1,000 Nurses Call on Congress to Act Now on Patient Safety

Gathering Highlights Growth of National Nurses Movement

More than 1,000 registered nurses from across the country rallied in Washington DC Wednesday, raising an unprecedented, unified voice for patient safety reforms and new, national standards for patient care conditions and standards for nurses.

The event was sponsored by the nation’s largest nurses’ union and professional association, the 155,000-member National Nurses United, which came to Washington to press the case for quality of care legislation that was not part of the national healthcare bill enacted earlier this year, and to build on the unity of RNs who are NNU members from coast to coast.

In addition to a march, rally, and conference, the RNs visited nearly 100 members of Congress, prodding legislators to work on the unfinished business of healthcare reform, quality of care and patient safety. The actions coincided with National Nurses Week.

Noting recent national attention on the West Virginia mining disaster and the Gulf Coast oil spill, NNU Co-President Jean Ross, RN said that “similar accidents happen every day away from the media spotlight in U.S. hospitals and other healthcare settings. It’s time to act to protect our patients and our communities.”

"We're the voice of not only nurses but patients across the country,” said NNU Co-President Karen Higgins, RN. “When we leave this room I want everyone to remember that. When it comes time to make decisions about healthcare and people say 'leave it to the experts,' tell them 'I am the expert.' "

Among the legislative solutions are S 1031/HR 2133 that would, among other components, establish minimum ratios of nurses to patients for all U.S. hospitals, modeled after a successful California law, and S 1788/HR 2381 which would also promote nurse retention and reduce patient accidents and injuries by establishing safe patient lifting and handling policies.

Sen. Al Franken of Minnesota, author of S 1788, hosted a hearing on the bill Tuesday at which several nurses on hand for the week cited experiences that demonstrated the need for the bill.

Speaking Wednesday to an NNU rally across from the Capitol, Franken told the RNs, "You are the ones we look to for advice, comfort, expertise and care. You are tireless advocates for the country's well-being. You're the ones we trust to care for our loved ones, that's what your expertise is, and it's simply unacceptable that you're putting your own health on the line to care for patients."

"Now it's time to make sure that all nurses in all states have access to a safe workplace. One injured nurse is one too many. Employers have a fundamental obligation to put in place a safe working environment for all workers and nurses are no exception," Franken said.

Rep. Lynn Woolsey of California, speaking to the nurses, also emphasized why the bill is needed, "We don't need to create another patient in the process of caring for one."

U.S. Labor Secretary Hilda Solis, who also addressed the conference, told the nurses that more than 36,000 health care workers were injured by lifting and transferring patients, according to 2008 Bureau of Labor Statistics data. In addition, she said, 12 percent of nurses who plan to leave the profession cited back injuries as a contributing factor.

“What a waste when the career of an experienced nurse is ended years or decades too early because of an easily preventable back injury,” Solis said. “In these days of ever-rising health care costs, what a waste of money to pay workers compensation and disability for easily preventable back injuries.”

S 1031 author Sen. Barbara Boxer of California and HR 2133 author Rep. Jan Schakowsky of Illinois also spoke the NNU event about the ratio legislation which, according to a groundbreaking study from the University of Pennsylvania released last month, could have cut post-surgical patient deaths by 14 percent in New Jersey and 11 percent in Pennsylvania, two comparable states the researchers compared to California.

"We know that nurse-to-patient ratios work, and it is time to enact them around the nation. California was the testing ground and it's working," Boxer said. "Too often you are overworked because of staffing levels that are inadequate and that is unacceptable."

The Penn study, from noted researcher Linda Aiken, RN, PhD, documents “what California nurses have seen every day at the bedside since passage of the law -- safer care conditions, an enhanced quality of life for patients, and, as an added bonus, reduced burnout for nurses which mitigates the nursing shortage,” said California RN and NNU co-president Deborah Burger.

NNU is also seeking passage of HR 949/S 362 to restore equal collective bargaining rights for Veterans Affairs nurses.

Strengthening the rights of direct care RNs and their ability to more effectively advocate for patients and their colleagues, was another major theme of the NNU gathering.

"We've got to say something in a united way that tells employers it's a new day in America and RNs are going to stand up and not take it anymore," NNU Executive Director Rose Ann DeMoro said.

The RNs unanimously endorsed a resolution to establish national collective bargaining standards that notes the growing attack by many hospital employers against nurses and patient safety conditions.

The resolution notes that NNU will oppose “concessionary agreements that are injurious to our patients, our members, and our profession that undermine all represented RN contract standards” that include reductions in health coverage, pensions and other retirement security, two-tier programs for new hires, and reductions that impair patient safety.

Additionally, the resolution pledges NNU to fight for enhanced RN staffing and other improvements in patient care standards, improved retirement security for RNs, limits on the introduction of new technology that displaces RNs or RN professional judgment, and additional workplace safety measures.

Cleveland Primary Care Doctors Fired For Lack of "Productivity"

Physicians for a National Health Program
April 29, 2010


Dear PNHP board members and activists,

We're writing to call your attention to an extremely significant event in the Cleveland area, which is sadly an increasingly frequent experience of physicians working for corporate entities.

Dr. George Randt and his colleague are board-certified internists who have had a contractual relationship with St. John Medical Center covering some 2,500 patients for several years. These two doctors have excellent records with the hospital, high patient satisfaction and retention rates, and have never had an unfavorable review. Both were awarded bonuses in 2009, and Dr. Randt's contract was renewed in January of this year.

This past month they were notified by the president of their hospital, Mr. Cliff Coker, that their contracts were being terminated due to lack of productivity and their having incurred excessive overhead expense. In other words, they weren't sufficiently profit-driven. At a previous staff meeting, the staff physicians were told by the CFO to admit just "one more Medicare patient a month" to improve hospital revenues.

If you can, please join Dr. Randt, his patients, and others at a rally at St. John Medical Center, 29000 Center Ridge Road, Westlake, Ohio, this Sunday, May 2, at 1:00 p.m. to call for the reinstatement of these two physicians and for the elimination of policies which are justified solely on the basis of maximizing the profits of a health care system. Speakers at the rally include PNHP's congressional fellow, Dr. Margaret Flowers, and Dr. Carol Paris. (See the press release below for more information.)

Call Mr. Cliff Coker today and demand that these physicians be reinstated to their position. His office number is (440) 827-5008. He can also be reached by e-mailing cliff.coker@csauh.com

We welcome you to share your views that patients should come before profits with the newspapers in the area by writing a letter to the editor to the The Plain Dealer or Sun News.

Dismissing these physicians without cause, merely to maximize hospital revenues, is the embodiment of the derangement of our system of health care finance. This was done without any semblance of due process. The livelihood and status of skilled professionals are being sacrificed to assure profitability; this is rapidly becoming the norm within our profit-driven system. As a result, it poses the gravest threat to professionalism and patient primacy. These issues would be greatly alleviated under a single-payer health financing system that places value on health outcomes, continuity of care, and quality.

Please join us in calling for the reinstatement of Dr. Randt, a longtime PNHP member, and his colleague and an end to health care practices that place the goals of profitability over the care of patients.


Health care for all,

Quentin Young, M.D.
National Coordinator, PNHP

Johnathon Ross, M.D.
Past-president, PNHP
State Coordinator, PNHP Ohio

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x8243878

C Difficile Surpasses MRSA as the Leading Cause of Nosocomial Infections in Community Hospitals

Emma Hitt, PhD

March 23, 2010 (Atlanta, Georgia) — Hospital-onset healthcare-facility-associated Clostridium difficile infections (CDI) have increased in incidence and have surpassed methicillin-resistant Staphylococcus aureus (MRSA) infections, according to a new study of a large cohort of patients from community hospitals.

Becky A. Miller, MD, an infectious disease fellow from Duke University in Durham, North Carolina, presented the findings during an oral session here at the Fifth Decennial International Conference on Healthcare-Associated Infections 2010.

"This is the first time this has been described using patient-level data (i.e., with the number of cases as the numerator and the number of patient days as the denominator)," Dr. Miller told Medscape Infectious Diseases.

"We think this trend, particularly in community hospitals, would not have been captured without our large network of 39 hospitals where we perform infection control and surveillance," she said. "We were also unaware that cases of nosocomial C difficile infection had increased and surpassed MRSA."

The researchers performed a prospective cohort study in 28 community hospitals participating in the Duke Infection Control Outreach Network between January 2008 and December 2009.

The cohort consisted of 3,007,457 patient-days. Numerically, nosocomial CDI was the most common healthcare-associated infection (847 cases), followed closely by nosocomial bloodstream infection (838 cases).

Nosocomial infections due to MRSA and intensive care unit device-related infections were approximately equal, at 680 and 681 cases, respectively.

Patients with nosocomial CDI (n = 840) and nosocomial MRSA (n = 655) were equally likely to be male, and to have diabetes or end-stage renal disease requiring hemodialysis. However, patients who developed nosocomial CDI were, on average, older than patients who developed nosocomial MRSA infection (65 vs 59 years; P < .0001). In addition, time to infection was, on average, 8 days for CDI and 7 days for MRSA infection (P < .0001), and overall mortality was higher among patients with MRSA infection than CDI (P < .0001).

The rate of nosocomial CDI was 0.28 cases per 1000 patient-days, whereas the rate of nosocomial MRSA infection was 0.23 cases per 1000 patient-days. Thus, nosocomial CDI occurred 25% more frequently than nosocomial MRSA infection.

Since 2007, rates of healthcare-associated MRSA infection have steadily decreased, whereas rates of CDI have increased, Dr. Miller said during her presentation.

According to Dr. Miller, C difficile spores are shed in stool, and these spores can persist in the hospital environment for months. "These infections are not being prevented by methods that are clearly working to prevent nosocomial infections due to MRSA," she said. She added that "we think that this study represents the tip of the iceberg, as we did not include nosocomial C difficile cases diagnosed after patients leave the hospital."

In another presentation on C difficile, researchers described a targeted strategy to eliminate C difficile using ultragermicidal bleach wipes. Robert Orenstein, DO, from the Mayo Clinic in Rochester, Minnesota, reported the findings here in a poster session.

"The beauty of this project was that implementation was relatively simple — it required putting together a committed team and emphasizing our goal of improving patient outcomes," Dr. Orenstein told Medscape Infectious Diseases.

The researchers targeted 2 units with a focused intervention of daily cleaning of all patient rooms with Clorox brand ultragermicidal bleach wipes containing 6.15% sodium hypochlorite, and cleaning after the patient had been discharged.

Cleaning was assessed by environmental services supervisors, and Clean-Trace technology was used. Patients and environmental services employees who cleaned the rooms responded to a survey regarding satisfaction and tolerance of the cleaning procedure.

Before the intervention was initiated, the incidence of CDI was 18.4 per 10,000 patient-days; after the intervention was initiated, the incidence was 3.76 per 10,000 patient-days, "far exceeding" their goal of a reduction in incidence of 30%, Dr. Orenstein said.

According to the authors, patients tolerated the cleaning well, and although environmental services "employees initially had concerns regarding odor and irritation, these were resolved." The cost of the intervention was estimated at $18,671 per year.

"I am struck by the fact that our highest-risk unit has gone 6 months without a hospital-acquired case attributable to their unit, despite the fact that the overall incidence (i.e., cases admitted with this infection) continues to rise," Dr. Orenstein said. "This suggests what we did really had a great impact," he added. "This is especially gratifying knowing the impact that C difficile disease can have on our patients lives."

"C difficile has been in the news for the last decade," said Carlene A. Muto, MD, medical director for infection control at the University of Pittsburgh School of Medicine in Pennsylvania. "What has taken focus this year is that the environment matters," she said.

According to Dr. Muto, an analysis by their group presented in the late-breaking session described the undetected reservoir in patients who asymptomatically carry C difficile (~6% of the patients tested).

"Many studies have described noncompliance with cleaning patient rooms and how a focused effort can change this behavior," Dr. Muto told Medscape Infectious Disease. "Our group implemented a bleach/detergent cleaning program years ago, but since June 2009, we have used this product on every surface, every time, not just in the rooms of patients known to be positive."

She noted that "patients not known to be colonized/infected one day may be so the next. We did see a decrease in C difficile healthcare-associated infections using this approach."

Neither study was commercially funded. Dr. Miller, Dr. Orenstein, and Dr. Muto have disclosed no relevant financial relationships.

Fifth Decennial International Conference on Healthcare-Associated Infections (ICHAI) 2010: Abstract 386, presented March 20, 2010; Abstract 142, presented March 19, 2010.

CEOs are less concerned about quality and patient safety

Healthcare CEOs Focusing on the Now
Philip Betbeze, for HealthLeaders Media, February 12, 2010

Here's a statement that should get your attention: CEOs are less concerned about quality and patient safety this year than last year. Actually, that broad conclusion is tough to draw from the data contained in the HealthLeaders Media Industry Survey 2010, which went live on our site yesterday. But what's clear is that long-term goals are dropping in importance in favor of initiatives that can bring near-immediate returns.

Without a doubt, CEOs are spending more of their intellectual capital this year on patient experience/satisfaction as well as cost reduction, according to the survey.

CEOs, obviously, drive their organizations, so what they say about their priorities carries a lot of weight. We actually asked CEOs to rank their top three priorities for the next three years, and what came back showed us that CEOs, perhaps in light of the turbulent economic times, are trimming back the importance they give to quality and patient safety (only 39.5% selected it this year, compared with 69% in 2009) while patient experience/satisfaction (33.98% vs. 25%) as well as cost reduction (35.36% vs. 19%) recorded big increases.

Interestingly, physician recruitment and retention dropped from 43% in 2009 to 35.36% for 2010. So what conclusions can we draw from this data? Perhaps CEOs feel like after years of concentration, their quality levels don't need as much attention. Perhaps more of them have achieved their short- and medium-term goals with physician recruitment.

But in the bigger picture, quality still leads the herd, and physician recruitment isn't far behind. They just have much less of a commanding lead than they did before. I think some areas simply have improved so much that they aren't highest priority anymore, at least at the top levels of the organization. That certainly seems true for revenue cycle, for example, which only 7.73% of CEOs ranked as among their top three priorities for 2010, compared with 23% in 2009.

But I think there's something else at work here. Short-term thinking has invaded the decisions emanating from the C-suite.

On first glance, that seems myopic. But it's not necessarily a bad thing: Sometimes a crisis requires you to dramatically shift your priorities, and if 2009 wasn't a crisis year with the recession and healthcare reform looming on the horizon, I don't know what would qualify. For example, physician recruitment is a long-term investment in a single human being. Improving quality also takes time, and while it generates an ROI, its ROI doesn't flow directly to the bottom line.

Banner Health, for example, spent big bucks on driving quality at their organization. They don't regret it. In fact, their quality scores in the obstetrics department recently meant they could reduce their reserves for malpractice to near zero for 2010. But it took at least three years of low or no claims to make the actuarial team comfortable with reducing those reserves and letting them flow to the bottom line.

CEOs in 2010 don't necessarily have that luxury of waiting for results, no matter how impressive they might eventually be. And that's the key for CEOs in 2010. They want to expend their energy on initiatives that bring immediate or near-immediate return because frankly their jobs, the jobs of others in the organization, and in some cases, their hospital's existence, are on the line.

Obviously, this is just very narrow snapshot of the wealth of information available in our survey. I encourage you to spend a half-hour on it in the next week or so. We've broken the results down by pillar, meaning there's one for CEOs, one for quality, one for CFOs, etc.

I've focused here on one question from the CEO pillar and have been able to draw several conclusions from it. But there's a story behind every question and knowledge to be gleaned from every pillar. Delve into the survey's findings now. You won't be sorry.

--------------------------------------------------------------------------------
Philip Betbeze is a senior leadership editor with HealthLeaders Media. He can be reached at pbetbeze@healthleadersmedia.com.

Hazards: Ambulance Stethoscopes May Pose Risk

The New York Times
By ERIC NAGOURNEY

Stethoscopes carried by ambulance crews are not always cleaned as often as they should be, and as a result they may be exposing some patients to drug-resistant bacteria, a new study reports.
Researchers who looked at stethoscopes used by emergency medical services workers in New Jersey found that a significant number carried methicillin-resistant Staphylococcus aureus, bacteria known as MRSA that are resistant to standard drugs.

Some of the ambulance workers could not recall the last time the instruments had been cleaned, said the researchers, whose report appears in the current issue of Prehospital Emergency Care.

The study’s lead author, Dr. Mark A. Merlin of Robert Wood Johnson Medical School, said it was unclear how big a threat MRSA on a stethoscope posed to a patient. But as incidents of infection by the bacteria become more common, and with the possibility that it will become more resistant to antibiotics, it is important to reduce its spread, he said.

Researchers asked ambulance crews arriving at an emergency department over a 24-hour period to let their stethoscopes be tested. They also asked when the instruments had last been cleaned.

Of 50 stethoscopes tested, 16 had the bacteria, which a simple alcohol swab is usually enough to kill, the researchers said. “The concept of cleaning an entire ambulance after every patient is not practical,” they wrote. “Cleaning a stethoscope, however, is not labor-intensive, does not require much time, and does not require any special equipment beyond currently stocked items.”