Free Falls Prevention Resource
Falls are among the most common adverse events encountered by home care patients. It is often difficult to persuade patients to implement recommendations to prevent falls, or protect themselves in case they do fall. The Veterans Administration's National Center for Patient Safety 2004 Falls Toolkit can help. This free, Web-based toolkit provides information on designing fall-prevention programs, interventions for patient's at risk for falls, and examples of equipment designed to protect the patient in case of a fall. In addition, patient, family, and staff education information is included. Although not specific to home care, several of the strategies can be easily adapted. http://www.patientsafety.gov/fallstoolkit/index.html
Having Trouble Determining if Hospice Services Are Right for Your Patient?
An article entitled "Hospice Referral and Care: Practical Guidelines for Clinicians" by Dr. Perry Fine and Clarinda Mac Low provides clinicians with a description of patient and clinical indications for a hospice referral. The article also explains the services included in the Medicare Hospice Benefit, and provides a discussion of issues related to appropriate timing for an end-of-life discussion. In addition, the article provides practical and tips to make the initiation of the hospice end-of-life discussion with the patient and family easier and provides CEUs, too!! To read the entire article visit:http://www.medscape.com/viewprogram/3345
Same Drug, Different Name
Pharmaceutical companies further complicate medication errors by giving the same drug different names, depending on the indication for use. Did you know that finasteride (generic) is prescribed as Propecia when used for alopecia, and as Proscar when used in the treatment of benign prostatic hyperplasia?
The Institute for Safe Medication Practices identifies cautions for other drugs such as Prozac and Sarafem: both are the same drug, fluxetine. If a patient is being treated for depression you likely will see the drug named Prozac, but if premenstrual dysphoric disorder is the patient's diagnosis, watch for Sarafem. Patients diagnosed with both conditions and being treated with Prozac and Sarafem are being doubly dosed. For more information related to preventing medication errors and generic drugs with different trade names log onto http://www.ismp.org.
NIH Panel Issues State-of-the-Science Statement on End-of-Life Care
The NIH State-of-the-Science Conference on Improving End-of-Life Care, held in late 2004, brought together national and international experts to clarify key questions regarding the definition of "end of life," the factors that influence outcomes, and future research directions for improving care at the end of life.
The panel concluded that the current Medicare hospice benefit limits the availability of the full range of interventions needed by many persons at the end of life. The panel cited the 6 month or less prognosis requirement, the forced selection of either skilled nursing or hospice care for patients entering nursing homes from hospitals, and limits on certain therapies that manage symptoms as specific problems.
A summary of the report is available on AHRQ's Web site at http://www.ahrq.gov/clinic/epcix.htm. A print copy of the summary and the full report are available by sending an e-mail to [email protected]. The archived Webcast of the conference sessions is available at http://consensus.nih.gov/.
New Osteoporosis Drug Now Covered by Medicare
In Transmittals 26 and 357 the Centers for Medicare & Medicaid Services (CMS) provides detailed guidance for billing of Forteo, a newly covered osteoporosis drug. According to Eli Lilly, the drug's manufacturer, Forteo is a synthetic of parathyroid hormone that must be administered by subcutaneous injection once daily, and is recommended to be taken for up to 24 months.
For home care, Medicare coverage of osteoporosis drugs is limited to those administered by an agency nurse to: 1 a female beneficiary who is eligible for Medicare Part B and has sustained a bone fracture that a physician certifies was related to postmenopausal osteoporosis. Also, the patient's physician must certify that the patient is unable to learn to self-administer the drug and has no willing or able caregiver to administer the drug.
Osteoporosis drugs are bundled under the home health Prospective Payment System (PPS); however, the drug's cost must be billed on a claim separately from home care services using bill type "34X" and revenue code "0636." Although the transmittals provide coverage information for osteoporosis drugs and billing instructions for both the drugs and skilled nursing visits, CMS did not address whether orders to administer daily injections for 24 months, as required for effective treatment with Forteo, would be considered to have a finite and predictable endpoint, as required to meet the intermittent nursing criteria for the Medicare home health benefit.
Is Caffeine Sabotaging Your Patient's Plan of Care?
In a Duke University study the correlation between caffeine consumption and its effect on glucose control in patients with Type 2 diabetes was assessed. Findings indicated that patients with diabetes who ingest caffeine before a meal have a more difficult time regulating both their glucose and insulin levels compared to those who avoided caffeine consumption.
Caffeine seemed to impact the digestion and of the meal and the subsequent regulation of the glucose and insulin levels. The researchers postulated that patients with diabetes who avoid caffeine may be able to improve the control of their disease. The complete article and its results can be found in Diabetes Care.
Reference
Lane, J. D., Barkauskas, C. E., Surwit, R. S., & Feinglos, M. N. (2004), Caffeine impairs glucose metabolism in type 2 diabetes. Diabetes Care, 27 (7), 2047-2048.