz, Monika; Stone, Patricia W.; Saiman, Lisa

2014-01-01

Background Bundles and checklists have been shown to decrease CLABSIs, but implementation of these practices and association with CLABSI rates have not been described nationally. We describe implementation and levels of compliance with prevention practices in a sample of US Neonatal ICUs and assess their association with CLABSI rates. Methods An online survey assessing infection prevention practices was sent to hospitals participating in National Healthcare Safety Network CLABSI surveillance in October 2011. Participating hospitals permitted access to their NICU CLABSI rates. Multivariable regressions were used to test the association between compliance with NICU specific CLABSI prevention practices and corresponding CLABSI rates. Results Overall, 190 Level II/III and Level III NICUs participated. The majority of NICUs had written policies (84%-93%) and monitored compliance with bundles and checklists (88% - 91%). Reporting ≥ 95% compliance for any of the practices ranged from 50%- 63%. Reporting ≥ 95% compliance with insertion checklist and assessment of daily line necessity were significantly associated with lower CLABSI rates (p<0.05). Conclusions Most NICUs in this national sample have instituted CLABSI prevention policies and monitor compliance, although reporting compliance ≥ 95% was suboptimal. Reporting ≥ 95% compliance with select CLABSI prevention practices was associated with lower CLABSI rates. Further studies should focus on identifying and improving compliance with effective CLABSI prevention practices in neonates. PMID:25087136

Annual Site Environmental Report: 2006

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nuckolls, H.; /SLAC

2008-02-22

This report provides information about environmental programs during the calendar year (CY) of 2006 at the Stanford Linear Accelerator Center (SLAC), Menlo Park, California. Activities that span the calendar year; i.e., stormwater monitoring covering the winter season of 2006/2007 (October 2006 through May 2007), are also included. Production of an annual site environmental report (ASER) is a requirement established by the United States Department of Energy (DOE) for all management and operating (M&O) contractors throughout the DOE complex. SLAC is a federally-funded research and development center with Stanford University as the M&O contractor. SLAC continued to follow the path tomore » self-declare an environmental management system under DOE Order 450.1, 'Environmental Protection Program' and effectively applied environmental management in meeting the site's integrated safety and environmental management system goals. For normal daily activities, all SLAC managers and supervisors are responsible for ensuring that proper procedures are followed so that Worker safety and health are protected; The environment is protected; and Compliance is ensured. Throughout 2006, SLAC focused on these activities through the SLAC management systems. These systems were also the way SLAC approached implementing 'greening of the government' initiatives such as Executive Order 13148. The management systems at SLAC are effective, supporting compliance with all relevant statutory and regulatory requirements. The SLAC Office of Assurance was created during 2006 in response to DOE Order 226.1. During 2006, there were no reportable releases to the environment from SLAC operations, and there were no Notice of Violations issued to SLAC from any of the regulatory agencies that oversee SLAC. In addition, many improvements in waste minimization, recycling, stormwater drain system, groundwater restoration, and SLAC's chemical management system (CMS) were continued during 2006 to better manage chemical use. Program-specific details are discussed below. SLAC operates its air quality management program in compliance with its established permit conditions. The Bay Area Air Quality Management District (BAAQMD) did not conduct a facility inspection of SLAC during 2006, though it did visit the site on four different occasions. The BAAQMD did compliment SLAC for the overall configuration of SLAC's gasoline dispensing facility and of SLAC's asbestos/demolition notification program during two of the visits. DOE awarded SLAC the 2006 Best in Class for Pollution Prevention and Environmental Stewardship Accomplishment in recognition of SLAC's CMS program which manages the procurement and use of chemicals. As an example of the efficiency of the CMS, SLAC reviewed its use of gases and associated tanks and phased out numerous gas tanks that were no longer needed or were not acceptable for long-term storage, in turn, reducing SLAC's on-site chemical inventory. As part of SLAC's waste minimization and management efforts, more than one thousand tons of municipal solid waste was recycled by SLAC during 2006. SLAC operates its industrial and sanitary wastewater management program in compliance with established permit conditions. During 2006, SLAC obtained a new facility-wide wastewater discharge permit which replaced four separate permits that were previously issued to SLAC. In 2006, no radiological incidents occurred that increased radiation levels or released radioactivity to the environment. In addition to managing its radioactive wastes safely and responsibly, SLAC worked to reduce the amount of waste generated. SLAC has implemented programs and systems to ensure compliance with all radiological requirements related to the environment. The Environmental Restoration Program continued work on site characterization and evaluation of remedial alternatives at four sites with volatile organic compounds in groundwater and several areas with polychlorinated biphenyls and low concentrations of lead in soil. SLAC is regulated under a site cleanup requirements order (board order) issued by the California Regional Water Quality Control Board, San Francisco Bay Region (RWQCB) for the investigation and remediation of impacted soil and groundwater at SLAC. The new board order lists specific tasks and deadlines for groundwater and soil remedial investigation. All 2006 submittals to the board were completed on time.« less

32 CFR 644.318 - Compliance with State Coastal Zone Management Programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true Compliance with State Coastal Zone Management... (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal § 644.318 Compliance with State Coastal Zone Management Programs. Subpart H will outline the provisions of the Coastal Zone Management Act of 1972, as...

32 CFR 644.318 - Compliance with State Coastal Zone Management Programs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 4 2011-07-01 2011-07-01 false Compliance with State Coastal Zone Management... (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal § 644.318 Compliance with State Coastal Zone Management Programs. Subpart H will outline the provisions of the Coastal Zone Management Act of 1972, as...

45 CFR 800.102 - Compliance with Federal law.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 3 2013-10-01 2013-10-01 false Compliance with Federal law. 800.102 Section 800... MULTI-STATE PLAN PROGRAM Multi-State Plan Program Issuer Requirements § 800.102 Compliance with Federal law. (a) Public Health Service Act. As a condition of participation in the MSPP, an MSPP issuer must...

45 CFR 800.102 - Compliance with Federal law.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 3 2014-10-01 2014-10-01 false Compliance with Federal law. 800.102 Section 800... MULTI-STATE PLAN PROGRAM Multi-State Plan Program Issuer Requirements § 800.102 Compliance with Federal law. (a) Public Health Service Act. As a condition of participation in the MSPP, an MSPP issuer must...

Ecological Monitoring and Compliance Program 2011 Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hansen, D. J.; Anderson, D. C.; Hall, D. B.

The Ecological Monitoring and Compliance (EMAC) Program, funded through the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office, monitors the ecosystem of the Nevada National Security Site and ensures compliance with laws and regulations pertaining to NNSS biota. This report summarizes the program's activities conducted by National Security Technologies, LLC, during calendar year 2011. Program activities included (a) biological surveys at proposed construction sites, (b) desert tortoise compliance, (c) ecosystem monitoring, (d) sensitive plant species monitoring, (e) sensitive and protected/regulated animal monitoring, (f) habitat restoration monitoring, and (g) monitoring of the Nonproliferation Test and Evaluation Complex. Duringmore » 2011, all applicable laws, regulations, and permit requirements were met, enabling EMAC to achieve its intended goals and objectives.« less

28 CFR 42.723 - Compliance information.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Compliance information. 42.723 Section 42...; Implementation of the Age Discrimination Act of 1975 Duties of Recipients § 42.723 Compliance information. (a) Upon request by the Department, a recipient shall make available to the Department information...

43 CFR 36.6 - NEPA compliance and lead agency.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SYSTEMS IN AND ACROSS, AND ACCESS INTO, CONSERVATION SYSTEM UNITS IN ALASKA § 36.6 NEPA compliance and... interested individuals and organizations. (6) The lead agency shall ensure compliance with section 810 of... the applicant, according to the BLM's cost recovery procedures and regulations implementing section...

43 CFR 36.6 - NEPA compliance and lead agency.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SYSTEMS IN AND ACROSS, AND ACCESS INTO, CONSERVATION SYSTEM UNITS IN ALASKA § 36.6 NEPA compliance and... interested individuals and organizations. (6) The lead agency shall ensure compliance with section 810 of... the applicant, according to the BLM's cost recovery procedures and regulations implementing section...

Implementation of a workplace smoking ban in bars: the limits of local discretion.

PubMed

Montini, Theresa; Bero, Lisa A

2008-12-08

In January 1998, the California state legislature extended a workplace smoking ban to bars. The purpose of this study was to explore the conditions that facilitate or hinder compliance with a smoking ban in bars. We studied the implementation of the smoking ban in bars by interviewing three sets of policy participants: bar employers responsible for complying with the law; local government officials responsible for enforcing the law; and tobacco control activists who facilitated implementation. We transcribed the interviews and did a qualitative analysis of the text. The conditions that facilitated bar owners' compliance with a smoking ban in bars included: if the cost to comply was minimal; if the bars with which they were in competition were in compliance with the smoking ban; and if there was authoritative, consistent, coordinated, and uniform enforcement. Conversely, the conditions that hindered compliance included: if the law had minimal sanctions; if competing bars in the area allowed smoking; and if enforcement was delayed or inadequate. Many local enforcers wished to forfeit their local discretion and believed the workplace smoking ban in bars would be best implemented by a state agency. The potential implication of this study is that, given the complex nature of local politics, smoking bans in bars are best implemented at a broader provincial or national level.

The assessment and management of chemotherapy-induced nausea and vomiting among cancer patients in a chemotherapy ward: a best practice implementation project.

PubMed

Gu, Lingli; Li, Jing

2016-03-01

Chemotherapy-induced nausea and vomiting (CINV) are considered to be two of the most distressing side-effects of chemotherapy. They have a negative impact on a patient's quality of life and can influence the continuance of treatment. Owing to the lack of effective management of CINV, regular assessment and management of CINV is recommended for patients undergoing chemotherapy. The aim of this project was to integrate the available evidence on the assessment and management of CINV into practice, and implement strategies to improve compliance with evidence-based practice. The project carried out a pre- and post-implementation audit procedure using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. Five audit criteria were established according to the best available evidence on the assessment and management of CINV. The program was divided into three phases and conducted over four months in the chemotherapy ward, Fudan University Shanghai Cancer Center, Shanghai, China. Sixty patients and 14 oncology nurses were involved in this project. The results of the follow-up cycle showed that the compliance rates regarding patient education, risk factors evaluation and non-pharmacologic managements were 100%, 100% and 80%, respectively. The rate of validated tools being used by patients and nurses improved by 93% and 97%, respectively. This project demonstrated that the use of pre- and post-best practice audits is an effective method for incorporating evidence into practice in a chemotherapy ward. The practice of assessing and managing CINV was significantly improved. The next step is to develop strategies for sustaining the new procedures of CINV assessment and management.

Determinants of success and sustainability of the WHO multimodal hand hygiene promotion campaign, Italy, 2007-2008 and 2014.

PubMed

Moro, Maria Luisa; Morsillo, Filomena; Nascetti, Simona; Parenti, Mita; Allegranzi, Benedetta; Pompa, Maria Grazia; Pittet, Didier

2017-06-08

A national hand hygiene promotion campaign based on the World Health Organization (WHO) multimodal, Clean Care is Safer Care campaign was launched in Italy in 2007. One hundred seventy-five hospitals from 14 of 20 Italian regions participated. Data were collected using methods and tools provided by the WHO campaign, translated into Italian. Hand hygiene compliance, ward infrastructure, and healthcare workers' knowledge and perception of healthcare-associated infections and hand hygiene were evaluated before and after campaign implementation. Compliance data from the 65 hospitals returning complete data for all implementation tools were analysed using a multilevel approach. Overall, hand hygiene compliance increased in the 65 hospitals from 40% to 63% (absolute increase: 23%, 95% confidence interval: 22-24%). A wide variation in hand hygiene compliance among wards was observed; inter-ward variability significantly decreased after campaign implementation and the level of perception was the only item associated with this. Long-term sustainability in 48 of these 65 hospitals was assessed in 2014 using the WHO Hand Hygiene Self-Assessment Framework tool. Of the 48 hospitals, 44 scored in the advanced/intermediate categories of hand hygiene implementation progress. The median hand hygiene compliance achieved at the end of the 2007-2008 campaign appeared to be sustained in 2014. This article is copyright of The Authors, 2017.

Staff and patient perspectives of a smoke-free health services policy in South Australia: A state-wide implementation.

PubMed

Martin, Kimberley; Dono, Joanne; Sharplin, Greg; Bowden, Jacqueline; Miller, Caroline

2017-08-01

Few jurisdictions have implemented and evaluated a complete smoking ban across all health sites in their jurisdiction, with no designated smoking areas. This article examines staff and patient perceptions and experiences of a mandated smoke-free policy implemented across all government health facilities in South Australia, including mental health sites. An online survey of health staff was conducted prior to policy implementation (n=3098), 3 months post-implementation (n=2673) and 15 months post-implementation (n=2890). Consumer experiences of the policy were assessed via a telephone survey (n=1722; smokers n=254). Staff support for the policy was high across all time points. Two thirds of staff reported having witnessed some policy non-compliance, and self-reported exposure to second-hand smoke was comparable pre-implementation to 15 months post-implementation. Under the policy, 56.3% of smoking patients abstained completely whilst hospitalised and 37.6% cut down the amount that they smoked. Furthermore, 34.7% reported having been offered cessation support during hospitalisation. Whilst the smoke-free policy was viewed positively and had benefits for staff and patients, reports of witnessing some non-compliance were prevalent. While the extent of non-compliance is not known, and the measure used was sensitive, complementary strategies may be needed to reduce exposure to second-hand smoke, particularly at entrances. Health-care staff should be further encouraged to offer support to nicotine-dependent patients to foster compliance and promote abstinence during hospitalisation. Copyright © 2017 Elsevier B.V. All rights reserved.

75 FR 23223 - Multi-Agency Informational Meeting Concerning Compliance With the Federal Select Agent Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-03

...] Multi-Agency Informational Meeting Concerning Compliance With the Federal Select Agent Program; Public... Select Agent Program established under the Public Health Security and Bioterrorism Preparedness and... Roberson, Veterinary Permit Examiner, APHIS Select Agent Program, VS, ASAP, APHIS, 4700 River Road Unit 2...

40 CFR 160.12 - Statement of compliance or non-compliance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 24 2011-07-01 2011-07-01 false Statement of compliance or non-compliance. 160.12 Section 160.12 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS GOOD LABORATORY PRACTICE STANDARDS General Provisions § 160.12 Statement of compliance or...

77 FR 60915 - Revisions to the Nevada State Implementation Plan, Washoe County Air Quality District

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-05

... compliance with permit conditions, recordkeeping, source sampling and testing, and statements of compliance... Demonstration of Compliance. WCDBOH 030.230 Record Keeping. WCDBOH 030.235 Requirements for Source Sampling... Federal Register Sampling and page number Testing''. where the document begins]. * * * * * * * 030.970A...

18 CFR 154.600 - Compliance with other subparts.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false Compliance with other subparts. 154.600 Section 154.600 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Changes § 154.600 Compliance with other subparts. Any proposal to implement a tariff change other than in...

18 CFR 154.600 - Compliance with other subparts.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false Compliance with other subparts. 154.600 Section 154.600 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Changes § 154.600 Compliance with other subparts. Any proposal to implement a tariff change other than in...

18 CFR 154.600 - Compliance with other subparts.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Compliance with other subparts. 154.600 Section 154.600 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Changes § 154.600 Compliance with other subparts. Any proposal to implement a tariff change other than in...

18 CFR 154.600 - Compliance with other subparts.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false Compliance with other subparts. 154.600 Section 154.600 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Changes § 154.600 Compliance with other subparts. Any proposal to implement a tariff change other than in...

18 CFR 154.600 - Compliance with other subparts.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Compliance with other subparts. 154.600 Section 154.600 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... Changes § 154.600 Compliance with other subparts. Any proposal to implement a tariff change other than in...

40 CFR 63.11508 - What are my compliance requirements?

Code of Federal Regulations, 2014 CFR

2014-07-01

...) You must be in compliance with the applicable management practices and equipment standards in this.... (iii) You must implement the applicable management practices specified in § 63.11507(g), “What are my standards and management practices?”, as practicable. (iv) You must state in your Notification of Compliance...

40 CFR 63.11508 - What are my compliance requirements?

Code of Federal Regulations, 2013 CFR

2013-07-01

...) You must be in compliance with the applicable management practices and equipment standards in this.... (iii) You must implement the applicable management practices specified in § 63.11507(g), “What are my standards and management practices?”, as practicable. (iv) You must state in your Notification of Compliance...

40 CFR 63.11508 - What are my compliance requirements?

Code of Federal Regulations, 2012 CFR

2012-07-01

...) You must be in compliance with the applicable management practices and equipment standards in this.... (iii) You must implement the applicable management practices specified in § 63.11507(g), “What are my standards and management practices?”, as practicable. (iv) You must state in your Notification of Compliance...

State and Local Compliance: a National Report.

ERIC Educational Resources Information Center

Beuke, Vernon

1981-01-01

Discusses the Abt Study of State and Local Compliance which sought to describe state and local implementation of the provisions of the Vocational Education Amendments of 1965; to understand ways in which local environment affects compliance; and to provide Congress with recommendations for achieving greater adherence to federal intent. (JOW)

DOE Office of Scientific and Technical Information (OSTI.GOV)

GOLDSTON, WELFORD T.; SMITH, WINCHESTER IV

DOE issued Order 435.1, ''Radioactive Waste Management,'' on July 9, 1999 for immediate implementation. The requirements for Low Level Mixed, Transuranic, and High Level Waste have been completely rewritten. The entire DOE complex has been struggling with how to implement these new requirements within the one year required timeframe. This paper will chronicle the implementation strategy and actual results of the work to carry out that strategy at the Savannah River Site. DOE-SR and the site contractors worked closely together to implement each of the new requirements across the SRS, crossing many barriers and providing innovative solutions to the manymore » problems that surfaced throughout the year. The results are that SRS declared compliance with all of the requirements of the Order within the prescribed timeframe. The challenge included all waste types in SRS facilities and programs that handle LLW, MLLW, TRU, and HLW. This paper will describe the implementation details for development of Radioactive Waste Management Basis for each facility, Identification of Wastes with No Path to Disposal, Waste Incidental to Reprocessing Determinations, Low Level Waste 90-Day Staging and One Year Limits for Storage Programs, to name a few of the requirements that were addressed by the SRS 435.1 Implementation Team. This paper will trace the implementation, problems (both technical and administrative), and the current pushback efforts associated with the DOE ''Top-to-Bottom'' review.« less

National standards for the long-term care ombudsman program and a tool to assess compliance: the Huber Badrak Borders Scales.

PubMed

Huber, R; Borders, K W; Badrak, K; Netting, F E; Nelson, H W

2001-04-01

We propose national standards previously recommended for the Long-Term Care Ombudsman Program by an Institute of Medicine program evaluation committee, and introduce a tool to measure the compliance of local ombudsman programs to those standards: the Huber Badrak Borders Scales. The best practices for ombudsman programs detailed in the committee's report were adapted to 43 Likert-type scales that were then averaged into 10 infrastructure component scales: (a) program structure, (b) qualifications of local ombudsmen, (c) legal authority, (d) financial resources, (e) management information systems, (f) legal resources, (g) human resources, (h) resident advocacy services, (i) systemic advocacy, and (j) educational services. The scales were pilot-tested in 1996 and 1999 with Kentucky ombudsmen. The means of 9 of these 10 scales were higher in 1999 than in 1996, suggesting that local ombudsman programs were more in compliance with the proposed standards in 1999 than three years earlier. The development process consisted of 10 adopt-test-revise-retest steps that can be replicated by other types of programs to develop program compliance tools.

Management strategies for trace organic chemicals in water - A review of international approaches.

PubMed

Bieber, Stefan; Snyder, Shane A; Dagnino, Sonia; Rauch-Williams, Tanja; Drewes, Jörg E

2018-03-01

To ensure an appropriate management of potential health risks and uncertainties from the release of trace organic chemicals (TOrCs) into the aqueous environment, many countries have evaluated and implemented strategies to manage TOrCs. The aim of this study was to evaluate existing management strategies for TOrCs in different countries to derive and compare underlying core principles and paradigms and to develop suggestions for more holistic management strategies to protect the environment and drinking water supplies from the discharge of undesired TOrCs. The strategies in different industrial countries were summarized and subsequently compared with regards to three particular questions: 1) Do the approaches different countries have implemented manage all or only specific portions of the universe of chemicals; 2) What implementation and compliance strategies are used to manage aquatic and human health risk and what are their pros and cons; and 3) How are site-specific watershed differences being addressed? While management strategies of the different countries target similar TOrCs, the programs differ in several important aspects, including underlying principles, the balance between aquatic or human health protection, implementation methods, and financing mechanisms used to fund regulatory programs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Lessons from an Evaluation of a Provincial-Level Smoking Control Policy in Shanghai, China

PubMed Central

Li, Xiang; Gao, Junling; Zhang, Zhixing; Wei, Minqi; Zheng, Pinpin; Nehl, Eric J.; Wong, Frank Y.; Berg, Carla J.

2013-01-01

Background The Shanghai Public Places Smoking Control Legislation was implemented in March 2010 as the first provincial-level legislation promoting smoke-free public places in China. Objective To evaluate the compliance with this policy as well as its impact on exposure to secondhand smoke (SHS), respiratory symptoms, and related attitudes among employees in five kinds of workplaces (schools, kindergartens, hospitals, hotels, and shopping malls). Methods A cross-sectional survey was conducted six months before and then six months after the policy was implemented. Five types of occupational employees from 52 work settings were surveyed anonymously using multistage stratified cluster sampling. Results Six months after implementation, 82% of the participants agreed that “legislation is enforced most of the time”. The percentage of self-reported exposure to secondhand smoke declined from round up to 49% to 36%. High compliance rates were achieved in schools and kindergartens (above 90%), with less compliance in hotels and shopping malls (about 70%). Accordingly, prevalence of exposure to SHS was low in schools and kindergartens (less than 10%) and high in hotels and shopping malls (40% and above). The prevalence of respiratory and sensory symptoms (e.g., red or irritated eyes) among employees decreased from 83% to 67%. Conclusions Initial positive effects were achieved after the implementation of Shanghai Smoking Control legislation including decreased exposure to SHS. However, compliance with the policies was a considerable problem in some settings. Further evaluation of such policy implementation should be conducted to inform strategies for increasing compliance in the future. PMID:24058544

Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in three cities of Colombia.

PubMed

Barahona-Guzmán, Nayide; Rodríguez-Calderón, María Eugenia; Rosenthal, Victor D; Olarte, Narda; Villamil-Gómez, Wilmer; Rojas, Catherine; Rodríguez-Ferrer, Marena; Sarmiento-Villa, Guillermo; Lagares-Guzmán, Alfredo; Valderrama, Alberto; Menco, Antonio; Arrieta, Patrick; Dajud-Cassas, Luis Enrique; Mendoza, Mariela; Sabogal, Alejandra; Carvajal, Yulieth; Silva, Edwin

2014-02-01

To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene (HH) approach in Colombia, and analyze predictors of poor HH compliance. An observational, prospective, interventional, before-and-after study was conducted from May 2003 through September 2010 in 10 intensive care units (ICUs) of six hospitals in three cities. The study was divided into two periods: a baseline and a follow-up period. Observations for HH compliance were done in each ICU during randomly selected 30-min periods. The multidimensional HH approach included: (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (6) performance feedback. A total of 13 187 opportunities for HH were observed. Overall HH compliance increased from 50% to 77% (relative risk 1.55, 95% confidence interval 1.43-1.68; p=0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor HH compliance: males vs. females (67% vs. 77%; p=0.0001), physicians vs. nurses (59% vs. 78%; p<0.0001), and adult vs. pediatric ICUs (76% vs. 42%; p<0.001), among others. Adherence to HH was increased by 55% with the INICC approach. Programs targeted at improving HH in variables found to be predictors of poor compliance should be implemented. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Quality assurance program requirements, Amendment 5 (9-26-79) to August 1973 issue

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

This standard sets forth general requirements for planning, managing, conducting, and evaluating quality assurance programs for reactor development and test facility projects and associated processes, structures, components, and systems. These quality assurance requirements are based on proven practices and provide the means of control and verification whereby those responsible fo poject management can assure that the quality required for safe, reliable, and economical operation will be achieved. The objective of the program of the programs covered by this standard is to assure that structures, components, systems, and facilities are designed, developed, manufactured, constructed, operated, and maintained in compliance with establishedmore » engineering criteria. To achieve this objective, controls are to be established and implemented at predetermined points, and necessary action taken to prevent, detect, and correct any deficiencies.« less

Large-scale implementation of enhanced recovery programs after surgery. A francophone experience.

PubMed

Veziant, J; Raspado, O; Entremont, A; Joris, J; Pereira, B; Slim, K

2017-06-01

Enhanced recovery after surgery program (ERP) has now surpassed the stage of clinical research in certain specialties and currently poses the problematic of large-scale implementation. The goal of this study was to report the experience during the first year of implementation in three French-speaking countries. This is a prospective study in which 67 healthcare centers, all registered in the Grace-Audit databank, participated. Included were patients undergoing colorectal (CRS), bariatric (BS) and orthopedic hip and knee surgery (OS), performed within an ERP. The main endpoints were duration of hospital stay, postoperative morbidity, the degree of compliance with the elements of the ERP, the relation between the extent of application of the elements and postoperative hospital stay, and finally the completeness of data inclusions in the databank. A total of 1904 patients were included in the Grace-Audit databank between January 1, 2015 and January 31, 2016, undergoing CRS (n=490), BS (n=431), and OS (n=983). The mean implementation rate was 83.7±10.0% for CRS, 75.0±23.7% for BS, and 83.5±14.9% for OS. The duration of hospital stay was 6.5 days for CRS, 2.6 days for BS and 3.4 days for OS. Overall postoperative morbidity (onset of postoperative undesirable event), surgical morbidity (superficial or deep organ space surgical site complications such as bleeding, infection or defective healing) and readmission rates were 20.6%, 7.5%, and 5.7% for CRS; 2.5%, 1.4%, and 1.6% for BS and 2.9%, 0.2%, and 2% for OS, respectively. A statistically significant relationship was found between the degree of compliance of the elements of ERP and the duration of hospital stay for CRS and BS; hospital stay was reduced when at least 15 of the 22 elements of the program were applied (P<0.001). The patients included in the Grace-Audit databank represented less than 20% of the patients undergoing operation in the same establishments during the study period for all three specialties. This study shows that large-scale ERPs are feasible and safe in French-speaking countries. Nonetheless, although encouraging, these preliminary results highlight that implementation must be improved in specialties such as bariatric surgery and that more complete data collection is needed. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Moving beyond Compliance: Promoting Research-Based Professional Discretion in the Implementation of the Common Core State Standards in English Language Arts

ERIC Educational Resources Information Center

Woodard, Rebecca; Kline, Sonia

2015-01-01

State- and local-level mandates are currently being implemented to ensure strict compliance to the new national Common Core State Standards for English Language Arts (CCSS for ELA) and related assessments. These standards provide many potential opportunities to improve literacy education nationally and locally. However, the CCSS for ELA will…

[Impulsivity: What are the consequences on compliance to rehabilitation?].

PubMed

Cancel, A; Naudet, F; Rousseau, P F; Millet, B; Drapier, D

2016-08-01

Impulsivity is a transnosographical dimension with major consequences on medical care with which psychiatrists are frequently confronted. Furthermore, compliance is a major variable that can affect the efficiency of therapeutics and hospitalizations in psychiatry. A study was carried out in three drug and alcohol rehabilitation hospitalization units to find out if impulsivity can have consequences on compliance. The studied population was composed of 85 patients aged from 18 to 70, hospitalized for one or more addiction disorders in a psychometric hospital in Vannes (France). Impulsivity was measured for all patients with the BIS-11 at the beginning of the rehabilitation program. Because no tool to evaluate a total rehab program compliance existed, a scale, used at the end of the hospitalization, was created to measure patient compliance. This score was composed of two simple numeric scales (one used by the nurses and one used by the patient's psychiatrist) and a coefficient of hospitalization duration that was the ratio of completed to planned days of hospitalization. Correlations were made between the different dimensions: impulsivity and compliance, impulsivity and hospitalization conditions, compliance and hospitalization conditions (voluntary or involuntary, planned by a psychiatrist or not, etc.). The main statistically significant result of the study was a negative correlation existing between the motor dimension of impulsivity and compliance (r=-0.37 and P=0.001). The other dimensions of impulsivity showed no significant correlation with compliance score. The study revealed that the different hospitalization conditions showed no link with compliance or impulsivity. These original results show that motor impulsive patients need an adaptation of the rehabilitation programs. Shorter programs might be more efficient. Copyright © 2015 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Environmental Education and Development Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1994-03-01

The Environmental Education and Development Program is a component on the effort to accomplish the Office of Environmental Restoration and Waste Management`s (EM) goal of environmental compliance and cleanup of the 1989 inventory of inactive DOE sites and facilities by the year 2019. Education and Development programs were designed specifically to stimulate the knowledge and workforce capability necessary to achieve EM goals while contributing to DOE`s overall goal of increasing scientific and technical literacy and competency. The primary implementation criterion for E&D activities involved a focus on programs and projects that had both immediate and long-range leveraging effects on infrastructure.more » This focus included programs that yielded short term results (one to five years), as well as long-term results, to ensure a steady supply of appropriately trained and educated human resources, including women and minorities, to meet EM`s demands.« less

Building Energy Efficiency in India: Compliance Evaluation of Energy Conservation Building Code

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yu, Sha; Evans, Meredydd; Delgado, Alison

India is experiencing unprecedented construction boom. The country doubled its floorspace between 2001 and 2005 and is expected to add 35 billion m2 of new buildings by 2050. Buildings account for 35% of total final energy consumption in India today, and building energy use is growing at 8% annually. Studies have shown that carbon policies will have little effect on reducing building energy demand. Chaturvedi et al. predicted that, if there is no specific sectoral policies to curb building energy use, final energy demand of the Indian building sector will grow over five times by the end of this century,more » driven by rapid income and population growth. The growing energy demand in buildings is accompanied by a transition from traditional biomass to commercial fuels, particularly an increase in electricity use. This also leads to a rapid increase in carbon emissions and aggravates power shortage in India. Growth in building energy use poses challenges to the Indian government. To curb energy consumption in buildings, the Indian government issued the Energy Conservation Building Code (ECBC) in 2007, which applies to commercial buildings with a connected load of 100 kW or 120kVA. It is predicted that the implementation of ECBC can help save 25-40% of energy, compared to reference buildings without energy-efficiency measures. However, the impact of ECBC depends on the effectiveness of its enforcement and compliance. Currently, the majority of buildings in India are not ECBC-compliant. The United Nations Development Programme projected that code compliance in India would reach 35% by 2015 and 64% by 2017. Whether the projected targets can be achieved depends on how the code enforcement system is designed and implemented. Although the development of ECBC lies in the hands of the national government – the Bureau of Energy Efficiency under the Ministry of Power, the adoption and implementation of ECBC largely relies on state and local governments. Six years after ECBC’s enactment, only two states and one territory out of 35 Indian states and union territories formally adopted ECBC and six additional states are in the legislative process of approving ECBC. There are several barriers that slow down the process. First, stakeholders, such as architects, developers, and state and local governments, lack awareness of building energy efficiency, and do not have enough capacity and resources to implement ECBC. Second, institution for implementing ECBC is not set up yet; ECBC is not included in local building by-laws or incorporated into the building permit process. Third, there is not a systematic approach to measuring and verifying compliance and energy savings, and thus the market does not have enough confidence in ECBC. Energy codes achieve energy savings only when projects comply with codes, yet only few countries measure compliance consistently and periodic checks often indicate poor compliance in many jurisdictions. China and the U.S. appear to be two countries with comprehensive systems in code enforcement and compliance The United States recently developed methodologies measuring compliance with building energy codes at the state level. China has an annual survey investigating code compliance rate at the design and construction stages in major cities. Like many developing countries, India has only recently begun implementing an energy code and would benefit from international experience on code compliance. In this paper, we examine lessons learned from the U.S. and China on compliance assessment and how India can apply these lessons to develop its own compliance evaluation approach. This paper also provides policy suggestions to national, state, and local governments to improve compliance and speed up ECBC implementation.« less

Improving and ensuring best practice continence management in residential aged care.

PubMed

Heckenberg, Gayle

2008-06-01

Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness of what best practice means and the impact their practices have on continence management. The JBI clinical audit and feedback cycle will continue to facilitate the measuring and implementation of best practice for resident outcomes in residential aged care. © 2008 The Author. Journal Compilation © Blackwell Publishing Asia Pty Ltd.

75 FR 68702 - Regulation SHO

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-09

... extended compliance period will give industry participants additional time for programming and testing for... time for programming and testing for compliance with the Rule's requirements. We have been informed that there have been some delays in the programming process, due in part to certain information, which...

Outpatient Management of Neonatal Abstinence Syndrome: A Quality Improvement Project.

PubMed

Chau, Kim T; Nguyen, Jacqueline; Miladinovic, Branko; Lilly, Carol M; Ashmeade, Terri L; Balakrishnan, Maya

2016-11-01

An increasing number of infants are diagnosed with neonatal abstinence syndrome (NAS). The study's primary objectives were to describe an academic medical center's level IV neonatal ICU's (NICU's) comprehensive outpatient NAS management effort, measure guideline compliance, and assess its safety. Secondary objectives were to describe the duration and cumulative methadone exposure, and to improve parent and provider knowledge of NAS. The study included 22 infants having a gestational age of 35-41 weeks, diagnosed with NAS, and discharged for outpatient methadone management. Discharges spanned 10 months and included 3 improvement periods. The outpatient program includes comprehensive discharge planning, a focused electronic health record (EHR) template, management guidelines, and parent and provider education. Providers complied with using the outpatient management guideline and EHR template, and assessed weight, NAS symptoms, and methadone dose during appointments. Two infants required NAS-related hospital readmission in the study period. From improvement period 1 to period 3 there was no difference in total outpatient days on methadone (58, 53, 74 days, respectively) or cumulative methadone dose (2.7, 2.6, 3.1mg/kg, respectively). A downward trend pattern in cumulative methadone exposure was noted in improvement period 2. Pre- and postimplementation surveys revealed that after implementation, parents had better understanding of NAS before delivery (71% vs. 100%, p = 0.009), while providers had increased comfort with outpatient management (24% vs. 67%, p < 0.001) and educating parents (48% vs. 82%, p = 0.001). This preliminary study suggests that outpatient NAS management can be safe when a comprehensive management program is implemented and can result in provider compliance with the program. Copyright 2016 The Joint Commission.

Factors influencing the incidence of maxillofacial fractures.

PubMed

Chrcanovic, Bruno Ramos

2012-03-01

Maxillofacial injuries occur in a significant proportion of trauma patients. Trauma causes considerable economic expense due to procedural costs, the time a patient is off work, and the associated loss of income. For these reasons, it is an important health and economic issue. The aim of this study is to discuss the factors that may influence the incidence of maxillofacial fractures. As it is necessary to determine trends to help guide the development of new methods of injury prevention, preventative measures are also discussed. An electronic search was undertaken in March 2011, including articles published between 1980 and 2011 with the terms "facial fractures" and "maxillofacial fractures" in the title. The texts of epidemiological studies were reviewed in order to identify factors that may influence the incidence of maxillofacial fractures. From the selected articles, ten factors were identified: age, gender, geographic region and cultural aspects, socioeconomic status, temporal and climatic influence, use of alcohol and drugs, compliance with road traffic legislation, domestic violence, osteoporosis, and etiology of the maxillofacial trauma. Care of injured patients should include not only management of the acute phase, but also combine preventive programs and interventional programs aimed at reducing the incidence of maxillofacial fractures. Therefore, there is a need to ensure strict compliance of traffic rules and regulations, implement improvement in automotive safety devices, organize prevention programs to minimize assaults, implement school education in alcohol abuse and handling potentially hostile situations (especially for men), improve protection during sporting activities, and legislate wearing of protective headgear in workers. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of trauma. Societal attitudes and behaviors must be modified before a significant reduction in the incidence of maxillofacial fractures will be seen.

A quality improvement project to improve the Medicare and Medicaid Services (CMS) sepsis bundle compliance rate in a large healthcare system.

PubMed

Raschke, Robert A; Groves, Robert H; Khurana, Hargobind S; Nikhanj, Nidhi; Utter, Ethel; Hartling, Didi; Stoffer, Brenda; Nunn, Kristina; Tryon, Shona; Bruner, Michelle; Calleja, Maria; Curry, Steven C

2017-01-01

Sepsis is a leading cause of mortality and morbidity in hospitalised patients. The Centers for Medicare and Medicaid Services (CMS) mandated that US hospitals report sepsis bundle compliance rate as a quality process measure in October 2015. The specific aim of our study was to improve the CMS sepsis bundle compliance rate from 30% to 40% across 20 acute care hospitals in our healthcare system within 1 year. The study included all adult inpatients with sepsis sampled according to CMS specifications from October 2015 to September 2016. The CMS sepsis bundle compliance rate was tracked monthly using statistical process control charting. A baseline rate of 28.5% with 99% control limits was established. We implemented multiple interventions including computerised decision support systems (CDSSs) to increase compliance with the most commonly missing bundle elements. Compliance reached 42% (99% statistical process control limits 18.4%-38.6%) as CDSS was implemented system-wide, but this improvement was not sustained after CMS changed specifications of the outcome measure. Difficulties encountered elucidate shortcomings of our study methodology and of the CMS sepsis bundle compliance rate as a quality process measure.

7 CFR 773.9 - Environmental compliance.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE SPECIAL PROGRAMS SPECIAL APPLE LOAN PROGRAM § 773.9 Environmental compliance. (a) Except as... cooperative which deals with the production, processing or marketing of apples; and (6) Payment of loan...

7 CFR 773.9 - Environmental compliance.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE SPECIAL PROGRAMS SPECIAL APPLE LOAN PROGRAM § 773.9 Environmental compliance. (a) Except as... cooperative which deals with the production, processing or marketing of apples; and (6) Payment of loan...

7 CFR 520.4 - Responsibilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... compliance with the provisions of NEPA and related laws, policies, plans, programs, and projects. The ARS... Administrator for assuring that ARS programs are in compliance with the policies and procedures of NEPA. ...