Medicare Nonpayment, Hospital Falls, and Unintended Consequences

Inouye, Sharon K.; Brown, Cynthia J.; Tinetti, Mary E.

doi:10.1056/nejmp0900963

Cited by 224 publications

(170 citation statements)

References 4 publications

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“…(4) In addition, falls in LTC seniors are very costly. They result in more injuries, longer hospital stays, more medico-legal issues and over USD 4000 in excess charges per hospitalization, (5) which ranges from USD 319 in minor, noninjurious falls to USD 22,368 in multi-injury falls. (6) Risk factors of falls can be divided into intrinsic and extrinsic factors.…”

Section: Introductionmentioning

confidence: 99%

Association Between Vitamin D Dosing Regimen and Fall Prevention in Long-term Care Seniors

Chua¹,

Wong

2011

Can Geri J

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IntroductionThe effectiveness of vitamin D in reducing falls among longterm care (LTC) seniors remains nonconclusive. We reviewed how vitamin D dosing regimen could affect rate of fall and number of fallers among LTC seniors.MethodsWe conducted a systematic literature review. Studies were selected by two independent reviewers based on study characteristics (age 75 or older), quality assessment (primary analysis randomized controlled trials), and outcome (rate of fall and number of fallers). Analyses of all trials following trials using daily standard dosage (800–1000 IU) only were performed to compare daily standard dosage with intermittent supratherapeutic dosage in fall prevention.ResultsSeventy-nine studies were identified, with 28 selected by reviewers (kappa 0.98), and four RCT were conducted in LTC. Daily standard dosage provides greater reduction in rate of fall by 16%, which was statistically significant. However, reduction in number of fallers remained statistically insignificant even taking dosing regimen into account.ConclusionsDaily standard dosage of vitamin D has greater benefits in reducing fall rate than that of intermittent supratherapeutic doses, but not in number of fallers. This could imply that vitamin D is useful in preventing fall recurrence rather than first fall. Prospective studies randomizing LTC seniors to different dosing regimens are warranted.

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Section: Introductionmentioning

confidence: 99%

Association Between Vitamin D Dosing Regimen and Fall Prevention in Long-term Care Seniors

Chua¹,

Wong

2011

Can Geri J

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“…The risk of fall with femoral nerve blocks (FNBs) has been cited as high as seven percent [3,4] but Memtsoudis et al [5] argued that this association may not completely be anesthesia related. Inpatient falls are categorized as "never events" by the Center for Medicare and Medicaid Services, which cost on average of $4000 per incident and are usually not reimbursed by Medicare [6,7] .…”

Section: Discussionmentioning

confidence: 99%

A Selective Anterior Obturator Nerve Block for Total Hip Arthroplasty

Yuan¹,

Meier²,

Kim³

2017

JAS

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An 83 year-old male with history of hypertension, complete heart block with a pacemaker, ankylosing spondylitis, prostate cancer, obesity and obstructive sleep apnea was scheduled for a right total hip arthroplasty (THA) for degenerative hip disease. His daily analgesic medications included oxycodone 5 milligrams (mg) every 3 hours, gabapentin 600 mg nightly, acetaminophen 650 mg every 6 hours and meloxicam 15 mg daily. A focused airway examination revealed a Mallampati III oropharyngeal exam, thyromental distance less than 6 centimeters, limited mouth opening and limited jaw protrusion. After a lengthy discussion regarding his anesthetic options, the patient elected for general endotracheal anesthesia and agreed to an obturator nerve block in the recovery room if postoperative analgesia proved difficult. The patient had taken his nightly dose of gabapentin and morning dose of acetaminophen prior to hospital arrival. In the preoperative area, he was given celecoxib 200 mg in addition as part of a comprehensive preoperative multimodal therapy.The patient was taken to the operating room where general anesthesia was induced with fentanyl 25 micrograms (mcg), propofol and succinyl choline intravenously (IV) and an endotracheal tube was placed without complication. General anesthesia was maintained with sevoflurane and a total of hydromorphone 0.8 mg IV. After successful completion of the surgery, the patient reported a pain numerical rating score (NRS) of 7/10 for generalized right hip pain upon arriving in the post anesthesia care unit (PACU). He was noted to have increased spasticity and pain with manipulation of the hip. The patient agreed to proceed with the previously consented postoperative obturator nerve block. He remained in the supine position with approximately 15 degrees of hip abduction. Skin cleansing of the medial proximal thigh and inguinal area was performed with 2% chlorhexidine and 70% isopropyl alcohol (Chloraprep). A selected obturator nerve block was performed with in-plane ultrasound-guided technique (Sonosite, M-Turbo, 6 to 15 MHz, Bothell, WA) with a 21G needle (Sonoplex). A 20-milliliter (mL) bolus of 0.5% ropivacaine was injected between the adductor longus and adductor brevis muscles to anesthetize the anterior division of the obturator nerve (Figure 1). Twenty minutes after block completion, the patient was re-evaluated. His NRS scores had decreased to 4/10 and he had significant improvement of mobility of his right hip. No opioid was given in the PACU. He was able to tolerate hip flexion and rotation without increased pain. Furthermore, hip adductions appear grossly equal bilaterally.The patient was transferred to an inpatient orthopedics floor for continued postoperative care and rehabilitation. Scheduled acetaminophen 650 every 6 hours and gabapentin 600 mg nightly was ordered. His NRS scores remained at 4/10 and required no additional opioid medication. At 11 hours post obturator nerve block, the patient received his first oral opioid dose of oxycodone 15 mg for an NRS of 6/10. On po...

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“…In this regard, the literature suggests that this symptom is preferably treated in a non-pharmacological way, considering the increased risk of falls due to the use of multiple medicines. The nurse should educate the patient about relaxation techniques, breath control, maintenance of concentration, and, only as a last resort, administer medicines [22].…”

Section: Discussionmentioning

confidence: 99%

“…Other measures involve advising the patient to get up only when assisted by a companion or health professional, scheduling time to take her/him to the bathroom, if possible; warning about the need to use devices and place them without hindering patient's mobility; advising on the use of vision or hearing correction devices; and accommodating the patient at risk of fall close to the nursing station. There nursing interventions have preventive potential and they should be prioritized when providing elderly patients with care throughout their hospital stay, because their physiological and clinical condition, non-modifiable factors, already poses risk enough to the occurrence of this event [13,22].…”

Section: Discussionmentioning

confidence: 99%

Fall prevention behavior among hospitalized elderly patients

Moura¹,

Araújo²,

Fernandes³

et al. 2016

Int Arch Med

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Purpose: This study aimed to check fall prevention behavior among elderly patients admitted to a hospital, by assessing the indicators of a nursing outcome from the "Nursing Outcomes Classification" (NOC).Methods: This is a quantitative, cross-sectional, survey conducted with elderly patients admitted to a university hospital. For collecting data, a validated instrument was applied, consisting of NOC indicators of the nursing outcome mentioned above. Results:The indicator asks for physical assistance to the patient, it was correlated to fall within the last six months, and the indicators agitation control and use of safe actions during transfer were associated with difficulty in walking. Conclusion:Fall prevention behavior by the elderly patient during hospital stay is a co-responsibility of her/his companion and the nursing team. There is a need to train nurses regarding patient safety measures, focusing on preventing falls and encouraging safe behavior among hospitalized elderly patients.

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Medicare Nonpayment, Hospital Falls, and Unintended Consequences

Cited by 224 publications

References 4 publications

Association Between Vitamin D Dosing Regimen and Fall Prevention in Long-term Care Seniors

Association Between Vitamin D Dosing Regimen and Fall Prevention in Long-term Care Seniors

A Selective Anterior Obturator Nerve Block for Total Hip Arthroplasty

Fall prevention behavior among hospitalized elderly patients

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