Friday, February 18, 2011

Hippa Form

Authorization for Use of Protected Health Information (Hippa Release) Page 1 of 2

Name of Hospital/Doctor: _________________________________________________

Hospital/Doctor Address: ______________________________________________________

Patient Name: Phone Number:

Date of Birth: Patient Record # (or SS #):


1. I authorize the above medical facility to disclose my health information specific to the following date or time period: To .

2. Name and address of individual or entity authorized to receive my health information:

3. The purpose for which disclosure is to be made: for use in a legal proceeding.

4. Information to be disclosed (check all applicable):

__Abstract __History and Physical Exam __Operative Report
__Admission Summary __Consultation __Laboratory Report
__Pathology Report __Radiology Reports
__EKG __Emergency Dept. Record __Discharge Summary
__ Entire Medical Record __Other:____________

5. To the extent applicable, I understand that my medical record may contain information that is considered sensitive under law. My check marks below indicate that I do not permit information of this time, if it exists, to be released. I understand that if I do not check the box, the above medical provider will release such information about me if it exists, including all healthcare information inclusive of alcohol, drug abuse, HIV testing, psychiatric notes, venereal disease and/or other sensitive related information.

__HIV/AIDS infection __Sexually TransmittedDiseases
__Mental/Psychiatric Health __Treatment for Alcohol And/or Drug Abuse

6. I understand that my records are protected under the federal privacy laws and regulations and under the general laws of the state of Massachusetts, and cannot be disclosed without by written consent except as otherwise specifically provided by law.

7. I understand that if the persons or entities that receive the information is not a healthcare provider or health plan covered by federal privacy regulations, the information described above may be disclosed and is no longer protected by those regulations. Therefore I release the above Hospital, Doctor or healthcare facility, its employees and my physicians from all liability arising from this disclosure of my health information.

8. It is my understanding that this authorization will expire 90 days from the day signed below. I understand that I may revoke this authorization by notifying, in writing, at any time. I understand that any previously disclosed information would not be subject to my revocation request.

Page 2 of 2

9. I understand that I may refuse to sign this authorization and that my refusal to sign will not affect my ability to obtain treatment, payment for my eligibility for benefits, unless otherwise described in the space provided here_________________________________


This form must be completed in full before signing.

________________________________ _______ ___________________________
(or Legal Representative) Date

____________________________ _____________________
Print Name of Legal Representative Relationship to Patient
(if applicable)

Guide to Nursing Home Care

Wednesday, February 16, 2011

Death of nursing home liability bill

Mississippi -

Just like last year, legislation that would have required nursing homes to carry a minimum $500,000 in liability insurance died.

Just like last year, the Mississippi HealthCare Association argued that legislation mandating minimum liability insurance for the state's nursing homes, personal care homes and assisted living facilities was unnecessary.

But unlike last year, the legislation that would have made the nursing homes carry such insurance died in the House rather than the Senate. In 2010, the legislation sailed through the House only to die in the Senate Insurance Committee.

But this year, the bill passed the House Insurance Committee by unanimous vote only to die in the full House. A number of House members who supported the measure in 2010 voted against it this year. Go figure.

The legislation would have required non-government nursing homes to carry the same $500,000 in liability coverage that government nursing homes carry. Nursing homes owned by county hospitals or other entities covered by the State Tort Claims Board are covered for legal claims up to the statutory cap of $500,000 if a jury finds that a patient has been abused, neglected or otherwise sufficiently harmed in a covered facility.

Yet a number of private nursing homes in Mississippi do not carry liability insurance sufficient to cover claims up to the statutory cap.

Some carry so-called "eroding" policies that take the nursing home's legal fees and other court costs out of the available liability insurance before a victim is compensated.

Is that fair to vulnerable patients in those private facilities? Is it fair for them to have paid taxes or have families paying taxes that subsidize the public nursing homes' tort claim coverage while the laws allow private nursing homes to be uninsured or underinsured for the very same offenses against the elderly? No.

My sisters and I had to make the painful decision to place our late parents in the care of such facilities here in Mississippi. My folks were fortunate. The people we paid to care for them when we could no longer care for them treated them with respect and compassion. That's the way it is in most of Mississippi's nursing homes, but surely not in all of them.

Nursing home abuse happens in Mississippi like it happens in the rest of the country - physical abuse, sexual abuse and financial abuse. There are some 16,000 Mississippians in Mississippi's skilled nursing facilities and that number will increase exponentially as 78 million Baby Boomers age.

In the tort reform fight, Mississippi lawmakers capped tort liability damages at $500,000.

Again, the minimum nursing home liability insurance that lawmakers are rejecting requires non-government nursing homes to carry the same $500,000 in liability coverage that government nursing homes carry under the Tort Claims Act.

But it seems that some Mississippi nursing homes don't carry enough liability insurance even to cover those damage caps if a vulnerable elderly person is injured, mistreated or abused while in their care.

The pure logic of lawmakers rejecting that legislation evades me.

The nursing homes and the insurance companies got the "tort reform" caps they sought. Now, the elderly deserve some accountability from those same entities.

Strange that we require liability insurance for cars but not nursing homes. Are our cars more valuable than our mothers and fathers?

Death of nursing home liability bill an insult to patients | | The Clarion-Ledger

Sunday, February 13, 2011

Fall Prevention and accidents FTAG 323

§483.25(h) Accidents.
The facility must ensure that –
(1) The resident environment remains as free from accident hazards as is possible; and
(2) Each resident receives adequate supervision and assistance devices to prevent accidents.

The intent of this requirement is to ensure the facility provides an environment that is free from accident hazards over which the facility has control and provides supervision and assistive devices to each resident to prevent avoidable accidents. This includes:
• Identifying hazard(s) and risk(s);
• Evaluating and analyzing hazard(s) and risk(s);

• Implementing interventions to reduce hazard(s) and risk(s); and
• Monitoring for effectiveness and modifying interventions when necessary.

Definitions are provided to clarify terms related to providing supervision and other interventions to prevent accidents.
• “Avoidable Accident” means that an accident occurred because the
facility failed to:
- Identify environmental hazards and individual resident risk of an accident, including the need for supervision; and/or
- Evaluate/analyze the hazards and risks; and/or
- Implement interventions, including adequate supervision, consistent with a resident’s needs, goals, plan of care, and current standards of practice in order to reduce the risk of an accident; and/or
- Monitor the effectiveness of the interventions and modify the interventions as necessary, in accordance with current standards of practice.
“Unavoidable Accident” means that an accident occurred despite
facility efforts to:
- Identify environmental hazards and individual resident risk of an accident, including the need for supervision; and
- Evaluate/analyze the hazards and risks; and
- Implement interventions, including adequate supervision, consistent with the resident’s needs, goals, plan of care, and current standards of practice in order to reduce the risk of an accident; and
- Monitor the effectiveness of the interventions and modify the interventions as necessary, in accordance with current standards of practice.

• “Assistance Device” or “Assistive Device” refers to any item (e.g., fixtures such
as handrails, grab bars, and devices/equipment such as transfer lifts, canes, and wheelchairs, etc.) that is used by, or in the care of a resident to promote, supplement, or enhance the resident’s function and/or safety.
• “Hazards” refer to elements of the resident environment that have the potential to cause injury or illness.
o “Hazards over which the facility has control” are those hazards in the resident environment where reasonable efforts by the facility could influence the risk for resulting injury or illness.
o “Free of accident hazards as is possible” refers to being free of accident hazards over which the facility has control.
• “Resident environment” includes the physical surroundings to which the resident has access (e.g., room, unit, common use areas, and facility grounds, etc.).
• “Risk” refers to any external factor or characteristic of an individual resident that influences the likelihood of an accident.
• “Supervision/Adequate Supervision” refers to an intervention and means of mitigating the risk of an accident. Facilities are obligated to provide adequate supervision to prevent accidents. Adequate supervision is defined by the type and frequency of supervision, based on the individual resident’s assessed needs and identified hazards in the resident environment. Adequate supervision may vary from resident to resident and from time to time for the same resident.

Numerous and varied accident hazards exist in everyday life. The frailty of some residents increases their vulnerability to hazards in the resident environment and can result in life threatening injuries. It is important that all facility staff understand the facility’s responsibility, as well as their own, to ensure the safest environment possible for residents.
The facility is responsible for providing care to residents in a manner that helps promote quality of life. This includes respecting residents’ rights to privacy, dignity and self determination, and their right to make choices about significant aspects of their life in the facility.
For various reasons, residents are exposed to some potential for harm. Although hazards should not be ignored, there are varying degrees of potential for harm. It is reasonable to accept some risks as a trade off for the potential benefits, such as maintaining dignity, self-determination, and control over one’s daily life. The facility’s challenge is to balance protecting the resident’s right to make choices and the facility’s responsibility to comply with all regulations.
The responsibility to respect a resident’s choices is balanced by considering the potential impact of these choices on other individuals and on the facility’s obligation to protect the residents from harm. The facility has a responsibility to educate a resident, family, and staff regarding significant risks related to a resident’s choices. Incorporating a resident’s choices into the plan of care can help the facility balance interventions to reduce the risk of an accident, while honoring the resident’s autonomy.
Consent by resident or responsible party alone does not relieve the provider of its responsibility to assure the health, safety, and welfare of its residents, including protecting them from avoidable accidents. While Federal regulations affirm the resident’s right to participate in care planning and to refuse treatment, the regulations do not create the right for a resident, legal surrogate, or representative to demand the facility
use specific medical interventions or treatments that the facility deems inappropriate. The regulations hold the facility ultimately accountable for the resident’s care and safety. Verbal consent or signed consent forms do not eliminate a facility’s responsibility to protect a resident from an avoidable accident.
An effective way for the facility to avoid accidents is to commit to safety and implement systems that address resident risk and environmental hazards to minimize the likelihood of accidents.2, 3 A facility with a commitment to safety:
• Acknowledges the high-risk nature of its population and setting;
• Develops a reporting system that does not place blame on the staff member for reporting resident risks and environmental hazards;
• Involves all staff in helping identify solutions to ensure a safe resident environment
• Directs resources to address safety concerns; and
• Demonstrates a commitment to safety at all levels of the organization. A SYSTEMS APPROACH
Establishing and utilizing a systematic approach to resident safety helps facilities comply with the regulations at 42 CFR §483.25(h)(1) and (2). Processes in a facility’s system approach may include:
• Identification of hazards, including inadequate supervision, and a resident’s risks of potentially avoidable accidents in the resident environment;
• Evaluation and analysis of hazards and risks;
• Implementation of interventions, including adequate supervision and assistive devices, to reduce individual risks related to hazards in the environment; and
• Monitoring for effectiveness and modification of interventions when necessary.

For nurses, it’s a constant dash to respond to alarms

For nurses, it’s a constant dash to respond to alarms
By Liz Kowalczyk
Globe Staff / February 13, 2011
E-mail this article To: Invalid E-mail address Add a personal message:(80 character limit) Your E-mail: Invalid E-mail address Sending your articleYour article has been sent.
E-mail|Print|Reprints|Comments (2)Text size – + Logan’s cardiac monitor flashed a red crisis alarm and broadcast a fast, high-pitched beeping, a piercing sound that reached his nurse, Tammy Dillon, in the hallway.

Logan was fine. His pumping legs had triggered the crisis alarm again.

The red alarm is the most urgent, meant to alert nurses to a dangerously slow or fast heart rate, abnormal heart rhythm, or low blood oxygen level. But on this morning in the 42-bed cardiac unit at Children’s Hospital Boston, infants and preschoolers activated red alarms by eating, burping, and cutting and pasting paper for an arts and crafts project.

All morning long, nurses heard — and responded to — constant beeping, dinging, and chiming; some kind of alarm sounded at least every minute.

Nurses know that a large percent of patient monitor alarms are false — triggered by movement, a poor connection, or some other factor — but they still must listen carefully to each one and react quickly in case a patient really requires immediate medical attention. Given the almost overwhelming number of alarms going off, nurses, doctors, and health care leaders are concerned about staff in hospitals across the United States becoming desensitized to the noise, a phenomenon called alarm fatigue.

“Children move a lot, and that creates lots of false alarms,’’ said Dillon, a nurse at Children’s since 1996. But “if you have an alarm that is real, a sick child goes down very fast. You never want to be the person responsible for a delay in care.’’

In the case of Logan Narolis of Williamstown, N.Y. — who had surgery at Children’s for a heart defect — the movement of his legs interrupted the oxygen level signal on his monitor.

Children’s is working with engineers at MIT to develop more sophisticated monitors that better identify true crises, with fewer false alerts.

On another morning at nearby Beth Israel Deaconess Medical Center, the 10 nurses caring for 35 patients on Clinical Center 7 responded to all manner of warnings — abnormal heart rate alarms, arrhythmia alarms, bed and chair alarms warning that fragile patients might be getting up, patient call bells, intravenous medication pump alarms, and emergency alarms in patient rooms.

Each has its own unique noise, speed, and pitch — the most urgent are, by design, the most annoying — differences barely discernible to visitors but second nature for nurses. The most serious alarms also scroll across signs in hallways or are sent to nurses’ pagers.

Nurse Sylvia LaRocca was caring for a patient whose cardiac monitor blared a low-heart-rate alarm every few minutes — each time pulling LaRocca away from other patients and into the woman’s room. In every instance, the patient was fine, alert, and breathing well. The hospital’s monitors are programmed to set off an alarm when a patient’s heart rate falls below 40 beats per minute. Doctors had lowered the limit on this patient’s monitor to 34, but her slower-than-normal heart, which dipped down to 31, was still triggering the alarm. Now doctors were debating whether to lower the parameters again.

“You have to respond to the alarm, you have to do it,’’ LaRocca said. “But there are some days when you feel you’re just running from alarm to alarm. It can be exasperating.’’

Dr. Julius Yang, medical director for the unit, said it’s a dilemma. Doctors could risk the patient’s safety if they made her monitor less sensitive, but if they don’t, they run the risk of desensitizing the nurses.

“I worry about alarm fatigue quite a bit,’’ he said. “The problem is, when is real real?’’

For nurses, it’s a constant dash to respond to alarms - The Boston Globe

Patient alarms often unheard, unheeded

Fresh from surgery, the patient was wheeled into the intensive care unit and immediately hooked up to a cardiac monitor that would alert nurses to a crisis. Sometime during the following days, though, the cables running from her chest to the machine slipped loose.

The monitor repeatedly sounded an alarm — a low-pitched beep. But on that January night two years ago, the nurses at St. Elizabeth’s Medical Center in Brighton didn’t hear the alarm, they later said. They didn’t discover the patient had stopped breathing until it was too late.

At Tobey Hospital in Wareham, nurses failed to heed a different type of warning on a September morning in 2008. An elderly man’s electrocardiogram displayed a “flat line’’ for more than two hours because the battery in his heart monitor had died. While nurses checked on him, no one changed the battery. The man suffered a heart attack and was found unresponsive and without a pulse.

These were just two of more than 200 hospital patients nation wide whose deaths between January 2005 and June 2010 were linked to problems with alarms on patient monitors that track heart function, breathing, and other vital signs, according to an investigation by The Boston Globe. As in these two instances, the problem typically wasn’t a broken device. In many cases it was because medical personnel didn’t react with urgency or didn’t notice the alarm.

They call it “alarm fatigue.’’ Monitors help save lives, by alerting doctors and nurses that a patient is — or soon could be — in trouble. But with the use of monitors rising, their beeps can become so relentless, and false alarms so numerous, that nurses become desensitized — sometimes leaving patients to die without anyone rushing to their bedside. On a 15-bed unit at Johns Hopkins Hospital in Baltimore, staff documented an average of 942 alarms per day — about 1 critical alarm every 90 seconds.

In some cases, busy nurses have not heard or ignored alarms warning of failing batteries or other problems not considered life-threatening. But even the highest-level crisis alarms, which are typically faster and higher-pitched, can go unheeded. At one undisclosed US hospital last year, manufacturer Philips Healthcare, based in Andover, found that one of its cardiac monitors blared at least 19 dangerous-arrhythmia alarms over nearly two hours but that staff, for unexplained reasons, temporarily silenced them at the central nursing station without “providing therapy warranted for this patient.’’ The patient died, according to Philips’s report to federal officials.

In other instances, staff have misprogrammed complicated monitors or forgotten to turn them on.

Patient alarms often unheard, unheeded - The Boston Globe