"NEVER Events"

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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 tele, oncology.

pretty soon willing staff to put up with this mess is going to be a "never event".

:yeahthat:

i would love it if medicare/caid started addressing these issues with the patients as well. as in, if you're a&o x3 and refuse to turn, you gotta pay for your own decube care. i realize it would never happen, but it seems like we're moving more and more towards a culture of never holding the patient accountable for anything...okay, scratch "it seems"...it is. and what about those who refuse lovenox/heparin and then go on to develop dvt despite education? why should my facility, and therefore ultimately me (as in, no money for raises), have to pay for that?

we swab all new ltc/group home/hd patients for mrsa and vre upon admit and they are placed on isolation as well. plus new protocol is to get a urine cx whenever placing a new foley.

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Specializes in Certified Wound, Ostomy & Continence Nurse.

What happens to the patient who experiences one of these events. It seems there is no remedy for the patient. Is the facility who "causes" the negative outcome required to provide free care? As we all know, some events cannot be prevented. Pressure ulcers can occur in spite of attentive care in those patients that are compromised by old age or disease. In some cases, moving the patient around can be life threatening. What about UTIs in patients that need to be cathed? Who will provide the free care? What if the patient wants care at another facility due to problem that developed? It sounds like if the patient gets one of the "never event," the patient is out of luck.

Diana

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Specializes in ER/Trauma.

I made this post not too long ago:

CMS has, in their infinite stupidi.... er... "wisdom" deemed that "falls" are a "never event" in hospitals... and that they won't compensate for falls suffered in hospitals.

Nurse: Can we tie everyone down to their beds? That will ensure a 100% no-fall stay.

CMS: Of course not!

Nurse: Well, how else can we ensure 100% no-fall numbers?

CMS: That's your problem... not mine!

Nurse: You DO know that many of the patients we treat are the elderly? That they are prone to falling just because of their age and unsteady gait? It's part and parcel of "growing old" ? People fall - be they at home or in a hospital or wherever. It's as human as sneezing.

CMS: That's your problem... not mine!

Nurse: So... you won't pay me if a patient has a fall on my unit but you'll pay me if I accept a transfer pt. who has had a previous fall/History of a fall?

CMS: That is correct.

Nurse: So what's to stop hospitals from forming cartels and shipping patients around just because they are a 'CMS risk'? Doesn't this ultimately work toward the detriment of patients and their care?

CMS: Silence! What the hell do you know about CMS?

Nurse: *muttering under breath* I know enough that you sleaze bags want to continue to pay less and less as compared to what you're supposed to reenumerate...

CMS: Such insolence! You're just a nurse! Wipe that bottom there...

cheers,
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Christopher Reeves died of a pressure ulcer and he had the best care money could buy.

So... if we fall at work, as nurses, or get hurt in any way for that matter, our insurance shouldn't pay for it because it was most likely preventable. Same with every single injury or illness out there folks!!!

Duh... every event is caused by something so why not just stop paying alltogether???

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Specializes in Geriatrics.

In the LTC I work for, my unit is composed of 41 pts, 95% dementia pts, 75% are fall risks, then figure in the % who refuse to take more than a sip of water with meds and refuse fluids the rest of the time. Add the ones who refuse meds, personal care, ignore bed & chair alarms, figured out how to shut off said alarms, no matter where we place them, are too deaf to hear alarms. All this and I have a staff of 4 CNA's and 2 Nurses, (including myself). Apparently the people who made this list have NEVER worked with dementia pts, have no clue what the average day is like, and really don't care for the pt's well-being. This never list is a dream, I would love to never have them happen, but, reality states that the opposite is the norm, bed sores will happen, so will pneumonia, UTI's C-diff, falls, dehydration, etc... how am I suppossed to prevent all this? Maybe it's time to change my major and go into culinary instead of RN. I am frustrated enough trying to keep them safe, this added pressure is going to ensure the burnout of Nurses very quickly.

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Documentation.

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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.

Sentinal events are huge, big things that happen which cause terrible harm or death of a pt, or the threat thereof.

In no way are bedsores, impactions, or dehydrarion sentinal events- they are normal events.

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called "sentinel" because they signal the need for immediate investigation and response.

http://www.jointcommission.org/SentinelEvents/

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They are unfortunately normal but we can attempt to prevent them. A pressure ulcer can lead to death. An impaction can lead to death. And dehdration can contribute to death. There are many things that we can do to try and prevent these normal things that happen to sick and frail people.

We all know what interventions are needed to prevent these events. Some patients are resistive to positioning changes. Some patients have problems with bowel movements, that why we have interventions to keep their bowels moving. Some people will not drink or have other problems contributing to dehydration that we can try to alleviate. We try all these interventions that we know and document them, or the patients noncompliance with the interventions that we try. All we can do is try.

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I was correcting the incorrect statement calling impactions and bedsores "sentinal events." We all know that impactions and bedsores can lead to serious problems, and should be avoided, but they are in no way sentinal events.

Calling an impaction a sentinal even is akin to calling a mild rain a hurricane.

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Specializes in Acute Care.

Wow, this is an old thread.

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Specializes in Cath Lab, OR, CPHN/SN, ER.

Jumping in, even if it's old...

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?

Document, document, document..... If you've documented you've done everything you can to prevent a fall and the person still falls, your documentation can allow the hospital to fight the charges and hopefully get reimbursed.

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.

WTH! :banghead:

We're screwed.

Word.

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Specializes in med-surg, psych, ER, school nurse-CRNP.

The way I look at it, it'll end one of two ways: One, the list of "never events" will become so ridiculous, providers will stop accepting Medicare/Medicaid because of the possibility of having to deal with this. I'm not sure hospitals could elect to do the same, unless they are private/for-profit facilities, but just imagine how quick the companies would rethink this cockamamie scheme if THAT happened. I know it would be classically unfair to the poor patients that you could not admit, but it's a surefire way to get the message across.

Two, They will keep on keeping on, until even an unscheduled sneeze is considered a "never event". You know who'll catch the brunt of that one. The nurses. They should have put Allergel on all the patients, kept all the pepper off the meal trays, or kept all patients with colds or allergies out by the Dumpster where no one could be exposed. It'll finally get so tied down and ridiculous that no one will want to work bedside anymore (yeah,right, who am I kidding?). I'd like to see how many "never events" occur with no one at the bedside.

I can see where they are trying to go with this, and it's a good premise, but all DVT's or UTI's or what-have-you may not be caused by errors or lapses in the hospital. Thereby, just arbitrarily deciding that you're not going to pay for ANY of these is tantamount to throwing the baby out with the bathwater. Makes no sense. JMHO.

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