Showing posts with label Quality assurance. Show all posts
Showing posts with label Quality assurance. Show all posts

Tuesday, May 17, 2011

Nursing Home Rehabilitation Stay Proves Terminal. Was Quality of Care Given An Issue?

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Summary: Nursing homes are frequently a patient's destination for
rehabilitation following surgery.  Common conditions fitting
this bill include large bone fractures, hip replacements and stroke.
Following these acute episodes, the patients are too unstable to
go home and not "sick" enough to have their hospital stays
reimbursed by insurance companies.  The purpose of admission
to a nursing home is to help the patient regain lost function,
strength and health.  In this case, the patient would remain in the
Nursing Home till her death of complications.

The patient was admitted to a state owned nursing home
following repair of a femoral fracture.  Her treatment plan
emphasized Physical, Occupational therapy and Nursing care
to provide for rehabilitation.

She had successfully undergone surgery to repair a fractured
femur.  The length of stay projected was six weeks.  During
this time, the patient's condition would worsen rather than
improve.

This is not an isolated incident.  Media attention is continuously
focusing on conditions in nursing homes.

"A TIME investigation has found that senior citizens in nursing
homes are at far greater risk of death from neglect than their
loved ones imagine. Owing to the work of lawyers, investigators
and politicians who have begun examining the causes of
thousands of nursing-home deaths across the U.S., the grim
details are emerging of an extensive, blood-chilling and for-profit
pattern of neglect."2

The patient's skin was intact and she was continent on admission.
She would develop multiple pressure ulcers on her bony
prominences.  These are frequently the consequence of inadequate
turning and poor nutrition.  Monitoring of both of these factors
are direct responsibilities of nurses and nursing home personnel.
If either is inadequate, a duty is owed to the patient by the nurse
to inform the physician.  The physician, once made aware, is
then charged with taking additional measures as needed.

The patient would have a Foley catheter inserted supposedly
for urinary incontinence.  Documentation would later show
that need for catheterization had not been established.

The patient had been fully continent on admission.  Her
rehabilitation plan called for her to ambulate to the bathroom
when needed.  An assessment of her ability to go on her own
was nowhere to be found at the time of her Foley catheter
insertion.  Development of a urinary tract infection is a known
complication of catheter use.  The patient would develop a
UTI soon after.

"In the last year, complaints against nursing homes in Texas
are up over 60%. Medication errors, under-staffing, unsanitary
conditions, neglect, lack of care, substandard care and injuries
from dangerous products, are but a few of the dangers. The
administrators of these facilities contend that the level of care
is excellent in Texas nursing homes but, state investigators and
Texas juries have been sending a different message."3

On the initial trial, the court dismissed the claims.  They based
this on the fact that the nursing home personnel were "state"
employees and supposedly immune from liability.

The patient's family appealed.

Questions to be answered:

1. Could the nursing home personnel in a public facility be
held liable for negligence in the care of the patient?
Specifically, could they be sued for not maintaining the
standards of care required by the state?

2. Were the "incidents" leading up to the patient's deterioration
reasonably "foreseeable" by a prudent caregiver in a
similar situation?

On appeal, the plaintiff presented multiple pieces of evidence
documenting neglectful incidents.

This documentation included fractures during transfers (one
requiring re-hospitalization and extensive surgical repair),
the development of skin breakdown, the development of
infections of the respiratory, urinary and gastrointestinal tract.

Each of these events suggested that care for the patient could
be falling below accepted standards.  Each of these events
could be identified as necessitating further therapy and
increasing the patient's length of stay.

In reviewing the Tort Immunity Acts of Illinois, it was
determined that liability could be assessed for acts of
negligence or omission in the patient's care.

It was clear from physical, mental and health status changes
that the patient was deteriorating.  These changes, specifically
the multiple injuries during transfers, development of skin
breakdown and infection could be traced to negligence in the
omission of required care.  Any time the treatments prescribed
by the physician are not carried out, or if it is not documented
that they have been carried out, the possibility of omission and
negligence is raised.

It is highly unlikely that if the treatments and care prescribed
had been given that the gross deterioration would have occurred.
In this case, documentation of care was not present.  Documentation
of "likely results of neglect" was present.

This underscores the necessity of properly documenting the care
you give.   Many facilities are adopting "charting by exception"
policies.  These are dangerous in that they may not account for
basic care given.  In saving time and nursing costs for a facility,
not fully charting care given can raise the question of a nurse's
omission and negligence later in court.

If the temptation to chart care that is not given is present, keep
this in mind.

If time for giving proper treatments and care is not there,
falsifying records is patently illegal.  It is an offense that
could cost you your license if reported to the State Board.

In the case of a lawsuit, it is much cheaper for a facility to
scapegoat a nurse, than defend one.  If reporting you to the
State Nursing Board, or threatening to will give their attorney's
a bargaining chip to keep an employee "quiet," about existing
conditions they'll use it.

"Generally, the nursing-home industry likes to settle lawsuits
quietly and often hands over money only in exchange for
silence."2

A nurse must decide if saving facility money by spending
less time charting or on patient care is worth possible liability
or loss of licensure down the road.  It is highly unlikely that
a nursing home or hospital will defend a nurse named in a
lawsuit.  This chiefly will happen only when the facility's
assets are at stake.

If conditions in a nursing home are visibly substandard, a
nurse must ask if it is wise to continue working in the facility.
Ask yourself.  Is the administration receptive to suggestions
for improvement?  Do they raise concerns over overtime and
time involved to complete care and charting?

As media attention and lawsuits increase, more nurses will
find themselves involved in legal actions.  If it's determined
that poor conditions existed yet nothing was done about
them, the cost in liability could be high.

"Palo Alto attorney Von Packard has studied the death
certificates of all Californians who died in nursing homes
from 1986 through 1993. More than 7% of them succumbed,
at least in part, to utter neglect--lack of food or water,
untreated bedsores or other generally preventable ailments.
If the rest of America's 1.6 million nursing-home residents
are dying of questionable causes at the same rate as in
California, it means that every year about 35,000 Americans
are dying prematurely, or in unnecessary pain, or both."2

Many states have "elder abuse" legislation mandating abuse
be reported.  Whistle blower legislation is slow in coming.
Currently the employer's interests are put first rather than the
patient's or employees in most cases.  Protections for nurses
that do report abuse are questionable in their effectiveness.
The risk of employer retaliation is high.

The chances of a nursing home or hospital defending you
against the State Board of Nursing when your license is
at stake over an incident are almost none.  In fact, it is
common for complaints to be filed by the facility where
a nurse has worked.

Unless you have a personal malpractice insurance policy,
you will be forced to pay for this representation out of pocket.
For less than the cost of a typical day's pay (around $70-$90
per year), most personal policies will provide representation at
no additional cost to you.

Related link Sections:

Direct Patient Care Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Foley Catheterization:
http://www.nursefriendly.com/nursing/directpatientcare/foley.catheterization.htm

Informed Consent:
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/informed.co...

Mechanical & Physical Restraints:
http://www.nursefriendly.com/nursing/directpatientcare/mechanical.physical.re...

Medical Legal Consulting Nurse Entrepreneurs:
http://www.nursefriendly.com/nursing/ymedlegal.htm

Operating Room (Surgical) Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directory/spec/operatingroom.htm

Nursing Homes, Long Term Care Links:
http://www.nursefriendly.com/nursing/nursing.homes.long.term.care.htm

Wound Care:
http://www.nursefriendly.com/nursing/directory/business/woundcar.htm

Sources:

1. 39 RRNL 12 (May 1999)

2. Time Magazine.  October 27, 1997. Fatal Neglect. Retrieved July 11, 1999 from the World Wide Web: http://cgi.pathfinder.com/time/magazine/1997/dom/971027/nation.fatal_neglect....

3. Law Offices of James K. Burnett, P.C. 1999.  Nursing Home Negligence. Retrieved July 11, 1999 from the World Wide Web: http://www.nursinghomenegligence.com/
 

The Uniform Resource Locator (URL) or Internet Street Address of this page is
http://www.nursefriendly.com/nursing/clinical.cases/071199.htm

Send comments and mail to Andrew Lopez, RN

Created on July 11, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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Thursday, April 28, 2011

Nyack Hospital's Code H Spells Safety and Satisfaction | New Jersey Nursing News

Nyack Hospital, Nyack, N.Y., has launched a system where patients and their visitors can trigger levels of rapid response. Impetus for the innovation came after the well-publicized medical error that ended in the death of 18-month-old Josie King at Johns Hopkins in Baltimore, Md., and the resulting focus on patient and family involvement in acute care.

Although patients and families can use the system to alert staff about potential emergency situations, such as chest pain, it also offers the reassurance that help is nearby. This is in case patients experience delays in bedside care, pain medications, and more, according to Ginni Norton, RN, MS, Nursing Performance Improvement, Nyack Hospital, a member of the NewYork-Presbyterian Healthcare System.

A team approach

Nyack Hospital patients and their visitors can call 3-1-1-1, which goes directly to hospital operators. The operators have been trained to ask callers questions according to an algorithm. Callers who report something physiological, such as bleeding or chest pain, are be routed immediately to rapid response. The call can trigger a team, including the nurse manager from the patient's unit, house physician, respiratory therapist, critical care nurse, and pharmacist.

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Sunday, April 24, 2011

Medicare Hospital Compare Quality of Care (Thanks @TheresaBrown)

Medicare.gov>Hospital Compare Home

Hospital Compare

Where do you want to find a hospital?

Search Information



e.g. 10009 or New York, NY

Search type

[What is Search Type? ? - Opens in a new window]







Hospital Spotlight


In the future, Hospital Compare will have new information about Hospital Acquired Conditions.

Medicare releases new data on Hospital Acquired Conditions. Click here for more information.


You can now visit Medicare's Hospital Value Based Purchasing Program page and learn more about potential future measures.

Data Last Updated: April 11, 2011

Click on the "via" link to read the full article.

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Monday, April 18, 2011

Not Running a Hospital: Painfully slow

You can already imagine the responses. "That's just in North Carolina." "Our patients are sicker." "There are problems with the data."

What would prompt that? This New York Times article, citing a forthcoming NEJM study about medical errors in North Carolina. Here's the lede:

Efforts to make hospitals safer for patients are falling short, researchers report in the first large study in a decade to analyze harm from medical care and to track it over time.

The study, conducted from 2002 to 2007 in 10 North Carolina hospitals, found that harm to patients was common and that the number of incidents did not decrease over time. The most common problems were complications from procedures or drugs and hospital-acquired infections.

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Monday, April 11, 2011

Patient complaints do not fit the primary care office visit

by Kevin Pho, MD

Primary care physicians often have to see patients with a litany of issues.  Often within a span of a 15-minute office visit.

This places the doctor in the middle of a tension — spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.

And, in some cases, it’s simply impossible to adequately address every patient question during a given visit.

It’s a situation that internist Danielle Ofri wrote recently about in the New York Times.

In her essay, she describes a patient, who she initially classified as the “worried well”:

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Andrew Lopez, RN
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Thursday, April 7, 2011

Errors still common in U.S. hospitals | Reuters

About one in three people in the United States will encounter some kind of mistake during a hospital stay, U.S. researchers said Thursday.

The finding, which is based on a new tool for measuring hospital errors, is about 10 times higher than estimates using older methods, suggesting much work remains in efforts to improve health quality.

"Without doubt, we've seen improvements in health care over the past decade, and even pockets of excellence, but overall progress has been agonizingly slow," said Susan Dentzer, editor-in-chief of Health Affairs, which published several studies on a special issue on patient safety.

The special issue came 10 years after an influential Institute of Medicine report that found significant gaps in health quality.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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856-415-9617, (fax) 415-9618

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Racial Disparities Remain for Health Care for Vets - MSN Health - High Blood Pressure

Gaps in care for black and white U.S. veterans have been reduced over the past decade as the VA Health Care System improved access to screenings and treatment of high-risk conditions among all patients. But major disparities persist in control of cholesterol, diabetes and high blood pressure, a new study says.

Researchers assessed 10 clinical performance measures among a national sample of more than 1.2 million VA enrollees between 2000 and 2009.

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Wednesday, April 6, 2011

Electronic Health Records: Status, Needs and Lessons – 2011 Report Based on 2010 Data

The use of electronic health records (EHRs) by medical practices and other organizations in the United States has increased measurably in the past decade. Despite the potential to improve the quality of patient care and enhance practices' financial performance, the technology remains far from universal.

To better understand the current state of EHR use, MGMA conducted a study funded by PNC Bank to explore the barriers and benefits of EHR adoption. MGMA collected data between Oct. 1, 2010, and Nov. 9, 2010, from 4,588 healthcare organizations nationwide that responded to the survey. The data represent the aggregate experience of more than 120,000 physicians in medical practice.

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Andrew Lopez, RN
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Monday, April 4, 2011

The five hospital factors that affect heart attack survival, Science Daily

Until now, little has been known about the factors that may influence this variation in death rates. The Yale team reviewed 11 hospitals through interviews and site visits. Those selected were among the best and worst performers, as rated by the federal agency that administers Medicare and Medicaid.

"Previous research looked at whether hospital characteristics like urban location, teaching status, geographical region, and socio-economic status of patients are related to acute myocardial infarction (AMI) mortality rates, but these factors don't explain much of the variation in mortality," said Leslie A. Curry, Ph.D., research scientist at the Yale Global Health Leadership Institute and lead author on the paper. "We were particularly interested in the roles of social interactions and organizational culture, which are difficult to measure using common research approaches like surveys."

Hospitals in the high- and low-performing groups differed substantially in five ways: organizational values and goals, senior management involvement, broad staff presence and expertise in AMI care, communication and coordination, and problem solving.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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856-415-9617, (fax) 415-9618

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Sunday, April 3, 2011

How to Find the Best Hospital Near You - US News and World Report

Some Americans are fortunate enough to live down the street from a world-class hospital. For them, where to go for highly skilled care is clear.

For most of us, though, finding a hospital that offers both excellent care and local convenience has long been a challenge. Healthcare consumers have faced a dearth of reliable information about how the hospitals near them stack up. The problem is most acute in large metropolitan areas, which are crowded with hospitals that offer varying degrees of expertise across a range of medical specialties.

Click here to find out more!

In principle, going to a renowned medical center such as one of the nationally ranked U.S. News Best Hospitals is a solid option. But that could be difficult if it requires travel, expensive if not covered by insurance, and unnecessary except in the most challenging medical cases. No wonder most hospital patients stay close to home.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
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Wednesday, March 30, 2011

Why Not The Best (Hospital Benchmark Data)

Comparative Health Care
Performance Data

 

  • See how well U.S. hospitals perform on measures of evidence-based care, patient experience, readmission and mortality rates, and costs
  • Compare a hospital's performance with peer organizations and national benchmarks
  • Find case studies and tools to help improve the quality of care

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

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Tuesday, March 29, 2011

Drug Shortages Distress Hospitals - WSJ.com

A shortage of injectable generic drugs for cancer and other serious diseases is putting pressure on hospitals, which are sometimes having to scramble to locate the medicines or search for alternative treatments.

The supply of these drugs has tightened in recent years as the generic-drug industry has consolidated, with many of the drugs now made by just one or two companies. In many cases patents have long expired and the original brand-name drug is no longer being produced.

Federal regulators have also stepped up enforcement of quality standards, limiting the ability of large manufacturers to ramp up production.

The drugs—typically used in hospitals and outpatient clinics—often require complex manufacturing processes with long lead times. Because factories produce many kinds of medicines, companies say they can't easily make more of one without creating a shortage in another.

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******************************************************

Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

150,000 + Nurse-Reviewed & Approved Nursing Links

http://www.4nursing.com
http://www.legalnursingconsultant.com
http://www.nursinghumor.com
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http://www.nursingexperts.com

Sunday, June 20, 2010

Quality Assurance Nurse Consultants, Nurse-Owned Businesses, Nurse Entrepreneur

Quality Assurance Nurse Consultants, Nurse-Owned Businesses, Nurse Entrepreneur:"Quality assurance is defined as an evaluation of the conditions under which care is provided. Quality assurance, which is also known as "quality improvement" or "quality assessment" may be applied in the hospital, in the medical office setting, at a health maintenance organization (HMO) or at a preferred provided organization (PPO)."

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