Announcement

President's Report
by: Rod Betit (August 18, 2006)

Summary: Mark McClellan does as promised and lets specialty hospital moratorium expire despite proof that there are serious problems that should be fixed.

Full Story: PRESIDENT'S REPORT August 18, 2006 On August 8th CMS released its final report to Congress on specialty hospitals. In addition to releasing the report, CMS allowed the moratorium that had been in place for more than three years to expire, opening the door for additional expansion of these types of facilities. Although disappointing, the CMS action was not unexpected, as CMS Administrator Mark McClellan had indicated on several occasions that the moratorium would not be continued by CMS. Here are two of the findings that CMS reported to Congress: That with respect to cardiac specialty hospitals, there did appear to be a correlation between the number of referrals (and corresponding revenue) and whether the physician had an investment stake in the hospital. (Didn’t Congress pass an anti-kickback law to prevent this kind of practice?). That specialty hospitals do not handle their fair share of charity and uninsured cases in a community. Why CMS would draw these conclusions and then not move to extend the moratorium or propose solutions to ‘level the playing field’ is another one of those mysteries about how this agency views its role in shaping health care policy. While some payment reforms are proposed in the report, they will have little beneficial impact when physicians can refer to facilities they have a financial stake in. If you want a copy of the full report let me know and I will email it to you. ________________________________________ The Alaska Nurses Association Board of Directors (AaNA) issued a position paper on the topic of nurses administering dietary supplements in nursing homes and assisted living facilities. The position paper concluded that ‘The current status and trend of practice in Alaska indicate that limited administration of dietary supplements (vitamins and minerals) by registered nurses is established, ongoing and should be recognized as properly performed by registered nurses…The Alaska Nurses Association supports administration of dietary supplements by the registered nurse with the following recommendations (available from ASHNHA upon request). Review of this practice question came as a result of heavy debate around House Bill 467 sponsored by Representative Mike Kelly (Fairbanks) during the 2006 Legislative Session. HB 467 would have given a nurse the discretion to administer these supplements, if prescribed by a physician, in these settings. The Alaska Board of Nursing had opposed this practice and implied nurses could be sanctioned who cooperated with physicians and families in administering these products. ASHNHA lobbied in support of Representative Kelly’s bill on the grounds that the present Board of Nursing policy was restrictive and outdated. Rod Betit testified that “If we generally believe that most people do not know if their supplements are harmful related to other medications they are taking or their present medical condition, how can we then advocate that the taking of these supplements should not be administered by caregivers as part of the patient treatment plan? Which approach presents the greater risk to the patient’s overall health?” As the bill gained momemtum during the session, Representative Kelly agreed to pull the legislation in return for a commitment from AaNA and the Board of Nursing to seriously review this practice question. This report is the first piece of that review process. We will keep you posted on further developments as this goes forward. If you want a full copy of the report, please email Rod at rbetit@ashnha.com . ________________________________________ The following is a reprint of excerpts from an article about Ketchikan’s 100,000 Lives Campaign Success! When asked about medication reconciliation, Dr. Ernie Meloche jumps in the air and claps his hands with joy. As an emergency room physician at Ketchikan General Hospital, he understands the value of this process to help him provide the best patient care. Dr. Meloche can depend on the list because every ER nurse participates in updating medications. “Everyone has to commit, so I can trust,” he says. The ER team at Ketchikan General Hospital (KGH) began updating patient allergies in LastWord about a year ago. They expanded that to full medication reconciliation early this year in response to JCAHO safety goals and the 100k Lives Campaign. According to RN Wanda Sonnenburg, computers at the bedside make the process easier and more complete because they can enter medications directly into LastWord rather than writing them on paper. Nurses Jessi Pilcher RN and Jason Harris RN agree. They used to handwrite only the medication name, but by using LastWord, nurses record all information including dose, route, and frequency. Dr. Meloche credits Bev Crum, the ER manager, with the success med reconciliation at KGH. “Bev is a leader in the true sense of the word,” he emphasizes. “When she says something, we know it will happen.” Crum credits Lisa Sheffler the hospital’s Quality Director for the inspiration and guidance. Together they found that other ERs across the country started the reconciliation process with admitted patients and transfers, which became the foundation for their process at KGH. The goal is 100% reconciliation for patients who are admitted through the emergency room. And a random check of the charts shows they are meeting this goal. The process is simple. When it is determined that a patient will be admitted, the attending nurse reviews and updates the patient’s medication list in LastWord. Of course this can be time consuming if patients have pages of medications, but after initial entry, the list needs only updating at future visits. Also, patients who use PeaceHealth physicians are likely to have a complete list that was updated in the clinic. The goal is 100% reconciliation for patients who are admitted through the emergency room. And a random check of the charts shows they are meeting this goal. The process is simple. When it is determined that a patient will be admitted, the attending nurse reviews and updates the patient’s medication list in LastWord. Of course this can be time consuming if patients have pages of medications, but after initial entry, the list needs only updating at future visits. Also, patients who use PeaceHealth physicians are likely to have a complete list that was updated in the clinic. Checking allergies is another part of the process. Nurses sometimes help the patients remember medication reactions that had been forgotten, which is critical information for their care. As final steps in the process, nurses print a list of medications for the admitting physician and a wallet size card for the patients. Both are popular. Physicians appreciate the complete and legible list that can be used as part of the admission orders. As new graduate Jennifer Taylor RN explains, “It speeds things up for them too.” And patients welcome the convenient card with all of their medications. Congratulations to Pat Branco and his entire team for this great program!! ________________________________________ We are interested in sharing the great patient care initiatives that our members are just now launching or have been in place for some time that are showing real results. Take a minute to write those up and submit them to Rod Betit at rbetit@ashnha.com . Thanks! ________________________________________ ________________________________________ The Alaska Federal Health Care Partnership is hosting a JCAHO training event, Environment of Care Update and Emergency Management. This all-day training will be Thursday, October 5th, in Anchorage, presented by Joint Commission Resources, an affiliate of JCAHO. Participants will be provided JCAHO survey process changes impacting environment of care (EC) issues, EC standard updates, EC risk assessment, plus specific focus on emergency planning and response. To obtain the offering brochure and learn more, please contact Linda Kingkade at 907-729-4483 or linda.kingkade@anthc.org. ________________________________________ Tova Cladouhos has been hired as the new Education Program Manager for ASHNHA. She will be working out of the Anchorage office as of September 5th, 2006 and will be at the annual meeting to meet everyone. Tova is an RN and has a master’s degree in teaching. She has worked in Kotzebue, Nome, Dillingham, Palmer and Juneau and so if well versed in the Alaskan culture and way of life. She has also implemented and managed regional educational grants. Her husband, Joe Cladouhos, works for the University of Alaska Anchorage on healthcare workforce development. Tova, welcome to ASHNHA and we all look forward to working with you!! ________________________________________ Upcoming ASHNHA Meetings: • ASHNHA 2006 Annual Meeting – to be held in conjunction with education sessions August 28 through August 31, 2006 in Sitka. The ASHNHA meeting will take place on August 30 & 31. The Shee Atika Totem Square Inn has no hotel rooms left in ASHNHA’s hotel block. ASHNHA has reserved several backup rooms at another hotel so call ASHNHA in Juneau at 586-1790 and we will help connect you with housing in Sitka. ALL THE MEETINGS WILL BE HELD AT THE HARRIGAN CENTENNIAL HALL. If there are other meetings you would like posted please let Rod know at rbetit@ashnha.com

Downloads
August 18 2006 (2).pdf