CERTAIN MANIFESTATIONS

OF POOR CONTROL OF BLOOD SUGAR

LEVELS

DEEP-VEIN THROMBOSIS

OR PULMONARY EMBOLISM AFTER

TOTAL KNEE AND HIP

REPLACEMENTS

AIR EMBOLISM

BLOOD INCOMPATIBILITY

CATHETER-ASSOCIATED

URINARY TRACT INFECTION

FALLS/TRAUMAOBJECTS LEFT

IN DURING SURGERY

PRESSURE ULCERS

VASCULAR CATHETER-

ASSOCIATED INFECTION

SURGICAL-SITE INFECTIONS AFTER CORONARY ARTERY

BYPASS GRAFT

SURGICAL-SITE INFECTIONS AFTER

CERTAIN ORTHOPEDIC

AND BARIATRIC SURGERIES

“ Never Events” How EBSCo’S EvidEnCE-BaSEd, Point-of-CarE rEfErEnCE toolS Can HElP

PrE vENtiNg

NursingReference Center

Medicare’s Quality of Care Payment Policyin order to improve the quality of patient care during a hospital stay, and to ensure that only items and services that are reasonable and necessary receive reimbursement, Medicare adopted payment policies that encourage hospitals to:

•  reduce the likelihood of certain events that could occur during a hospital stay

•  reduce hospital-acquired conditions

for patient discharges after october 1, 2008, Medicare has denied payments to hospitals for additional care resulting from 11 of the 28 “never Events.” these 11 conditions were identified by the nQf as patient safety events that pose serious harm to patients and that should be considered entirely preventable. Hospitals were informed that they were not allowed to charge patients directly for care related to these events for cases in which one of the selected conditions was not present on admission (Poa).2

the “Never Events” for which hospitals no longer receive Medicare reimbursement include:

the NQF “Never Events” reportin 2002, the national Quality forum (nQf) published a report listing 27 adverse events that were “serious, largely preventable and of concern to both the public and health care providers.” these events and subsequent revisions to the list became known as “never Events,” meaning they should never happen in a hospital. this concept led to the creation of the nQf’s Consensus Standards Maintenance Committee on Serious reportable Events, which maintains and updates the list that now contains 28 items.1

the Evolution of “Never Events”

“Never Events” are ‘serious, largely preventable and of concern to both the public and health care providers.’

1. Air embolism

2. Blood incompatibility

3. Catheter-associated urinary tract infection

4. Certain manifestations of poor control of blood sugar levels

5. Deep-vein thrombosis or pulmonary embolism after total knee and hip replacements

6. Falls/trauma

7. Objects left in during surgery

8. Pressure ulcers

9. Surgical-site infections after certain orthopedic and bariatric surgeries

10. Surgical-site infections after coronary artery bypass graft

11. Vascular catheter-associated infection

How can you protect your hospital?with the skyrocketing cost of patient care and preventable medical errors at an all-time high, it is essential that hospitals and physicians have access to the best available evidence at the point-of-care to help prevent “never Events” from happening. Critically-analyzed information is paramount to improving patient outcomes.

1 National Quality Forum: Serious Reportable Events in Healthcare2 Centers for Medicaid and Medicare: National Coverage Determinations

DynaMed, EBSCo’s point-of-care clinical reference tool for physicians, ensures the highest-quality evidence is driving decision making, resulting in fewer errors. DynaMed is updated daily and monitors the content of over 500 medical journals and systematic evidence review databases.

Additionally, DynaMed:

� Can be used to create and maintain Clinical Pathways which reduce the variability of patient care

� Can improve hospital compliance with Core Measures

� Provides remote access to assist with off-hour research, preparation or as a reference tool for on-call physicians

� integrates with EMrs to provide availability at the point-of-care

� Covers all major guidelines, fda safety alerts, Cochrane reviews, CdC reports, aHrQ and Health technology assessments

� Provides a convenient means for obtaining CME credits when practitioners use DynaMed to answer clinical questions

� is available on mobile devices for access anywhere

Example of how DynaMed can help prevent “Never Events” — Catheter-Associated Urinary tract infection

Nursing Reference Center (nrC), EBSCo’s web-based nursing reference system, is designed to provide the latest evidence-based clinical information for nursing practice, education and research at the point-of-care.

Nurses can be proactive in preventing serious avoidable events by using the information from over 4,000 documents contained within NrC, including:

� deep coverage of diseases & conditions

- Quick lessons

- Evidence-Based Care Sheets

� Skills & Skill Competency Checklists

� More than 700 CEU modules (at no extra cost)

� drug information

� legal cases

Example of how NrC can help prevent “Never Events” — Catheter-Associated Urinary tract infection

Preventing “Never Events” with EBSCO’s Evidence-Based, Point-of-Care reference tools

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Protecting your hospital from “never Events” is a collaborative effort that must include all members of the interdisciplinary team. By providing physicians and nurses with the best available evidence-based information to care for their patients, the incidence of serious errors can be decreased.

EBSCo’s DynaMed™ and Nursing Reference Center™ resources provide physicians, nurses and other health care professionals with the latest evidence-based information directly at the point-of-care to help reduce the incidence of serious errors. the ultimate goal is to ensure that “never Events” never happen.

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Catheter-associated urinary tract infection

United States Department of Health and Human Services prioritized recommendations to prevent catheter-associated urinary tract infections

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recommendations to prevent urinary catheter-associated UTI based on literature review◦

Priority Module 1 - recommendations for appropriate urinary catheter use•

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◦◦

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insert catheters only when indicated and only for as long as needed (Category 1A)do not use urinary catheters to manage incontinence (Category 1B)remove catheter as soon as possible postoperatively, preferably within 24 hours (Category 1C)

Priority Module 2 - recommendations for aseptic insertion of urinary catheters•catheter should be inserted by properly trained persons only (Category 1C)use aseptic technique and sterile equipment (except when clean technique is appropriate forintermittent catheterization) (Category 1C)

Priority Module 3 - recommendations for proper urinary catheter maintenance•maintain sterile, continuously closed drainage system (Category 1C)do not disconnect catheter and urinary drainage system unless catheter must be irrigated(Category 1B)

Healthcare Infection Control Practices Advisory Committee (HICPAC) categorization of recommendations•Category 1A and 1B - recommendations with strong evidentiary supportCategory 1C - recommendations including state and federal regulations regardless of evidentiary support

Reference - HHS Action Plan to Prevent Healthcare-associated Infections accessed 2009 Jan 7•

Prevention and Screening

Prevention:

Evidence-Based Care Sheet: Urinary Catheter Use and Prevention of infection

Prevention and Screening: Catheter-associated urinary tract infection prevention recommendations

topic Summaries — More than 3,200 clinically organized evidence-based topic summaries covering all aspects of care

Drug information — Comprehensive drug information from respected sources such as aHfS is fully integrated into DynaMed’s evidence-based topic summaries

Detailed reference Support — More than 200,000 journal article references and web links

iCD-9/iCD-10 Codes — includes relevant iCd-9 and iCd-10 codes for all applicable diseases and conditions

Continuing Medical Education (CME) — Easy, cost-effective method for obtaining CME credits for point-of-care searching

Daily Updates — Systematic surveillance of hundreds of medical journals and evidence-based sources provides the most up-to-date, accurate information

Patient information — access relevant supplemental content to help educate patients about their conditions

Unlimited Access — all DynaMed subscriptions include unlimited access (on-site and remote) for all authorized users

Medical Calculators — More than 500 unique medical reference calculators featuring a wide array of pertinent medical formulae, clinical criteria sets and decision tree analysis tools used every day by clinicians, medical educators, nurses and health care students of all types

EMr integration — Easy integration with all Electronic Health/Medical records (EHr/EMr), decision support and patient record applications

Mobile Access — DynaMed is available as a mobile application, compatible with devices such as the iPhone, iPad, iPod touch, android Smartphone, BlackBerry, Microsoft Mobile and Palm

DynaMed Weekly Update Newsletter — Sign up for the free weekly newsletter to receive updates on timely and significant changes from “articles most likely to change clinical practice.” free CME credit is available.

Quick Lessons — Clinically-organized nursing overviews on diseases and conditions

Evidence-Based Care Sheets — Evidence-based summaries on key topics

Drug information — Comprehensive drug information from a variety of top sources

Best Practice guidelines — Summaries for evidence-based clinical practice guidelines

Continuing Education (CE) — internationally-accredited CE Modules are available from Cinahl information Systems, an anCC and iaCEt accredited provider

Nursing Skills — Clinical papers detailing the necessary steps to achieve proficiency in specific nursing tasks, including skill competency checklists for skill performance evaluation

Cultural Competencies — Key considerations, based on evidence, to consider in the provision of culturally competent care

Full-text Journals — available when nrC is subscribed to with other relevant EBSCohost databases

Point-of-Care reference Books — full-text books including Davis’s Comprehensive Handbook of Laboratory & Diagnostic Tests with Nursing Implications, Taber’s Cyclopedic Medical Dictionary, Davis’s Drug Guide for Nurses, AHFS Drug Information Essentials, etc.

research instruments — descriptions of research instruments, clinical assessment tools, psychological tests, attitude measures, etc.

Legal Cases — detailed information covering a wide range of malpractice issues in health care

News — the latest nursing and medical news from HealthDay News

What Will i Find in Nursing Reference Center? What Will i Find in DynaMed?

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