Nursing facilities, in many ways, house the health care system’s most vulnerable patients: those recovering from serious injury or accident; those with physical or mental disability; and those who have reached an age at which they can no longer care for themselves.
It is this vulnerability, perhaps, that makes a new report on adverse events at nursing homes so noteworthy.
Released on March 3, 2014, the report – entitled Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries – reviewed the medical records of 653 patients. Each patient in this sample group was a Medicare beneficiary, and each had been placed in a skilled nursing facility for around one month.
The report – which was released by the Office of the Inspector General of the U.S. Department of Health and Human Services – found that one third of these patients experienced an adverse medical event. Eleven percent of the 653 patients had gone through a temporary harm event – an allergic reaction, for example, in which the patient required medical intervention, but no lasting harm occurred. More concerning is the researchers’ estimate that 22 percent of all patients studied underwent a non-temporary adverse event, requiring a higher degree of medical intervention, and leading to a prolonged hospital stay or even permanent harm. Unfortunately, 1.5 percent of patients experienced an adverse medical event that directly contributed to their death.
Such a high incidence of adverse events amongst nursing facility patients is certainly cause for concern, and health care administrators and legislators are further displeased by the financial ramifications of the study’s findings. An adverse event usually means that more treatment or a return visit to the hospital is required. An unexpected adverse health event can easily send a patient to the emergency room, meaning a huge medical bill for Medicare (and the federal government) to foot. Report writers estimate that in 2011, Medicare spent US$2.8 billion on services to patients who had experienced harm while in a skilled nursing facility.
Although more than US$2 billion may seem like a lot of money, in reality it is only around 2 percent of the annual Medicare budget – a figure that has been growing every year. Medicare spending already accounts for 16 percent of the federal budget, and the non-partisan Congressional Budget Office has reported that future federal spending on Medicare is likely to rise significantly over the next 10 years, due to the rising average age in America as well as higher costs in all areas of health care.
It is quite timely, then, that the Centers for Medicare & Medicaid Services (CMS) are currently developing a new set of guidelines to better regulate oversight at nursing homes around the country. As mandated by the Affordable Care Act, CMS will establish new programs to improve staff performance and quality of care at nursing facilities. Chief at CMS Marilyn Tavenner has said that nursing facility inspectors will soon be re-trained in how to better identify and reduce adverse events at hospitals, through such means as working together with a registered nurse during mandatory inspections.
Many involved in the skilled nursing industry are hopeful that with better guidelines for care and more diligent inspections, adverse medical events can be decreased – after all, according to the Health and Human Services report, nearly two-thirds of the documented adverse events were preventable.
By preventable, researchers mean that the adverse medical event could have been avoided if the physician had more closely observed a patient’s medical records, or if common literature into that health situation had been researched, or if a discussion with fellow health care staff had been conducted. A nurse might, for example, be unable to prevent a patient’s allergic reaction to a drug never taken before; however, a patient’s sudden shoulder pain and shortness of breath should be recognizable to nursing staff as pneumothorax, or a collapsed lung. Adverse events related to medication were found to be the most preventable type of event, indicating a need for better reading and recording within a patient’s medical records.
In their conclusion and recommendations of this report, the Office of the Inspector General of Health and Human Services remarks that a reduction in adverse medical events in nursing facilities is both necessary, and possible. The Office firstly recommends that CMS works together with AHRQ (the Agency for Healthcare Research & Quality) to make and distribute a list of adverse effects that commonly occur – and encourage nursing facilities to report any events on that list. In that way, inspectors and administrators will be aware of what adverse medical events occur most, and can come up with ways to prevent them: through better staff training and oversight.
The Office of the HHS Inspector General also recommends that CMS continue its work in providing new guidelines to nursing homes, and that adverse medical events should be discussed within these quality guidelines. Hospitals and nursing facilities should be required to educate staff as to what an adverse health event entails, and should be trained on how to detect, report and avoid these events.
In their recommendations, the Office of the HHS Inspector General emphasizes the need for adverse health events to be better publicized, and encourages nursing facilities to report such events to Patient Safety Organizations. A Patent Safety Organization is an association that works to improve the quality of health care by collecting and analyzing data on medical events and patient safety – research which can help legislators and health care administrators to better understand the needs and the potential harms that patients face while in a nursing home or treatment facility. Hopefully, with better coordination both inside and outside nursing facilities, incidences of adverse medical events will see a decline in the future.