"NEVER Events"

Published

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?

Specializes in ICU/ER.

Delirium??? thats half my patients....Bring on the ativan. ---for me!!! lol

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Specializes in NICU.

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)

Wow... and how many infected perm caths do I see? Everyone tries to be sterile but it happens...

Extreme blood sugar derangement? You can't always expect how people will react to insulin.. Sometimes septic patients have extremely low blood sugars as well.

And a pneumothorax is a possible complication with many procedures. Our doctors are only human!!!??

Delirium? Yea cause we can really prevent all cases?

DVT? Of course we can try but dang this is ridiculous...

C-diff? I mean maybe if it is hospital acquired from poor infection control... but you can't help if the patient gets it after receiving antibiotics...

Grr.. You're right.. we are screwed!!!

Tiger

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Wow! Unbelievable!

So we'd better not make any mistakes.............not that we should be able to make them to start with, but good grief, we're only human and things do happen, and nurses can't prevent everything!

So I wonder if this is also going to apply to LTC's also?

Like someone else posted, it's hard to prevent falls in the nursing home. How are we supposed to do that?

I can't babysit with every resident who is at risk for falling. It is impossible to do.

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Wow! Unbelievable!

So we'd better not make any mistakes.............not that we should be able to make them to start with, but good grief, we're only human and things do happen, and nurses can't prevent everything!

So I wonder if this is also going to apply to LTC's also?

Like someone else posted, it's hard to prevent falls in the nursing home. How are we supposed to do that?

I can't babysit with every resident who is at risk for falling. It is impossible to do.

It does. A bed alarm allows you to get there in time to assess them after the event.

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It does. A bed alarm allows you to get there in time to assess them after the event.

That's right.

And some residents won't stay in their wheelchairs either,

and will get up and fall.

LTCs or hospitals would just about to have one to one care for alot of residents and patients to prevent some of these events.

And that ain't happening.

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Specializes in med-surg.
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.

:eek: What's the doc smoking?

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Specializes in med-surg.
Wow! Unbelievable!

So we'd better not make any mistakes.............not that we should be able to make them to start with, but good grief, we're only human and things do happen, and nurses can't prevent everything!

So I wonder if this is also going to apply to LTC's also?

Like someone else posted, it's hard to prevent falls in the nursing home. How are we supposed to do that?

I can't babysit with every resident who is at risk for falling. It is impossible to do.

This means that the families are going to have to pick up the slack and spend time with thier loved ones. Unfortunately, the reality is that the tv lawyers are going to be convincing the public that since Medicare didn't cover it, that means the professionals did something wrong and they should sue to get their piece of the pie.

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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.

You're right. This is what has led our ICU to nasal swab all pts on admission and keep all pts on isolation until they have a negative swab. That is so they can prove that the pt already had MRSA prior to admission, and to hopefully prevent the spread so nobody else gets it. I don't think it's going to help with the spread, but it will show that people were colonized before admission.

RIDICULOUS about the falls one. They all suck, but esp. the falls. If I'm responsible for 5 pts and 3 of them are crazy and clibing out of bed and I only have one sitter, and can't restrain them so they can go to an ECF...I mean, it's not physically possible to prevent every fall!!! I was shocked when my boss told us about this a few months ago. It's just not humanly possible to be in 5 places at once.

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Most ltcs are restraint free or at the very least use minimal restraints like lap buddies or self release belts which, hey can be released by dementia pts.

How will this be weighed against the states position that they have a "right " to fall?:banghead:

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

Ventilator associated pneumonia?!?!

Uh, I'm not an ICU nurse but I thought a LOT of people on vents get some kind of respiratory ailment. Even Dr. G (on Discovery Health) mentioned it that a lot/most pts on a vent get pneumonia!

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Yeah... I just don't understand how they can categorize some of these complications as "never ever should happen if proper care is administered" type of events. Falls, whatever, not possible. Infections??? Come on now, really? Are you going to tell me the patient that refused his/her bath all week and then scratches his/her butt and then picks at their scabs shouldn't be expected to get a raging infection no matter how many times I clean my hands and tell him/her the risks/benefits of them not adhering to the plan of care... and proper hygiene???

I have yet to see any newspapers, or even nursing mags for that matter, yet defend the health care workers on this issue. It is not all to improve care, but rather it seems, to save the government and insurance companies more money. Whatever.

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We're screwed.

You've got it. And the patients will pay the biggest price in some instances. Docs won't be ordering foleys for fear of infection so patients will suffer.

We won't be able to control what patients do and force them to bathe/wash their hands nor can we ensure they won't pick at sores so there will be infections at times.

And the poor LTC nurses will really feel the brunt of it where falls are concerned. My hospital is putting fall signs outside of every door now as a reminder to everyone. Can't wait until the patients complain about that.

Patients are getting swabbed now upon admission for MRSA. They aren't all too happy about it but we have no choice.

Patients rights will be in direct opposition to some of these events. They have the right to fall and not bathe but we will pay the price for it.

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