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jm_emt

jm_emt

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  1. Thanks to all who responded. First to answer sockov's question, the chair has not had a clinical trial or pilot test yet. But we are looking to do one (an expensive proposition). I especially want to thank Thanksforthedonuts for the thoughful reply. This is excellent feedback. My LTC consultant nurses told me patients should be changed every 2 hours but perhaps every 3 hours might be more accurate. This is an excellent point and the video should be updated to reflect this. However this is still a hugely labor-intensive activity for LTC nurses - even at 3-4 hour intervals. For statement (1), I do not understand. Hoyer lifts are very slow and the by-directional transfer is going to take a minimum of 8 minutes. To build and unbuild the stretcher takes about one minute, and there is little danger of a patient fall, a nursing back injury, and little patient pain involved. For (2), I completely agree that a $2,000 to 3,000 chair is expensive and money is tight. It is hard to compete with a $150 WC and a $1,000 patient lift that can transfer multiple patients per hour. That is why the chair needs to do a lots of things very safely and efficiently (bed transfer in 2-3 minutes, shower transfer in 30 seconds, commode transfer in 30 - 90 seconds) in order to justify that expense. There is an HCPCS Medicare code for insurance reimbursement for the chair and patients at home could apply for a chair and bring it into LTC in some cases when they can no longer live at home. For (3), the chair can be used with a high quality foam seat cushion which will limit pressure sores. Most LTC patients I have seen sit on vinyl seats in cheap WCs without cushions - not very comfortable. For (4), the chair has about the same footprint (viewed from above) as a 18" seat WC but is certainly heavier (50 - 60 lbs.). This is MUCH smaller than a lift combined with a standard WC as far as space required for use. The chair/gurney surface is 24 inches wide and obviously would not work well for patients over 250 lbs. but a 200 lb. patient should be able to be changed easily enough. Thanks again for taking your valuable time to reply!
  2. Thanks for responding. The wheelchair converts to the gurney (by reclining the backrest, and adding footrest support). They are the same device. So no transfer to the bed is necessary for changing briefs. It takes about 30 seconds to convert the WC to the gurney compared to 10-12 minutes to transfer them to/from the bed.
  3. I spoke to a director of a skilled home heathcare agency who said it can take months to get Medicare to pay for needed DME (homecare beds, commodes) for her patients. She said there are at least two problems with the new Medicare rules. First, the new Medicare rules require home care patients (who are often home-bound) to visit with a physician who must document their needs for DME, and write a Certificate of Medical Necessity. The agency must then go through the application process to obtain the equipment using the certificate. Clearly the difficulty of getting the patient to the doctor's office in the first place, and then getting the certificate and submitting the paperwork creates a roadblock. On the supplier side, she said the new Medicare bidding requirements for who is allowed to supply the DME have resulted in large nationwide companies putting in low bids which crowd out local DME suppliers. These bids are so low that the supplier companies cannot make money on a variety of DME items and therefore try to avoid actually renting some types of equipment to patients. They drag their feet and slow or halt the process, and the patient has to wait and in some cases is denied the equipment for a variety of reasons. Are these problems being experienced by other caregivers in homecare agencies?
  4. Libby1987 - I have never heard of reimbursement for Hoyer lift training in the home for primary caregivers. I thought the DME delivery company that rented/sold the lift did what little training there was. If reimbursement were available, ideally a PT would do the training however I assume home health care nurses (LPN, CNAs) could also do it. In either case, I think the hospital release coordinator (or the case manager at the home health care agency) would be responsible for requiring that two trained caregivers (2 family members, or a nurse and a family member) were present when using any lift that they authorized for home care. If a patient got hurt without the two trained caregivers present, the hospital or agency could be held liable. I personally have had dealings with one of the larger internet sellers of lifts who supposedly have salespersons with an average of 10 years experience. The salesperson I talked with had no idea how many people were required to use the lift even though the literature at the site strongly recommended that two caregivers be present. It seems that people who buy lifts on the net will not get much information or support about how to use them. They will need to depend on medical professionals for that.
  5. Many nurses in facilities complain of the lack of needed SPH equipment to reduce back injuries and safely move patients. However, the methods used to get management to buy this equipment seem haphazard, and often do not meet with success. I am interested in successful approaches and methods that nurses have used to overcome management resistance and obtain the needed safe patient handling equipment.
  6. It seems that unless there is lots of family caregiver support, many patients would be forced into LTC.
  7. Thanks to all for their comments. It seems like there is no standard for training in the use of lifts. However when it is done, PTs are the best sources of training. But not all people that leave a hospital or an in-patient rehab facility are assigned a home-based PT. It would be interesting to know if PTs and nurses routinely request Hoyer lift rental in the home if the patient cannot bear weight or cannot provide the caregiver much assistance in moving from the bed. But then they would also be responsible for doing the training themselves.
  8. Thanks for your comment CoffeeRTC. What concerns me is the negative psychological effect on these patients who are treated like infants (whose dirty briefs must be changed) when they are normal older people who need toileting help in a limited time frame (10 -15 minutes). Imagine how depressing and demoralizing it is for these pts. The sad thing is that changing multiple patient's briefs may actually take longer and be less efficient than attending to their toileting needs one at a time. However following a set schedule often does not permit such "as needed" toileting requests. But even if it takes a little longer to keep patients out of briefs, the positive psychological effect on the patient, his or her family, less stress on the CNAs (who often dread changing multiple patient's briefs), and fewer problems with skin breakdown would seem to justify some additional staff.
  9. I am asking this question because there seems to be so much concern in LTC settings about under-staffing of CNAs. Say you have a dependent pt (who requires help in transfer) in bed or in a wheelchair who can be toileted on a commode but can normally only hold it for 5-10 minutes. If the facility is under-staffed, that pt is likely to wet or soil him or herself before the CNA can attend to them. That pt will then likely be considered incontinent. If a patient requires a two-person assist transfer to a commode (or toilet) and only one caregiver is normally available, the same thing can happen. If a patient requires a one-person assist transfer but the caregiver is often not available, again the patient may be considered incontinent. These patients (who may not actually be incontinent by common standards for older patients) will likely be put in briefs and have to be changed in bed periodically. However this activity can be scheduled whereas giving them toileting assistance as needed cannot be as easily scheduled. So the incentive is to diagnose them as incontinent and the indignity of being in briefs and being changed may be more common than it needs to be. Changing briefs is a labor-intensive and difficult activity and being in briefs can contribute to skin breakdown. I am wondering how common this questionable incontinence diagnosis is in LTC settings.
  10. I thought this might interest CCU nurses because they sometimes work with organ donners and specialize in cardiac transplants. A new device that perfuses oxygenated blood through the heart and keeps the organ viable much longer has been used in Europe and is said to be coming to the US. The Organ Care System (OCS) works for hearts, lungs, and livers. Organs which are kept warm and perfused with blood using the OCS could potentially stay viable for weeks and even months. See the quotes and article [h=1]Heartwarming Story: Developing a Better Way to Preserve Organs[/h]from Newsweek below. Quote 1: One factor is the standard method of transport. Cold storage offers a very short window of time to get the organ from donor to recipient—typically less than four hours for a heart, six for lungs and slightly longer for others. Quote 2: Since the dawn of organ transplantation until today, every aspect of organ transplant therapy has seen advancement...except one area: organ preservation for transplant,” says Dr. Waleed Hassanein... Quote: 3 The [new] compact portable console has a universal power system, a battery, a pump, a wireless monitor, embedded software and an organ-specific perfusion module, which is a sterile single-use cassette with sensors to monitor the organ it holds. Heartwarming Story: Developing a Better Way to Preserve Organs
  11. jm_emt

    Coping With A Difficult Death

    It seems unfair to ask a nurse to visit a patient who they have never seen before (seems to be the case from you description) at the very end of his or her life. As a Hospice volunteer for a number of years, in my opinion, nothing can substitute for being with the family and patient over a period of weeks or months. It can often create a deep bond and sense of appreciation between the caregiver and the family. Entering a situation where the patient been in extended pain at the very end of life seems like you are being set up to fail in relating to the family. Unfortunately, the patient needs professional care (with shortness of breath and other issues) and someone needs to do it. It seems kind of like being a policeman where you have to go outside your comfort zone and face unpleasant, no-win situations for the greater good of the society (or the patient). It is sacrificing one's own well-being for the sake of another. In the short term it feels bad but in the larger scheme of things, I believe it is a noble and praiseworthy act.
  12. Patient care plans usually designate how to transfer patients who need assistance sometimes describing them as one-person or two-person "transfer assist" patients. However a patient who is fresh, alert, and orientated most of the time often becomes disorientated and unable to follow directions or communicate effectively with the caregiver (often later in the day). Such a patient would clearly be designated as a candidate for using a patient lift to transfer them in these circumstances (regardless of what the care plan says). The SPH&M flowchart from VISN8 concludes that full body lifts should be used when a patient is not cooperative or cannot follow directions. (reference: http://www.visn8.va.gov/VISN8/PatientSafetyCenter/safePtHandling/SafePatientHandlingAssessment_Algorithms_121112.doc ) My question is: How do nurses handle transfer for these patients whose moods and skills vary so much based on time of day, level of consciousness, most recent medication, etc.? It seems like a new ad-hoc assessment must be done every time these patient must be transferred. This seems like a big patient safety issue that is difficult to address.
  13. jm_emt

    nursing care plan for multiple fractures.. help!

    If you look at the settings page, it says highest education and it has different degree options (mostly nursing). It also has an "other" option. It then has "years of experience". I chose "other" (non-nursing) and gave my engineering degree. The experience is 15 years of "other". If the site interprets this as 15 years of "nursing experience" when I clearly state otherwise, it needs to be rewritten. But thanks for judging me. Makes me feel welcome at this site.
  14. jm_emt

    nursing care plan for multiple fractures.. help!

    4 years as an aide. 15 years as a hospice volunteer. 20+ as an engineer. Hope this helps.
  15. jm_emt

    nursing care plan for multiple fractures.. help!

    I have no connection with either company or product I mentioned. But I do think transfer chairs are the answer to some of the problems nurses confront, especially when mobilizing patients who cannot tolerate lifts. As a former aide and Hospice volunteer, I have watched patients struggle with being bedfast for weeks and months on end. It is a very serious situation and the nurses and caretakers I worked with found it difficult to watch also. I do not see it as "advertising" to recommend a generic type of medical device (transfer chair) that solves a difficult challenge for nurses.
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