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Medicare/Medicaid Reg Changes Against Hospitals and Patients

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bocker3:

--- Quote from: Ann on September 06, 2007, 05:08:54 am ---My thoughts exactly. The patients who are most vulnerable to hospital-caused infections are very often those who are so ill they could not possibly be responsible for enforcing the hospital's hygiene codes. ::)

Ann


--- End quote ---

This is exactly why the regulators are trying to "force the hands" of health care facilities to enforce their Infection Control plans.  The patient should not HAVE to be the enforcers.  It should be automatic for the staff to do.  Just as it has become automatic (well, mostly) for staff to glove up before touching a bleeding patient for their own protection, they need to glove up for the protection of their patient also.

Now -- I'm not saying that I am in favor of the a blanket reimbursement ban, but I wanted to point out what the "theory" behind this plan is all about.  I think there might be better ways to do this and the regulators seem to be using the "hammer" approach.

Mike

tester8888:
You are correct micro, the whole purpose of the new regulation is to 'force' hospitals into compliance.
Unfortunately, this is not going to accomplish the intended goal.
In my original post, I pointed this out, by saying that while hospitals DO have infection control policies in place, some of the staff does not follow the policy due to ignorance, apathy, denial, clumsiness, or pure defiance.
Additionally, we cannot control what visitors do while at the hospital.

Ex: Mr. Brown's wife pats on him while visiting him in his room.  Mr. Brown has acintobacter, but nobody knows it yet, because the culture hasn't come back.  Mrs. Brown doesn't wash her hands good, or at all, and then touches a rail in the elevator when she leaves.  Mrs. Green's son touches that same rail in the elevator on his way up to visit her.  He gets the a-bacter off of that rail and then goes to visit Mrs. Green, and she ends up getting the a-bacter.  We just recently had an acintobacter outbreak in our facility, and in the process, performed weekly environmental cultures.  We found the Public Elevator to have more organisms than the Nurses Station.

I see in the future, based on conversations I have had this week, that there will be a lot of bean counters and lawyers looking for loop holes in this regulation.  We are going to continue taking high risk patients at our facility, and just eat whatever the cost happens to be.  I have no doubt that this will lead to some rather 'creative' DRG coding and etc.  Failure to adhere to infection control techniques on patients in strict isolation, is now an automatically fireable offense.  Additional employee education and surveillance is under way, as well as patient and visitor education.

bocker3:

--- Quote from: tester8888 on September 06, 2007, 04:41:23 pm ---You are correct micro, the whole purpose of the new regulation is to 'force' hospitals into compliance.
Unfortunately, this is not going to accomplish the intended goal.
Failure to adhere to infection control techniques on patients in strict isolation, is now an automatically fireable offense.  Additional employee education and surveillance is under way, as well as patient and visitor education.

--- End quote ---

While I agree that this approach isn't going to eliminate hospital-acquired infections, I suspect the goal is around reducing them anyway, which, by your comments here show that it likely WILL impact things.

Now, I absolutely agree with you that this is a terribly ill-advised approach and doesn't do as much for the visitors as it does for the staff, but it still should have a positive impact.

Now, i also think that regulators will always be poking their heads in where they don't belong, as long as someone else is paying.  These regulators may be governmental ones, or they may be from insurance companies who demand quicker discharges, etc.  At the end of the day, the person with the $$$ will always yield the most power.  Again, I'm not saying this is a good thing -- it is simply reality.

Mike

JohnOso:

--- Quote from: tester8888 on September 06, 2007, 04:41:23 pm ---Additionally, we cannot control what visitors do while at the hospital.


--- End quote ---

One thing visitors can do is...do NOT BRING YOUR CHILDREN TO THE HOSPITAL!

I can't tell you how many arguments i've gotten into with families about what an asshole i am for refusing to allow little Johnnie and Susie back to see Grandma.

Actually i'm thinking allowing children to play around inside the hospital lobby/waiting room is a form of child neglect and should be reportable to the child protection services.


I will say, I'm glad that I work at the county hospital, i.e. the hospital of last resort where we don't really have the moral dilemma (or is that luxury?) of refusing patients.

John

Basquo:

--- Quote from: tester8888 on September 06, 2007, 04:41:23 pm --- We are going to continue taking high risk patients at our facility, and just eat whatever the cost happens to be.  I have no doubt that this will lead to some rather 'creative' DRG coding and etc.  Failure to adhere to infection control techniques on patients in strict isolation, is now an automatically fireable offense.  Additional employee education and surveillance is under way, as well as patient and visitor education.

--- End quote ---

I hadn't heard about these changes until now, but I'm sure my hospital will be doing the same as yours.  Right now Infection Control is a real pain in my ass, as I've had to draw up several new order sets for our new MRSA initiative.  One is a standing delegation order meaning that the nurse signs the order and it doesn't have to be signed by a physician.  The problem is that certain responses on the admission history and assessment automatically triggers this order to be printed out, then the nurses don't sign it.  Since an unsigned order makes the chart incomplete, the IC Coordinator said, well, just have the nurses come down to your department and sign the order.  I told her no f-ing way.  So when the analysts find an unsigned order, they send it to me, and i package them up and send them to her so SHE can track down the nurses.  Either way, it's an extra piece of loose filing that my department has to match up with the chart one way or another. And if they can't sign a simple piece of paper, I can guarantee that some of them are not following precautions the way they should. I think I'm the only one in the whole building that "foams" in and out of ICU, and I'm not even a clinical person!

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