I HAVE TO REPLY TO 3 POSTS

FIRST POST

Hospital-Acquired Falls

Hospital-acquired patient falls can be a burden on a healthcare organization’s economy. Nonfatal falls can still cause patient’s major injuries with prolonged effects and can increase costs for both the patient and healthcare system (Haddad et al., 2019). Fehlberg et al. (2017) state that “Up to 1,000,000 inpatient falls occur annually in the United States with associated direct medical costs greater than $30 billion.” In 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing costs related to hospital-acquired falls since they are events that should have never happen or “never events” (Fehlberg et al., 2017). The CMS Non-Payment Policy did influence the implementation of fall preventions in the inpatient setting. However, due to the CMS Non-Payment Policy, fears of the overuse of physical restraints were feared (Fehlberg et al., 2017). Restraints could limit patient mobility and cause negative outcomes. I work at a restraint-free hospital, but we do have a fall prevention policy which includes, yellow non-skid socks, fall-risk armband, bed or chair alarm, and we must do purposeful hourly rounding. If the patient is a high fall-risk they should be placed in a room closest to the nurses’ station and if needed, a personal sitter should be provided. The CMS Non-Payment Policy impacts the use of those cost-effective interventions to prevent falls. Bed alarms are the easiest to implement and least expensive and a personal sitter is probably the costliest intervention (Fehlberg et al., 2017). A master’s prepared nurse can promote the importance of fall prevention by implementing the fall-risk interventions in their daily practice. It is important that every healthcare team member respond to any bed or chair alarm. By doing so, a fall can be prevented almost immediately. Hospital-acquired falls are preventable especially when all fall-risk interventions are in place. Research has shown that the CMS Non-Payment Policy has influenced the increased practice of nursing fall prevention care (Fehlberg et al., 2017).

References

Fehlberg, E. A., Lucero, R. J., Weaver, M. T., McDaniel, A. M., Chandler, M., Richey, P. A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3). https://doi.org/10.1093/geroni/igx036

Haddad, Y. K., Bergen, G., & Florence, C. S. (2019). Estimating the economic burden related to older adult falls by state. Journal of Public Health Management and Practice, 25(2), E17–E24. https://doi.org/10.1097/PHH.0000000000000816

SECOND POST

Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) is a common hospital acquired condition among mechanically ventilated patients. VAP is defined as pneumonia that develops 48 hours following endotracheal intubation (Villar et al., 2016). Despite advances in diagnosis and treatment, the mortality rate of VAP remains between 33-50% (Villar et al., 2016). However, VAP is a preventable complication of mechanical ventilation.

Economic Effects

VAP contributes to an increase in healthcare costs; therefore, it affects a healthcare organizations’ economy. According to Ladbrook et al. (2020) “VAP places significant demand on acute beds and is a key contributor to rising acute health care costs” (p. 2). In fact, VAP-related hospital costs are estimated to be between $25,000 to $28,000 per patient in the United States (Ladbrook et al., 2020). Furthermore, financial estimates suggest that VAP adds an additional $1.45 billion annually to the overall cost of health care provision (Ladbrook et al., 2020). As a result, there is a global need to reduce healthcare expenditure related to VAP.

Cost-effective Care

The Center for Medicare & Medicaid Services (CMS) have instituted financial penalties to healthcare organizations for healthcare-associated infections such as VAP. The additional cost of care associated with managing VAP is not covered by CMS; therefore, healthcare organizations must implement cost-effective strategies to alleviate the risk of VAP (Ladbrook et al., 2020). Although controversy exists regarding the effectiveness of financial incentives, it is introduced as a means to provide cost-effective care.

Evidence-based Policy

VAP care bundles have been implemented in many healthcare organizations in an effort to reduce the incidence of VAP. VAP care bundles are an example of an evidence-based policy for VAP prevention that combines the use of several core evidence-based elements (Ladbrook et al., 2020). Khan et al. (2016) describes a 7-element care bundle including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The master’s prepared nurse can promote the evidence-based policy of VAP care bundles by implementing its use in clinical practice.

References

Khan, R., Al-Dorzi, H. M., Al-Attas, K., Ahmed, F. W., Marini, A. M., Mundekkadan, S., Balkhy, H. H., Tannous, J., Almesnad, A., Mannion, D., Tamim, H. M., & Arabi, Y. M. (2016). The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia. American Journal of Infection Control, 44(3), 320–326. https://doi-org./10.1016/j.ajic.2015.09.025

Ladbrook, E., Khaw, D., Bouchoucha, S., & Hutchinson, A. (2020). A systematic scoping review of the cost-impact of ventilator-associated pneumonia (VAP) intervention bundles in intensive care. American Journal of Infection Control. doi:10.1016/j.ajic.2020.11.027

Villar, C. C., Pannuti, C. M., Nery, D. M., Morillo, C. M. R., Carmona, M. J. C., & Romito, G. A. (2016). Effectiveness of intraoral chlorhexidine protocols in the prevention of ventilator-associated pneumonia: Meta-analysis and systematic review. Respiratory Care, 61(9), 1245–1259. https://doi-org./10.4187/respcare.04610 (Links to an external site.)

THIRD POST

Pressure ulcers are a prevalent hospital-acquired condition. Schellack (2020) describes a pressure ulcer as skin breakdown common among immobile patients. Pressure ulcers are also known as decubitus ulcers. Incontinence can make a person more susceptible to developing a pressure ulcer. Pressure ulcers are more common among the elderly. Pressure ulcers are caused by direct pressure on the skin. Pressure ulcers are often preventable and usually occur during a patient’s hospital stay classifying them as a hospital-acquired condition. Smith et al. (2018) discusses the economic impact of hospital-acquired pressure ulcers (HAPU). In the United States, pressure ulcers can cost an estimated nine to eleven billion dollars. Once a person develops a stage 3 or stage 4 pressure ulcer, it is a long and difficult process to heal it. The Center for Medicare and Medicaid Services (CMS) Non-Payment Policy influences resources for providing care. Padula et al. (2015) states that the nonpayment policy was proposed after CMS declared they would no longer reimburse hospitals for costs related to hospital-acquired conditions. Padula et al. (2015) studied the incidence of HAPUs in hospitals since the policy was enacted and found HAPU incidence decreased significantly. Hospitals have made a greater effort at preventing HAIs since the CMS Non-Payment was passed. The CMS Non-Payment Policy can have a negative effect on hospitals’ care. If CMS refuses to pay for HAIs hospitals have to take care of the cost themselves and that takes away from the hospitals funding which ultimately affects the care they can provide to their patients. A policy that supports the reduction of hospital-acquired conditions is a pressure ulcer preventative initiative called Deal with Heels. Birkil (2020) discusses how heels are the second most common site for pressure ulcers to occur. The Deal with Heels initiative was a project that was implemented across inpatient settings to reduce heel pressure ulcer prevalence. Over the three-year period, the project reduced incidence of pressure ulcers by 80%. The main focus of the initiative is education so the master’s prepared nurse can promote it by educating his or her patients on pressure ulcer prevention. Educating staff nurses on preventing pressure ulcers is very effective so the master’s prepared nurse can promote the Deal with Heels initiative by training and teaching the staff nurses about the plan.

References

Birkill, K. (2020). Deal with heels: a pressure ulcer prevention initiative. British Journal of Community Nursing, 25(3), S6–S10. https://doi-org./10.12968/bjcn.2020.25.Sup3.S6 (Links to an external site.)

Padula, W., Makic, M., Wald, H., Campbell, J., Nair, K., Mishra, M., & Valuck, R. (2015) Hospital-acquired pressure ulcers at academic medical centers in the United States, 2008–2012: Tracking changes since the CMS Nonpayment Policy. The Joint Commission Journal on Quality and Patient Safety, 41(6), 257-263. https://doi.org/10.1016/S1553-7250(15)41035-9 (Links to an external site.)

Schellack, G. (2020). Basic staging and colour-coding for pressure ulcer management. Professional Nursing Today, 24(2), 22–25.

Smith, S., Snyder, A., McMahon Jr., L. F., Petersen, L., & Meddings, J. (2018). Success in hospital-acquired pressure ulcer prevention: A tale in two data sets. Health Affairs, 37(11), 1787–1796. https://doi-org.ezproxylocal.library.nova.edu/10.1…