NATIONAL DECUBITUS FOUNDATION RECEIVES QUALITY OF LIFE GRANT FROM
CHRISTOPHER REEVE FOUNDATION
Grant to have direct impact on people living with paralysis
Aurora, Colorado – The Christopher Reeve Foundation (CRF) announced today that the NATIONAL DECUBITUS FOUNDATION (NDF) – www.decubitus.org has been awarded a $4000 Quality of Life grant. The CRF awarded a total of $717,404 in Quality of Life grants to 90 nonprofit organizations around the world. Since 1999, when the Quality of Life program was conceived by the late Dana Reeve as a way for the CRF to help improve the day-to-day health and well-being of those living with paralysis, 1,163 grants totaling $9,220,980 have been awarded.
“The Christopher Reeve Foundation is proud to carry on Christopher and Dana Reeve’s amazing legacy and make a real difference in the lives of people living with paralysis, their families and communities,” said Kathy Lewis, president and CEO of the CRF. “Our Quality of Life grantees help thousands of individuals Go Forward to lead happier – and healthier – lives.”
Decubitus ulcers (bedsores) afflict those confined to bed and/or to a wheelchair for long periods; the paralyzed are, of course, especially vulnerable. The NDF has identified those few hospitals that have succeeded in substantially reducing their bedsore rate of incidence. An NDF study describes the best practices implemented by those hospitals. This grant will allow the NDF to disseminate this information to the approximately 1800 US hospitals with 100 beds or more, and to all State regulatory agencies. Implementation of these best practices will be urged through volunteer visits and/or phone calls as well as a follow-up survey.
“An astounding 16 percent of the US hospital population, on average, is suffering from pressure wounds at any one time. This figure has seen no improvement whatsoever over the past many years. These wounds cause immense suffering and are often the site of life-threatening infection,” said Edward H. Comfort, Ph.D., NDF Executive Director. “Something must be done! We thank the Christopher Reeve Foundation for making it possible for the NDF to take these important steps.”
Health Promotion grants, a special category of Quality of Life grants, are funded through a cooperative agreement with the Centers for Disease Control and Prevention (Cooperative Agreement number U10/CCU220379). Funding is awarded to non-profit organizations that address the needs of people living with paralysis caused by spinal cord injuries and other diseases and birth conditions that result in paralysis. Health Promotion grants strive to remove societal and environmental barriers that limit the abilities of individuals living with paralysis to participate in life activities. Participation in these activities improves physical and emotional health and prevents secondary conditions for persons living with paralysis.
CRF Quality of Life grants are awarded twice annually to programs or projects that improve the well-being of people living with paralysis, particularly spinal cord injuries. Awarded in 13 categories that span everything from health promotion to employment to sports and recreation, Quality of Life grants address many aspects of life, and are given to programs around the globe. For more information about the Quality of Life Program or the grant application process, please contact the Quality of Life department at 1-800-225-0292 or visit the CRF website at www.ChristopherReeve.org for a complete list of the Quality of Life grant recipients.
The Christopher Reeve Foundation is dedicated to curing spinal cord injury by funding innovative research, and improving the quality of life for people living with paralysis through grants, information and advocacy.
The National Decubitus Foundation is committed to the eradication of the hospital-caused bedsore, whether a result of patient beds, wheelchairs, or the operating table. Medical professionals are urged to visit the NDF message board at www.decubitus.org where they can respond to the pleas for help from the afflicted patient’s friends and relatives who never dreamt that their loved one ran the risk of such horror in the hospital that he or she depended on for healing.
For help with healing, please click on Links and go to the WOCN to find a nurse wound specialist in your area.
Conn. Atty Gen Acts on Bedsores
Proposes Hospital Reporting Penalties
Richard Blumenthal, Attorney General of the state of Connecticut, has proposed daily fines for hospitals that fail to report Stage 3 and Stage 4 bedsores to the Department of Public Health as required by Connecticut law. Fines would be levied for every day and for every case for which the required reporting fails to take place.
Attorney General Blumenthal, interviewed February 2007 on NBC30 in Hartford, Conn. by reporter Deborah Bogstie, stated that he was “absolutely appalled” at what he had learned of the bedsore situation at Milford Hospital, Milford, CT. But as readers of The Ugly Secret know, many by their own experience, the appalling sight he witnessed is a regular occurrence at nearly all of our nation’s hospitals.
The hospital was investigated by the Connecticut Dept of Public Health after com-plaint by the daughter of the victim, Naomi K. Press, her 85 year old mother who was allowed to develop a stage IV bedsore, then shipped to the nursing home to die. The hospital was cited for seven violations.
Also interviewed for the report was Prof. Lowell S. Levin of Yale University and consultant to the World Health Organization. Dr. Levin is author of the book Medicine on Trial: The Appalling Story of Ineptitude, Malfeasance, Neglect, and Arrogance. He called for daily oversight of hospitals with regard to their bedsore problem, and he stated that this was a “modest” proposal in view of the severity of the problem.
The NDF was asked to provide statistical information with regard to the extent of the bedsore problem as background for this special NBC30 report. Please send an email to info@decubitus.org if you would like to receive an emailed copy of this video.
Wound Staging Updated
NPUAP Proposes New Categories
The National Pressure ulcer Advisory Panel has updated its staging system, in general use for the past several years. Biomechanical analysis has long shown that maximum pressure and greatest potential for tissue damage occur right at the bony prominence. In recognition of this fact, the NPUAP has added the category “Suspected Deep Tissue Injury” to the existing Stages I – IV. In addition, a category termed “Unstageable” has been added to account for wounds that require removal of slough and/or eschar in order to expose the base of the wound and therefore its actual depth.
Deep tissue injury may be involved in virtually all pressure ulcer development. This is why all admitted hospital patients judged to be at risk for bedsores must be placed on a specialized support surface without waiting for the first superficial indication of bedsore initiation.
MSNBC.com
August 12, 2008
Tennessee is among 23 states that have approved non-payment policies for specific mistakes, with at least three more expected to do so by fall, a new review shows. Hospitals in another eight states have agreed to general guidelines that advise eliminating bills on a case-by-case basis for errors proven to be both serious and preventable.
The remaining states have not adopted even those voluntary standards, a concept that still stuns Patty Canakaris, 63, of St. Augustine, Fla. Her 67-year-old brother, Blake Oliver, died in December after a Florida hospital mistakenly gave him type A positive blood instead of type O positive blood during a transfusion for a simple operation.
“With something this horrific, whether they’ve operated on the wrong person or removed the wrong finger, they shouldn’t expect reimbursement,” she said.
Medicare shift driving changes
It's not clear how many private patients or their insurers are still billed for medical mistakes, but a July study by the federal Agency for Healthcare Research and Quality estimated that preventable errors that occur during or after surgery may cost employers nearly $1.5 billion a year.
The idea of cutting payments for avoidable errors has gained considerable momentum in the year since federal officials sparked the shift by announcing that, starting Oct. 1, Medicare will no longer reimburse hospitals for the extra costs of treating certain injuries, infections and complications that occur after admission
"Hospitals around the country are scrambling to put new programs in place to prevent pressure ulcers, commonly known as bedsores, after the federal Centers for Medicare and Medicaid Services announced last month that as of October 2008, it will no longer reimburse hospitals for treating eight “reasonably preventable” conditions. Pressure ulcers are among the most prevalent, costly and dangerous on the list: In addition to interfering with recovery, lengthening hospital stays and causing extreme pain and discomfort, pressure ulcers can increase the risk of infection, with nearly 60,000 deaths annually from hospital-acquired pressure ulcers.
Nursing homes and long-term care facilities have made strides of their own in prevention, motivated in part by the costs of litigation for failure to prevent pressure ulcers. But in acute-care hospitals, where patients stay for much shorter periods, prevention has been sporadic. Acute-care hospitals treat about 2.5 million pressure ulcers each year, and as many as 15% of hospitalized patients may have pressure ulcers at any one time, according to the Institute for Healthcare Improvement. Estimates for the cost of treating all pressure ulcers in the US range up to $11 billion annually.
To combat this, hospitals are pushing screenings of all incoming patients from head to toe for skin issues that could lead to pressure ulcers. They are using visual examinations, ultrasound and other technologies that can help identify skin with tissue damage. In some cases, they are photographing areas of a patient’s skin to document how it changes from day to day.
Hospitals are also buying special beds with high-tech air mattresses that minimize or redistribute pressure. And they are adhering to strict monitoring schedules that include shifting patients every two hours, frequently cleaning and moisturizing soiled or sensitive skin, and making sure that at-risk patients have enough protein and other nutrients in their diet to help the healing process.
Pressure ulcers are caused when skin lesions form near prominent bony parts of the body from unrelieved pressure when patients stay in one position for too long. Starting with skin redness or a blister, sores can progress to a deep crater that damages muscles, tendons and bone, requiring surgery and increasing the risk of complications such as the bloodstream infection sepsis. The late actor Christopher Reeve was being treated for an infection associated with a pressure ulcer when he died of cardiac arrest."
Great article in NY TIMES - Making Hospitals Pay for Their Mistakes
"In most businesses, customers don’t pay for a vendor’s mistakes. But when hospitals make errors, they charge patients additional money to fix the problem.
The perverse economics of hospital charges were outlined yesterday in a fascinating article in the Journal of the American Medical Association. The story focused on one common but largely preventable medical error: urinary tract infections associated with the use of a catheter. It showed how in some ways, the medical system has built-in financial incentives for bad care.
Hospitals use urinary catheters more than almost any other medical device, and they account for 40 percent of all hospital-acquired infections — about one million annually. A urinary tract infection can add a day to a hospital stay; sometimes it can lead to a more serious infection, even death.
At one Colorado hospital, the article noted, Medicare would pay $5,436.66 for the care of a heart attack patient who recovered without complications. But if the patient developed a urinary tract infection related to use of a catheter, the hospital would receive $6,721.44. If the patient developed a more serious infection after a catheter was used, the hospital collected $8,905.43. That means the hospital would earn 63 percent more by providing inferior care.
Hospital-acquired urinary tract infections cost the health care system more than $400 million every year. But they are largely preventable, occurring most often because a catheter is left in too long. The risk of infection rises dramatically 48 hours after insertion. Most patients don’t need a catheter for nearly that long, but when nurses and other hospital staff are overstretched, or when record-keeping is lax, catheters may not be removed quickly enough.
The reimbursement system “tolerates and even financially rewards poor performance by hospitals that fail to prevent hospital-acquired complications,'’ write the report’s authors, Dr. Heidi Wald and Dr. Andrew Kramer, health care policy researchers at the University of Colorado at Denver.
In an effort to hold hospitals accountable for the costs associated with eight largely preventable injuries, Medicare changed its rules this fall. Now, the agency will not pay additional amounts to hospitals when doctors leave an object in a patient during surgery, use incompatible blood or introduce an air embolism while treating a patient.
Medicare also will no longer reimburse hospitals for infections that develop due to the use of vascular catheters, or for pressure ulcers, surgical site infections after coronary bypass surgery and other hospital-acquired injuries, such as fractures or burns that occur due to lax care. Some private insurers are considering adopting similar rules.
Some of the administrative changes relating to the new rules take effect in January, and they won’t apply to patient discharges until October. Patients may worry that hospitals will not have as much financial incentive to provide decent care, but hospitals are required by law to provide adequate care to patients. And because the rules are administrative in nature, many doctors making treatment decisions for patients in the hospital won’t necessarily know whether the care is to be reimbursed by the agency. The goal of the new rules is to force hospitals to adopt strict guidelines that will prevent the mistakes from happening altogether.
“All too often, clinicians, hospitals, and payers conclude that some harms are part of the price of doing business. But in many cases they are not,'’ write Dr. Wald and Dr. Kramer. “When properly designed, financial incentives should provide rewards for desired clinical outcomes, not hospital-acquired harms.'’
