Some wireless devices are causing problems with hospital equipment.

CHICAGO (AP) - Wireless systems used by many hospitals to keep track of medical equipment can cause potentially deadly breakdowns in lifesaving devices such as breathing and dialysis machines, researchers reported Tuesday in a study that warned hospitals to conduct safety tests.

Some of the microchip-based “smart” systems are touted as improving patient safety, but a Dutch study of equipment - without the patients - suggests the systems could actually cause harm.

A U.S. patient-safety expert said the study “is of urgent significance” and said hospitals should respond immediately to the “disturbing” results.

The wireless systems send out radio waves that can interfere with equipment such as respirators, external pacemakers and kidney dialysis machines, according to the study.

This is just an FYI post.

I have seen a disturbing trend of late. Quietly, medical and nursing facilities have been laying off staff in higher numbers. Not just housekeepers and janitors either; but nurses and CNA’s. In my state, a couple weeks ago a highly rated hospital closed down a unit and laid off 23 nurses and aides. Another facility was going to trim down a nursing unit by 15 beds, and would have laid off about 20 LNA’s and several nurses; the facility changed it’s mind on this, for now.

What’s going on? Did we ever think CNA jobs would be targeted for lay offs? Times are getting tough.

Cape Cod Hospital has notified an employees’ union it intends to eliminate about 17 full-time positions, including jobs held by cleaning staff, shuttle bus drivers, nursing assistants and food service workers.

The hospital is looking to save $800,000 through a combination of layoffs and not filling currently vacant positions, said David Reilly, spokesman for Cape Cod Healthcare Inc., the parent company of Cape Cod and Falmouth hospitals.

The job loss affects only Cape Cod Hospital, which is feeling the brunt of a multimillion-dollar revenue decline.

The 16.9 positions are “full-time equivalents,” meaning each is the equivalent of a 40-hour-a-week job. But the job loss could actually affect more than 17 individuals, since several of the jobs are shared by part-timers.

Revenue is the income a facility receives to pay for it’s operating costs. Much of this money comes from the federal government and state government, as well as from insurance payments. But, because these sources are not increasing their rates of reimbursement to the facilities, we have a shortfall.

Don’t assume belonging to a union will save CNA jobs:

‘The entire health system is feeling the pressure,” said Jerry Fishbein, vice president of 1199 SEIU, United Healthcare Workers East, whose union represents the workers whose jobs will be eliminated.

As required by collective bargaining stipulations, the hospital gave the SEIU a “30-day notice” of its intent to lay off the employees.

The next step is for the union to meet with hospital officials to see if they can whittle down the list, said Fishbein, whose union has 1,200 members at Cape Cod Hospital. “At the end of the day, there will undoubtedly be some layoffs. We certainly think the numbers should come down. It’s process of negotiation.”

This process might save one job, or position. It’s not comforting to know this process, negotiation, is all the unions can offer us when we face a job loss.

Last month, Cape Cod Healthcare CEO Steve Abbott announced that the organization had suffered a $17.6 million revenue loss in seven months.

The company responded by laying off 11 employees, mainly in mid-management and clerical positions, requiring a dozen senior executives to take a 10 percent pay cut and asking employees to consider early retirement.

The cut backs weren’t enough. So now they take it to the next level.

“Cutting back on the nursing assistants is a big problem for us,” said Stephanie Francis of the Massachusetts Nurses Association.

The two nursing assistant jobs scheduled to be eliminated could require nurses to pick up the slack and spread themselves thinner among patients, she said. Such a move would be in direct opposition to the Patient Safety Act being proposed on Beacon Hill, which requires a certain ratio of nurses to patients, Francis said.

Well usually the nurses whine when it’s THEIR job on the line; they complain when they are replaced with the less skilled, lower educated unlicensed assistive personnel (as we’re known as); they cite patient care problems when there are more of US then them. Since UAP don’t fall under Nurse s scope of practice rules, this claim is disingenuous at best. BUT, at least she’s sticking up for the aides in this case.

Abbott, who is retiring this summer, has blamed some of the hospital’s financial woes on the rise of off-site, privately run surgical centers and on an independent physician association, Physicians of Cape Cod, that he says is making fewer referrals to Cape Cod and Falmouth hospitals and their affiliated laboratories and services.

By sending patients to private organizations for procedures that receive lucrative reimbursements, the physicians in the I.P.A. are forcing the nonprofit hospitals to absorb more and more of the cost of serving the community, Abbott said.

More disingenuous stuff here. First off, remember this is Cape Cod. Kennedy country. John Kerry country. Where the rich live and house up for the summers. These people will not utilize the services of a public hospital no matter what. Cape Cod is full of private facilities that offer services at far cheaper rates than the public hospitals, believe it or not. Private sector doesn’t always mean more costs. The people who reside in this area do have a right to pick and chose where they will receive their health care, surgeries and the like. I do know these private facilities offer jobs to nurses and CNA’s and pay them better.

Do we take away this choice in the name of saving jobs? I think not.

What is certain is times are changing. More and more medical and nursing facilities are going to be forced to make cutbacks; this will result in patient care being put in jeopardy in many situations. I would expect to read more and more similar articles in the next decade or so, too. The trend is only just beginning. Brace yourselves.

A reminder as to why it’s SO important to wash your hands:

LONDON (AP) - Nurses who didn’t wash their hands and left patients lying in soiled beds were cited in an official report blaming mismanagement for the deaths of 90 people who contracted a bacterial infection in hospitals in southern England.

“Significant failings” at all levels contributed to infections of more than 1,000 patients at three hospitals, the Healthcare Commission said Thursday.

The patients were infected with Clostridium difficile, or C. diff, which can cause diarrhea, colitis and other intestinal problems, officials said.

“The Healthcare Commission has passed the copy of the report to us and that is being reviewed,” said a spokesman for Kent Police, speaking on condition of anonymity in line with force policy.

The report into the spread of the highly contagious bacterium said nurses at three hospitals run by the Maidstone and Tunbridge Wells NHS trust were often too busy to wash their hands and left patients in their own excrement.

Across the pond they’re having HUGE problems battling these germs and bugs. It sounds like hand washing isn’t on top of the things nursing staff do over there.

Fighting back:

OAKLAND, Calif., Sept. 26 /PRNewswire/ — SEIU United Healthcare Workers-West and SEIU Local 121RN have filed for injunctive relief seeking to stop Tenet Healthcare Corp. from cutting health benefits for nearly 7,000 California hospital employees, including registered nurses, pharmacists, licensed vocational nurses, respiratory care practitioners, radiology technicians, surgical technicians, and certified nursing assistants.

Workers represented by the two unions have been in negotiations with Tenet Healthcare for nearly a year. In June, Tenet and the workers reached an agreement on maintaining all health benefits and costs. Last week, however, Tenet changed their position and announced that they plan to cut benefits beginning in November, during the open enrollment period with PacifiCare, which administers the corporation’s health plan.

Once an agreement has been made it needs to be honored. Tenet is well known for pulling stunts like this. Again, these for profit centers are not worth the jobs they offer. Sooner or later, employees are screwed over.

Instead of talking about the shortage of nurses and aides, this hospital decided to do something about it.

University Health System, a public hospital in San Antonio, faced a critical shortage of nurses in 2001, with the vacancy rate climbing to 21 percent. Without new nurses, the hospital might be forced to curtail or shut down some key emergency functions.

Contract nursing providers could fill the gap quickly. But the hospital decided to gamble on a training and development program, hoping to create a long-term pipeline of new nurses, some of whom would be culled from the hospital’s own unskilled worker ranks. The strategy included nursing school scholarships and training assistance, and it worked so well that the hospital’s nursing vacancy rate is down to 4.59 percent today.

The nuts and bolts:

…the hospital began looking closer at its 5,400-member workforce. While the hospital has about 950 nurses, it also has hundreds of unskilled workers serving in housekeeping, maintenance and cafeteria jobs. The hospital determined that many of those workers would welcome the chance to move up to more skilled and higher paying jobs but lacked the time or resources to do so.

So the hospital launched a certified nursing assistant program under which a local community college offered courses on site toward a medical technician certificate, which is often a first step to becoming a nurse. The program has been a hit with the hospital’s lower-skilled workers.

To encourage continued education toward a full nursing degree or certificate, the hospital partnered with local nursing schools to fund a $3,000-per-year nursing scholarship program open not only to hospital workers but to other students as well. The catch: graduates must agree to work for University Health for periods ranging from two to three years.

To help make sure the nursing schools had enough faculty, the hospital arranged for professional staff members to teach the courses. The program is funded through a government grant.

Innovative and inspirational. Other hospitals could do similar things.

How’s it worked so far?

The series of initiatives worked so well that the hospital now has a steady stream of new nurses lining up to fill open slots. The scholarship program has proven so successful that it was recently put on temporary hiatus because the hospital has all the nurses it can handle at the moment.

Now that is success.

More than ever, medical errors and poor nursing care will become a very hot topic in the near future.

WASHINGTON, Aug. 18 — In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.

Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”

Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.

“If a patient goes into the hospital with pneumonia, we don’t want them to leave with a broken arm,” said Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services.

The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the health industry.

It also raises the possibility of changes in medical practice as doctors hew more closely to clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission.
[…]
The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year — about 270 a day.
[…]
Consumer groups welcomed the change. And while hospital executives endorsed the goal of patient safety, they said the policy would require them to collect large amounts of data they did not now have.

Lisa A. McGiffert, a health policy analyst at Consumers Union, hailed the rules.

“Hundreds of thousands of people suffer needlessly from preventable hospital infections and medical errors every year,” Ms. McGiffert said. “Medicare is using its clout to improve care and keep patients safe. It’s forcing hospitals to face this problem in a way they never have before.”

Christine K. Cahill, a registered nurse who used to inspect hospitals for the California Department of Public Health, said: “This is a great start. Infection-control specialists have been screaming for 20 years that federal and state officials should pay more attention to this problem because hospital infections hurt patients and cost money.”
[…]
The rules, first reported in The Star-Ledger of Newark, carry out a directive from Congress included in a 2006 law. When they were proposed in May, consumer advocates said they feared that some hospitals might charge patients for costs that Medicare refused to pay.

But that is forbidden. “The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,” the final rules say.

Trust me. Someone WILL pay these bills. Hospitals are great at shifting costs; they will simply charge more for services and we will all pay for the errors of a few and the ensuing costs to care for the results. That pressure sore? Think about all the time, the dressing changes and wound care…the products…everyone will pay. But we won’t see any benefit from this. Less money coming into the system will mean even less money for wages and benefits. It’s strange how these rules are thought out. IF there were enough nurses and aides to begin with, pressure sores wouldn’t be prevalent now would they? If OR nurses weren’t so rushed, there wouldn’t be so many errors; same with medications and other things. AND if we all just washed our hands more often, and wore gloves with each contact with patients/residents, these infection rates would go down. It’s pretty elementary.

What every health care professional should know about durable powers of attorney.

C Diff. The infection that can run rampart in nursing homes and hospitals. Nursing Homes Magazine has an article about this nasty illness we deal with, often:

Clostridium difficile—also known as C. diff—is a bacterium commonly found in hospitals and long-term care (LTC) settings. Infection can lead to diarrhea, colitis, and other symptoms that can be debilitating and even deadly, particularly in the elderly. In recent years, there have been several reports of infection affecting both individuals and whole groups of patients treated in hospitals and healthcare facilities around the world. Based on available reports, hundreds of thousands of people experience symptoms related to C. diff infection each year, and that number is growing as more virulent and resistant strains emerge.

Some interesting facts:

Although clinicians report that C. diff spores are present in most hospital and LTC settings, many questions remain as to why some infected patients go on to develop symptoms while others do not. In fact, most of those infected—70–90%—experience no symptoms at all. Others go on to develop symptomatic disease and potentially recurrent life-threatening symptoms.

I always assumed those who tested positive for C Diff had the symptoms as well.

While discontinuation of antibiotic therapy is generally the first-stage treatment, it can also introduce serious risks for some patients. A sudden cessation of treatment might reexpose patients to the infection that therapy was originally intended to treat or prevent. Also, after cessation of antibiotic therapy, treatment typically—and paradoxically—involves the use of antibiotic therapy. This makes C. diff infection one of the few health problems that is both caused by and treated with antibiotics.

This makes sense of course.

There have also been some difficulties recorded with the use of antibiotic therapy to treat this infection. Patients treated with metronidazole, an antibiotic commonly used to treat moderate infection, show a failure rate of at least 10% and a recurrence rate reaching 30% or more. Many experts also express concern that treatment with vancomycin, prescribed for more severe cases of infection, could be contributing to greater drug resistance among other infection-causing organisms. In recent years, there have been many reported cases of selection of vancomycin-resistant Enterococcus species following treatment with the antibiotic.

NOT what we need: C Diff to become a superbug.

Many infectious disease specialists believe that new and more virulent strains of C. diff could someday represent a potentially serious threat to public health. As researchers explore possible correlations between strain virulence and higher incidences of community-acquired CDAD, clinicians have become particularly concerned about strains of community-acquired CDAD occurring in people who have not previously been treated with antibiotics. A recently discovered epidemic C. diff bacterium produces up to 20 times more toxin than other strains and, even more ominously, appears to be resistant to fluoroquinolone antibiotics such as ciprofloxacin and levofloxacin. This strain has thus far been found only in hospitalized patients and some LTC facilities and not in the community.

And this news doesn’t surprise me at all: Community acquired C Diff. The challenges this will present will be very difficult to deal with.

Heightened awareness of C. diff could help facilities develop more effective preventive strategies to reduce incidences of infection. Most basic strategies call for increased attention to personal hygiene. Because the primary means of transmission seems to be via the hands of healthcare workers and other patients and residents, proper sanitation (handwashing) and barriers (gloves, gowns) are considered by infectious disease experts to be the most effective measures of disease control in healthcare settings. Regular and thorough cleaning of patient rooms with antibacterial cleaning agents—including bleach at a 1:10 dilution in water—can be effective in reducing the presence of C. diff spores in the environment.

We can’t say it LOUD enough: WASH YOUR HANDS. WITH SOAP AND WATER. DO not use gel sanitizers- they don’t kill all the spores. I know of a few nursing homes in my area that insist the staff DO USE the gels, and also, use the gels to wipe down surfaces and door knobs! These places have entire units of residents infected and re-infected with C Diff…it’s because they’re not following the proper hand cleaning procedures.

CDC Web Site on C Diff

The Joint Commission releases new Patient Safety Goals:

(OAKBROOK TERRACE, Ill. – June 25, 2007) The Joint Commission today announced the 2008 National Patient Safety Goals and related Requirements for each of its accreditation programs and its Disease-Specific Care Certification Program. The Goals and Requirements, recently approved by the Joint Commission’s Board of Commissioners, apply to the nearly 15,000 Joint Commission-accredited and certified health care organizations and programs.

Major changes in this sixth annual issuance of National Patient Safety Goals include a new Requirement to take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy, and a new Goal and Requirement that address the recognition of, and response to unexpected deterioration in a patient’s condition. The new anticoagulant therapy Requirement addresses a widely-acknowledged patient safety problem and becomes a key element of the Goal: Improve the safety of using medications. It is applicable to hospitals, critical access hospitals, ambulatory care and office-based surgery settings, and home care and long term care organizations. The new Goal and Requirement respecting the deteriorating patient will ask hospitals and critical access hospitals to select a suitable method for enabling care-givers to directly request and obtain assistance from a specially-trained individual(s) if and when a patient’s condition worsens. Each of the foregoing new Requirements has a one-year phase-in period that includes defined milestones. Full implementation is targeted for January 2009.

In addition, an existing Requirement to assure the timely reporting of critical test results has been extended to the long term care program. Further, for all programs, the Requirement that addresses hand hygiene also has been expanded to permit use of the World Health Organization (WHO) Hand Hygiene Guidelines as an alternative to the Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.

Finally, the Requirement to limit and standardize drug concentrations that is part of the Goal to improve the safety of using medications will be retired as a National Patient Safety Goal, but organization compliance will continue to be evaluated as part of the Medication Management standards.

Read more at the JCAHO’s site.

We’ve all seen this happen: A resident is admitted on a Friday afternoon when doctors are no where to be found; family tells us the patient is “doing well” and the discharge summary from the hospital tells us the patient is stable. THEN, we find out the truth over the weekend. The resident is NOT stable and needs attention nursing homes are not able to provide. This case is interesting. The death of a resident is at issue. Specifically the nursing home and some staff are being charged with negligence because they allowed the resident’s 02 to run dry; the nursing home defense is claiming the resident should not have been admitted on a
Saturday in an unstable condition.

BIG RAPIDS – Attorneys representing six former nursing home employees charged in the death of a 50-year-old patient pointed the finger of blame elsewhere during a court hearing Monday, saying Sarah Comer died because Spectrum Health transferred her to the home before she was stable.

That is in contrast to the state attorney general’s claim that Comer died because the home’s employees allowed her oxygen tank to run empty.

The long-running preliminary hearing, which began last August and has resumed sporadically ever since, is to determine whether there is enough evidence for the former employees to stand trial.

Defense attorneys began laying the groundwork Monday to prove Comer died not from lack of oxygen, but because she had an irregular heartbeat when transferred from Spectrum’s Meijer Heart Center to Metron of Big Rapids.

“This woman should never have been released from Spectrum,” David Nickola, one of seven defense attorneys, said during a break in the hearing. “It’s a matter of making a buck and someone dying.”

Comer was found dead the morning of Jan. 16, 2005, 16 hours after she was transferred from Spectrum’s Butterworth Campus.

The state attorney general contends she died because a nurse aide and two nurses at Metron of Big Rapids allowed her oxygen tank to run empty.

Another nurse, former administrator Robert Koch and former medical director Rudy Ochs are charged with falsifying records to cover-up Comer’s cause of death.

Earlier in the long-running hearing, Dr. Gregory Sandman, former head of the hospital’s intensive care unit, testified Comer was stable when she was transferred to Metron of Big Rapids.

On Monday, Gary Jeromin, a former respiratory therapist for Metron, said he tried in vain to convince his bosses at the Cascade Township-based company not to accept patients with respiratory problems on Fridays, Saturdays or Sundays, since no respiratory therapist was on duty weekends.

Comer was admitted on a Saturday.

“This is really crazy,” testified Jeromin, who is not a defendant in the case. “We get these patients with no notice at all showing up at our door.”

Much is at stake here. Depending upon the outcome of this case, nursing homes will look at the policy regarding accepting admissions on weekends and off hours. Also, this proves a point in sending a nurse or the DON to the actual hospital and making an assessment BEFORE accepting a resident…we do this at my work. No matter what the discharge summary tells us, we send in our own people to check things out.