The bad news: The Centers for Medicare and Medicaid Services (CMS) deny Medicare reimbursement for eleven hospital-acquired conditions and ban hospitals from charging patients directly for these ‘never events’- or incidents that should never happen. This affects reimbursement for hundreds of thousands of hospital stays, putting revenues at risk.
The good news: The CMS reimbursement policy offers nurses an opportunity to take a leadership role in preventing these avoidable incidents.
The ability of highly skilled nurses to reduce medical errors is being recognized, as more than half of all never events are nursing-sensitive, particularly pressure ulcers and patient falls. As nursing’s effect on patient outcomes becomes increasingly accepted, the CMS policy has established an indelible link between Medicare reimbursement and quality nursing care.
Now, nurses are likely to be viewed as an investment instead of a cost. The reason: When nursing staff increases, the quality of patient care improves and preventable incidents decrease.
Clearly, engaging nurses’ capability to prevent never events is the smartest approach for nursing administrators who must also build a case for additional financial investment in nursing. Nurse leaders need to take a strategic approach to prevention in order to achieve a more effective and efficient outcome. By applying lessons learned in one care area to all nursing-sensitive conditions (rather than simply targeting specific strategies for each condition), nurse leaders are more likely to accomplish the desired result.
Prevention StrategiesTo prevent pressure ulcers and falls, try these selected strategies in four key areas.
1. Optimal assessment
- Use standardized present-on-admission risk assessments.
- Use evidence-based tools for risk and physical assessments.
- Visually identify at-risk patients, such as with a SAFE (Stay Alert for Fall Event) sticker.
- Ensure accurate staging of pressure ulcers, for example, through staff education and photographic documentation of wounds.
- Promote critical thinking, such as by using assessment-driven prompts for appropriate nursing actions.
2. Targeted care mandates
- Simplify protocols to foster compliance.
- Prioritize urgent nursing interventions.
- Intervene early, such as by using air mattress overlays for patients immediately after surgery.
- Bolster toileting protocols to prevent falls. For instance, develop a safe toileting schedule and make assisted toileting mandatory.
3. 360-degree support
- Provide point-of-care staff support.
- Use effective reminders for repositioning, such as musical cues.
- Institute wound care grand rounds once a week.
- Develop a bedside report that allows collaborative assessment and documentation.
- Allow patient care assistants to share tasks.
- Empower patients and families, for example, by using family teaching tools, return demonstrations, and patient-centered technologies.
4. Innovations for complex patients
- Consider cutting-edge technology, such as Fluid Immersion Simulation* to prevent pressure ulcers.
- Use cost-effective alternatives for observation, such as multiple-room monitors or video surveillance for patients at high risk of falls.
Mosby’s wants to help you prevent these ‘never events’ from occurring in your facility. For more prevention strategies, check out Mosby’s online course, Healthcare-Associated Conditions and Medication Safety, and the CMS Never Events Tool from Mosby’s Nursing Consult.
*Fluid Immersion Simulation is a registered trademark of Biologics Inc.