Tips to help avoid a preventable return trip to the hospital

Patients too often leave the hospital without knowing how to care for themselves, leading to a preventable return. Here are tips to improve your chances of a successful recovery at home:

Be sure you understand your illness, and the care you received in the hospital.

Ask if you will require help at home. Can you bathe yourself? Climb stairs? Will you need bandages changed or shots? If so, do you have a caregiver to help, or will you need to arrange a visiting nurse?

Repeat back your care instructions to those who give them, to be sure you understand them.

Ask for a written discharge plan that lists your medical conditions, your treatments, and the plan for your ongoing care.

Get a list of all medications, how to use them, and what to do if you experience side effects. Be sure to ask whether to continue medications you were taking before this hospitalization.

Ask what symptoms suggest you’re getting worse and what to do if that happens, especially at night or during the weekend.

What follow-up appointments will you need and when? Ask if your hospital will make the appointments for you, and send your records.

Do you have transportation home, to follow-up appointments, and to the drugstore?

If you have a regular physician, make sure the hospital sends a report of your hospital stay.

If you are uninsured or will have difficulty affording prescriptions, a hospital discharge planner or social worker may be able to link you to community resources that can help.

Get a name and number to call if questions about your hospitalization or discharge arise.

Sources: The Associated Press; Dr. Eric Coleman, University of Colorado; Robert Wood Johnson Foundation; Journal of the American Medical Association.

Patients too often leave the hospital without knowing how to care for themselves, leading to a preventable return. Here are tips to improve your chances of a successful recovery at home:

Be sure you understand your illness, and the care you received in the hospital.

Ask if you will require help at home. Can you bathe yourself? Climb stairs? Will you need bandages changed or shots? If so, do you have a caregiver to help, or will you need to arrange a visiting nurse?

Repeat back your care instructions to those who give them, to be sure you understand them.

Ask for a written discharge plan that lists your medical conditions, your treatments, and the plan for your ongoing care.

Get a list of all medications, how to use them, and what to do if you experience side effects. Be sure to ask whether to continue medications you were taking before this hospitalization.

Ask what symptoms suggest you’re getting worse and what to do if that happens, especially at night or during the weekend.

What follow-up appointments will you need and when? Ask if your hospital will make the appointments for you, and send your records.

Do you have transportation home, to follow-up appointments, and to the drugstore?

If you have a regular physician, make sure the hospital sends a report of your hospital stay.

If you are uninsured or will have difficulty affording prescriptions, a hospital discharge planner or social worker may be able to link you to community resources that can help.

Get a name and number to call if questions about your hospitalization or discharge arise.

Sources: The Associated Press; Dr. Eric Coleman, University of Colorado; Robert Wood Johnson Foundation; Journal of the American Medical Association.

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Prescription-painkiller epidemic is spurred by societal shift, experts say: People think every problem has a pill for an answer

By Molly Burchett
Kentucky Health News

The prescription-painkiller epidemic stems partly from an evolution of society's views toward pain and how to deal with it, said experts at "The Different Faces of Substance Abuse" conference in Lexington Jan. 23-24.

"The entire society's viewpoint of pain and the management of pain has completed shifted," said Dr. Ryan Stanton, an emergency physician and conference panelist.

Pain is considered the fifth vital sign, after temperature, pulse, blood pressure and respiratory rate, but it is the only sign that is subjective, which complicates the problem, said Stanton, because patient satisfaction is associated with the amount of drugs the provider prescribes. If an emergency-room doctor suggests exercise to combat back pain, he said the patient's reaction might be, "You might as well ask a man to deliver a baby."

The substance-abuse problem shouldn't be laid at the feet of prescribers because patients think there is a pill out there for every problem when sometimes the answer is non-prescription ibubrofen and an ice pack, said Van Ingram, executive director of the state Office of Drug Control Policy.

"This is a complicated issue," Ingram said. "It's easy to be against heroin, and it's easy to be against cocaine. But prescription opioids are things that many people need to live and need to improve their quality of life at the end of life."

Patients need to understand how much a doctor can or should do, said Dr. Helen Davis, conference panelist and chair of the Gov. Steve Beshear's KASPER Advisory Council. "Patients come in to the doctor's office expecting a silver bullet . . . but when looking at pain, the goal isn't to make the patient pain-free," she said. "The goal is to reduce the pain enough that they can have systematic and functional relief to go about their daily living."

Davis said doctors and nurses must change their culture to become more collaborative with the patient to address the non-pharmacological management of pain. There are some things that are the responsibility of the provider and there are some things that are the patients', families' and communities' responsibility, she said, adding that all professionals must look at their interdisciplinary responsibility to the people of the state.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

By Molly Burchett
Kentucky Health News

The prescription-painkiller epidemic stems partly from an evolution of society's views toward pain and how to deal with it, said experts at "The Different Faces of Substance Abuse" conference in Lexington Jan. 23-24.

"The entire society's viewpoint of pain and the management of pain has completed shifted," said Dr. Ryan Stanton, an emergency physician and conference panelist.

Pain is considered the fifth vital sign, after temperature, pulse, blood pressure and respiratory rate, but it is the only sign that is subjective, which complicates the problem, said Stanton, because patient satisfaction is associated with the amount of drugs the provider prescribes. If an emergency-room doctor suggests exercise to combat back pain, he said the patient's reaction might be, "You might as well ask a man to deliver a baby."

The substance-abuse problem shouldn't be laid at the feet of prescribers because patients think there is a pill out there for every problem when sometimes the answer is non-prescription ibubrofen and an ice pack, said Van Ingram, executive director of the state Office of Drug Control Policy.

"This is a complicated issue," Ingram said. "It's easy to be against heroin, and it's easy to be against cocaine. But prescription opioids are things that many people need to live and need to improve their quality of life at the end of life."

Patients need to understand how much a doctor can or should do, said Dr. Helen Davis, conference panelist and chair of the Gov. Steve Beshear's KASPER Advisory Council. "Patients come in to the doctor's office expecting a silver bullet . . . but when looking at pain, the goal isn't to make the patient pain-free," she said. "The goal is to reduce the pain enough that they can have systematic and functional relief to go about their daily living."

Davis said doctors and nurses must change their culture to become more collaborative with the patient to address the non-pharmacological management of pain. There are some things that are the responsibility of the provider and there are some things that are the patients', families' and communities' responsibility, she said, adding that all professionals must look at their interdisciplinary responsibility to the people of the state.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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Northern Kentucky included in Medicaid's pilot program to increase data about quality of health care

The Health Improvement Collaborative of Greater Cincinnati, which includes much of Northern Kentucky, is included as one of three regions to participate in a program designed to bolster availability of information about doctors, hospitals and health care providers, the federal Centers for Medicare & Medicaid Services has announced. According to the Robert Wood Johnson Foundation, the new program will match private data with Medicare claims data to create comprehensive reports on provider performance.  The other two organizations selected are Kansas City Quality Improvement Consortium and the Oregon Health Care Quality Corporation.

The program will place quality markers on those receiving Medicare claims data. For example, they must show that they can manage and process consumer-focused data, can prevent breaches of protected health information and that they are working with private insurers in order to produce comprehensive reports on provider performance. The program is also intended to protect patient privacy, enforcing strong penalties if Medicare data is misued.
(Read more)

The Health Improvement Collaborative of Greater Cincinnati, which includes much of Northern Kentucky, is included as one of three regions to participate in a program designed to bolster availability of information about doctors, hospitals and health care providers, the federal Centers for Medicare & Medicaid Services has announced. According to the Robert Wood Johnson Foundation, the new program will match private data with Medicare claims data to create comprehensive reports on provider performance.  The other two organizations selected are Kansas City Quality Improvement Consortium and the Oregon Health Care Quality Corporation.

The program will place quality markers on those receiving Medicare claims data. For example, they must show that they can manage and process consumer-focused data, can prevent breaches of protected health information and that they are working with private insurers in order to produce comprehensive reports on provider performance. The program is also intended to protect patient privacy, enforcing strong penalties if Medicare data is misued.
(Read more)

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Infections, other safety issues plague hospitals, maybe more so when nursing is cut; here's a good series on it

The Centers for Disease Control has reported that nearly 1 million patient-safety incidents, including infections that patients acquired in hospitals, occurred among Medicare patients over the years 2006, 2007, 2008. In all, the incidents -- which represented 2.3 percent of Medicare admissions -- were associated with $8.9 billion in costs. One of every 10 patients involved died as a result, the "HealthGrades Patient Safety in American Hospitals" study reported.

Financially squeezed hospitals should be careful about reducing nursing staff, because the fewer such staff they have, the more likely they are to have a patient-safety incident, says Kevin Kavanagh, a Somerset doctor and board chairman of Health Watch USA, in "Moving Healthcare Quality Forward with Nursing-Sensitive Value-Based Purchasing," an article in the Journal of Nursing Scholarship. Kavanagh explains that research has shown that adverse events in hospitals and any subsequent mortality "are highly dependent on nurse staffing levels and skill mix." He cites studies in which nurse staffing levels were a clear indicator of whether or not patient-safety accidents or "sentinel" events occurred. (Examples of "sentinel" events include falls, pressure ulcers, urinary tract infections, postoperative infections, pneumonia, upper gastrointestinal bleeding, shock and cardiac arrest.)

Kavanagh's article notes that nursing is at serious risk from being cut in cost-driven healthcare delivery systems. He is quick to point out the dangers and financial costs of making that cut. (To read the study, go here.)

So, how to report on this issue? In 2011, The Las Vegas Sun revealed that during the second half of 2009 area hospitals had reported 44 preventable hospital injuries or hospital-acquired infections when, in fact, those facilities had experienced 342 such events. That revelation led the paper's staff to take on the issue of hospital accountability in an award-winning five-part series, "Do No Harm: Hospital Care in Las Vegas." When all was said and done, the newspaper not only unearthed repeated incidences where the hospitals' own records did not reconcile with what they reported to the state, but showed lawmakers and health-care professionals how to properly disclose the incidence of patient infection and accidents. Their work eventually forced Nevada lawmakers to pass legislation that requires hospital records in two of the state's largest counties to be transparent, consumer-friendly and readily available on the state's Health and Human Services Department website. (To read their remarkable work, go here.)

Health Watch USA will host its annual conference in Lexington on Nov. 9 at The Four Points Sheraton, 1938 Stanton Way. Cost is $35 including lunch. Over 6 hours of continuing education credits have been approved for doctors, nurses, physical therapists, occupational therapists and human resource managers  For more information or registration, go to www.healthconference.org.

The Centers for Disease Control has reported that nearly 1 million patient-safety incidents, including infections that patients acquired in hospitals, occurred among Medicare patients over the years 2006, 2007, 2008. In all, the incidents -- which represented 2.3 percent of Medicare admissions -- were associated with $8.9 billion in costs. One of every 10 patients involved died as a result, the "HealthGrades Patient Safety in American Hospitals" study reported.

Financially squeezed hospitals should be careful about reducing nursing staff, because the fewer such staff they have, the more likely they are to have a patient-safety incident, says Kevin Kavanagh, a Somerset doctor and board chairman of Health Watch USA, in "Moving Healthcare Quality Forward with Nursing-Sensitive Value-Based Purchasing," an article in the Journal of Nursing Scholarship. Kavanagh explains that research has shown that adverse events in hospitals and any subsequent mortality "are highly dependent on nurse staffing levels and skill mix." He cites studies in which nurse staffing levels were a clear indicator of whether or not patient-safety accidents or "sentinel" events occurred. (Examples of "sentinel" events include falls, pressure ulcers, urinary tract infections, postoperative infections, pneumonia, upper gastrointestinal bleeding, shock and cardiac arrest.)

Kavanagh's article notes that nursing is at serious risk from being cut in cost-driven healthcare delivery systems. He is quick to point out the dangers and financial costs of making that cut. (To read the study, go here.)

So, how to report on this issue? In 2011, The Las Vegas Sun revealed that during the second half of 2009 area hospitals had reported 44 preventable hospital injuries or hospital-acquired infections when, in fact, those facilities had experienced 342 such events. That revelation led the paper's staff to take on the issue of hospital accountability in an award-winning five-part series, "Do No Harm: Hospital Care in Las Vegas." When all was said and done, the newspaper not only unearthed repeated incidences where the hospitals' own records did not reconcile with what they reported to the state, but showed lawmakers and health-care professionals how to properly disclose the incidence of patient infection and accidents. Their work eventually forced Nevada lawmakers to pass legislation that requires hospital records in two of the state's largest counties to be transparent, consumer-friendly and readily available on the state's Health and Human Services Department website. (To read their remarkable work, go here.)

Health Watch USA will host its annual conference in Lexington on Nov. 9 at The Four Points Sheraton, 1938 Stanton Way. Cost is $35 including lunch. Over 6 hours of continuing education credits have been approved for doctors, nurses, physical therapists, occupational therapists and human resource managers  For more information or registration, go to www.healthconference.org.

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Pill-mill bill causing problems for patients who have long-term prescriptions: expensive drug-screening tests

In July, Kentucky started making long-time holders of certain controlled-substances prescriptions submit to urine tests to determine if they were actually taking the drugs, rather than selling them. Because insurance companies don't consider the tests medically necessary, patients often have to pay for them out of pocket. It can be expensive, reports John Cheves of the Lexington Herald-Leader, citing one couple that had to pay $533.

The tests are required under emergency regulations issued to implement House Bill 1, the "pill mill bill," and Gov. Steve Beshear has said he understands the financial burden the tests can bring on those who are not abusing prescriptions. Changes could happen in January when the emergency regulations expire and are replaced with permanent rules, Cheves reports. The Kentucky Medical Licensure Board is hearing complaints, and has extended a grace period for compliance for doctors until Nov. 1.

"But critics say they warned last spring that HB 1 — intended to crack down on the illicit sale of prescription drugs — would treat everyone like a potential felon, including doctors and patients engaged in legitimate medical care," Cheves reports. Much debate about the bill has revolved around its implication on doctors, with little attention paid to patients. Cheves reports that soon may change.

Under the law, doctors are required to get an initial urine test from patients who have long-term controlled substance prescriptions. They must also get random drug tests once a year for "low-risk" patients who are most unlikely to abuse drugs based on test results, and three times a year for "high risk" patients. The amount of people requiring drug tests is "likely to be in the tens of thousands," Cheves reports. (Read more)

In July, Kentucky started making long-time holders of certain controlled-substances prescriptions submit to urine tests to determine if they were actually taking the drugs, rather than selling them. Because insurance companies don't consider the tests medically necessary, patients often have to pay for them out of pocket. It can be expensive, reports John Cheves of the Lexington Herald-Leader, citing one couple that had to pay $533.

The tests are required under emergency regulations issued to implement House Bill 1, the "pill mill bill," and Gov. Steve Beshear has said he understands the financial burden the tests can bring on those who are not abusing prescriptions. Changes could happen in January when the emergency regulations expire and are replaced with permanent rules, Cheves reports. The Kentucky Medical Licensure Board is hearing complaints, and has extended a grace period for compliance for doctors until Nov. 1.

"But critics say they warned last spring that HB 1 — intended to crack down on the illicit sale of prescription drugs — would treat everyone like a potential felon, including doctors and patients engaged in legitimate medical care," Cheves reports. Much debate about the bill has revolved around its implication on doctors, with little attention paid to patients. Cheves reports that soon may change.

Under the law, doctors are required to get an initial urine test from patients who have long-term controlled substance prescriptions. They must also get random drug tests once a year for "low-risk" patients who are most unlikely to abuse drugs based on test results, and three times a year for "high risk" patients. The amount of people requiring drug tests is "likely to be in the tens of thousands," Cheves reports. (Read more)

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