Articles Posted in Nursing Care

LV100117-300x215Caregivers and the community in Las Vegas, Nev., deserve a salute for their response to the gun violence last week, which could have overwhelmed a less-prepared community’s medical system.

Las Vegas  isn’t a giant metropolis (pop. 2 million in its metro area), and, due to the high costs to operate such a facility, it has just one Level 1 trauma center. That’s a facility staffed and equipped to provide a “gold standard” of emergency care. In the state of Nevada, the only such center is at the 541-bed University Medical Center of Southern Nevada.

It was slammed with more than 100 critical patients, many with life-threatening or fatal gunshot wounds.  A torrent of patients also was routed to the hospital, some for treatment of injuries they suffered while fleeing Stephen Paddock’s rampage. First-responders soon were flooding another facility, Sunrise Hospital and Medical Center in Las Vegas—a Level II trauma facility—with hundreds more.

Donald_Trump-1-225x300Even as President Trump belittles Puerto Rican political leaders, the Americans on the island have been swamped by a hurricane-caused health care crisis, according to doctors, hospitals, and nursing homes there.

The disturbing news reports show that sick and injured patients, with gas supplies limited, are struggling to navigate tree-blocked roads to get to hospitals that often lack power for cooling and to provide medical services. Doctors are reporting shortages of drugs and medical supplies.

Public health experts increasingly fear that health conditions will worsen, even as more rescue and recovery aid slowly trickles to a spot that long has wrestled with poverty and the isolation of many of its rural communities.

flanursinghome-300x190Although Hurricanes Harvey and Irma have stormed off into the record books, their harms, particularly to health, persist for Texans, Floridians, and residents of the Caribbean. Recovery and return to normalcy will take the ravaged areas longer than many Americans realize, experts say. And they already are uncovering systemic woes, some fatal, with which planners and lawmakers will need to reckon with to better prepare for the next storm.

In Florida, for example, while hospitals, generally speaking, had adapted and rode out Irma maybe better than might be expected, nursing homes did not. They’re under new scrutiny, notably after eight residents died in an already troubled and roasting Hollywood, Fla., nursing home.

That incident refocused official attention on a sizable and particularly storm-afflicted population in the Sunshine State: its senior citizens. Whether in others’ care or ostensibly on their own, millions of older Floridians were left even more vulnerable after Irma, which cut off critical life services, including power, cooling, transportation, and access to medical services and food and other supplies.

Medicine and law enforcement can be a combustible combination, as a widely publicized incident in a Utah emergency room has reminded. The ugly incident has underscored the importance of hospitals keeping big, upset guys with guns cordoned off from caregivers, as well as the importance of front-line medical personnel knowing, respecting, and protecting patients’ privacy rights about their medical treatment.

Nurse Alex Wubbels became a heroine for firmly and politely telling Salt Lake detectives that the law forbade them from ordering blood extraction and testing on patient William Gray. The unconscious truck driver turned out to be a reserve cop in a nearby small town, and he had been involved in a crash connected to a high-speed chase by Salt Lake officers.

umcDoctors and hospitals across the country push the frontiers of medical science every day, finding new ways to improve health care and to change and save lives. But at the same time, some of medicine’s basics—like delivering babies safely and protecting mothers’ well being—also keep getting botched, especially for poor and black women. It’s a national disgrace, and it’s on sad, terrible display in the growing scandal in Southeast Washington’s only full-service hospital, which recently was ordered to stop delivering babies.

Why? The Washington Post, which has done some good digging and needs to do more, says that health regulators for the District of Columbia have provided sketchy details to officials of United Medical Center, which serves the poor and predominantly African American residents of the neighborhoods east of the Anacostia River, as to why the public hospital’s obstetrics unit was shut down for 90 days.

The paper says United’s staff failed to properly care for a newborn to ensure the infant didn’t acquire HIV from the baby’s mother, who was infected and had a high viral load. The hospital didn’t test the baby properly for HIV, failed to deliver the child via cesarean to reduce the chances of HIV infection, and didn’t administer a recommended antiretroviral drug as a postpartum precaution.

caregiver-300x200Pick up that phone. Dash off a text or an email. Issue a dinner invitation or make a date for a casual lunch. Or just drop by to see that friend or loved one who struggles with the burdens of caring for someone in poor physical or mental health.

Why now? Why not? Paula Spann deserves credit for her latest New York Times column highlighting the “unbearable” loneliness and isolation that caregivers confront as, other experts estimate,  43.5 million Americans provide $470 billion in tough, unstinting, and unpaid work for loved ones.

Even as they do so, however, they often must abandon their own careers and chunks of their own lives, watching with sadness as their social contacts and intellectual interests narrow, especially as their worlds become consumed with washing, feeding, entertaining, and keeping safe a spouse, grandparent, uncle, aunt, or other loved one. Their woes can be especially great if they’re caring for loved ones with the increasingly common and hugely demanding conditions of dementia and Alzheimer’s.

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.

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