Preventing Pressure Ulcers (Bed Sores) Never Events with Technology
In October 2008, the Center for Medicare & Medicaid Services (CMS) began requiring hospitals that receive federal funding from Medicare and Medicaid to begin disclosing “never events.” CMS has stated that they will no longer reimburse hospitals for any costs associated with never events, and hospitals are prohibited from passing costs onto the patient.
What are Never Events?
Never events are a series of medical errors that are defined by CMS as, “clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility.” Included in the CMS financial year 2009 list of never events that will be denied federal reimbursement are the following medical errors:
List of Never Events covered under the FY 2009 provision
- Object left in patient during surgery
- Air embolism
- Blood incompatibility
- Catheter-associated urinary tract infection
- Pressure ulcers
- Vascular-catheter-associated infection
- Surgical site infection (specifically mediastinitis after coronary artery bypass graft surgery)
- Hospital-acquired injury due to external causes (fractures, dislocations, intracranial injury, crushing injury, burns, and other unspecified effects)
How Dalcon Alert! Helps Prevent Pressure Ulcers (Bed Sores)
Obviously, never events can be quite costly for hospitals. Yet some occur much more frequently than others. Preventing bed sores can be difficult, but new technology is available to help hospitals prevent bed sores. Dalcon Alert! is a system that contains 3 distinct sections that help nurses treat and prevent pressure ulcers.
- Remote Patient Monitoring
- Alert Management Software
- Pressure Ulcer Management System
Dalcon Alert! Remote Patient Monitoring
Remote Patient Monitoring is achieved by integrating with existing patient monitoring devices in the hospital. Dalcon Alert! automatically forwards all device alerts—via a text message—to wireless phones carried by the nursing staff.
Although Dalcon Alert! contains the technology for nurses to remotely monitor patients via wireless phones, the pressure ulcer management system does not require their use or purchase. If desired, hospitals can implement Dalcon Alert!‘s Alert Management software & Pressure Ulcer Management System as a stand alone system, and use it as a tool to create and manage bed turn alerts using current hospital policy.
Dalcon Alert! Alert Management Software
Dalcon Alert!’s Alert Management application helps caregivers actively manage the many patient monitoring alerts that are created in the hospital. The Alert Management software is similar to a web application, but it can only be accessed from the browsers of computers on the hospital network.
The function of the Alert Management software is to display, in real time, all active alerts that are being managed by the Dalcon Alert! system. Combined with Dalcon Alert!’s pressure ulcer management system, Dalcon Alert!‘s Alert Management software makes sure no pressure ulcer treatment is overlooked by staff.
Dalcon Alert! Pressure Ulcer Management System
Dalcon Alert!’s pressure ulcer management system is a unique solution. When this feature is turned on, the system automatically creates a “bed turn” alert that reoccurs after a set period of time (dictated by the hospital). This “bed turn” alert is treated the same as any other alert that Dalcon Alert! manages; relevant caregivers receive the alert on their wireless phone, and the alert is reported on the system’s alert management software. Thus, caregivers are continually reminded to attend to and turn at risk patients. Because Dalcon Alert! helps nurses pro-actively prevent pressure ulcer negligence, the occurrence of dangerous pressure ulcers in at risk patients is significantly reduced.
Creating a Homelike Environment in Nursing Homes with New technology
In June 2009, the Centers for Medicare & Medicaid Services (CMS) issued new revolutionary guidelines for long term care facilities (nursing homes) that receive federal funds. These guidelines called upon nursing homes to create a “Homelike Environment” for residents; creating a call to action to deinstitutionalize these facilities by making changes such as:
• Removing overhead paging and piped in music.
• Removing institutionalized signage and labeling (such as closet and bathroom labels).
• Removing medicine carts and large centralized nursing stations.
• Discontinuing long term use of patient monitoring systems that use audible alarms.
• Eliminating mass-purchased furniture displayed throughout the building.
Dalcon’s unique patient care communications solution, Dalcon Alert!, is designed to help nursing homes make several of these changes. As a result, facilities using the Dalcon Alert! system will meet numerous new CMS Homelike Environment guidelines, and their quality of patient care will drastically increase.
Dalcon Alert! provides a communications platform that eliminates the need for:
- Overhead Paging
- Audible patient monitoring alarms
- A large centralized nursing station
How Does Dalcon Alert! Eliminate Audible Alarms?
Dalcon Alert! is a patient care communications system that has several features. The system provides Remote Patient Monitoring and Alarm Management by integrating with patient monitoring devices including but not limited to:
• bed exit pads
• bed fall pads
• IV-Pumps
• Patient Nurse Calls
When an alert is created by any integrated device, Dalcon Alert! routes that alert to a remote nursing station where it can be actively managed on a PC monitor using Dalcon Alert!’s alert management software. Dalcon Alert! also sends that alert to select staff carrying fully functional wireless phones via text message, so they are immediately made aware of that alert regardless of their location—and without the use of audible alarms.
How Does Dalcon Alert! Reduce the need for Overhead Paging and a Large Centralized Nursing Station?
Equipping vital staff with wireless phones is a central piece of the Dalcon Alert! system. These phones allow staff to receive important alerts regardless of their location. Caregivers can be reached remotely by phone, vastly eliminating the need for overhead paging.
A key component of the successful implementation of a decentralized nursing station system is staff communication. Dalcon Alert! provides staff with an effective decentralized communications platform, built around fully functional wireless phones. Also, Dalcon Alert!’s alert management software is accessed via a browser, and there is no limit to how many computers can be logged on to it at once. Thus, each decentralized nursing station can be actively managing alerts at any given time.
New CMS Guidelines: Homelike Environment for Nursing Homes
The Center for Medicare & Medicaid Services (CMS) creates guidelines for long term care facilities (nursing homes) that receive federal funding via Medicaid and Medicare. Licensed state surveyors perform annual checkups on nursing homes to make sure that these facilities are meeting the expectations of CMS—if not, those facilities are ineligible for CMS reimbursement.
In June 2009, CMS updated their guidelines for long term care facilities (nursing homes) in several ways. Out of the many changes made, the new “Homelike Environment” guideline is one of the most revolutionary.
Section §483.15(h) Homelike Environment
The actual CMS guideline reads, “The facility must provide a safe, clean, comfortable and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.” CMS interpretation of this guideline suggests that, “A ‘homelike environment’ is one that de-emphasizes the institutional character of the setting, to the extent possible, and allows the resident to use those personal belongings that support a homelike environment.” What this means for nursing homes across the nation, is that sweeping changes will have to be made gradually to transform and deinstitutionalize these facilities.
Some of the more drastic “homelike environment” changes include:
• Removing overhead paging and piped in music.
• Removing institutionalized signage and labeling (such as closet and bathroom labels).
• Removing medicine carts and centralized nursing stations.
• Discontinuing long term use of patient monitoring systems that use audible alarms.
• Eliminating mass-purchased furniture displayed throughout the building.
Homelike Environment Compliance Expectations
Obviously, many of these CMS homelike environment suggestions represent sweeping changes for many nursing homes throughout the nation. CMS has stated that these guidelines have been effective since June 12, 2009; but in their own words they don’t expect most nursing homes to be able to meet them immediately. However, they are expecting nursing homes to actively pursue the new guidelines—or face the consequences:
“Many facilities cannot immediately make these types of changes, but it should be a goal for all facilities that have not yet made these types of changes to work toward them. A nursing facility is not considered non-compliant if it still has some of these institutional features, but the facility is expected to do all it can within fiscal constraints to provide an environment that enhances quality of life for residents, in accordance with resident preferences.”
Meeting Homelike Environment Expectations
New technologies exist, such as Dalcon’s patient care communications system Dalcon Alert!, that help nursing homes meet numerous “Homelike Environment” expectations. However, CMS has also stated that physical changes alone won’t fit the bill of a “Homelike Environment.” They are expecting serious culture change by nursing home staff; including a shift towards person centered care, and quality staff-to-resident relationship building.
