"NEVER Events"

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Specializes in Assisted Living, Med-Surg/CVA specialty.

NM said yesterday theres like 15+ NEVER events and they (Medicaid/Medicare, I think) are going to be releasing a bunch more by next year.

All I know are Pressure ulcers and falls. I'm thinking any kind of nosocomial infection might be on that list, too? What are these NEVER events?

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Hmm, not sure what you mean. In LTC they are called sential events. Pressure sores, impactions and I think dehydration are some.

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Specializes in Community Health, Med-Surg, Home Health.
NM said yesterday theres like 15+ NEVER events and they (Medicaid/Medicare, I think) are going to be releasing a bunch more by next year.

All I know are Pressure ulcers and falls. I'm thinking any kind of nosocomial infection might be on that list, too? What are these NEVER events?

If I am not mistaken, the 'Never Events' you are speaking of are negative outcomes based on nursing care; like as nosocomial infections (because of lack of adhering to infection control protocols), leaving surgical instruments inside of patients, falls (I am sure, anyhow), and such. I have not found the entire list, but I will ask a friend and then, post it if no one else has done so by then. If these events happen, then, medicaid and medicare will not eat the cost of the additional stay. It was told to me that other health insurances would be sure to follow. It makes me wonder if they would also be checking into the initial nursing assessments/diagnosis as well, because this is the time to catch some of this. Someone feel free to correct me if I am wrong.

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Specializes in ICU, PACU, Cath Lab.

I think she is talking about the things that should "never" happen. And when they do medicare/caide will not be paying the bill. Not sure what they all are though!

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Specializes in ICU/ER.

As of June 1st if one of our patients in the hospital with a catheter gets a UTI, medicaide/medicare will not pay for the tx of the UTI. Soooo that means no more caths for us unless totally--totally needed.

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Specializes in Nephrology, Cardiology, ER, ICU.

Here ya go:

"CURRENT NATIONAL QUALITY FORUM LIST OF “NEVER EVENTS”

Surgical Events

Surgery performed on the wrong body part

Surgery performed on the wrong patient

Wrong surgical procedure on a patient

Retention of a foreign object in a patient after surgery or other procedure

Intraoperative or immediately post-operative death in a normal health patient (defined as a Class 1 patient for purposes of the American Society of Anesthesiologists patient safety initiative

Product or Device Events

Patient death or serious disability associated with the use of contaminated drugs, devices, or biologics provided by the healthcare facility

Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended

Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a healthcare facility

Patient Protection Events

Infant discharged to the wrong person

Patient death or serious disability associated with patient elopement (disappearance) for more than four hours

Patient suicide, or attempted suicide resulting in serious disability, while being cared for in a healthcare facility

Care Management Events

Patient death or serious disability associated with a medication error (e.g., error involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation, or wrong route of administration)

Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO-incompatible blood or blood products

Maternal death or serious disability associated with labor or delivery on a low-risk pregnancy while being cared for in a healthcare facility

Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility

Death or serious disability (kernicterus) associated with failure to identify and treat hyperbilirubinemia in neonates

Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility

Patient death or serious disability due to spinal manipulative therapy

Environmental Events

Patient death or serious disability associated with an electric shock while being cared for in a healthcare facility

Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances

Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility

Patient death associated with a fall while being cared for in a healthcare facility

Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility

Criminal Events

Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider

Abduction of a patient of any age

Sexual assault on a patient within or on the grounds of a healthcare facility

Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a healthcare facility"

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1863

I must also add that these are current as of 2006.

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Specializes in Cardiac, ER.

I don't get it!1 I work ER, but I'm sure you LTC folks are pulling out your hair. They won't pay when a pt falls and breaks a hip in your facility,.but we can't restrain them and no one wants to pay for a sitter!!! Perhaps this is designed to force better staffing ratios, but so far I'm not seeing that!!!

What exactly are we supposed to do with the confused/combative/intoxicated etc pt that won't stay in bed but isn't steady enough to stay on their feet when they get up?

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".................. Soooo that means no more caths for us unless totally--totally needed."

Just my :twocents:, but isn't that the way it should be? No procedure should be performed unless it is clearly necessary, especially something like a urinary cath where the risk of infection is somewhere in the 7-10% per day range.

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As of June 1st, if a patient in the hospital aquires any nosocomial infections they(the tx for these infections) will no longer be covered by Medicare and Medicaid. Some of them are UTI, MRSA, VRE, C-Diff, vent asst pneumonia, pneumonia due to E. coli, etc. Basically, the facility will have to absorb the cost and we know who they will be looking at. :specs:

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Specializes in ICU/ER.
".................. Soooo that means no more caths for us unless totally--totally needed."

Just my :twocents:, but isn't that the way it should be? No procedure should be performed unless it is clearly necessary, especially something like a urinary cath where the risk of infection is somewhere in the 7-10% per day range.

Yes I agree we shouldnt nor do we cath our patients to make our jobs easier, but last week I had an 87 year old with a fractured pelvis, who cried and whimpered in pain every time we tried to put her on the fracture pan, she felt like she had to urinate but was so tense with pain with every movement she couldnt relax enough to go, so she ended up dribbling when she got on there, then cried to get off, then cried that she had to urinate, then cried when we ever so gently tried to get her back on, Then of course we had to ever so gently with 4 of us try and change the pads under her. Didnt matter how much morphine we gave her, she was in pain all because she had to urinate and could not get comfortable.

Needless to say she got no sleep, felt terrible and nothing we were giving her for pain was working. She finally feel asleep and soaked the bed, so complete bed change. With a fractured pelvis.

So was a catheter needed? I think so, I am sure she thought so, but Dr did not.

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To consolidate the HOSPITAL NEVER EVENT LIST SO FAR, WHICH TAKES EFFECT ON OCT. 1 2008, IN WHICH MEDICARE/MEDICAID WILL NOT PAY, TAKE A LOOK AT THE FOLLOWING LIST:

Object inadvertently left in after surgery

Air embolism

Blood incompatibility

Catheter associated urinary tract infection

Pressure ulcer (decubitus ulcer)

Vascular catheter associated infection

Surgical site infection- Mediastinitis (infection in the chest) after coronary artery bypass graft surgery

Certain types of falls and trauma

There are NINE more proposed additons under review, asking for public consideration that will be announced later this year

  • Surgical site infections following certain elective procedures
  • Legionnaires' disease (a type of pneumonia caused by a specific bacterium)
  • Extreme blood sugar derangement
  • Iatrogenic pneumothorax (collapse of the lung)
  • Delirium
  • Ventilator-associated pneumonia
  • Deep vein thrombosis/Pulmonary Embolism (formation/movement of a blood clot)
  • Staphylococcus aureus septicemia (bloodstream infection)
  • Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis)

To add to the complexity, AHRQ, the Agency on Healthcare Research and Quality, who partners with CMS (Centers for Medicare and Medicare Serrvices) on the federal level, is proposing FORTH THREE new quality standards. It just gets more complicated to implement.

Your nurse managers should be acutely aware of what is going on here. If they aren't, provide them with this list. Figure out best practice in order to conform, based on best practice research that you can implement.

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We're screwed.

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