Nursing Notes

January 8, 2012

Most in-hospital adverse events unreported: OIG

Here is an article from ModernHealthcare.com  that addresses the failure to report events causing patient

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harm.  The article goes on to point out reasons for such a failure and the reasoning does make sense.  However, I feel quite strongly that if nurses had the time to make reports and if those reports were simple and easy, there would be quite a few made.  As it is, nurses are drowning in patient loads, paperwork, and have little to no time to eat or use the restroom, so forgive me if we sometimes don’t stay after our shift to enter cumbersome reports into the computer about events that really did not cause harm but could have.

Please read this article and I would love to hear your take on this topic.

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By Maureen McKinney

Posted: January 6, 2012 – 4:00 pm ET
Read more: Most in-hospital adverse events unreported: OIG – Healthcare business news and research | Modern Healthcare http://www.modernhealthcare.com/article/20120106/NEWS/301069970#ixzz1isnhQ09U
?trk=tynt

The vast majority of in-hospital adverse events go unreported by staff, according to a report from HHS’ inspector general’s office (PDF).

Using a month of survey data from a sample of 189 hospitals, the inspector general’s office found that hospitals’ voluntary incident reporting systems captured only about 14% of events that cause patient harm, such as medication errors. Federal investigators attributed low reporting rates, at least in part, to poor knowledge among hospital staff about what patient harm actually means.

“For example, staff reported only one of 17 sample events related to catheter usage (e.g., infection and urinary retention), a common cause of harm to Medicare beneficiaries,” according to the report.Other types of events that went unreported included cases of excessive bleeding related to misuse of blood thinning medications, and hospital-acquired infections.Incident reporting systems are a requirement for participation in Medicare, but a lack of uniform requirements—such as lists staff can use to identify patient harms—can damage the systems’ reliability, according to the report.“Because hospitals rely on incident reporting systems to track and analyze events, improving the usefulness of these systems is critical to hospitals’ efforts to improve patient safety,” the report said.

The report urged the CMS and HHS’ Agency for Healthcare Research and Quality to develop a list of adverse events for hospitals to use. Additionally, the office said, the CMS should reassess its methods for judging hospital compliance with the reporting-system requirement.

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April 28, 2011

Residential Health’s med monitoring pilot slashes readmissions

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Here is an article that describes another way that telemedicine can be utilized to prevent readmission.  In reading this article, I was confused by the physicians who did not want to participate in this study.  Why?  If this is a way to maintain a patient’s health while out of the hospital, what is the problem?

Please read the entire article and come back here to tell me what you think, okay?  I really would like to hear from you on this topic.  It seems that telemedicine is the wave of the future and we need to be prepared to use it as nurses.  I think it is a great tool for health.  That’s just my opinion.  What’s yours?

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By Jay Greene

Crain’s Detroit Business

A pilot project by Madison Heights-based Residential Home Health LLC that uses remote medical monitoring held hospital readmissions to 3 percent last year for 239 patients with congestive heart failure and chronic obstructive pulmonary disease.

National data show that 20 percent of all Medicare patients are readmitted to hospitals within 30 days, and 33 percent are readmitted within 90 days, costing Medicare more than $17 billion annually, according to a 2009 study in the New England Journal of Medicine.

In similar patients who did not participate in Residential’s Cardiopulmonary Hospital Admit Management Program, called CHAMP, during the last six months of 2010, the readmission rate was 25 percent, said David Curtis, Residential’s president.

But remote monitoring isn’t universally popular.

“Not every patient wants to use telemonitoring, and some physicians don’t want it,” Curtis said. “In order to drive down readmissions, we need better alignment (with patients and physicians).”

Curtis said the reduction in readmissions comes by focusing on three areas: educating patients within 24 to 48 hours after going home from the hospital, preventing medication errors, and having patients take vital signs with the devices daily.

Residential uses remote medical monitoring devices provided by Philips Telehealth Solutions including wireless weight scales, blood pressure cuffs and blood glucose meters.

Residential nurses and therapists teach patients to use the Philips devices. The data is transmitted daily to Residential, where nurses monitor it and contact physicians if warranted.

But the use of remote medical monitoring devices to reduce readmissions is still in its infancy and studies have shown mixed results.

For example, a study published November in the New England Journal of Medicine showed no reduction in readmissions from use of telemedicine in heart failure patients. However, the study concluded that many of the patients didn’t take daily readings from the instruments.

Curtis is familiar with the studies and says the effectiveness of the remote monitoring devices is only as good as nurses and therapists following up with patients to make sure they are compliant.

“If we don’t hear from our patients by 11 a.m., we are calling to remind them,” Curtis said. “The value of telemedicine is not in the equipment, it is in the process and patient education we use to prevent readmissions.”

Christopher Kim, M.D., a hospitalist at the University of Michigan Hospitals in Ann Arbor and a readmission reduction expert, said some technology vendors are aggressively promoting the use of telemedicine devices to reduce hospital readmissions.

“I am not sure it is completely justified yet,” he said. “The technology can help, but we have to look at our workflow and make sure we coordinate care with post-acute providers to keep patients out of the hospital.”

Besides the program saving Medicare money and improving patient care, Curtis said demonstrating low readmission rates will help bring more patient referrals to Residential from physicians.

“If we have the best outcomes, we can generate new business,” said Curtis, a health care and manufacturing consultant who acquired Residential six years ago with three other partners, including Chairman and CEO Mike Lewis, a lawyer who was a senior partner at Troy-based Dean & Fulkerson.

The company is already one of the state’s largest non-hospital-based agencies with more than 2,200 patients, according to the Michigan Home Health Association.

Annual revenue for 2010 for Residential and its affiliates totaled $48 million, down from $53 million in 2009, Lewis said. The revenue slide came from rising costs and flat Medicare payments, a shortage of nurses and therapists that limited census, and costs associated with expanding into Illinois, he said.

“We had staffing issues last year because of the nursing shortage, but this year we have hired one clinician every other day (more than 50 nurses and therapists),” Lewis said.

Of Residential’s 473 employees in Michigan, 255 are nurses and therapists and 17 employees are part of the company’s marketing and community liaison team, Curtis said.

In Michigan, Residential averages 1,500 patient home care visits per day, a 20 percent increase from last year. The company also has an agency in Illinois that averages about 300 patient visits per day.

Jerry Wilborn, M.D., a pulmonary critical care specialist and hospitalist who refers some patients from Botsford Hospital to Residential, said he uses data collected by Residential to determine…[read the rest here]

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January 9, 2010

Justice – finally – is served

This is a rather lengthy article, so I did not post the entire article here.  Please do follow the link to the next page to finish reading this.  This is a travesty against nurses everywhere.  In a time when nursing is struggling and when daily news spout off about the shortage of nurses, to find that you have to fight with, not only your hospital but also with your nursing association (that is supposed to be on your side and  looking out for you) to “do the right thing” is appalling.  No wonder nurses are leaving the profession in droves.  Nurse’s get no respect from anywhere.

If you are a nurse and this article doesn’t make you angry, then I really don’t know what will. Maybe nothing.

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David Joles, Star Tribune

Ladonna Schweer has been wrapped up in litigation for 15 years after she reported suspected Medicare fraud at a Fridley hospital. The lawsuit helped save her profession, but she had to sue her own organization to get the compensation she was promised.

Two nurse anesthetists sacrificed their careers in a legal battle to save their profession, only to find themselves left behind again by their own organization.

By JAMES ELI SHIFFER, Star Tribune

Last update: December 28, 2009 – 11:29 PM

These days, doctors and nurses who provide anesthesia work side-by-side in the operating room and birthing suite, dispensing the drugs that keep patients blissfully unaware of pain.

Yet this relative harmony came after a decade of bitter litigation in which the nurses accused doctors and hospitals of defrauding Medicare and conspiring to keep nurses subservient and poorly paid.

Two nurse anesthetists from the Twin Cities sacrificed their careers to pursue lawsuits against Allina Health Care, which ended with a settlement and changes to Medicare rules that helped save the profession.

Despite the victory they helped bring about, Ladonna Schweer and Gayle McKay were left behind. This year, they had to sue their own organization, the Minnesota Association of Nurse Anesthetists (MANA), in order to make the group honor its long-standing vow to compensate them for putting their ideals ahead of their jobs.

When Schweer sat down in a Hennepin district courtroom in October, she had waited 15 years for justice. She was fired from an Allina-owned hospital, blackballed from jobs in the Twin Cities and forced to take lower-paying work in rural Wisconsin. Then she heard four words from Judge Ann Alton that validated all her feelings.

“Whistleblowers are always punished,” Alton said at the hearing.

The next day, the association agreed to compensate Schweer and McKay for their lost wages and benefits, plus interest. Schweer received $788,000 while McKay got $398,000.

“This was not a windfall for me,” Schweer, 58, said. “This was money that I lost.” Yet she said she would do it again. “I have a hard time looking away from an injustice that I see,” Schweer said.

Doctors vs. nurses

The October hearing in Judge Alton’s courtroom started with a nasty dispute between two groups of medical professionals in the early 1990s.

Trained to provide sedation and pain relief, nurse anesthetists were increasingly taking the place of anesthesiologists, usually at less than half the cost. In the Twin Cities, nurse anesthetists were mainly employed by hospitals, while anesthesiologists worked for physicians’ groups that billed separately for their hospital procedures.

Schweer, who supervised nurse anesthetists at Allina’s Unity Hospital in Fridley, was asked to look into Medicare’s rejection of bills related to anesthesia services. Anesthesiologists, who are licensed physicians, were charging for procedures actually performed by nurse anesthetists. For example, the doctors might pop in at the beginning and end of a procedure, but they billed as if they were present the whole time.

The hospitals’ solution: fire all nurse anesthetists, eliminating any possibility of Medicare double-billing. In early 1994, Mercy and Unity hospitals terminated 38 nurse anesthetists. Schweer and McKay, who worked at Abbott Northwestern, were both active in the 1,000-strong Minnesota Association of Nurse Anesthetists. Though they kept their supervisory jobs, the two realized hospitals were threatening their profession.

In November 1994, with Schweer and McKay’s help, the association filed twin lawsuits against Allina, affiliated hospitals and several doctors’ practices. The first suit alleged anti-trust collusion designed to put nurse anesthetists under the control of doctors. The second — filed secretly with the assistance of the U.S. Department of Justice — accused the hospitals and doctors of defrauding Medicare of millions of dollars.

Long haul to payment

In a 1994 agreement between Schweer, McKay and their organization, MANA became the designated plaintiff, thereby benefiting from any big court judgment.

In exchange, Schweer and McKay were promised a cut of any court proceeds based on the wages and benefits they might lose due to their hamstrung careers.

The gloomy expectations were justified. Once Schweer’s involvement in the litigation became public, she said, the hospital turned hostile. Her co-workers stopped talking to her. Her car was vandalized twice, so she stopped parking in hospital lots.

In 1998, the hospital reorganized and Schweer’s job was gone. She wouldn’t discuss how much of a financial hit she took. But McKay, who lost her job in 1997, said her annual salary dropped from about $88,000 to $29,000. The two nurses estimate the litigation consumed 4,000 hours of their lives.

In September 2003, a settlement was finally reached. Allina and other defendants agreed to pay $2.75 million to the federal government to settle the Medicare fraud allegations. They paid $8 million to the association, which dwindled to $2.7 million after paying legal fees and loans from the national organization.

As a more far-reaching result of the case, Medicare reformed its practices, paying nurses and doctors equally when they collaborate on anesthesia service.

In early 2005, the association appeared ready to fulfill its agreement with Schweer and McKay. But the actuary who calculated the value of the women’s lost earnings brought up an unexpected issue: Paying them might get the association in trouble with the IRS, which could reconsider its status as a nonprofit organization.

“No one has ever thought that they did not deserve compensation,” said Marc Kessler, a spokesman for the association. “They were worried about the tax-exempt status of the organization.”

Schweer figured she could wait for the IRS to weigh in on the issue, but the agency took four years before issuing an ambiguous ruling. When the association still refused to hand over their money in 2009, the two nurse anesthetists went to court.

“It’s outrageous that Ladonna and I eventually had to sue to get them to honor the contract that they wrote and they gave to us,” said McKay, 64, who’s now retired.

The conflict came down to that October day in Judge Alton’s courtroom. At the plaintiffs’ table sat two lawyers, one of whom was Schweer’s daughter, Jennifer Pirozzi, who was a senior in high school when her mother’s legal journey began. After a few preliminaries, Alton quickly signaled that her patience with the association had run out.

The IRS issue was “100 percent irrelevant,” the judge said, declaring the association should have figured that out before suing in the 1990s. “That is MANA’s problem,” Alton said. “It is absolutely not Ms. Schweer’s problem or any of these other people who are entitled to get money.”

Though Schweer has gotten her money, she said she’ll keep pressuring the association to compensate another 10 to 15 nurse anesthetists who worked on the lawsuit and signed agreements with the group. Until her colleagues are paid, Schweer said, “it’s not over.”

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