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Posts tagged ‘Acute Care Hospitalizations’

Medication Competency


This list of the top 15 drugs prescribed in the United States thus far in 2011.  The good news is that they are all generics meaning they are available at a lower cost.  The bad news is that because they have become so common, we forget that these are major pharmaceuticals that can cause major problems.

If you’ve been paying attention, you will realize that the key to doing well in 2012 is directly related to your ability to keep patients out of the hospital.  In reviewing hospitalizations and  Reason for Transfer OASIS assessments, I would bet the farm that medication errors are a direct or indirect cause of a lot more hospitalizations than are reported.

When I read charts, I also see very vague medication teaching.  In reviewing clinical records it is not unusual to see ‘teaching’ such as:

  • Taught patient to take meds exactly as MD ordered.
  • Call MD for any side effects.
  • Take insulin at the same time each day.
  • This medicine helps to lower your cholesterol

I understand that patients have different learning abilities and that sometimes the best we can do is teach the patient the bare minimum.  But whether we teach a lot or a little about medications, it isn’t working.

The first step in providing really effective teaching about medications is to know your medications.

To see how well you or your staff know your meds, click here to take a basic medication competency test.  Until you are able to answer the questions with complete confidence, keep researching.

Of course, not every can know every medicine but there are tools that can be used.  My favorite for when I work offsite is the Medscape app (available for iPhone, Droid and Blackberry) which has two options for download.  One is a smaller download and the larger download includes the entire database for use offline.  Using the larger download option, nurses are able to look up drugs and interactions on their phone even when the internet isn’t available.  It is amazing the things I find when I use it.  The downside of the app is that it does provide every possible drug interaction in the world.  I try to focus on the most serious interactions and read through the remainders to see if they apply to a particular patient.

By really looking at meds and planning teaching as you write a careplan, you can gather all sorts of appropriate teaching materials for the patient.  Medications are also my favorite hunting ground to see if any diagnoses have been missed.

Let me know what you think about the competency test and how you scored.  If you have any other questions to add, please feel free to email them to me or to post below.  Heaven forbid I made an error in the test.  If that’s the case, please post below.

What are You doing about CHF?

What have you done lately to reduce your acute care hospitalization rate? If you don’t do anything else this year, a campaign to educate your staff about Congestive Heart Failure may make an appreciable difference. In March of this year, the American College of Cardiology published updated research and guidelines on Congestive Heart Failure which can be found here. Found within the paper are common factors precipitating hospitalization. Many of these factors are easily addressed in the course of a home health visit. Please share with your staff.

• Noncompliance with medical regimen, sodium and/or fluid restriction

• Acute myocardial ischemia

• Uncorrected high blood pressure

• Atrial fibrillation and other arrhythmias

• Recent addition of negative inotropic drugs (e.g., verapamil, nifedipine, diltiazem, beta blockers)

• Pulmonary embolus

• Nonsteroidal anti-inflammatory drugs (Note: Ibuprofen worsens the risk of hospitalization in heart failure patients by 43 percent. Other NSAIDS increase risk even more!)

• Excessive alcohol or illicit drug use

• Endocrine abnormalities (e.g., diabetes mellitus, hyperthyroidism, hypothyroidism)

• Concurrent infections (e.g., pneumonia, viral illnesses)

Knowing that CHF patients have these risk factors prior to hospitalization is not enough.  Addressing these conditions as they arise can prevent a hospitalization.  Many agencies are using phone encounters between visits to assess weight fluctuations, new medications, control of diabetes and comorbidities.   In reviewing charts, it is amazing how many patients with a diagnosis of CHF have NSAIDS ordered that probably can be replaced with other pain relievers.

It is rare that an agency is so large or has a hospitalization rate so high that avoiding even a couple of high risk hospitalizations a month for CHF patients won’t make a difference in reported outcomes.  However, these efforts must be sustained and agencies must be patient to see their efforts reflected on the CMS reported outcomes.

If you have any questions or comments, please leave a comment below or contact us at

Bundled Services and Outcomes

Bundling of Services

One legislative policy option for controlling postacute care costs is for Medicare to make a “bundled” payment to hospitals to cover episode costs.

This policy is being suggested by an economist Pete Welch in the Health and Human Services Division of the Congressional Budget Office. In short, bundled services would include all post acute care services for a period of thirty days to be included in the hospital DRG payment.  If post acute care services were ineffective, the financial risk to the hospital would be considerable.

It is only a ‘suggestion’ at this time but there is a very real possibility that Congress will take this suggestion seriously as a means to reduce post acute costs to Medicare. Whether this is good or bad depends on where you are sitting. But, as a consultant, my job isn’t to determine the suitability of such a proposal but rather to get clients ready for the possibility of bundled services.

It stands to reason that if hospitals are going to be paying for the first thirty days of care following a hospitalization they will have serious motivation to choose the best post acute care option with the best potential to meet the needs of the patient thereby reducing costs. Furthermore, the hospitals would have to justify their decisions.

Therefore, if I owned any type of facility that rendered care to patients following an inpatient stay, I would start now to ensure that my reported outcomes were as pristine as possible. And the outcome I would focus the most attention on is Acute Care Hospitalizations. If and when this comes to pass, I cannot see a hospital deliberately choosing an agency or facility that had a high rate of hospitalizations.

And if this doesn’t come to pass, there are millions of other reasons why preventing hospitalizations is a good thing. Ask any patient or family member of a patient who has been hospitalized lately how their lives were disrupted by an inpatient stay.

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