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:

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.

1. Remote Patient Monitoring
2. Alert Management Software
3. 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.

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.

Preventing Patient Falls

With the growing concern over “Never Events” and the huge costs connected with them, hospitals are striving to lower the occurrence of Never Events—to save both their patients’ trust and their budgets.

Although Never Events are considered preventable, some are far more prevalent than others. Patient Injury or Death resulting from a fall inside the hospital is a particularly high risk Never Event. As a result, additional concern should be applied to preventing patient falls.

The Cost of Patient Falls

Aside from lowering the safety reputation of a hospital, patient falls are a large financial burden as well. Since patient injury or death due to falls are included on the list of “Never Events” published by the Centers for Medicare & Medicaid Services (CMS) for 2009, hospitals are denied full reimbursement should any such event occur. Patient falls can cost even a small hospital tens of thousands of dollars annually, not including the cost of any resulting litigation.

See also the White Paper, “An Assessment of Falls in Patients’ Rooms and Methods of Prevention” which analyzes the severity of patient fall liability for hospitals; and methods of fall prevention.

Fall Prevention Methods

The great burden to reduce patient falls has led hospitals to incorporate many different methods and techniques over the years aimed at lowering patient fall rates. Risk-assessment tools have been popular in hospitals. Such tools include:

• The Morse Fall Scale
• The STRATIFY tool
• The Hendrich II Fall Risk Model
• Schmid Fall Risk Assessment Tool

Falls prevention programs have also been utilized. These programs can be used to educate both nurses and patients regarding fall risk factors and injuries that can result from falls. Some hospitals have even used extensive physical therapy to reduce the risk of falls for individual patients.

Fall Prevention Technology

From a technological standpoint, many devices have been implemented to help nurses respond rapidly to fall-risk patients. Bed fall alert systems and monitoring systems utilize a variety of alerts, both visual and auditory, to help nurses respond more quickly.

Recently, new technologies have become available, such as Dalcon Alert!, which integrates with patient monitoring systems and sends alarms directly to nurses regardless of their location.  Because nurses receive patient monitoring alarms immediately with Dalcon Alert!, they can quickly react to alerts, and proactively reduce patient falls.

An Overview of CMS Never Events

Over the past few years, hospitals have begun placing extra attention on the Centers for Medicare & Medicaid Services (CMS) Never Events, stimulating new policies aimed at reducing their occurrence. But what are Never Events exactly, and why are they so important?

Never Events Explained

The term “Never Event” was introduced in 2001 by the National Quality Forum (NQF). A never event is generally defined as an incident that should “never happen” in a hospital. Never Events are preventable, and may have serious consequences for both the patient and the health care facility in which the incident occurs.

There are six categories of incidents that may qualify as Never Events:

1. surgical events
2. product or device events
3. patient protection events
4. care management events
5. environmental events
6. criminal events.

Examples of these events include:
• Surgery performed on the wrong patient
• Misuse of patient care devices that result in patient injury or death
• Infants discharged to the wrong person
• Patient death or injury resulting from a medication error
• Patient death or injury resulting from a fall while being care for in the facility
• Abduction of patient from facility

The High Cost of Never Events

Aside from the great emotional and physical pain caused by Never Events, there is also a very real financial cost. As of October 1, 2008, CMS has required Hospitals to disclose all Never Events. Also, CMS has stated that they will no longer reimburse hospitals for Never Events. Nor will hospitals be allowed to push such costs onto the patient.

Hospitals bear full accountability for the occurrence of Never Events, and, as such, are liable to the great financial burden created by these events. Because hospitals are no longer reimbursed for expenses incurred by Never Events, these events will cost hospitals billions of dollars annually if they continue to occur at historical rates. Clearly, hospitals must find new ways to prevent Never Events, to limit the huge liability of these events.

Limiting Patient Fall Never Events

New solutions have been developed to limit the occurrence of Never Events.  Dalcon Alert! is a system that decreases the prevalence of Never Event injury due to patient falls. Dalcon Alert! alerts caregivers immediately to events surrounding a patient by connecting with patient monitoring devices such as IV pumps and bed fall pads.

See also the White Paper, “An Assessment of Falls in Patients’ Rooms and Methods of Prevention” which analyzes the severity of patient fall liability for hospitals; and methods of fall prevention.