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| Medicare: We Won't Cover Errors
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Leaving a sponge in a Medicare patient will become an even more expensive mistake next year.
As of October 2008, Medicare will no longer reimburse hospitals for the additional cost of treatment for what it considers preventable errors. These include injuries and some infections acquired during a hospital stay, according to the new rules announced on Aug. 1. So far several conditions, including objects left during surgery, blood incompatibility, air embolism, falls, pressure ulcers and urinary tract infections associated with catheters will not be covered by Medicare, if they are the result of a hospital visit.
The first step in the process will begin this October, when hospitals will be required to collect information on secondary diagnoses present at the time patients are admitted. Medicare will use this data to add to the list of non-reimbursable conditions.
The change is part of the federal government's Deficit Reduction Act of 2005, which this year includes cuts of $20 billion in Medicare payments to hospitals for inpatient services. The American Hospital Association opposes the new rules and has been working to generate support in Congress. "This move flies in the face of Congressional intent and makes hospitals' mission of caring for patients even more challenging," says Rich Umbdenstock, president of the AHA, in a statement.
The Bush administration estimates that not paying for preventable errors will save Medicare $20 million a year, according to an Aug. 19 article in the New York Times. At the same time, some doctors and hospital administrators worry that the rules will drive up costs because of the need for more testing at the time of admission.
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| Study: Prescription Abbreviations Endanger Patients
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While physicians are under pressure to work quickly, it's in their patients' best interest for them to take time to write out the name, dosage and particularly the instructions of any drug they prescribe.
A study in the September issue of the Joint Commission Journal on Quality and Patient Safety cites a retrospective review of nearly 30,000 medical error reports from the United States Pharmacopeia's MEDMARX database to conclude that five percent of medication errors are attributable to abbreviations.
According to the study, the most common abbreviation resulting in a medication error was the use of "qd" instead of "once daily," which accounted for 43.1 percent of the abbreviation errors reviewed. Other abbreviations commonly associated with errors were "U" for units, "cc" for mL, "MSO4" or "MS" for morphine sulfate and decimal errors in the dosage.
While 81 percent of the errors studied occurred during prescribing, only 14 percent occurred during transcribing and 2.9 percent during dispensing. Abbreviation errors originated from physicians more often than from nurses, the pharmacy or other healthcare or non-healthcare providers.
"Accurate communication in the healthcare environment is a critical component of patient safety," says the study's lead author, Luigi Brunetti, PharmD, clinical assistant professor at the Ernest Mario School of Pharmacy at Rutgers University in New Jersey. "Abbreviation contributes to lapses in communication and may lead to patient harm."
The study's authors suggest that the Joint Commission consider making additions to its "Do Not Use" list of abbreviations. In the meantime, they urge individuals and organizations that report medication errors to describe the error, including its cause (if the error was caused by an abbreviation, what the abbreviation was), the contributing factor, the outcome, the staff involved and the point in the process where the error occurred so they can learn from the incident and improve patient safety.
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| On-demand Treatment of Peritonitis is Best
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Performing relaparotomy only when it's clinically necessary is advantageous to the routine scheduling of the procedure in the treatment of peritonitis, according to a study published in the Aug. 22/29 issue of the Journal of the American Medical Association.
The study's authors note that up to 16 percent of patients undergoing elective abdominal procedures develop intra-abdominal infection or inflammation and treatment weighs heavily on health care utilization costs, including surgery to eliminate the source of the infection and extended stays in hospital intensive care units.
The researchers tested two widely employed follow-up strategies after an initial emergency laparotomy to treat peritonitis. The first, on-demand relaparotomy, is performed only when the patient's condition deteriorates or fails to improve. The second strategy, planned relaparotomy, is performed every 36 to 48 hours for inspection, drainage and washing out of the peritoneal cavity.
"The planned strategy may lead to early detection of persistent peritonitis or a new infectious focus but harbors the risk of potentially unnecessary re-explorations in critically ill patients, while the on-demand strategy harbors the risk of a potentially harmful delay in the detection of ongoing infectious sources," say the researchers.
In a randomized trial conducted between November 2001 and February 2005, 232 patients were divided equally and assigned to an on-demand strategy or planned strategy cohort. The researchers note that the while there was no significant difference in clinical endpoints between planned and on-demand relaparotomy, 42 percent of the on-demand patients had relaparotomy versus 94 percent of the planned relaparotomy group.
"This randomized trial found that compared with planned relaparotomy, the on-demand strategy did not result in statistically significant reductions in the primary outcomes of death or major peritonitis-related morbidity but did result in significant reductions in the secondary outcomes of health care utilization, including the number of relaparotomies, the use of percutaneous drainage, and hospital and ICU stay," the researchers conclude.
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| News and Notes
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Performing relaparotomy only when it's clinically necessary is advantageous to the routine scheduling of the procedure in the treatment of peritonitis, according to a study published in the Aug. 22/29 issue of the Journal of the American Medical Association.
The study's authors note that up to 16 percent of patients undergoing elective abdominal procedures develop intra-abdominal infection or inflammation and treatment weighs heavily on health care utilization costs, including surgery to eliminate the source of the infection and extended stays in hospital intensive care units.
The researchers tested two widely employed follow-up strategies after an initial emergency laparotomy to treat peritonitis. The first, on-demand relaparotomy, is performed only when the patient's condition deteriorates or fails to improve. The second strategy, planned relaparotomy, is performed every 36 to 48 hours for inspection, drainage and washing out of the peritoneal cavity.
"The planned strategy may lead to early detection of persistent peritonitis or a new infectious focus but harbors the risk of potentially unnecessary re-explorations in critically ill patients, while the on-demand strategy harbors the risk of a potentially harmful delay in the detection of ongoing infectious sources," say the researchers.
In a randomized trial conducted between November 2001 and February 2005, 232 patients were divided equally and assigned to an on-demand strategy or planned strategy cohort. The researchers note that the while there was no significant difference in clinical endpoints between planned and on-demand relaparotomy, 42 percent of the on-demand patients had relaparotomy versus 94 percent of the planned relaparotomy group.
"This randomized trial found that compared with planned relaparotomy, the on-demand strategy did not result in statistically significant reductions in the primary outcomes of death or major peritonitis-related morbidity but did result in significant reductions in the secondary outcomes of health care utilization, including the number of relaparotomies, the use of percutaneous drainage, and hospital and ICU stay," the researchers conclude.
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