11-256 NEWSLETTER Nurses Notes_Nurses Notes 8/4/11 1:16 PM Page 1
Nurses Notes
A quarterly newsletter for nurses at Decatur Memorial Hospital
Vol. 21, No. 3
August 2011
Value Based Purchasing: How it affects nursing care
By Linda Fahey, Vice
care terms, that means—
evidence that they received a beta-
President of Nursing
■ 100 percent of our MI patients need
blocker peri-operatively every time.
to go to the cath lab and have neces-
As you can see, there is not much
The Affordable Care Act
sary intervention within 90 minutes.
room for error, but we have been work-
(ACA) of 2010 mandates
Appropriate discharge instructions
ing on these standards for quite some
that CMS implement an inpatient
must be given to 100 percent of all
time so—by working together with our
VALUE-BASED PURCHASING program
CHF patients.
medical staff—we can meet them.
that links our Medicare payments to our
■ Blood cultures for pneumonia
In addition to core measures, HCAH-
performance on specific quality and cus-
patients before antibiotic therapy
PS scores will also impact our reim-
tomer service measures.
must by obtained on every patient
bursement. Core measures will be
This will affect payment to DMH
and the appro-
beginning Oct. 1, 2012, and will be
priate antibiotic
Value-Based Purchasing
based on our performance from July 1,
given to at least
2011 to March 31, 2012. Medicare will
99.58 percent of
A MANDATORY PROGRAM
FOR ALL EMPLOYEES
reduce payments by one percent or
patients.
about $500,000 increasing each year
■ In surgery,
after that. Some of that money will be
appropriate
given back based on quality perform-
antibiotic pro-
ance and customer satisfaction scores.
phylaxis has to
We have been working on some of
these quality measures for quite some
time and often refer to them as core
measures and HCAHPS. CMS has limited
weighted at 70 percent; HCAHPS scores
at 30 percent.
Benchmark scores
are needed in all cat-
7 am, Wednesday,
Aug. 10—through
5 pm Friday, Aug. 12
Old Cafeteria
be selected for
egories. This means
that we need to
achieve scores above
the 75th percentile
for every category
every patient and given within one
on our customer satisfaction survey.
hour 99.98 percent of the time.
Many of these are specifically impacted
■ Prophylactic antibiotics must be dis-
by our nursing practice group.
the measures and taken out the ones
continued within 24 hours of surgery
where hospitals generally perform well.
end time for 99.68 percent of our
Medicare will be adding measures that
In other words, CMS will base reimbuse-
patients and 99.68 percent of our
they just started reporting publicly.
ment on stretch goals rather than goals
open heart patients must have their 6
Among those are Hospital Acquired
that are generally achieved.
am postoperative glucose within con-
Conditions (unexpected problems that
trol parameters.
happen after the patient is admitted to
Because of that, you and I have
some work to do as a nursing practice
■ All surgery patients must have
As we move past the initial year,
the hospital), injuries from falls, pres-
group to help the hospital gain its fair
venous thromboembolism prophylax-
sure ulcers, catheter-associated urinary
share of reimbursement for Medicare
is ordered and needs to be evidence
tract infections, and central line infec-
patients that we serve.
in 99.85 percent of those patients
tions are examples of conditions directly
that those orders were implemented.
impacted by how we implement
For core measures, we must hit close
to the benchmark to receive full return
of that one percent reduction. In real
■ For those patients who are on beta
blockers before surgery, there must be
evidenced-based care. Complications,
(Continued, page 2)
11-256 NEWSLETTER Nurses Notes_Nurses Notes 8/4/11 1:16 PM Page 2
Value Based Purchasing
Pneumonia Core Measures
■ documentation of smoking cessation
(Continued, from front page)
re-admissions, and mortality scores will
also be a part of future CMS calculations.
I have asked our Clinical Practice
and Professional Practice Councils to
take a leadership role in assuring that
we design our nursing care to meet
these quality parameters, because the
evidence supports these as the best
practice and our patients deserve
benchmark care. We, of course, would
also like to receive appropriate reimbursement from Medicare for the nursing services that we provide so that
needs to be an extra driver as we work
for the benchmarks in all of the areas.
■ appropriate antibiotic selection
By Chris Pope, RN, BSN
Director, Medical Nursing
education (if patient is a smoker)
■ Pneumonia/flu vaccines given or documented that patient has received a
Patients admitted with a pneumonia
vaccine within guidelines.
diagnosis require specific care to meet
So, what can nursing do?
CMS guidelines. Sometimes patients are
■ First, make sure you document vacci-
admitted with symptoms (“shortness of
nation status and smoking history.
breath” or “cough”) rather than a diag-
■ Obtain blood cultures and administer
nosis. It is very important for nurses to
antibiotics in a timely manner.
pay attention to CXR reports and doctors
(review back of core measure sheet
progress notes. A patient admitted with
respiratory failure or sepsis also falls into
pneumonia core measures.
Criteria for pneumonia core measures:
for appropriateness of antibiotic)
■ Give the pneumonia vaccine if needed (>65 years old, not rec’d in past
five years) and flu vaccine (>50
■ blood cultures done prior to antibiotics
years old, not rec’d this season,
■ antibiotics started within four hours
October—March only). Document if
patient refuses or is allergic.
of arrival
Core measures defined
By Tana Lamb, RN, BSN, Quality
Review Analyst
Wheelchairs, medical equipment
available at the right time, place!
Hospital-based core measures help
GE Healthcare consultants are support-
their status in real time throughout the
improve quality care and can provide
ing DMH staff members to develop new
facility. DMH staff will be able to—
consumers with information to make
processes to ensure that—
■ Search by equipment location, mod-
more informed decisions about their
■ wheelchairs are available for your
healthcare and to see how hospitals
compare when treating common medical illnesses.
CMS (Medicare) and JCAHO (Joint
Commission) have joined together to
patients at all times;
■ IV pumps are better utilized through
PAR levels optimization and efficient
use;
els, repair and service history;
■ Receive alerts if equipment leaves
designated areas.
By the fourth quarter of 2011, this
system should be in place and will help
■ Other categories of equipment
determine what specific quality core
(wound vacs, air mattresses, etc.)
measures to focus on when treating
are easy to find, use and track by
these common illnesses such as acute
their main users.
Myocardial Infarction, emergency
you by—
■ saving you time searching for equipment (e.g. wheelchairs)
■ saving you time waiting for equip-
These changes will be facilitated by
ment to arrive (e.g. air mattresses)
department, heart failure, pneumonia
the implementation of a system called
■ will provide more resources to buy
Surgical Care Improvement Project,
AgileTrac. With AgileTrac Asset
more modern equipment (e.g. IV
outpatient surgery.
Manager, each piece of equipment will
pumps)
This initiative allows hospitals to
be equipped with a real-time location
Please support our staff and consult-
care for the consumer while receiving
system (RTLS) tag that communicates
ants as we test out new theses process-
financial incentives through Medicare.
with a central visualization system.
es. And let us know if you can you tell
Using a web browser, staff will be able
a difference and give us your ideas.
This program is constantly evolving
with new core measures being created,
to track where these assets are and
so be on the look out for more to
come!
Page 2
11-256 NEWSLETTER Nurses Notes_Nurses Notes 8/4/11 1:16 PM Page 3
Core measures in critical care
By Sue Krows, RN, BSN, Director, Cath Lab
Core Measures Congestive Heart Failure
Confirm patient is a CHF core measure.
■ Automatic if admission diagnosis is
charge but helpful to have accurate
worsen; weight monitoring; follow-up
diagnosis while tin the hospital.
appointment information; provide the
■ A history of CHF does not automat-
education while here. DO NOT wait
ically make a patient a core meas-
until discharge—even though it is
ure; it does warrant review.
called discharge teaching. That way,
■ Must have a documented EF (ejection
fraction) on the chart.
CHF/Pulmonary Edema. Otherwise,
■ Check in Portal for old echos.
look at these items:
■ Check with MD offices to see if an
education can be reinforced while they
are here.
■ Use the DMH Discharge form to discharge every patient. These have the
■ Check BNP, an indicator of CHF but
echo has been done in the office;
CHF and AMI core measure mandato-
can be elevated for other reasons.
ask for a faxed copy for medical
ry fields on them. Never cross out
Look at the whole picture.
record.
any of sections on discharge form.
■ Review CXR or CT scan. If results
■ If an old echo is placed on the chart, it
■ Enter the nursing measure orders on
indicate CHF/vascular congestion,
must be stamped with “retain with
these patients if not already done. This
pulmonary edema, interstitial mark-
chart;” must have been done within
includes daily weights and a 1500cc
ings, fluid overload, increased vas-
past 12 months.
fluid restriction. The diet should be 2
cularity, this qualifies as CHF.
■ If MD notes CHF, then it is a core
measure; will indicate to Medical
■ If no old echo is available, order Echo
(protocol, not STAT) per CHF protocol.
■ If EF is less than 40 percent, patient
Gm Na and the fluid restriction entered
into the modifier, unless the patient is
an ACS protocol. This patient would be
must have ACE/ARB therapy ordered
a House Cardiac diet with a fluid
OR have a documented contraindica-
restriction as a modifier. Also place a
noses: SOB, dyspnea, DOE, edema,
tion. Use contraindication form for
Fluid Restriction magnet on their door.
fluid overload, pulmonary edema,
easy documentation.
Records to code the chart for CHF.
■ Review patients with these diag-
■ Weights should be completed by
■ CHF education requires several topics;
6 am daily and entered on flowsheet.
Management to change symptom
all covered on education handout:
Compare weight to previous day and
(SOB) diagnosis to disease (CHF)
instruction on activity; diet and fluid
look for trends, accuracy, etc. Ensure
diagnosis. This gets done after dis-
restriction; written discharge medica-
bed has been zeroed and the same
tion list; what to do if symptoms
items are on the bed to be consistent.
etc. If fit CHF criteria, ask Case
Core Measures Acute MI
ordered or have a documented con-
Initiated on patients with—
traindication
■ Chart against these meds on the
MAR so it is known that they
■ Use contraindication form only if
have been received. Make note
NonQ wave, subendocardial MI
there is a known contraindication
on the MAR: “given in ECC” or
■ Patients with a positive troponin
such as renal insufficiency,
“taken at home.”
■ Diagnosis of MI, includes Stemi, NSTEMI,
■ Must have a EF on the chart. Check
cardiac cath report and/or Nuclear
hypotension, etc.
■ AMI patients need aspirin, beta block-
scan/stress test result for an EF
er within first 24 hours of admission
■ Reported EF will be the most recent
■ ASA taken at home counts for core
■ If patient is nauseated and unable
to take p.o. beta blocker, ask MD to
change to IV lopressor.
■ Must have a documented LDL on chart
■ Lipid panel has to be done within
EF done. For example, if cath is
measure but beta blocker taken at
done on Monday with EF of 40
home does not. This is why there is
24 hours of admission. Can be
percent and Echo done on Tues
a 1x dose of Coreg on the ACS
placed on chart from previous
with EF or 35 percent, the 35 per-
orders. It benefits the patient to
admission or MD office.
cent will be reported.
receive chewable aspirin in order to
■ If no documented EF, order Echo to
be done per ACS protocol
■ A change in the MI Core Measure
have an active effect at the time of
(regardless of the LDL result) the
infarct/injury.
patient needs to be discharged on a
■ If EF is less than 40 percent,
Statin or have a contraindication
documented.
patient must have ACE/ARB
Page 3
11-256 NEWSLETTER Nurses Notes_Nurses Notes 8/4/11 1:16 PM Page 4
Surgical Care Improvement Project (SCIP) Core Measures
By Sue Kiefer-Griffin, CRNA, Executive
Director, Anesthesia Services
■ The VTE prophylaxis reports whether
or not VTE preventative measures
were ordered and initiated within 24
The SCIP program is sponsored by the
hours prior to incision time or within
Centers for Medicare and Medicaid
24 hours after surgery. If prophylaxis
Services (CMS) in collaboration with a
is not appropriate, the medical reason
number of other national partners includ-
must be documented in the medical
ing the American Hospital Association
chart and an exclusion modifier
(AHA), Centers for Disease Control and
applied when coding the medical
Prevention (CDC), Institute for
record. The majority of VTEs in total
Healthcare Improvement (IHI), the Joint
hip and total knee replacement sur-
Commission, and others.
geries occur after hospital discharge,
Information on SCIP is located within
the in-patient Hospital Quality Measures.
The CMS quality net website provides
several educational materials to other
yet the number of patients receiving
VTE prophylaxis declines after the
patient leaves the hospital.
■ To combat interruptions in prophylax-
organizations and has information avail-
is that happen during care transitions,
able for patients to download as well.
CMS has developed the Care
SCIP focuses on—
■ prevention of surgical site infections
Transitions Project.
■ Blood glucose, normothermia, and
■ VTE (venous thromboembolism)
proper skin prep is also part of the
■ Cardiac complications
SCIP initiative, as well as Beta Blocker
■ Administering correct antibiotic, at
administration preoperatively.
correct time (within one hour of sur-
■ Another current focus is removal of
gical incision) and discontinuing at
Foley catheters on post op day one or
proper time (within 24—48 hours)
two.
depending on the type of surgery.
**Of note, Foley catheters are not
SCIP involves all physicians, surgical
required for patients receiving epidural
services staff, pharmacy and nursing
anesthesia. The Foley placement and
to correctly complete for each surgical
removal orders most often come from the
patient in the following categories;
surgeon.
■ CABG, and other cardiac procedures
We have reached our goal of 100 per-
■ Lung procedures
cent compliance on the SCIP measures
■ Total hip and knee replacements
and continue to have processes in place
■ Vascular cases
to continue to meet the SCIP goals for
■ Colon procedures
each patient having surgery. The Core
■ Hysterectomy
Measure Team meets monthly (at 2 pm
■ Craniotomy and spine procedures
on the third Tuesday in Café DMH 1).
involving fusions
You are welcome to attend the
monthly meetings for any questions, and
to become more involved in the process.
Page 4
Save-The-Vein
campaign
By Bonnie Matthews, RN
Patients who
receive peritoneal dialysis
may have a
future need for
hemodialysis
s
This patient ha
e.
as
se
di
kidney
SAVE THE
VEIN!
requiring a
venous access
device.
Patients who
receive
hemodialysis
and have an AV fistula or AV graft are
always at risk of needing a replacement of their fistula or graft in the
opposite extremity.
The “Save The Vein Campaign” is
geared to site protection for future
access.
Patients wearing yellow bracelets
indicate no venipunctures (lab draws,
or IVs) in the antecubital space but it is
okay use the lower forearm and hand
for IV, lab draws, as well as blood pressures.
To help you remember this: Yellow
band = ok hand. Example:
■ A patient with a peritoneal dialysis
catheter would get yellow bracelets
bilaterally.
■ A patient with an AV fistula or AV
graft would get a red bracelet on
this arm, AND a yellow bracelet on
the opposite arm.
11-256 NEWSLETTER Nurses Notes_Nurses Notes 8/4/11 1:16 PM Page 5
Flu shot mythbusters
By Sandra Shoop, RN, BSN,
Infection Control
Truth: Unvaccinated healthcare
Fall prevention,
preventing trauma
related to falls
workers spread the flu. In 1998, an
outbreak of influenza in a neonatal
By Kathy McDowell, RN, MSN,
Myth: I’m healthy, I don’t need the flu
intensive care unit started because one
Clinical Quality Consultant
shot.
nurse came to work sick. 19 out of 54
Truth: Even if you are healthy and
do not develop any symptoms, you can
carry and transmit the influenza virus
to others. Our patients do not always
have optimal immune systems. If they
babies were positive for flu and one
Falls and fall-related injuries are
died!
among the most serious and common
Myth: If I get sick, the flu shot did
in older adults. Nearly one-third of
older adults fall each year; half of them
not work.
The flu shot protects against influen-
fall more than once. Due to underlying
get influenza, the results can be cata-
za. It will not protect against other res-
osteoporosis, decreased mobility and
strophic.
piratory or GI illness.
reflexes, falls often result in hip frac-
Myth: The flu causes vomiting and
diarrhea.
Truth: Many people who have GI
symptoms think they have “the flu.”
Myth: It won’t do any good to get
the shot. If I am going to get sick, I’ll
fracture from a fall have an incomplete
get sick.
recovery with an overall deterioration
Truth: The flu shot is very effective
Influenza is actually a respiratory illness
against strains of influenza that are
characterized by fever, severe body
included in the vaccine.
aches, chills, dry cough and chest discomfort, NOT vomiting and diarrhea.
Myth: The flu shot will cause you to
get the flu.
tures (75 percent of those with a hip
Myth: The vaccine has too many
in health), other fractures, head
injuries and even death.
All inpatients are assessed for risk
for falling. Interventions are put into
place to reduce their risk, yet some
side effects.
Truth: Most side effects are mild and
may last one to two days: soreness,
patients still fall.
On Aug. 10, 11, and 12, mandato-
redness, or swelling where the shot was
ry Value-Based Purchasing education
vated (containing killed virus) vaccine.
given; hoarseness, sore, red or itchy
fall prevention training and prevention
There is no live virus to cause illness,
eyes; cough, fever, aches
of trauma related to falls will be offered
Truth: The flu vaccine is an inacti-
only inactivated virus so your body can
Life-threatening allergic reactions
in the old cafeteria. Introduction and
recognize and develop defenses (anti-
from vaccines are extremely rare. If
inservice of new equipment to reduce
bodies) against it.
they do occur, it is usually within a few
trauma related to falls will be presented
Myth: The flu is not that bad.
minutes to a few hours after the shot.
(Posey floor mats, hip protectors).
Truth: Each year, Five to 20 percent
The risk of Guillain-Barre’ Syndrome is
Specific injuries are considered trauma
of the population gets the flu; 200,000
no more than one or two cases per
from falls (fractures, dislocations,
are hospitalized; and 36,000 people die
1,000,000 people vaccinated, which is
intracranial injuries, crushing injuries,
from influenza.
much lower that the risk of influenza.
burns, electric shock). In the past,
Myth: If I am not sick, I cannot
spread the flu.
Truth: Symptoms usually begin one
to four days after exposure to Influenza.
Myth: I don’t have to decide
whether to take the shot.
Truth: Illinois law requires that hospitals provide documentation of
DMH has gone 11 months without
trauma from falls. We can do this
again with all your help!
The training promises to be fun
Adults spread the virus up to one full
Influenza vaccination/declination for all
with popcorn, sno-cones, candy, door
day before symptoms begin. Fifty per-
personnel. All employees are offered the
prize drawings and interactive poster
cent of people show no symptoms at all
flu shot or must actively decline the
presentations. Information will be pre-
but can still spread the virus.
vaccine.
sented on Hospital Acquired Conditions
Myth: I should come to work sick,
(HAC), Value-Based Purchasing (VBP)
because the shift will be short if I am
HCAHPS, Mortality measures, Present
not there.
on Admission and Core Measures.
Page 5
11-256 NEWSLETTER Nurses Notes_Nurses Notes 8/4/11 1:16 PM Page 6
RN, LPN license renewal/CE information
The Countdown Continues
By Stacey Taylor, RN, Education,
cation in Basic Life support for
Bonnie Matthews, RN, Preop RN
Healthcare Providers (BLS),
Liaison, and Gail Fyke, RN, Clinical
Advanced Cardiac Life Support
Nurse Specialist Med/Surg
(ACLS) or Pediatric Advanced Life
Support (PALS).
Nine months left to go and how are you
Nurses at DMH are required to have
doing on your continuing education?
a healthcare provider BLS certification
Effective next May (2012), RNs will
which must be renewed every two
need 20 hours of continuing education
years. Great news: you can use three
for their nursing license renewal. LPN’s
hours toward your licensure renewal for
will require this by January 2013.
that certification! You will need to keep
Here are some tips from the Illinois
your CPR card issued to you as proof of
Department of Professional Regulations
attendance in the class. In addition, if
(IDPR) to help you:
you take an ACLS or PALS class you
■ When you submit your application
can claim up to a maximum of five
for license renewal, there will be a
hours total for your license renewal.
“check box” on the form asking you
(For example: three for CPR and two for
to declare that you have completed
ACLS).
your 20 hours of CE’s. You will NOT
For the purpose of renewal of your
Illinois nursing license only (i.e. not for
ed on the application form.
national certifications), education
offered at DMH will now count toward
applicants within 6 months to pro-
continuing education hours if the fol-
duce to the state evidence of 20
lowing criteria is met; the content must
hours of CE’s.
contribute to the advancement of pro-
■ You MUST keep your records for 6
fessional skills and scientific knowledge
months after you get your renewed
of the RN or LPN; the education must
license of your proof/evidence of
be offered by a person with experience
what your 20 hours of CE’s was
and expertise in the subject matter.
what you declared. After six months,
■ The educational offering will include
you will not be liable for providing
evidence of CEs.
Nurses: you can earn up to five CE
a evaluation form
■ The attendee will receive a certificate
with your name on it as evidence of
The DMH in-home Palliative Care
program is provided through DMH
Home Health Services department.
This special program is either for
patients who are receiving ongoing
curative treatment, or for patients
who want to receive this service on
its own.
Palliative Care is care that manages symptoms and side effects. It is
care that focuses on helping people
with end-stage diseases live as comfortably as possible for weeks,
months, or years. This type of care
al, emotional, and practical needs.
Palliative care also provides support
for a patient’s family, friends, and
caregivers.
Each patient has a registered
nurse assigned to him or her. Other
team members include a social worker, home health aide, physical and
occupational therapists, and chaplain.
Team members make home visits as
ordered by the patient’s physician
and can provide additional visits to
respond to changes and to meet the
patient’s needs and wishes. Our care
will include—
■ Expert treatment of pain and other
hours for completion of “skills certifica-
attendance.
tion courses” toward your license
To learn more about continuing
renewal requirement.
education requirements for licensure,
■ A maximum of two hours in car-
go to the Illinois Department of
diopulmonary resuscitation certified
Professional Regulations websites,
by the American Red Cross or the
www.idfpr.com/DPR, or
American Heart Association.
www.ilga.gov/commission/jcar/admin-
■ A maximum of three hours may be
By Karen Hood, RN, MSN/MHA,
DMH Hospice Care Coordinator
addresses a person’s physical, spiritu-
have to list what you have complet■ IDPR will perform random audits on
Palliative Care
code/068/068013000A01300R.html
symptoms, such as shortness of
breath, nausea, constipation, loss
of appetite or difficulty sleeping.
■ Educating the patient and family on
medications, the disease process,
symptoms and how to conserve
energy.
■ On-Call nurses 24 hours a day,
accepted for certification or re-certifi-
seven days a week, for questions
and visits.
Page 6
11-256 NEWSLETTER Nurses Notes_Nurses Notes 8/4/11 1:16 PM Page 7
Care explained
Do you know isolation definitions?
By Sandra Shoop, RN, BSN,
■ Emotional and spiritual support for
Infection Control Coordinator
patients and family members.
■ Helping families understand the
best ways they can assist the
patient.
■ Communicating with the patient’s
physicians and other health care
providers to coordinate care.
■ Easing transitions, such as to hospice if needed, or back to the
patient’s own daily routine if services are no longer needed. Patients
may go to the hospital if desired.
Eligibility: Homebound patients
who have any potentially life-threatening diagnosis and a need for skilled
care are eligible for Palliative Home
Health Care. We frequently serve
patients who have cancer, chronic
obstructive pulmonary disease, congestive heart failure, kidney disease,
multiple sclerosis, HIV/AIDS or other
chronic diseases with flare-ups.
Studies have shown that patients
receiving palliative care at home have
fewer emergency room visits, a
decreased length of inpatient hospital
stays, better health care outcomes
and higher rates of satisfaction with
their care.
Care starts with a phone call from
the patient’s physician, a hospital
staff member, a family member, or
the patient.
Call 217-876-6770 for more information or to arrange to meet with
one of our staff to learn more about
how we can help you.
With the agreement of the
patient’s physician, services can start
as soon as the patient is ready.
✄
■ Each of these spreads by contact
with patient or the environment.
■ Patients colonized with these
Hand Hygiene: The first and foremost
organisms contaminate their
way to prevent the spread of infec-
environment just as patients with
tions for ALL patients! Use alcohol-
active infections do.
based hand rub or soap and water to
■ Patients shed these organisms
cleanse hands when—
intermittently, that’s why it takes
■ entering a patient’s room; don’t
multiple screens to clear a patient
bring them an organism that’s not
theirs
■ MRSA – Staphylococcus aureus testing resistant to oxacillin
■ moving from a contaminated area
to clean area (ex: after wound
dressing change)
■ leaving a patient’s room; don’t take
their organisms to anyone else
Contact Isolation: Use of gowns,
gloves, hand hygiene to prevent
■ Carried on the skin, nares,
nasopharynx and perineum
■ Not all staphylococcus is MRSA
■ MRSA carried by different
patients may be susceptible to different antibiotics
■ VRE—Any Enterococcus species
spread of organisms by contact
testing resistant to Vancomycin
(i.e., multi-drug resistant organisms,
■ Enterococcus is carried in GI tract
■ May be Enterococcus faecium or
RSV, lice)
Total Isolation: Use of gowns, gloves
and masks to prevent the spread of
faecalis
■ VRE carried by different patients
organisms spread by contact or
may be susceptible to different
droplet spread (such as multi-drug
antibiotics
resistant organisms in sputum, any
■ ESBL Extended Spectrum Beta
multi-drug resistant organism isola-
Lactamase – enzyme produced by
tion patients in ICU/CVU)
certain bacteria causing increased
Airborne Isolation: Use of negative
airflow room and fit tested N-95
respirators and possibly gowns and
gloves to prevent the spread of
organisms spread by the airborne
resistance to antibiotics.
■ Most commonly E. coli and
Klebsiella pneumoniae
■ Carried in the urinary and GI tract
■ Clostridium difficile—spore forming
route, or airborne and contact (such
pathogen that causes diarrhea; treat-
as TB, measles, chickenpox)
ed as a multi-drug resistant organ-
Droplet Isolation: Use of masks to
ism due to limited treatment options
prevent spread of organisms spread
■ Very hardy in the environment,
by droplet route (such as influenza,
requires bleach for cleaning
group A Strep pharyngitis in children
or invasive in all ages)
■ No clearance for C. diff, diarrhea
must resolve for 48 hours
MDRO (Multi-drug Resistant Organism):
There are other MDROs that we are
Pathogens resistant to many antimi-
monitoring but not yet seeing. But you
crobial drugs with limited treatment
may hear about them on the news:
options—
KPC, CRE, VISA/VRSA. Stay tuned!
Page 7
11-256 NEWSLETTER Nurses Notes_Nurses Notes 8/4/11 1:16 PM Page 8
Editorial Board:
Editors:
Bonnie Matthews, PACU, x3203
Photogr aphers:
Patty Brumett, Lung Center, x4212
Anne Minks, Heart Ctr/Cardiac Rehab, x2749
Layout/Desig n:
Laura Bratten, Publications, x3235
New Medicare regulations
for Home Health Care
By Sandra Bosomworth, LPN,
cian may see the patient for the condi-
Home Health Services
tion as long as the form is completed by
office personnel and signed by the
Effective April 1, the Center for
physician. The form should be returned
Contributors:
Medicare/Medicaid Services enforced the
to the agency prior to admission to
Sandra Bosomworth, Home Health, x4600
new “face-to-face” (F2F) physician
home care.
Rebecca Dunakey, Endoscopy, x6030
encounter requirement, which includes—
Gail Fyke, CNS, x5408
■ date the patient is seen
within the past 90 days, the agency lets
When the patient has not had a visit
Lisa Harmon, Wound Therapy
■ medically necessary reason for services
the referral source know that the patient
Sue Hesse, Family Birth Center, x3416
■ treatment needed
must be seen in their office prior to an
Joyce Highley, Pediatrics, x3100
■ clinical findings to support the need
admission to home care.
Cindy Jenkins, Regulatory Compliance, x4371
Julie Kirkley, Case Management
for services
■ homebound status
Shirley Kroll, Surgery, ext. 6000
All Medicare patients admitted to
■ When a new referral comes from an
inpatient facility, such as a hospital or
nursing home, the F2F encounter may
Rick Landgrebe, Anesthesia, pgr 748
home care will have to have an F2F
have already occurred with the referring
Errika Long, Critical Care Educator, x2914
encounter with a qualifying MD to
physician and not the patient’s attend-
Pam McMillen, Women’s Health, x4373
assure appropriateness for home care
ing physician. The encounter form may
Tracy Newlin, Education, x2910
services within the guidelines of 90
be signed by the referring physician.
DeAnn Rose, 5100/Surgical Nsg, x5100
days prior to the “Start of Care” (SOC),
John Saylor, Clinical Informatics
or within 30 days of SOC.
visits. An I-form is available in DMH
Hospitalists are allowed to perform
Brenda Schwass, CVU, x5400
Documentation of this encounter will be
Portal that DMH physicians/Hospitalists
Sandra Shoop, Infection Control, x2508
secured and maintained as a part of the
may complete which can then be
Julie Sims, Orthopaedic Unit, x3500
medical record.
retrieved by the home care agency.
Marie Stauder, Wellness Center
At the time of the referral, the home
Hospital discharge planners and nurses
Stacey Taylor, Education, x2904
care agency will ask if the patient has
are able to complete the F2F, but the
Marilyn White, 4100/Medical Nsg, x4100
been seen within the past 90 days for
physician must sign the form.
the diagnosis the patient is being
Mission Statement:
To communicate, recognize and promote
the Nursing Profession within Decatur
In addition, DMH physicians are able
referred for. If that has occurred, then
to complete the F2F form in Logician
the F2F document will be faxed to the
where the document can be retrieved by
physician’s office for completion and
the agency.
signature. A nurse practitioner or physi-
Memorial Hospital in our service to
Decatur and the surrounding community.
Nurses Notes
DMH Education department recognized by INA
By Tracy Newlin, RN, BSN, Education
This means that if you are interested
in developing a continuing education
Vol. 21, No. 3
August 2011
Nurses Notes is published for nurses at Decatur Memorial
11-134
Hospital. All contents are copyrighted. Articles appearing in Nurses Notes may
be used with permission. For copies of this or any of our other publications,
call or write the DMH Publications department, 2300 N. Edward St., Decatur,
Ill., 62526, 217/876-3235.
© Copyright Decatur Memorial Hospital 2011
DMH’s Education department has been
program and would like to receive nurs-
granted “Approved Provider Unit” status
ing contact hours, contact the Education
by the Illinois Nurses Association, an
Department. Someone from Education
accredited approver by the American
must be involved from the very incep-
Nurses Credentialing Center’s
tion of the program to be able to assign
Commission on Accreditation.
nursing contact hours to the program.