Articles Posted in Nursing Care

legionnaires-232x300Hospitals and nursing homes, by failing to properly maintain their water systems, may be putting older patients at high risk of an unusual form of pneumonia, with federal officials tracking 1 in 5 suspected or confirmed  cases of life-threatening Legionnaire’s Disease to health care facilities.

Anne Suchat, acting director of the Centers for Disease Control and Prevention, has urged caregivers to redouble their efforts to stamp out Legionella bacteria contamination in areas where poor maintenance may allow infections to flourish, including in water storage tanks, pipes, cooling systems, showers, sinks, and bathtubs. She said Legionnaire’s cases were too widespread, “deadly … and preventable.”

CDC researchers analyzed 2,809 of 6,079 Legionnaire’s cases nationwide in 2015 alone. They found 553 cases in 21 different and targeted jurisdictions, including Virginia, definitely or possibly occurring in a nursing home or hospital. The infections caused 66 deaths.

Knee-300x166Hip and knee replacements, especially among seniors, have become so prevalent that almost 7 million Americans by 2010 had undergone the surgeries. With the cost to Medicare of knee replacements running between $16,500 and $33,000, and with roughly half of the procedures’ expense occurring post-operatively, there’s some good news for patients on saving money—and staying safer too.

Patients may want to get themselves out of the hospital and stay out of in-patient rehab centers in favor of well-planned, careful recuperation at home, studies show. The research focused on single adults living alone, and whether they fared better over the short- and long-term by rehabbing from total knee and hip replacements at skilled nursing facilities or at home, particularly if their home care was well considered and followed through.

They did at least as well and were happier recuperating at home, researchers found, adding that they also may have been safer: That’s because a third of patients in rehab facilities suffered adverse events in their care, a rate comparable to unacceptably high hospital harms and those in skilled nursing facilities.

ICUThe spots in hospitals where patients in the direst shape receive specialized treatment are themselves in need of urgent care, experts say, explaining that antiquated intensive care units (ICUs)

contribute to needless harm. But how exactly to yank them and the therapies they provide into the 21st century?

Usha Lee McFarling, a Pulitzer Prize winner, examines ICU reforms for the online health news site Stat, finding that these crucial and “heroic” hospital facilities fundamentally have changed little in a half century, although they now are jammed with new technology and devices. They serve almost 6 million Americans in grave condition, but in them, she says, “studies show serious and sometimes fatal medical errors are routine. And a recent review published in the journal Critical Care found no major advances in ICU care since the field’s inception in the 1960s.”

elderly-hospitalUncle Sam is stepping up to try to help ailing elderly patients who may get stuck with big hospital bills and gaps in their medical coverage due to a linguistic loophole. A Medicare law, newly in force, requires hospitals to tell Medicare patients that they are “under observation,” and not formally admitted. The difference to patients’ wallets can be huge.

Doctors and hospitals have jammed patients into this nightmare status to work around auditors for Medicare. Those fiscal overseers can accuse them of giving seniors inappropriate care, with the auditors then earning a share of financial penalties imposed against the hospitals and MDs; doctors called this approach bounty hunting by the private auditors hired by Medicare to ferret out waste. Advocates had hoped that stepped up scrutiny of admissions might get doctors and hospitals to treat more seniors in medical offices or with hospital outpatient services, instead of checking them into pricey hospital rooms.

But “observing” seniors, who actually could be receiving extensive care, ended up slapping them with big bills that Medicare might not cover; if they then needed to be transferred to nursing home care, Medicare also would not recognize their observation time and count it against its requirement that patients first have spent three days admitted to a hospital. Seniors and their families, then, could be liable for thousands of dollars for skilled nursing care.

The events of recent days ─in Texas, Louisiana, and Minnesota─ have been so tragic that it’s easy to despair. Here are four health-related people stories worth reading to remind us of humanity’s enduring better side:

  • In the horrors of Syrian combat, medical Samaritans strive to maintain some kind of care

syriaFirst, let’s stipulate that there’s almost as much barbarous conduct as can be imagined in this recent New Yorker report about the struggle to maintain medical care in combat-ravaged Syria. President Assad’s predation on his own people has become an international abomination, including his forces unleashing snipers to maim emergency medical personnel, and their dropping barrel bombs, laden with lacerating shrapnel, on hospitals or known care-giving sites (February, 2016, photo of a bombed hospital from Doctors Without Borders/Medicins san Frontieres).

Hypodermic-NeedleAs the epidemic of prescription drug abuse spreads nationwide, public health authorities are failing to protect patients from the criminal wrong-doing of opioid-addicted caregivers, the Denver Post has reported.

The paper launched an investigation because of several prominent cases in the region, including a Colorado surgical technologist who infected hospital patients with hepatitis in 2008 and 2009 by injecting herself with fentanyl, an opioid painkiller, and leaving behind dirty needles. Further, the uproar over criminal conduct by addicted caregivers spread over several states in the region when a surgical tech at a major medical center in suburban Denver recently was reported to have stolen syringes containing fentanyl, and replaced them. This led the hospital to offer free HIV and hepatitis blood tests to about 2,900 patients because the tech carries an unidentified blood-borne illness.

The Post says that Colorado public health officials have been too eager to hush up cases involving addicted caregivers. Even when hospitals report incidents, including required reports of missing or stolen drugs, the officials fail to bring in police and prosecutors. This contradicts federal regulations, which require hospitals and other facilities to report to the Drug Enforcement Administration when controlled substances go missing or are believed to have been stolen.

bwhospitalBecause money makes such a difference in health care in the United States, what happens when it’s no object? The results aren’t pretty, a prestigious Boston hospital has found. It rolled out the red carpet and penthouse suites for a Saudi prince who stayed for seven months of therapy for a drug-resistant infection.

His lavish ways, however, ended up tainting the institution’s best practices, resulting in internal and Massachusetts state investigations. The Boston Globe said the episode, in which the unidentified prince and his entourage made unusual care demands and lavished gifts on staff in violation of hospital policies, shows the risks of so-called VIP care.

The paper said the post-mortem of the royal treatment found that: medical staff failed to adhere to best practices in wearing protective gowns when treating the princely patient who found the attire “off-putting” and dirty; nurses and others were accused of mishandling narcotics, giving them to members of the royal entourage and not administering them to the patient himself.

CRE superbugExperts say antibiotic-resistant microbes may be spreading from hospitals to other health care facilities because of transferring patients’ dirty hands.

And new research in Southern California raises the concern that existing treatment municipal treatment plants may lack the sanitizing punch needed to kill superbugs (such as the CRE microbes shown) flushed from hospital and other health care facilities into sewer lines. The supposedly treated water, too frequently with flourishing super bug colonies, then gets dumped into oceans.

Patients’ infectious hands

Hypodermic-NeedleIt’s one thing when the makers of sodas or breakfast cereals tweak their packaging to maximize their profits. But Big Pharma deserves a slap for its practice, newly spotlighted by researchers, of putting out over-sized dosages of cancer fighting drugs. This ensures that $3 billion in already costly drugs get tossed out and wasted each year.

Nurses and physicians have no choice about using jumbo size packages of these injectable drugs. They typically give the shots in offices and clinics, and they toss out unused portions to avoid transmitting one patient’s germs to the next patient. Some of the one-size-fits-all vials, the New York Times said, contain a dose, based on patients’ weight and height, that’s suitable for an NFL linebacker or an NBA forward.

As the co-author of the study on this mendacious packaging said: “Drug companies are quietly making billions forcing little old ladies to buy enough medicine to treat football players, and regulators have completely missed it. If we’re ever going to start saving money in health care, this is an obvious place to cut.”

An elderly couple wait to cross the road
With the United States getting grayer by the day and a national crisis looming in dementia- and senior-care, new information from one of the larger, longer running, and more significant health studies has offered a glimmer of optimism. Experts say dementia risks are showing a  decline─by as much as 20 percent. They’re uncertain exactly why. But increased education and individuals’ improved overall health, especially their cardiovascular wellness, may be helping.

An elderly couple wait to cross the road (Photo by Garry Knight/ Creative Commons)

The surprising dementia trend emerges from the legendary Framingham Heart Study, which has monitored and detailed the health of thousands of Americans for decades. Framingham research led to greatly improved heart and lung care with information on such issues as high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity.

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