Blog

31
Aug

Patient Safety Spotlight

CMS Expands QI Program on Compare

Federal health officials have announced that they have expanded the HospitalCompare website, making more information available on 30-day mortality rates for three conditions, and showcasing a new “one-stop shopping” format to find data on various types of healthcare services, from physicians to dialysis centers.

Hospital Compare provides information on how well hospitals provide recommended care to patients.

Officials also announced expansion of the Quality Improvement Organization program, which provides technical assistance and resources to providers who are having trouble meeting quality standards.

The first part of the expansion involves an additional year of data on 30-day mortality rates for heart attack, pneumonia and heart failure for each of 4,700 hospitals in theU.S.where those care services are performed. New data showing small changes were also released for 30-day readmission rates for these same diagnoses. Readmission rates were .1% lower for heart attack in the 2007-2010 period (from 19.8%) compared with 2006-2009 (19.9%) but were higher for pneumonia (from 18.2% to 18.4%) and heart failure (from 24.5% to 24.8%).

Long ED Waits Related to Increased Mortality

A new study published in the June 2011 issue of British Medical Journal found that patient presenting to the emergency department during longer wait times might be at an increased risk being admitted to the hospital or even death within the next week.

Patients who left without being seen, however, were not at higher risk of adverse events in the short-term compared to patients who were seen and discharged.  Researchers state in the study this could be because of slightly higher rates of follow-up doctor appointments or conditions that resolved while waiting in the ED.

Maine Law to Require MRSA and C. Diff Reporting

On June 13, Mainepassed LD 1212 (Public Law, Chapter 316), which replaces its 2009 MRSA screening legislation. The new law requires all hospitals to submit data on a monthly basis on MRSA and Clostridium difficile for all inpatients to the National Healthcare Safety Network. This replaces the 2009 provisions that focused on MRSA screening.

Ultrasound in Wound Management

Ultrasound was used successfully for years as a non-invasive diagnostic tool before its potential benefits in wound healing were first investigated. Ultrasound waves, formed when electrical energy is converted to sound waves at frequencies above the range of human hearing, are now used routinely in wound management and can be transferred to tissue though a treatment applicator. The depth of penetration is dependent on the frequency, with higher frequencies resulting in lower tissue penetration.

Both the thermal and non-thermal properties of ultrasound contribute to its therapeutic benefits. The warmth generated at relatively high intensities can be used in musculoskeletal conditions such as spasm, as well as in the remodeling phase of wound healing to improve scar/wound outcome. The non-thermal effects of ultrasound generated at lower intensities are currently attracting considerable interest as they appear to cause changes in cell membrane permeability and thus the diffusion of cellular metabolites.

Ultrasound therapy is indicated for chronic or recalcitrant wounds that are clean or infected, pressure wounds, venous insufficiency, acute trauma, and recent surgery. The technique should not be used in simple wounds or in cases of osteomyelitis, bleeding, severe arterial insufficiency, or acute DVT.

Although ultrasound therapy appears to have a number of advantages, the main evidence to support its use still comes from laboratory results, with clinical data proving somewhat disappointing. However, anecdotal reports do provide some evidence for its use in a broad range of wound types.

Wound Care Standards for Documentation

{from K. Martin Lecture Power Point program on topic for Nurses}

Per standard of care and regulation, the following is to be documented in a consistent manner: AHCPR-# 15: assessment and documentation is to be done at least weekly. If complications, more often.

  • Follow a systematic¬† method:
  • Type of wound
  • Staging or classification {Stage, I, II, II, IV, or partial thickness wound}
  • Correct anatomical location
  • Measurements in centimeters {include depth}.Use consistent system: clock
  • Wound base tissue-slough, eschar, granulation, epithelialization; doc % of tissue noted in wound bed.
  • Symptoms of infection-Fever, increased white ct, hypotension, general malaise, redness, swelling, induration, streaking, purulent drainage
  • Drainage-Amount, color, consistency
  • Odor
  • Tunneling/Undermining

Wound edges-curled {epiboly}, callused, macerated, detached

  • Periwound-Intact, scaly, edema, redness, warmth, color variations, patterns, alleviating and aggravating factors, current and past pain management plan, effects of pain, pain goal, physical exam of pain.

Treatment-

  • Current topical treatment-Cleansers, Dressings, Ointments
  • Response- Better, no change, decline, modifications.
  • Any procedure performed and response-
  • What was performed?
  • When was it performed?
  • Who performed it?
  • How well the patient tolerated it.
  • Adverse reactions to any interventions.

Additional-

  • Record each phone call to and form physician, and response.
  • Dietary Interventions:
  • Supplements, vitamins
  • Lab work
  • Turning schedule, support surface, heel protection, skin barriers.
  • Incontinence management
  • Document any discussion of questionable medical orders. Be detailed. YOU ARE RESPONSIBLE!!
  • Referrals-Dietary, CNS, Wound Care Svc., Podiatrist, Therapy.