Fire Safety and the Elderly
October 31, 2009
I know that there are more cheery things to think about as we venture into the coldest months of the year but our patients have a better chance of enjoying the Holiday season if we take steps to protect them from fire.
Facts & figures*
- In 2003, there were 388,500 reported home fires in the United States, resulting in 3,145 deaths, 13,650 injuries and $5.9 billion in direct property damage.
- Nationwide, there was a civilian home fire death every 3 hours.
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The statistics below are based on NFPA´s most recent analyses:
- Almost half of all home fire deaths in 1999 resulted from fires that were reported between 10:00 p.m. and 6:00 a.m. Only one-quarter of the home fires occur during these hours.
- In 1999, January was the peak month for home fire deaths. December ranked second, and March was third.
- Smoking was the leading cause of home fire deaths overall, but in the months of December, January and February, smoking and heating equipment caused similar shares of fire deaths. Cooking was the leading cause of home fires and home fire injuries year-round.
- Although children five and under make up about 7% of the country’s population, they accounted for 14% of the home fire deaths, assigning them a risk twice the national average. Based on 1995-1999 annual averages, adults 65 and older also face a risk twice the average, while people 85 and older have a risk that is four-and-a-half times more than average.
- Roughly 30% of the home fire deaths in 1999 were caused by fires in which a smoke alarm was present and operated.
- Most fatal fires kill one or two people. In 2003, 15 home fires killed five or more people. These 15 fires resulted in 86 deaths.**
A great teaching tool for patients can be found here.
If you have any questions, please call your local fire department. Many times, the fire departments will provide and install smoke detectors for patients. For goodness sakes, don’t call us about fire safety because our area of expertise lies elsewhere!
But we love your comments below and your emails at haydelconsulting@haydel.com.
* From national estimates reported to U.S. municipal fire departments based on NFIRS and NFPA survey. Excludes fires reported only to federal or state agencies or industrial fire brigades.
** From “The Catastrophic Multiple-Death Fires of 2003,” September 2004.
Note: Homes include dwellings, duplexes, manufactured homes, apartments, rowhouses, townhouses and condominiums.
Depression and OASIS-C
October 26, 2009
The OASIS-C dataset will be asking if our patients are depressed. Although no tool is mandatory, the dataset includes a copy of the P2 tool as follows:
In using this tool, it seems that many of our patients will show signs and symptoms of depression. I asked Randy Still, a psychiatric nurse to help us address those patients who were depressed related to their situation and yet not qualified for a psych evaluation. Here is what he said:
- Consult with patient’s MD to see if MD thinks that a short term use of an antidepressant might be indicated.
- Teach patient coping skills to ameliorate situational depression
- Do something. Do something. Get active. Even if it is calling a friend on the telephone. DO SOMETHING.
- Teach patient to take a short walk or sit outside with friends or family (if able…does not mean pt. is not homebound). Get outside in the sun if possible.
- Teach pt to take a warm bath when depressed.
- Teach pt. to talk to friends and family via telephone or in person if they can visit
- Teach pt. positive visual imaging
- Teach pt. to find a way to help someone else, daily. ( to attempt to quit thinking about self continually in home isolation if even just a “how are you” telephone call)
- Teach sleep hygiene (sleep at night, no caffeine, no heavy meals before bed, etc.) if it is a problem
- Teach patients about above subjects using patient handouts (Med-Line is a good free source of handouts via internet, copy them and initial and date what part of the page and when and leave in chart attached to nurses note. Surveyors like that.
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Be sure to document anything you teach and also the content of what you taught. That is why I like the teaching handouts. I simply say, “refer to patient handout sheet attached”.
Randy reminds us to always be alert to signs and symptoms of serious depression and to investigate suicide ideation if the patient seems seriously depressed.
Randy Stilly is the administrator of
Star Light Home Health, LLC
Longview, Texas
In addition to providing home health services in his area he also provides consultation to other agencies who want to offer psychiatric services. If you are interested in adding psychiatric services or improving those you offer, Randy can be reached at randy52@cablelynx.com.
Comments are always welcome below. We can be reached at Haydelconsulting@bellsouth.net.
A Hot and Sweaty Email
October 19, 2009
Dearest Julianne;
I will seek and find you.
I shall take you to bed and have my way with you.
I will make you ache, shake & sweat until you moan & groan.
I will make you beg for mercy, beg for me to stop.
I will exhaust you to the point that you will be relieved when I’m finished with you.
And, when I am finished, you will be weak for days.
All my love,
The Flu
I received the above love letter in my email box today. It certainly got my attention although I would prefer a different suitor.
In addition to protecting yourself and your family so you don’t miss work, consider that many current home health care patients will be on service in January of 2010. The OASIS-C discharge assessment will ask if the patient has been immunized against the flu for ‘this year’s influenza season’ which is October through March. Although CMS has not announced which outcomes will be publicly reported, it is my guess that CMS will look favorably on agencies that ensure their patients are protected against the flu.
Furthermore, as patients become vaccinated, it is important that you document the vaccine status of your patient in an easy to find location. Agencies with high acuity patients may find themselves with an enormous chart to review at discharge if they don’t implement processes for easy retrieval of data.
Note that H1N1 flu vaccine is not considered in the OASIS data. As vaccine becomes available in your area, check with your local health departments for immunization recommendations.
If you have questions or comments, please feel free to leave a comment below or email us at haydelconsulting@bellsouth.net.
One More Reason to Document
October 18, 2009
It isn’t as though most agencies need more reasons to document but I found one more at an unexpected survey this week.
My client, Intensive Home Health Care in Vidalia, Louisiana was still up in the air about whether or not to continue JCAHO accreditation. No application had been filed and no payment was made and the agency had just moved locations last week. Imagine our surprise when a JCAHO surveyor walked in for the triennial survey. Oops.
It was an even bigger surprise when the agency without any specific JCAHO survey preparation did very well on survey.
When it came to clinical documentation, the surveyor noted that on the two charts she looked at for home visits had all the skills from the care plan documented accurately, she really didn’t see the need to look further. Go, Rachel! It was Rachel’s charts that were randomly chosen for review. It may have been the first survey that I have ever been a part of where clinical records did not pose a big issue.
On the flip side, one of the nurses during a home visit didn’t wash her hands quite as often as the surveyor would have liked. This is not to say that the nurse did not wash her hands often and thoroughly. However, at one point, the nurse decided to change gloves and neglected to wash her hands as the CDC recommends. Note, this agency has a very low infection rate and there was no prior indication that infection control guidelines weren’t being followed.
So after a week of surveys last week, I have only two pieces of advice. First – wash your hands incessantly much the same way as Lady McBeth is reported to do. Choose either the CDC or WHO hand hygiene (fancy way of saying hand washing) guidelines and educate your staff on them. Secondly, if you pay attention to your documentation now, it will be a most wonderful surprise at survey time when clinical records are not an issue.
Congratulations to Intensive Home Healthcare!
Process Measures in OASIS-C
October 13, 2009
One of the biggest changes in OASIS-C is the inclusion of Process Measures. According to the OASIS-C manual, process measures are the use of assessment tools and the care and delivery of specific clinical interventions. In other words, CMS wants to know how you are assessing patients and what you are doing about the stuff you find in your assessment.
CMS goes further to state that the inclusion of specific interventions and assessments are NOT mandatory. However, they are expected to affect your future outcomes. Read: Process measures ARE mandatory.
The list of process measures is below from chapter one of the new manual are:
- Date of referral and physician-ordered start of care (timeliness)
- Patient-specific parameters for physician notification (care coordination)
- Influenza and pneumococcal vaccines (population health and prevention)
- Formal pain assessment, pain interventions, and pain management steps (effectiveness of care)
- Pressure ulcer risk assessment, prevention measures, and use of moist healing principles effective care and prevention)
- Diabetic foot care plan, education and monitoring (disease specific: high risk, high volume, problem prone)
- Heart failure symptoms of volume overload and follow-up (disease specific: high risk, high volume, problem prone)
- depressive symptom screening and intervention/referral (influences self-management abilities)
- Falls risk assessment, planning and interventions (safety)
- Medication adverse events/reaction, reconciliation and follow up; drug education (high priority for safety – care coordination)
A compliance rate of 100 percent is not anticipated by CMS. CMS allows that clinicians may find that these interventions have no application for a particular patient. And the new OASIS manual states emphatically that CMS will not mandate the use of any one intervention in your care planning.
The process measures represent an entirely new aspect of assessment. In the past, we have specifically looked at the patient status on the day of assessment except where otherwise specified. In the new OASIS-C dataset, we will be assessing the patient as well as the agency and also a period of time since admit/roc or last comprehensive data collection.
Agencies who currently take case conferencing seriously will have little problems with the clinical record review. If your agency signs off on case conference with minimal discussion of patients, it is time to change your approach or be prepared for a very uncomfortable OASIS-C experience!
For questions or comments, please leave a comment below or email at haydelconsulting@bellsouth.net. More information on OASIS-C training will be posted soon. Mark November 12 and 19 on your calendars!
