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Incontinence Support Blog

Spinal Cord Injuries & Depression

Posted by Sarah Woodward

Feb 11, 2013 10:36:00 AM

Now I’m not a big fan of lawyers, (in fact, any joke that ends with a lawyer being eaten by an alligator is almost guaranteed to get a laugh), I have to concede that I was impressed with the blog below from Rix & McKay Solicitors LLP in the UK. So I’ve decided to share the full blog on mental health treatment after spinal cord injuries below:

Spinal Cord Injuries – How Would You Feel?

When you know, meet or work with people who have suffered a spinal cord injury you are allowed a small insight into the impact it has had upon that person and the way their life has changed. Imagine you woke up tomorrow without the ability to get out of bed and make your morning cup of tea.

While the physical changes and challenges a spinal cord injury presents are often obvious to the eye, the mental impact can often remain a very private and personal battle to the individual who has suffered the injury.

Studies have shown that 25-30% of people who suffer a spinal cord injury suffer from either depression and/or Post Traumatic Stress Disorder (PTSD).  Those suffering with depression and/or PTSD who are actually diagnosed however is a shockingly poor 1-2%. Why is it the diagnosis rate so poor? How come so many people being left to suffer with the mental anguish following such a traumatic and life changing injury?

The answer lies possibly in the poor training of healthcare professionals of the symptoms of depression and PTSD along with the fact that many think it is someone else’s job to diagnose and treat the symptoms rather than being pro-active and finding the right person to help make the diagnosis and then help obtain the right treatment.

Each person who has a spinal cord injury is likely to have a different reaction to it, for example, the impact of a spinal cord injury resulting in paraplegia (loss of used of the legs) is likely to have much higher psychological implications for someone who is young or a professional sportsman or someone who takes particular pride in their personal appearance compared to someone who is not so concerned about appearance or perhaps works in an office job and isn’t particularly active.

In the first example, a sportsman is going to have their career and ‘identity’ taken away by this traumatic event and is far more likely to have a psychological impact resulting in PTSD or depression. In the second example however, the person who works in an office at a desk may find that life hasn’t changed so much and while changes occur, they are still able to continue with work and have an identity or life at least familiar to that before their accident.

There of course is no exact science to define how each person will react to a spinal cord injury and multiple factors come into play. What is clear however, is that the consequences of not diagnosing depression and PTSD can be serious and sometimes fatal. Studies have shown that those who suffer a spinal cord injury are 5 times more likely to commit suicide than the general population and there are concerns that this number could be higher still because the psychological impact of these injuries is not being properly diagnosed and therefore not being addressed or recorded in their entirety.

What can be done therefore to ensure that the right diagnosis and treatment is obtained? Speaking as a Claimant Solicitor, the role we play is far greater than obtaining compensation for our clients. Being aware of our client’s well-being , change in mood and personality pre and post accident mean we look for the signs that a psychological issue may exist and subsequently ensure that the right help is sought for our client as early as possible. If our client is bringing a personal injury claim then normally the cost of the treatment can be recovered from a Defendant’s insurer.

Treatment is often in the form of Cognitive Behavioral Therapy which can help prevent mood disorders developing and safe guarding the individual into their future. It can help them to adjust to their new life and is recognized as being effective to most of those who undergo the treatment with a properly qualified therapist.

To view the full blog post: http://www.rixandkay.co.uk/2013/01/25/spinal-cord-injuries-how-would-you-feel/

 

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Topics: urinary management, Caregiving, spinal cord injury, nursing

The Importance Of Physical Therapy For Spinal Injuries

Posted by Sarah Woodward

Jan 21, 2013 12:00:00 PM

Since we’re at the American Physical Therapy Association conference this week, I thought it was the perfect time to share some great information on the importance of physical therapy after spinal cord injuries. We’re thrilled to welcome Matt Anton as a guest blogger!


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When you are treating a person who has suffered a spinal cord injury, the biggest focus is on regaining function and independence so that patients can be active, healthy and happy, despite the challenges they face. Among clinicians, it's widely accepted that the best results come from  using a variety of treatment methods and that the more you put into your rehab, the more you get out!  

What Happens After A Spinal Injury

When you suffer a spinal injury, you need to allow enough time for the injured muscles and the bones to heal. This is why there is usually a phase of immobilization that allows the bones and the muscles to repair themselves. While this is going on, your doctors usually prescribe medication which will encourage faster healing as well as provide nutritional supplements like vitamins and minerals to speed up the healing process.

Rehabilitation After Injury

When the rehabilitation process starts, physical therapists along with occupational therapists, health care professionals and psychologists work as a team under the coordination of a specialist who will set goals for the patient’s recovery and develop a plan for the patient’s discharge. In the acute care phase the physical therapists usually focus on the respiratory status of the patient. They do this in order to prevent indirect complications as well as maintain a range of motion activities and keep the muscles active.

Complexity Of Neurological Impairment

When spinal injuries occur, there are often neurological impairments and/or damages involved. The level of impairment differs in different cases. The higher up the spine the injury occurs, the greater the challenges. Often the level of neurological impairment is such that some of the ventilator muscles are impaired and that puts more stress on muscles that are unaffected. Most spinal injury patients suffer from reduced lung capacity as well as reduced tidal volume. Thus, the therapists at such a stage teach the patients accessory breathing methods and techniques.

Method Of Physical Therapies

Physical therapists may also assist such patients in learning how to cough as well as clearing the secretions that come up the throat. The stretching of the thoracic wall is done in a way that is taught to such impaired patients. Many of these patients are provided abdominal support belt as it becomes necessary. The amount of the time that a patient remains in an immobilized condition depends on the spinal cord injuries that they sustain. Physical therapists need to work with such patients in order to prevent any complications that may arise due to such immobilized state. Other complications that arise from immobilization are osteoporosis and muscle atrophy. That, in turn, increases the risk of fractures of the femur and the tibia.

Importance Of Physical Rehabilitation

To prevent such conditions during the immobilization period, there are many kinds of electrical stimulation techniques that are used in order to achieve effective results. The intensity and the frequency as well as the duration of the stress that is given to the bones is decided by the therapist. Thus, physical therapy for spinal injury patients is essential. Even though they are painful at certain stages especially during the phase of immobilization, one needs to keep up such therapies in order to reduce the risk of related damages to other areas of the body.

Getting Out of the Hospital

Rehabilitation therapy involves relearning old skills and developing new ones. Patients will learn to use new equipment including wheelchairs, transfer benches and shower chairs. This may also include special equipment for bladder or bowel management. During this learning phase it is critical to set goals for yourself and your recovery that allow you to work toward resuming your previous lifestyle and getting back to the routines and activities you enjoyed prior to your injury.

 

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Author Bio:
Matt Anton is an author who contributes articles on different healthcare forums. He also writes articles on a variety financial matters. For more articles from Matt, check out: http://paymentsavvy.com.
 

Are you a blogger looking for opportunities to share your work? Men's Liberty is looking for guest bloggers to provide great new content featuring spinal cord injuries, incontinence and your personal stories. We'd love to feature you! If interested, email: Swoodward@mensliberty.com

 

**Please note: Men's Liberty does not endorse or support any products or services mentioned in the above article or associated links**

Topics: urinary management, bladder control, Caregiving, spinal cord injury, physical therapy, nursing

Healing Technophobia among Nurses with Men's Liberty

Posted by Sarah Woodward

Dec 10, 2012 10:04:00 AM

“IT professionals are great at coming up with nifty tools for bringing clinical data to clinicians – as long as nurses are willing to memorize lots of byzantine paths to that information.”

“Nurses are dedicated to providing direct care for their patients and advocating for them in every way – as long as it doesn’t mean having to adapt to ever-changing computer systems,” says author John Rossheim.

In a great recent article, John delved into the relationship between healthcare and IT and how implementing better technology can support patient centered care. It’s a great message, so we’ve included excerpts from his article below. Catheter management is a huge issue where IT has made an impact through catheter removal reminders and by encouraging nurses to look at other options like Men's Liberty.

There are some great ideas in there - take a look and share your thoughts!!

Stereotypes have helped perpetuate the notion that there’s a culture clash between clinicians and IT folks, a conflict that can scuttle the implementation of an electronic records system or at least reduce its effectiveness. But with careful planning and execution, this clash can be reframed to create a working coalition of healers and technologists. Here are some principles for increasing the odds of a successful collaboration.

Time Savings Come, with Time.
Let’s start with one perceived clash that any healthcare IT implementation team must address: that a new or upgraded electronic system will take direct-care time away from clinicians, at least in the early going. “Nurses have a way of viewing anything that comes between them and the patient as a threat,” says Mary Cothron, RN, a clinical trainer and implementation specialist at Informatics Corporation of America in Nashville.

Given nurses’ heavy record-keeping burden, their concern is understandable. Among the major tasks in an average shift, nurses spent 55.7 percent of their time on indirect care tasks such as documentation, versus just 32.8 percent of each shift on direct patient care, according to a 2008 study appearing in Nursing Leadership. So it’s reasonable for clinicians to push hard for an IT implementation that on balance will give them more time with patients. “When you add something to nurses’ workload, you also have to look at what you can take away,” says Harry Jacobson, M.D., CEO of Vanderbilt University Medical Center. “Nurses already have too many tasks.”

While navigating an online recordkeeping system may initially take longer than pen and paper, a digital records system has clear-cut time-saving features, and these should be highlighted. “When you bring in electronic records, you go from not being able to find the chart 20 percent of the time to always being able to find it,” says Chris Wood, M.D., Medical Director of Information systems at Intermountain Healthcare, a nonprofit system based in Salt Lake City. “You have to remind people again and again why you’re bringing in the technology.”

Efficiencies Come with an Increased Comfort Level.
For some nurses, an even greater fear is that the simple and transparent, if inefficient, information structure of a paper chart becomes opaque when reincarnated in electronic form. If you’re having trouble locating a test result in a paper chart, you simply leaf through every page; in an electronic health record, with its nonlinear structure, clinicians worry they could run circles around that test result without ever finding it.

“Clinicians are really making a leap of faith that the same kinds of information are being communicated” through a new electronic records system, says Claire McCarthy, Director of Change Management at Kaiser Permanente in Oakland, Calif. Or, as Cothron puts it, “As a nurse I’ve wondered: Do I have it all, am I missing any piece of the picture?”

Success Arrives when Clinical Insight Informs Technology.
Clinicians are the best advocates for their own usability requirements. They can, for example, insist that screens are configurable for individual patients, while key information is presented consistently throughout the system, Cothron says. Electronic dashboards can help nurses track all the requirements of a protocol in a unified view, says Dr. Jacobson, whether the patient is on an IV catheter, a ventilator or a complex regimen of medications.

Basic patient information such as allergies, fall risk and height and weight should be visible on the nurse’s screen at all times, says Cothron, perhaps on a static banner.

Screens can also be optimized to meet the specialized needs of nurses, therapists and other clinical professionals. “Our respiratory therapists suggested that to streamline their work, we modify the documentation flow sheets so that they could consolidate their entries in one area and not have to skip around,” says Ann Filz, RN, a floor nurse and designated super user at a medical center in Clackamas, Ore. “We’re trying to limit the number of clicks that a clinician has to make in a record.”

Proof of Patient Safety Brings Instant Gratification.
Perhaps the best way to bridge the culture gap is to demonstrate to clinicians that many aspects of automation improve patient safety. Bar-coding of medications is one innovation that does just that.

Reconciling the medications of a patient who is moving between units is complex and stressful for nurses, even when the transfer is within a hospital, Cothron says. “This scares nurses to death when they don’t know what the electronic record is going to look like when viewed from the other department.”

The solution? “We use bar-code scanning for medication,” says Filz. “So if a nurse had the wrong medication and scanned the patient’s wristband, the medication administration screen will open with the alert: ‘This medication has not been ordered for this patient.’ ”

As always, the perceived risks and clear wins of automation should be presented in tandem to clinicians, to show that a system implementation will yield a net gain for the patient. “There were concerns that our implementation might pose a risk, but in fact one of the big reasons to use electronic records is that they truly enhance patient safety,” says Filz.

Ultimately the culture clash can be tempered if technologists begin to understand the clinicians’ perspective, and if clinicians learn to appreciate how the IT implementation improves patient care, especially in the long run.

Says Dr. Wood: “When clinicians have experienced time after time that IT brings an increase in functionality or efficiency, even though there’s pain in the change, they’ll work with it.”

 

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Topics: external catheter for men, hospital errors, proactive patients, nursing

Cutting Hospital Readmissions with Men's Liberty

Posted by Sarah Woodward

Dec 7, 2012 9:58:00 AM

Here is some great new information out recently from Stephen Jencks, MD, MPH.


Dr Jencks is the lead author of the New England Journal of Medicine study on the cost of readmissions to the American healthcare system. He says hospitals must look beyond the four walls of their facilities to reduce readmissions. That’s great news for us because we talk to WAY TOO MANY guys who ricochet back and forth between hospitals and home health care due to urinary tract infections. Reducing infections and readmission rates go hand in hand!

Speaking recently in Florida, Dr Jencks expanded on his previous work to convince attendees that the best way to cut hospital readmissions was to build relationships within the local community.

“The idea that it is not just that the patient leaves the hospital and goes into the community. It’s that information leaves the hospital and goes to the community, and that information comes back to the hospital from the community. This is feedback. This is how you improve what you do when you send a patient out. And if you are not securing that feedback, it’s going to be really hard to make the discharge more effective and better, yet the truth is that relatively few organizations have a systematic way of getting that feedback from nursing homes, physicians, home-health agencies and hospice.”

“On the other end, the same increasing complexity of information flow is here. You have the patient going back to the emergency service and you have information going with the patient from the home health agency or the skilled nursing facility or from the family.  And you have feedback coming from the emergency room to the organization that sent the patient, and that information may come back with the patient. Suddenly, the emergency room is now in an active dialog with the nursing home or the home-health agency or community nursing. This is a partnership. And partnerships with community organizations are emerging out of attention to readmissions. There are conversations going on between nursing homes and hospitals that weren’t going on five years ago.”

The biggest lesson is not to look at readmission as a black and white issue.  “Discharges are not something written in stone. In fact, in readmissions, the best way to reduce bad outcomes is to reduce exposure to the risk of bad outcomes,” i.e. reducing exposure to things like indwelling catheters will cut initial infection rates AND readmissions.

describe the imageFor partner organizations, “it’s not enough to put people in the back of the ambulance at 11 o’clock in the evening and shove them to the emergency room with a slip of paper pinned to them that reads, “Please diagnose and treat.”

“Understanding community is not new for hospitals. What is new is the need for partnerships within that community. The community shifts from where people flow in out to a set of partners you actively work with. That’s an enormous challenge for some hospitals. My personal suspicion is the hospitals’ ability to succeed with that challenge is going to be the difference between hospitals that really succeed over the next 10 years and those that find that it’s all too much for them.”

We’re rooting for hospitals, nursing homes, home health agencies, patients and families as they make this transition and we look forward to supporting the reduction of urinary tract infections by introducing the healthier alternative, Men’s Liberty.

Have you experienced a catheter-associated UTI recently? Looking for a healthier option that gets you out of the hospital and back out in the world living life to the fullest? See if Men’s Liberty could work for you!

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Topics: urinary management, doctors visit, hospital errors, urinary tract infections, nursing, hospital acquired infections

Five Things to Think About When Choosing an Incontinence Product

Posted by Sarah Woodward

Oct 29, 2012 1:00:00 PM

Recent estimates by the National Institutes of Health (NIH) suggest that over 4 million men in the U.S. experience urinary incontinence, including those with spinal cord injuries, MS, ALS and nearly a dozen other diagnoses. Incontinence is also a major factor in nursing home admission in the U.S., with more than 50% of male nursing home residents requiring assistance in controlling urine output or using the toilet. Taking control of continence management is integral to maintaining an active, independent lifestyle.


Products for managing mens' urinary incontinence include diapers, condom catheters and indwelling catheters.  Newly available is Men’s LibertyTM, a new hydrocolloid based external device which provides a secure, skin-friendly seal for 24-48 hours.

When it comes time to think about managing you or your loved ones' incontinence, be sure to consider the following five factors. There is a lot of variation out there and it’s important to find the urinary management tool that works best for you!

1.    What is the cause of your incontinence?

For men with a blockage that reduces or prevents the flow of urine, external products aren’t going to be appropriate. Indwelling catheters, surprapubic catheters or intermittent catheterization may be appropriate.

However, the vast majority of incontinent men experience stress, urge or functional incontinence. This includes minor leaks when bending or reaching, a sudden and immediate need to urinate or simply the inability to reach a bathroom in time due to mobility challenges. For these individuals, a variety of external products exist which may be appropriate including diapers, condom catheters and Men’s Liberty.

To determine what kind of incontinence you are experiencing and to discuss appropriate management options, please contact your health care professional.

2.    What are the potential side effects or complications?

Using indwelling catheters, diapers, pads and condom catheters can cause serious complications.  Care givers and patients need to be vigilant to prevent:

Infections: Urine is an excellent medium for bacterial growth.  The longer an individual retains urine, the more likely they are to develop a urinary tract infection (UTI). Do not take UTIs lightly.  Treatment may require a doctor’s visit and antibiotics. If left untreated, UTIs can lead to more serious infections like sepsis and require hospitalization.

Wounds, Rashes and Bedsores: Wounds and infections can develop under diapers, pads or condom catheters because they allow the skin to be exposed to urine for extended periods of time. If the skin is compromised and left untreated, deeper wounds can result.  Most men can use an external continence management device such as Men’s Liberty to eliminate dampness and reduce the possibility of wounds. 

3.    What are the costs involved?

Out of pocket costs vary depending on Medicare and insurance coverage. Diapers and pads are not covered by Medicare, leaving the vast majority of costs to the consumer. Alternatives such as condom catheters or Men’s Liberty are reimbursed by Medicare and most private insurance plans, reducing initial out of pocket costs. However, patients should also consider the cost of treating the complications of any product they use. Paying for lotions, ointments, antibiotics and doctor’s visits can add up.

4.    How will this impact my partner or caregiver?

If you need help managing your urine, it’s important to create as much free time for your spouse or companion as possible.  Tying caregivers to your bathroom schedule makes it difficult for them to get a break.  Choosing a urine management option that empowers you and does not require frequent assistance is preferred.  Alternatively, plans may include employing a personal caregiver, at least on a part-time schedule to provide respite assistance.   

5.    Make a plan to stay active. And stick to it!

Once you’ve mastered the mechanics, set goals on how you can remain active.  Make a schedule and establish routes with available restrooms.  Try finding a support group because life is more pleasant when you can share your challenges with other people who understand.  Exercise as much as you can.  Create a daily routine involving moderate physical activity and make it permanent. 

The typical response when dealing with urine control is to cut back on social activities.  This is understandable until you learn to manage it.  But that’s the key – manage it; then get out and live life to the fullest. 

 

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This article offers health and wellness information and is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional.

Topics: urinary management, bladder control, external catheter for men, spinal cord injury, tips from Men's Liberty users, nursing

Doctor-Patient Disconnect: Taking Charge of Your Incontinence Care

Posted by Sarah Woodward

Oct 26, 2012 1:00:00 PM

I went to the Doctor this week and it was a thoroughly unsatisfying experience. I spent about 40 minutes waiting and 10 minutes or less with the Doctor. While all the staff were polite and helpful, I can’t help but feel that I was just one piece on an assembly line. No one really listened to what I wanted to discuss and I left with a treatment plan I don’t really understand and more than a few questions unanswered.

Turns out, I’m not alone. Earlier this week, Steve Wilkins of Health Messaging wrote a fascinating blog article contrasting the responses patients provide on satisfaction surveys and other published data. He suggests that there is a significant disconnect between what patients say in surveys and what happens in practice. Based on my experiences this week, I would agree, so I thought I would share some of the highlights with you all here.

Studies of primary care physicians show that:

  • Patients are interrupted by their physicians within the first 18 seconds of their opening statement during office visits
  • Physicians and patients agree on the reason for the office visit only 50% to 70%  of the time
  • Physicians underestimate the patient's desire for health information 65% of the time
  • 50% of patients walk out of their doctor's office not understanding what their doctor told them to do
  • Patients are not asked if they have any questions in up to 50% of office visits

Despite the stats above, most patient satisfaction surveys show a consistent satisfaction rate of 80%-90%. So, what’s the disconnect? Wilkins argues that it’s really three things -

  1. Beginning with childhood, we all have been socialized to assume the "sick role" when seeing the doctor. From our initial visits to the pediatrician with our Mom we quickly learned the doctor is in charge and our role is to sit passively by while the doctor does most of the talking. Notwithstanding all the "talk" about how empowered patients are today, most of us still assume the sick role when seeing our doctor.
  2. Accustomed as most of us today are to the sick role, and accepting the fact that physicians are very busy, we are not surprised when doctors don't seem to listen to us or interrupt us. We are not surprised they don't have time for all our questions or frown on us bringing in lists of things we have researched on the internet. This for most patients is what we are used to ... it is what we are satisfied with, given that most of us don't have another or better point of comparison, i.e., a highly patient-centered physician.
  3. Consistent with the sick role, we as patients "tend to be overly patient." We "grant our doctors the benefit of every doubt." Most of us begrudgingly put up with poor service, inconvenience and unnecessary discomforts until we can't overlook it anymore. Even then we are reluctant to take our busy, overburdened doctor to task for these shortcomings by giving them a low score on a satisfaction survey.

So what can we do? For one thing, “be cautious about putting too much credence in patient ratings of physician communication skills.” And as the patient, be proactive. Don’t shy away from doing your own research and asking your Doctor about what you find. Most people with incontinence never mention it to their doctor. And when a patient comes in wearing a diaper, the Doctor may not even bring it up!

If the study above wasn’t enough a related article that also came out this week. A study of 1,068 adults conducted by Consumer Reports National Research Center for the Institute of Medicine's Evidence Communication Innovation Collaborative found that 90 percent of patients wanted their doctors to offer them options – not just their best recommendation – for making a medical decision, but far fewer people were actually offered this information by their doctors.

Two-thirds of patients agreed they wanted to know the risks of each option, including how a choice might affect their quality of life. Nearly half agreed that they wanted to discuss the option of doing nothing. However, patients' experiences rarely matched up to their desires. According to the study:

  • 61% strongly agreed that their provider listens to them
  • 50% strongly agreed that their provider explains the risks of their options
  • 36% strongly agreed that their provider clearly explains the latest medical evidence
  • 47% said that their provider takes into account their goals and concerns
  • 37% said that their provider explains the option of not pursuing a test or treatment

"This gap represents an enormous missed opportunity," William D. Novelli, a Georgetown University professor and former AARP CEO wrote. "Healthcare practitioners have a key role to play in bridging this gap by routinely offering all the reasonable options for healthcare decisions through systematic implementation of unbiased, evidence-based tools, such as decision aids," they continued.

Here at Men’s Liberty we sit on the other side of this divide. Patients are desperate for something better to manage their incontinence; they find us and end up introducing the product to their Doctor. There are thousands of products, pills and treatment options out there. Even the best Doctor can’t keep track of everything new that comes out. But proactive patients are seeing the benefits!

Does your Doctor know about Men’s Liberty? Would you like to send them information or take the information to your next appointment? Click here to send them information!

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For more information on either study, please click on the links above to the original blog posts/articles.

Topics: bladder control, external catheter for men, proactive patients, nursing

Using Medicare’s paying power to change hospital behavior

Posted by Sarah Woodward

Oct 18, 2012 9:42:00 AM

The idea was sound; the execution was a little shaky.

If you’re anything like me, you have been seeing a lot in the news lately about medical errors and hospital acquired infections and how expensive this problem is becoming. If not, don’t worry, I turn off my TV during election season too!

Fortunately, I get to catch up on the highlights online, without most of the ads. One article caught my eye last week and I wanted to share. It’s a report on a recent study published in the Annals of Internal Medicine. In 2008, there was a lot of hullaballoo when Medicare and Medicaid published a new rule saying that they were no longer going to pay hospitals for treating preventable hospital acquired infections. The goal was to give hospitals and doctors a financial incentive to reduce their infection rates. It made sense to me; draining my bank account has always been a pretty good incentive for me to change my shopping habits!

But perhaps unsurprisingly to the health care professionals out there, this isn’t working out quite like they had planned. A recent analysis from the University of Michigan showed that hospitals are not correctly identifying infections in their coding/billing systems so that they can continue to get paid!

“For all adult hospital stays in Michigan in 2009, eliminating payment for [urinary tract] infections decreased hospital pay for only 25 hospital stays (0.003% of all stays).” This drastically underestimates the number of people who get infections. The CDC estimates that 560,000 catheter-associated urinary tract infections (CAUTIs) occur annually and leads to an estimated 13,000 attributable deaths each year.  

Doctor in Hospital

When this program was originally announced, Medicare expected savings of $20 million annually and Medicaid estimated a further savings on their side of $35 million over 5 years. The savings was expected to come from reduced reimbursements for ten “never events” including UTIs and pressure ulcers. It is now clear that this is NOT going to happen without a major change within hospital systems.

“The policy was well intended but its financial savings from non-payment for catheter-associated UTIs are negligible because of the data used to implement the policy,” says author Jennifer Meddings, MD, MSc, an assistant professor in the Department of Internal Medicine, Division of General Medicine at U-M Medical School.

But why should this matter to you? There are lots of reasons, but the top three are below:

  1. You or someone you know may be at risk of a UTI right now. Over half a million patients develop a catheter-associated urinary tract infection (CAUTI) in a U.S. hospital each year.

  2. You’re paying for it. The Government funds Medicare and Medicaid through my and your taxes. We are continuing to pay top dollar for lower quality care.

  3. It’s about to get worse. Effective 2015, Medicare is going to start penalizing hospitals with high infection rates. Sounds like a good idea, right? The problem is that they are using data that we already know is wrong. In effect, this new policy is going to disproportionately penalize hospitals who are declaring their infections correctly and allow hospitals that skirt the system to benefit even more. That hardly sounds fair, does it?

The best thing we can do as consumers is insist that hospitals report their infection rates honestly so that patients can make informed decisions and know what they’re getting for their money! So the next time you’re in the hospital, stay away from the Foley. Ask for alternatives and make your infection concerns known to the doctors and nurses. Demand better!

(And just a little shameless self promotion to the men reading this, there are better urinary management options out there. An indwelling catheter isn’t always the best answer –talk to your doctor about alternatives like Men’s Liberty.)

 

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Topics: urinary management, bladder control, external catheter for men, spinal cord injury, urinary tract infections, nursing, hospital acquired infections

Are you turning into Nurse Ratched? Nurse Burnout & Infections

Posted by Sarah Woodward

Oct 8, 2012 10:56:00 AM

Caregiver burnout is a well documented phenomenon and it is something we’ve talked about here in this blog. Well intentioned, hardworking, dedicated cargivers struggle on a daily basis to provide the best possible care and quality of life to their loved ones. It's overwhelming, emotionally draining and physically exhausting. Well, it turns out that it applies to nurses just as much – and we have the study to prove it!


A new article in the American Journal of Infection Control, by Jeannie Cimiotti RN et al., shows that there is a “significant association between patient-to-nurse ratio and urinary tract infections.” According to the authors, if Pennsylvania hospitals reduced burnout by 30% they would have 4,006 fewer urinary tract infections and see an annual cost saving of $3.3 million.

Cimiotti and her colleagues looked at data from over 7,000 nurses working in 161 hospitals in Pennsylvania. On average, each nurse cared for 5.7 patients and more than 30% of nurses reported job related burnout. Overall, 16 of every 1,000 patients acquired an infection; and the single most common infection was urinary tract infections. They also discovered that the addition of a single patient per nurse increased infection rates by a full point per thousand.

“Fewer infections were seen in hospitals in which nurses cared for fewer patients… [at least in part because] high nurse burnout [is] associated with heavier patient caseloads.” The authors suggested one possible explanation, saying: “the cognitive detachment associated with high levels of burnout may result in inadequate hand hygiene practices and lapses in other infection control procedures.”

The lesson: We need to invest more in reducing nurse burnout and patient caseloads. Investing more in staffing, education, performance feedback and support services will pay dividends throughout the system.

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One of the study's authors, Dr. Linda Aiken suggested that "it's a great time for hospitals to implement evidence-based staffing standards." The good news is that there are some pioneering states leading the charge. In California, the legislature has established minimum requirements for safe staff ratios. A supporting study funded by the Agency for Healthcare Research and Quality (AHRQ), discovered that hospitals with an effective nurse-to-patient ratio had lower rates of adverse patient outcomes (just like the study we looked at above).

Urinary tract infections are only one of many types of hospital acquired infections (HAI) which can be linked to nurse burnout. HAIs kill nearly 100,000 people every year. There’s usually a lot of hand-wringing when these kinds of statistics get published and lots of new transformative initiatives that never seem to go anywhere. One question the healthcare industry has had trouble answering is why simple solutions – like washing your hands or using newer, better products like Men’s Liberty – don’t always get implemented.

And just maybe, this is one of the reasons – health care professionals like nurses are suffering under the crushing weight of a  “do more with less” philosophy that is literally killing people.

What do you think?

 

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Topics: urinary management, external catheter for men, Caregiving, urinary tract infections, nursing