Don’t stick with this No. 1 bad habit known to cause injuries.

Prevention is the best remedy for needlestick and other Read More...]]> Don’t stick with this No. 1 bad habit known to cause injuries.

Prevention is the best remedy for needlestick and other sharps injuries, which can be largely avoided if you follow these key strategies.

1. Know the ropes for safely disposing of sharps. The Occupational Safety and Health Administration “requires you to put the needle and syringe together in the” sharps container, says Terry Jo Gile, a safety expert in Ft. Myers, Fla. She also notes that OSHA requires you to close and dispose of sharps containers when they are three-fourths full.

Most containers have a line on the label indicating the point beyond which they should not be filled, adds Dennis Ernst, director of the Center for Phlebotomy Education in Corydon, Ind.

An accident waiting to happen: “Nurses should not allow sharps containers to overfill,” stresses Ernst. He recounts, in fact, that he got stuck by a contaminated needle that poked through the bottom of an overflowing sharps container as he tried to force the container into a lock position. “The containers are puncture-resistant — not puncture-proof,” Ernst warns.

2. Always use the needle product’s safety features. “OSHA mandated use of safety needles in 2001, but that solved only half of the exposure risk dynamic,” says Ernst. “People have to activate the safety features and make sure they are not recapping needles, which historically has been the single most notorious behavior leading to accidental needlesticks.”

3. Have a plan for managing unpredictable patient behaviors. Some impaired patients can be unpredictable in how they react to having a needle come near them or pierce their skin.

“Nurses should stabilize the arm being punctured and make sure the person can’t swing the other arm at you. Healthcare providers should seek assistance from another caregiver when that possibility even exists,” Ernst says.

4. Don’t use the old-fashioned lancets for finger-sticks. “Lancets by law must be retractable and single use,” says Ernst. But some providers have “squirreled away” some of the old-fashioned lancets that don’t automatically retract after using them. Use of such devices is an OSHA violation, he warns. “They pose a risk to anyone doing finger-sticks.”

5. Use safe phlebotomy procedures. If you draw patients’ blood for stat labs, as an example, pay close attention to your venipuncture technique. For one, never put your index finger above the puncture site while you’re inserting the needle, Ernst cautions.

Also use a safety transfer device when evacuating blood from a syringe to a blood collection tube. When drawing blood with a syringe, “OSHA wants us to activate the safety features on the needle, remove it, discard it, and attach a safety transfer device” to fill the blood collection tubes, says Ernst. Too often, however, “the individual pulls the needle out of the patient’s vein and punctures the stopper of the blood collection tube with the same needle.” And that practice has caused many nurses to sustain a needlestick injury — for example, you can impale a finger on the hand holding the tube, he cautions.

© Home Care Week

The needs of patients who choose to die at home often ignored.

There is not enough quality palliative care available for Read More...]]> The needs of patients who choose to die at home often ignored.

There is not enough quality palliative care available for dying cancer patients in Canada, according to a special report by the Canadian Cancer Society (CCS) on end-of-life care. This, despite cancer being the leading cause of death in the country (29 percent).

“Uniform, high-quality support for any person dying of cancer should be available no matter where they live,” says Heather Chappell, Director, Cancer Control Policy, CCS. Depending on where the person lives in Canada, the type and quality of care to ensure that patients die with dignity in the setting of their choice is inadequate, if not absent at all. Chappell claims that “some cancer patients and their families are not getting the support they need during a very difficult time.”

The CCS special report covered data from three Canadian provinces: British Columbia, Ontario and Nova Scotia. One notable finding of the survey shows that while most dying patients chose to die at home, about 55 percent of deaths occur in hospitals. “One reason for this is because community-based services are not available for dying people in some jurisdictions,” reports CCS in a news release. Other important findings include:

• Palliative care services exist, but they are often not used.
• Patients and their families sometimes are not aware of available services.
• Health care providers enroll patients to palliative care in late stages, resulting on missed benefits.
• Families caring for dying people experience significant psychological and financial burdens.
• The family of a person with cancer assumes most of the costs and other burdens of home care.

CCS recognizes that every person dying of cancer deserves the best of care no matter where they live, says Paul Lapierre, Vice President, Public Affairs and Cancer Control. The report brings forward some recommendations to make sure high quality support is available including:

• surveillance about end-of-life care be improved to help define the needs of people dying from cancer and to allow better planning;
• definitions and methods of reporting end-of-life care be standardized so that surveillance data are more comparable across jurisdictions — this would allow researchers, policy makers and health care planners to more easily identify gaps in care.

A Miami study says HIV-positive heavy drinkers are nearly three times at risk.

Moderate and heavy drinking might accelerate HIV disease Read More...]]> A Miami study says HIV-positive heavy drinkers are nearly three times at risk.

Moderate and heavy drinking might accelerate HIV disease development on patients who consume two or more alcoholic drinks every day, says a study in Miami.

The research — published online in the journal AIDS Research and Human Retroviruses — found that of the 231 HIV-positive individuals who were monitored during a 30-month period, 54 percent consumed alcohol. Among this group, 23 percent had two or more drinks per day. About 67 percent of the participants were taking antiretroviral (ARV) medicines at the time of the study.

Marianna Baum, PhD, RD, Florida International University in Miami, and her colleagues concluded that those who drank moderately — two or more drinks per day — were more likely to lose CD4 cells over time. People who consumed four or more drinks were considered heavy drinkers and were 2.91 times more likely to have their CD4 counts drop below 200. The results remained the same even when the researchers factored in adherence, ARV use, viral load and crack-cocaine use.

“Our findings support the hypothesis that frequent alcohol intake, as well as the combination of frequent alcohol and crack-cocaine, accelerates HIV disease progression,” reports research head Baum and her colleagues.

“The effect of alcohol on CD4 cell decline appears to be independent of ARV therapy, through a direct action on CD4 cells, although alcohol and substance abuse may lead to unmeasured behaviors that promote HIV disease progression. The effect of alcohol abuse on viral load, however, appears to be through reduced adherence to ARV therapy,” the researchers add.

Participants of the study had an average monthly income was less than $350, with nearly half homeless.

Scientists first found that alcohol has significant effect on HIV disease progression through animal and in vitro studies. In 2007, a similar study by Boston University School of Medicine linked HIV disease progression in infected patients and alcohol consumption. Nevertheless, Baum’s team claims that their study contributes some of the strongest evidence available that alcohol might have something to do with the disease’s progression.

Hint: Modified clothing choices could level the playing field.

After struggling for months to dress herself, your patient decides to modify Read More...]]> Hint: Modified clothing choices could level the playing field.

After struggling for months to dress herself, your patient decides to modify her clothing choices so that she is no longer dependent on an aide for help.

Do you know how her choice will affect your OASIS C selections? Follow this guidance to ensure you make the correct assessment:

Amount of Assistance is Key

Your responses to items 1810 (Current ability to dress upper body safely…) and 1820 (…lower body…) hinge on two details: what’s happening right now (including the previous 24 hours) and how much help your patient needs, explains Jane Gorwin, a post-acute care consultant in Oakland, Calif.

This means you shouldn’t pay attention to what your patient did last week or what they plan to do next week, but instead must home in on the day of the assessment for deciding whether your patient is able to dress herself. You’ll assess your patient for items 1810/1820 at the start of care, resumption of care, follow up, and discharge — so you’ll have plenty of opportunities to show your patient’s progress in dressing herself, notes Fazzi Associates in Northampton, Mass.

Crucial: You must take into account any “human intervention” your patient requires when dressing in her permanent style of clothing, Fazzi points out. Human intervention includes having to talk her through the process, laying out or handing her any item considered clothing, or just being on stand by in case she needs help. For a patient needing this type of light assistance, you’d choose “1.”

Example: You are providing care for a patient who has a wound on her left shoulder. She has difficulty reaching up for her shirt, so you hand it to her. She is then able to dress her upper body. She puts on a pair of pants, but is unable to zip them on her own.

For this patient, you’d choose “1” for both 1810 and 1820 because she required at least some assistance from you in dressing both her upper and lower body.

However, a patient who relies on non-human intervention for dressing, such as a “grabber,” is considered completely able to dress herself, Gorwin says. For a patient who requires zero human intervention but relies on a non-human device, you’d select “0” for both items.

Modifications Trump All Else

Part of your education and care plan should be to evaluate whether a patient can realistically expect to return to her previous level of ability. If the likelihood is slim that she’ll ever be completely able to dress in the clothing style that she’s used to wearing, you can help her modify her clothing style so that she gains back her independence, Fazzi says.

Important: Once your patient modifies her clothing style — say, choosing items without buttons or zippers, using a grabber, or finding new places to store clothing — you can evaluate her based on those changes. The key here is the changes are permanent and will be routine for the patient, the Centers for Medicare & Medicaid Services clarifies on the OASIS Certificate and Competency Board website.

CMS doesn’t set up a timeframe for deciding when a change is permanent. To determine whether a clothing style is temporary or permanent, inquire into your patient’s intentions, suggests Gorwin.

© OASIS Alert

Plus: You’ll soon be able to review the most common errors that the RACs find.

The feds are attempting to limit Read More...]]> Plus: You’ll soon be able to review the most common errors that the RACs find.

The feds are attempting to limit the amount of bounty that the so-called RAC “bounty hunters” are able to collect, to the delight of many providers.

Then: During the Recovery Audit Contractors’ original demonstration period, if the RAC lost an appeal at the initial level, it had to return its contingency fee. But if the RAC lost at a later level, it got to keep the fee.

Now: “If the RAC loses at any level of appeal, the RAC must return the contingency fee,” said the Centers for Medicare & Medicaid Services’ Amy Reese, project officer for Region C RAC (Connolly Healthcare), during a May 12 RAC Open Door Forum. “We feel that this is a much better way to incentivize the RACs to stick to clear-cut, black and white issues that are able to hold up over the appeal process.”

RACs also must use certified coders for all coding determinations, and are required to use registered nurses or therapists “for other types of reviews,” Reese indicated. “And they’re also required to have a physician medical director on staff to oversee the review process,” she added.

Reminder: The four national RACs currently have dozens of durable medical equipment topics approved by CMS, including some that relate to hospice and home health agency items. Home care, particularly hospice, may be next on RACs’ direct hit list.

Reviews for the Reviewers

RACs also must hire RAC Validation Contractors to perform accuracy reviews. “What they’re doing is taking a sample of each RAC’s claims and making a decision as to whether they agree with the RAC’s improper payment determination on the claim,” Reese said on the call. “From there they’ll determine an accuracy score, and those scores will actually be compiled annually to be released to the public on our yearly report.”

In the future, the RACs will post their major findings to the Web for everyone to review. “We don’t have any yet, because the RACs have only been reviewing for a short amount of time,” Reese said. “But after there’s a little bit more data for us to analyze, we’re going to check and see what codes and what services seem to have resulted in the greatest amount of improper payments and have shown themselves to be vulnerabilities to the Medicare Trust Fund,” she added.

Currently, you can check areas where previous improper payments were found during the RAC’s initial demo periods at www.cms.gov/rac.

© Home Care Week

Do you know what important role caregivers play on rating quality of life?

Compared to other types of cancer, malignant gliomas Read More...]]> Do you know what important role caregivers play on rating quality of life?

Compared to other types of cancer, malignant gliomas or primary brain tumor has huge effects on a patient’s personality, language function, and overall functionality. Yet people afflicted with brain cancer assess their well-being more optimistically than their caregivers do, a recent study by the Northwestern University Feinberg School of Medicine has found.

One reason may be because a caregiver knows more about the patient’s clinical state than the patient himself. Another is because a patient tends to “rise to the occasion” — minimizing his symptoms when seeing his doctor. “You may ask a patient if he is tired and he says, ‘No,’” says Jeffrey Raizer, M.D., senior author of the paper in a press release. “Then the caregiver will say, ‘But you are sleeping 20 hours a day.’ So, there is a disconnect. The patient tells you one thing and the caregiver says another.”

The disconnect could be a critical information for brain cancer patients, caregivers, doctors, and scientists because “brain tumors change people in many ways,” Raizer adds.

For the study, the researchers asked 19 patients recently diagnosed or re-diagnosed with grade 3 or 4 malignant gliomas to fill out a questionnaire about their quality of life, rating physical, emotional, functional and social well-being. The same questionnaire was filled out by caregivers (i.e., family members, spouses, and close friends).

The study’s results suggest the importance of understanding the psychosocial aspects patients are dealing with – especially from the patients and caregivers themselves. Doing so allows for positive interventions to occur.

Sponsor of the study, American Brain Tumor Association, has awarded more than $12 million toward brain tumor research over the past 10 years. Last year, an estimated 12,920 people died from brain and other nervous system cancers in the US, according to National Cancer Institute.

A clinical trial suggests antiretroviral drugs can cause serious side effects.

The longer an AIDS patient survives his condition, the Read More...]]> A clinical trial suggests antiretroviral drugs can cause serious side effects.

The longer an AIDS patient survives his condition, the more they are likely to develop cancers. New research has found high rates of cancers not previously associated with AIDS in the subjects studied.

“Marked increases in risk are seen in certain cancers, including lung, liver, head and neck, anogenital, and Hodgkin’s lymphoma,” John F. Deeken, director of head and neck oncology at Georgetown University Medical Center, and author of the clinical trial, writes in an abstract published at the American Society of Clinical Oncology’s website.

The trial’s objective is to determine the safety, and evaluate the effects of an antiretroviral drug to treat non-AIDS-related cancers in HIV-positive individuals. Deeken underscores the importance of addressing the growing cancer threat. The threat has shown up in different research around the globe in recent years, but has remained unpublicized.

“Even when we control for smoking, we see a higher rate than the general population,” Deeken says in a Washington Post report. He can’t say the reason for the growing trend, but insists that experts and authorities should figure it out.

The international AIDS charity group AVERT defines the HIV antiretroviral drug treatment as “the main type of treatment for HIV/AIDS,” which keeps the amount of the virus in the body at a low level. “It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of a person’s life,” it adds.

Recent advances in drug therapy have saved thousands of AIDS patients from dying, but a lifetime intake of pills has its side effects, such as premature aging, heart attacks, and now cancers. AIDS victims, as well as their doctors, should be wary of the side effects.

According to the United Nations Joint Programme on HIV/AIDS (UNAIDS), 33.4 million people globally are living with HIV/AIDS in 2008. About 1.4 million of these come from North America.

Eastern European countries have the most limitations, impeding proper patient care.

A study in Europe cries foul over government regulations Read More...]]> Eastern European countries have the most limitations, impeding proper patient care.

A study in Europe cries foul over government regulations restricting access to opioid-based drugs such as morphine. Curbing the availability and access of the painkillers violates a patient’s human rights, reported the authors of the study.

The European Society for Medical Oncology and the European Association for Palliative Care conducted the study in February by gathering data from 21 Eastern European countries and 20 Western European countries.

In the study, the researchers looked at three major components, including the various types of opioid analgesics for each country, the cost of opioid drugs to patients, and the regulatory limitations that create problems for doctors and patients to get their opioid supply.

The results showed that Western European countries had no difficulty gaining access to the drugs, while Eastern European countries experienced the opposite. In countries such as Lithuania, Tajikistan, Belarus, Albania, Georgia and Ukraine, the supply of some essential opioid drugs was zero.

The authors attributed the low or zero supply to the countries’ drive against substance abuse, which governments usually prioritize. “Preventing drug abuse is important, but it should not hinder patients’ ability to receive the care they need and deserve. This is the approach of the WHO [World Health Organization] and the INCB [International Narcotics Control Board] . . . Both recommend that opioids should be available for cancer patients at hospital and community levels and that physicians should be able to prescribe opioids according to the individual needs of each patient,” they said in the report.

They added that in most countries “regulations to reduce substance abuse and to restrict the diversion of medicinal opioids into illicit markets unduly interfere with medical availability for the relief of pain.”

According to an article in Science Daily, the restrictions that came up in the study included:

• requiring special patient permits;
• limiting the authority of physicians to prescribe opioids even for cancer patients with strong pain;
• imposing arbitrary dose limits that limit the ability to adjust the dose to individual patient needs;
• imposing severe limits on the duration of the prescription;
• restricting opioid dispensing so that it’s harder for patients to access the medication;
• increasing bureaucratic burdens through the use of complex or poorly accessible prescription forms or complex reporting requirements; and
• intimidating health care providers and pharmacists with legal sanctions.

“This is an issue of cancer patients’ human rights, and it’s not only a legal imperative, but a moral imperative for the WHO and individual European countries to address the findings of our report. At present, cancer patients in a number of countries are suffering unnecessarily as a result of the under-treatment of their pain,” noted author Dr. Nathan Cherny, of the Cancer Pain and Palliative Medicine Service at the Shaare Zedek Medical Center, Jerusalem, Israel.

The authors emphasized the need for governments to address the barriers in order to improve the opioid’s supply chain. They recommended:

• sticking to the WHO essential medicines list should be the minimum standard for lists of allowed opioid drugs;
• ensuring access to immediate-release morphine as soon as possible;
• reviewing and repealing (if necessary) over-vigilant restrictions that impede good clinical care of cancer pain;
• allowing for emergency prescribing and technical error corrections.

As a conclusion, they stressed that “there is an ethical and public health imperative to address these issues vigorously and urgently.”

Study suggests new infection patterns may have been unmasked.

More whites ages 25 to 39 develop cancer of the lower Read More...]]> Study suggests new infection patterns may have been unmasked.

More whites ages 25 to 39 develop cancer of the lower stomach, said researchers from the National Cancer Institute (NCI) of the National Institutes of Health. They noted, however, that cases have lowered overall in American adults.

Stomach cancer incidence is usually common in older age groups. “But incidence rates that are specific to particular age groups can provide important clues about future cancer trends that may vary from group to group,” noted William F. Anderson, M.D., Division of Cancer Epidemiology and Genetics, NCI.

From the Surveillance, Epidemiology and End Results (SEER) program of the NCI, the researchers identified 39,003 cases of noncardia gastric cancer diagnosed from 1977 through 2006. They then compared changes in incidence rates during the 30-year period by age, race, and other factor classifications.

The SEER program collects cancer incidence and survival data from population-based registries that cover 26 percent of the US population.

The study showed that incidence rates of noncardia gastric cancers declined from 5.9 to 4.0 among whites, from 13.7 to 9.5 among blacks, and from 17.8 to 11.7 among other racial groups. Among whites, incidence rates decreased from 20 to 13 in people ages 60 to 84, and from 3 to 2 in the 40 to 59 age group. There was a decline of incidence for almost all age groups in blacks and people of other races.

Of particular concern was the increase in incidence rates among those ages 25-39 (0.27 to 0.45).

Researchers point to changes in infection patterns during the last 50 years as the reason behind the new incidence trends showing in younger white individuals. The bacterium H. pylori infects the stomach lining, thus becoming the primary cause of noncardia gastric cancer. “The declines in noncardia gastric cancer seen in the older cohorts are consistent with observed declines in H. pylori infection, reflecting improved hygiene and less crowding during childhood, when the infections are typically acquired. The increase in younger cohorts may indicate a change in the age at infection or even a reversal of the long-term decline in the prevalence of the infection,” the NCI explained in a press release.

It is also possible that a new carcinogenic process is developing, following the eradication of H. pylori, the authors added. They recommend that further studies be conducted to confirm the trends.

“Fortunately, the overall burden of stomach cancer has been declining among all racial groups in the United States. However, increasing rates in 25-to-39 year old whites could mean there is an important new risk factor to be identified,” said Charles S. Rabkin, M.D., senior author of the NCI study.

Late effect of CVA turns guidelines upside

When coding for late effects, sequencing is everything. Keep one rule of thumb Read More...]]> Late effect of CVA turns guidelines upside down.

When coding for late effects, sequencing is everything. Keep one rule of thumb and two exceptions in mind and you’ll be accurate every time.

Here’s When to Report Late Effects

A late effect is the condition produced after the acute phase of an illness or injury has run its course, according to the ICD-9-CM Official Guidelines for Coding and Reporting.

There is no time limit on when you can report a late effect, according to the guidelines. The residual effect of your patient’s illness or injury may be apparent early, such as when he’s had a cerebrovascular accident (CVA). Or a residual may occur months or years later, such as when your patient has had a previous injury.

Dig deeper: Frequently the original illness or injury is forgotten, says Jan McLain, RN, BS, LNC, COS-C, HCS-D, with Adventist Health System Home Care in Port Charlotte, Fla. Identifying a true late effect can require investigation of the past medical history and targeted questioning to determine the relationship between the event from years before to the symptoms that are presenting today.

Narrow your search: Many coders aren’t sure how to find the code they need to indicate the residual effect of a disease or injury. “They’ll look under ‘syndrome’ or ‘complication’ in the alphabetic index of the coding manual,” says Trish Twombly, RN, BSN, HCS-D, CHCE, director of coding with Foundation Management Services in Denton, Texas. And there’s no section in the tabular list of your coding manual that includes all the late effects codes, Twombly notes.

To find the right late effect code, look in the alphabetic index under “late effects.” Then look through the sub-terms to find the diagnosis that fits your patient.

For example: Your patient has myelitis as a late effect of polio. When you get to the sub-term “Polio” in the alphabetic index, it says “(Conditions classifiable to 045) 138.” You would use 045.xx (Acute poliomyelitis) for your patient if he had polio today, says Twombly. Check the code series the late effect code references to make sure you have found the right code for your patient.

Tip: Never use the code for the acute phase of an illness or injury that led to the late effect in conjunction with a code for the late effect.

Know the Late Effects Rule of Thumb

You’ll generally need to list two codes for a late effect — let this guide your late effects coding. Sequence the condition or nature of the late effect first, followed by the late effect code.

For example: Your patient had polio as a child. Now you are providing care for the late effect of paraplegia. To code for this patient, Twombly says you would list the following:

• 344.1 — Paraplegia

• 138 — Late effects of acute poliomyelitis.

Case mix: Paraplegia is a Neuro 1 case mix code and polio is one of the few late effect etiologies that can earn case mix points.

Use One Code for CVA Late Effects

CVAs are the first exception to late effects coding guidelines. When coding for the late effects of a CVA, you’ll often need only one code. Most late effects of stroke codes are combination codes, Twombly says.

For example: Two new late effects of stroke codes became available Oct. 1, 2009:

• 438.13 — Late effects of cerebrovascular disease; dysarthria and

• 438.14 — Late effects of cerebrovascular disease; fluency disorder.

There are some combination codes, however, that still require additional information according to the coding guidelines. So, if you’re coding for the residual of a stroke and there is no ICD-9 combination code for it you would list 438.89 (Other late effects of cerebrovascular disease), Twombly says. Follow this with a second code to identify the specific late effect.

Pick Manifestation Sequencing Over Late Effects

Manifestations are the second exception in late effect coding. When the condition produced from the late effect you’re coding for is designated as a manifestation code, you’ll need to follow manifestation coding guidelines.

For example: Your patient has curvature of the spine as a late effect of polio. For this patient, Twombly suggests coding 138 for a late effect of polio first, followed by 737.40 (Curvature of spine, associated with other conditions; unspecified).

© Home Health ICD-9 Alert