Implementation of the FIRM (Foley Insertion, Removal, and Maintenance) protocol in skilled nursing facilities

2014 ◽  
Vol 1 ◽  
pp. 10-12
Author(s):  
Murthy Gokula ◽  
Phyllis M Gaspar
Keyword(s):  
Health Care Providers ◽  
Care Management ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Skilled Nursing Facilities ◽  
Evidence Based ◽  
Nursing Facilities ◽  
Care Providers ◽  
Urinary Catheters ◽  
Skilled Nursing

The purpose of this study was to determine the feasibility and outcomes of the implementation of an evidence based protocol, Foley Insertion Removal and Maintenance (FIRM) for the use and care management of indwelling urinary catheters (IUC) for skilled nursing facilities (SNF). The protocol consists of an order set for insertion, maintenance, and removal complemented with an education program for health care providers of SNF.  It was implemented over a six month period in two SNF.  Prospective chart review following implementation revealed an 11.3 rate of IUC per month.  Documentation of the indication for placement of an IUC was 98.5%.  Retrospective chart review revealed a lower use of IUC prior to implementation of the protocol but the lack of documentation of orders for IUC artificially reduced the rate.  FIRM protocol is advocated as a facility policy with a nurse champion to facilitate implementation and surveillance.

Competitive Spillovers and Regulatory Exploitation by Skilled Nursing Facilities

2016 ◽  
Vol 19 (1) ◽  
pp. 45-70 ◽  
Author(s):  
John R. Bowblis ◽  
Christopher S. Brunt ◽  
David C. Grabowski
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Medicare Reimbursement ◽  
Care Providers ◽  
Skilled Nursing ◽  
For Profit ◽  
Market Dominance ◽  
Selection Of

Abstract Typically, research on the effect of ownership has considered health care providers in isolation of competitive interaction from other firms. This analysis considers how the selection of Medicare reimbursement codes for skilled nursing facilities varies by ownership and is influenced by the competitive spillovers from market dominance of for-profit institutions. We find evidence that not-for-profits are less likely to code patients into the highest reimbursement categories. Further, as the market becomes dominated by for-profits, both for-profit and not-for-profits increase the share of patients in these high reimbursement categories.

scholarly journals Are Fenestrated Tracheostomy Tubes Still Valuable?

2019 ◽  
Vol 28 (3) ◽  
pp. 1019-1028
Author(s):  
Vinciya Pandian ◽  
Sarah E. Boisen ◽  
Shifali Mathews ◽  
Therese Cole
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Health Care Providers ◽  
Tracheostomy Tube ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Primary Reason ◽  
Care Providers ◽  
Airway Protection ◽  
Tracheostomy Tubes

Purpose The purpose of this clinical focus article is to describe the frequency, indications, and outcomes of fenestrated tracheostomy tube use in a large academic institution. Method A retrospective chart review was conducted to evaluate the use of fenestrated tracheostomy tubes between 2007 and 2017. Patients were included in the study if they were ≥ 18 years of age and received a fenestrated tracheostomy tube in the recent 10-year period. Results Of 2,000 patients who received a tracheostomy, 15 patients had a fenestrated tracheostomy tube; however, only 5 patients received a fenestrated tracheostomy tube at the study institution. The primary reason why the 15 patients received a tracheostomy was chronic respiratory failure (73%); other reasons included airway obstruction (20%) and airway protection (7%). Thirteen (87%) patients received a fenestrated tracheostomy tube for phonation purposes. The remaining 2 patients received it as a step to weaning. Of the 13 patients who received a fenestrated tracheostomy tube for phonation, only 1 patient was not able to phonate. Nine (60%) patients developed some type of complications: granulation only, 2 (13.3%); granulation and tracheomalacia, 2 (13.3%); granulation and stenosis, 4 (26.7%); and granulation, tracheomalacia, and stenosis, 1 (6.7%). Conclusions Fenestrated tracheostomy tubes may assist with phonation in patients who cannot tolerate a 1-way speaking valve; however, the risk of developing granulation tissue, tracheomalacia, and tracheal stenosis exists. Health care providers should be educated on the safe use of a fenestrated tracheostomy tube and other options available to improve phonation while ensuring patient safety.

scholarly journals Difficult Discharges to Skilled Nursing Facilities Attributed to Multiple Sclerosis Medications: An Observational Study

2019 ◽  
Vol 10 (2) ◽  
pp. 82-87
Author(s):  
Kathleen C. Munger ◽  
Benjamin P. George ◽  
Lawrence M. Samkoff ◽  
Jessica F. Robb
Keyword(s):  
Multiple Sclerosis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Medication Costs ◽  
Medication Discontinuation ◽  
Academic Medical

Background: The costs of multiple sclerosis (MS) disease-modifying therapies (DMTs) and certain symptomatic treatments (ie, dalfampridine [DFP]) are high. Consolidated billing models require that medication costs be covered by skilled nursing facilities (SNFs) after hospitalization. As a result, patients may experience suboptimal discharge, off of medication or without rehabilitation. Methods: To characterize the frequency with which MS pharmaceutical costs lead to suboptimal discharge, we performed a retrospective chart review of admissions to a large academic medical center from January 2013 to December 2017 among patients with MS on DMT and/or DFP with SNF rehabilitation recommendations. We quantified the burden of suboptimal discharge due to medication discontinuation, limited medication supplies, or forgone rehabilitation. Results: Among 169 admissions of patients with MS with discharge recommendations for SNF rehabilitation, there were 57 (33.7%) admissions across 49 patients with MS on DMT/DFP. Overall, 39 (68%) of 57 admissions (71% of patients) experienced a suboptimal discharge. Overall, 29 (65%) discontinued DMT/DFP, 9 (16%) took their remaining home supply of medications during rehabilitation (including 5 admissions also affected by a discontinuation), and 6 (11%) were discharged home to remain on DMT. Among those discharged to rehabilitation, discharge to a hospital-owned SNF was associated with a routine discharge with no lapse in medication (n = 11/15 vs 7/36, P < .001). Conclusions: High costs of MS medications in conjunction with SNF consolidated payment models result in misaligned incentives and often lead to medication discontinuation or other suboptimal discharge for patients with MS.

Extended Use of Urinary Catheters in Older Surgical Patients: A Patient Safety Problem?

2008 ◽  
Vol 29 (2) ◽  
pp. 116-124 ◽  
Author(s):  
Heidi L. Wald ◽  
Anne M. Epstein ◽  
Tiffany A. Radcliff ◽  
Andrew M. Kramer
Keyword(s):  
Orthopedic Surgery ◽  
Older Patients ◽  
Urinary Catheter ◽  
Gastrointestinal Surgery ◽  
Patient Characteristics ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Urinary Catheters ◽  
Skilled Nursing ◽  
Indwelling Urinary Catheter

Objectives.To explore the relationship between the extended postoperative use of indwelling urinary catheters and outcomes for older patients who have undergone cardiac, vascular, gastrointestinal, or orthopedic surgery in skilled nursing facilities and to describe patient and hospital characteristics associated with the extended use of indwelling urinary catheters.Design.Retrospective cohort study.Setting.US acute care hospitals and skilled nursing facilities.Patients.A total of 170,791 Medicare patients aged 65 years or more who were admitted to skilled nursing facilities after discharge from a hospital with a primary diagnosis code indicating major cardiac, vascular, orthopedic, or gastrointestinal surgery in 2001.Main Outcome Measures.Patient-specific 30-day rate of rehospitalization for urinary tract infection (UTI) and 30-day mortality rate, as well as the risk of having an indwelling urinary catheter at the time of admission to a skilled nursing facility.Results.A total of 39,282 (23.0%) of the postoperative patients discharged to skilled nursing facilities had indwelling urinary catheters. After adjusting for patient characteristics, the patients with catheters had greater odds of rehospitalization for UTI and death within 30 days than patients who did not have catheters. The adjusted odds ratios (aORs) for UTI ranged from 1.34 for patients who underwent gastrointestinal surgery (P <.001) to 1.85 for patients who underwent cardiac surgery (P <.001); the aORs for death ranged from 1.25 for cardiac surgery (P = .01) to 1.48 for orthopedic surgery (P = .002) and for gastrointestinal surgery (P < .001). After controlling for patient characteristics, hospitalization in the northeastern or southern regions of the United States was associated with a lower likelihood of having an indwelling urinary catheter, compared with hospitalization in the western region (P = .002 vs P = .03).Conclusions.Extended postoperative use of indwelling urinary catheters is associated with poor outcomes for older patients. The likelihood of having an indwelling urinary catheter at the time of discharge after major surgery is strongly associated with a hospital's geographic region, which reflects a variation in practice that deserves further study.

Care Management and the Transition of Older Adults From a Skilled Nursing Facility Back Into the Community

2011 ◽  
Vol 12 (2) ◽  
pp. 54-59 ◽  
Author(s):  
Adam G. Golden ◽  
Shanique Martin ◽  
Melanie da Silva ◽  
Bernard A. Roos
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Nursing Care ◽  
Care Management ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Management Interventions

After hospitalization, many older adults require skilled nursing care. Although some patients receive services at home, others are admitted to a skilled nursing facility. In the current fragmented health care system, hospitals are financially incentivized to discharge frail older adults to a facility for postacute care as soon as possible. Similarly, many skilled nursing facilities are incentivized to extend the posthospitalization period of care and to transition the patient to custodial nursing home care. The resulting overuse of institution-based skilled nursing care may be associated with various adverse medical, social, and financial consequences. Care management interventions for more efficient and effective skilled nursing facility use must consider the determinants involved in the decisions to admit and maintain patients in skilled nursing facilities. As we await health care reform efforts that will address these barriers, opportunities already exist for care managers to improve the current postacute transition processes.

scholarly journals Adapting Project RED to Skilled Nursing Facilities

2018 ◽  
Vol 29 (3) ◽  
pp. 149-156 ◽  
Author(s):  
Lori L. Popejoy ◽  
Amy A. Vogelsmeier ◽  
Bonnie J. Wakefield ◽  
Colleen M. Galambos ◽  
Alexandria M. Lewis ◽  
...  
Keyword(s):  
Transitional Care ◽  
Primary Care Providers ◽  
Health Condition ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Care Providers ◽  
Skilled Nursing ◽  
Discharge Plan ◽  
Care Processes ◽  
Field Notes

This article describes our recommendation for adapting hospital-based RED (Reengineered Discharge) processes to skilled nursing facilities (SNFs). Using focus groups, the SNFs’ discharge processes were assessed twice additionally, research staff then recorded field notes documenting discussions about facility discharge processes as they related to RED processes. Data were systematically analyzed using thematic analysis to identify recommendations for adapting RED to the SNF setting including (a) rapidly identifying, involving, and preparing family/caregivers to implement a patient focused SNF discharge plan; (b) reconnecting patients quickly to primary care providers; and (c) educating patients at discharge about their target health condition, medications, and impact of changes on other chronic health needs. Limited SNF staff capacity and corporate-level policies limited adoption of some key RED components. Transitional care processes such as RED, developed to avoid discharge problems, can be adapted for SNFs to improve their discharges.

scholarly journals 2056. Retrospective Analysis of Intravenous Vancomycin Outcomes in Patients Discharged to Skilled Nursing Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S693-S693
Author(s):  
Heather D Gibson ◽  
Gretchen S Arnoczy ◽  
Andrew Kessell ◽  
Jaspaul S Jawanda
Keyword(s):  
Adverse Events ◽  
Retrospective Chart Review ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Therapy Assessment ◽  
Increased Risk ◽  
Vancomycin Trough ◽  
Provider Outcomes ◽  
Significant Opportunity

Abstract Background Patients treated with intravenous (IV) vancomycin at skilled nursing facilities (SNFs) are at increased risk for adverse events. Methods Single-center, retrospective chart review to assess specific outcomes of patients receiving IV vancomycin discharged to an SNF from a single institution under the care of infectious diseases (ID) physicians. Population included all patients under the care of an ID provider between November 1, 2017 and October 31, 2018 with GFR > 30 who were discharged to an SNF on IV vancomycin for a minimum of 2 weeks. Patients with chronic kidney disease and patients younger than 18 years old were excluded. It was intended that all patients have weekly labs, including vancomycin troughs, communicated to the ID provider. Outcomes evaluated included complications related to vancomycin therapy, assessment of appropriate trough timing and sub-therapeutic troughs (defined as a trough less than 10), and assessment of communication to the prescribing physician. Complications were defined as vancomycin trough greater than 30, increase in serum creatinine greater than 0.5 above baseline, documented adverse events related to vancomycin, or hospital readmission during antibiotic therapy. Results 25 patients who met inclusion criteria were admitted to 14 different SNFs. Osteomyelitis was the most common indication and MRSA was the most commonly isolated organism. 13 of 25 patients experienced the predefined complications; 5 of 25 patients had at least one trough value greater than 30. 13 of 25 patients had troughs drawn at inappropriate times in relation to doses and 15 of 25 patients had either absent or incomplete labs communicated to the prescriber. 4 of 25 patients had at least one trough value less than 10. Only 2 of 25 patients assessed had no complications, troughs appropriately drawn, and lab values communicated to the prescriber. Conclusion Patients discharged to SNFs on vancomycin had high rates of complications, low rates of appropriate laboratory monitoring, and poor communication between SNFs and the prescribing ID physician. Vancomycin administration at an SNF warrants careful monitoring for patient safety and demonstrates an area with significant opportunity for improvement. Disclosures All authors: No reported disclosures.

Perceptions of Speech-Language Pathologists Linked to Evidence-Based Practice Use in Skilled Nursing Facilities

2014 ◽  
Vol 23 (4) ◽  
pp. 612-624 ◽  
Author(s):  
Natalie F. Douglas ◽  
Jacqueline J. Hinckley ◽  
William E. Haley ◽  
Ross Andel ◽  
Theresa H. Chisolm ◽  
...  
Keyword(s):  
Evidence Based Practice ◽  
Skilled Nursing Facilities ◽  
Evidence Based ◽  
Nursing Facilities ◽  
Speech Language Pathologists ◽  
Skilled Nursing
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