Category: nursing

New Wound Treatment Code Available to PTs

A new code for the use of a modality to heal wounds using sound energy has been made available to physical therapists (PTs) in the 2014 version of the Current Procedural Terminology (CPT) document maintained by the American Medical Association (AMA).

The new active wound care management code—97610—replaces Category III code 0183T. The modality uses acoustic energy to atomize saline and deliver ultrasound energy by way of a continuous mist to the wound bed and surrounding tissue, and is identified as “low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day.”

For more information on the new treatment code, visit APTA

Innovation 2.0 Deadline January 20

APTA members have a Monday, January 20, deadline to submit letters of intent to let staff know if they will be making a proposal to receive funding and mentoring through the association’s Innovation 2.0 program.

APTA’s Innovation 2.0 program will offer up to $150,000 to support innovation in service delivery and payment in a wide range of areas from the integration of physical therapy into collaborative care models to management of patients and clients that focuses on reducing hospital readmissions. The complete list of proposal areas can be found on APTA’s Innovation 2.0 webpage.

More information on the deadline at APTA

Who’s to Blame? Attitudes on Accountability for Patient Safety Lapses

In the years following the Institute of Medicine’s landmark report, To Err is Human: Building a Safer Health System,[1] the field of patient safety and medical error prevention underwent a material change. Gone were the days of punitive reactions to incident reports, as healthcare institutions gradually shifted to a “blame-free” approach to error. This approach relied heavily on the notion that systems, rather than individuals, were responsible for error, and that errors were learning opportunities to improve safety within the entire facility. Education was the chief remedial action, and personal responsibility played a minor role in the new patient safety paradigm.

Now, the pendulum might have swung too far from individual accountability for a failure to follow established patient safety protocols. New questions have been raised about how healthcare institutions should deal with healthcare providers who repeatedly flaunt safety protocols, such as hand hygiene. Should they be punished? If so, how many infractions are enough to justify punishment? How do healthcare providers and patients feel about these issues?

A study by Driver and colleagues provides some preliminary answers to these questions. Researchers at the University of California, San Francisco (UCSF), administered a survey to a convenience sample of physicians (attending physicians and residents), medical students, nurses, and patients that posed 3 clinical scenarios involving a healthcare provider who committed a patient safety protocol lapse:

Full story of patient safety at MedScape

Foot osteoarthritis affects one in six over 50s

Experts at Keele University’s Arthritis Research UK Primary Care Centre studied more than 5,000 people with painful foot osteoarthritis.

The condition is caused by inflammation in and around the joints, damage to cartilage and swelling. People can suffer a range of symptoms including pain, stiffness and difficulty moving and often have osteoarthritis in other joints, such as hips or knees.

The study found that foot osteoarthritis affects more women than men, while those who have spent a lot of time in manual work are more likely to develop it.

Three-quarters of people with the condition reported having difficulty with simple day-to-day activities such as walking, standing, housework and shopping.

Dr Edward Roddy, clinical senior lecturer in rheumatology at Keele University, said the research had focussed on “midfoot” joints, which previous studies have neglected to do.

He said a “substantial proportion of people” with painful foot osteoarthritis have the problem in this area, meaning there has been a previous underestimate in how common it is.

Full story of foot osteoarthritis over 50 at Nursing Times 

How best to celebrate Christmas with a person with dementia

Christmas can be a stressful time for hosts and guests alike, and it’s more so for carers of people living with dementia.

It’s difficult to give general advice about how to get through the holiday season with as little fuss as possible because everyone is unique, and the various types and stages of dementia affect behaviour in different ways.

So I’m going to tell you a story of how one couple is getting through. Hopefully, their strategies will suggest things other families can do for a better Christmas.

Tom and Nola are not real people. Their portraits below are based on my experience working with people with dementia, and on conversations I’ve had with these people, their carers and service providers about how to cope at Christmas time.

Tailoring Christmas

Tom was diagnosed with dementia about three years ago.

“My memory is not so good now,” he says. But Nola, his wife and carer, says that he’s still sociable and enjoys food and company.

Full story of celebrating Christmas with Dementia at The Conversation

This Mom Lost 3 Children To HIV. She’s Making Sure No Other Mother Suffers Such A Devastating Loss

One by one, each of Connie’s three children died before her eyes in the 1980s from a relentless disease she had suspected was HIV, but didn’t have the “courage” at the time to find out.

Today, the grieving mother is working to make sure that no parent makes the same tragic decision.

In Zambia, where Connie lives, and other parts of the sub-Saharan Africa — HIV and AIDS still carry a pervasive stigma, a stigma so strong that it keeps people from even getting tested.

Once Connie’s husband fell ill, the two felt that they had no choice but to find out if they were infected. They both tested positive.

The pair enrolled in the Kanyama Health Center, a clinic that offers free life-saving drugs –- a decision that has kept Connie alive and has also helped her find a new purpose.

Connie now serves as an AIDS ambassador and peer counselor. She tests people in the comforts of their own homes and helps them navigate their treatment options.

Full story of HIV and loss at Huffington Post

Heart attack, stroke prevention tool debated

The debate over new heart disease prevention guidelines proposed by U.S. cardiologists is being stirred.

In Tuesday’s issue of the medical journal The Lancet, a U.S. doctor and a researcher call the American Heart Association and American College of Cardiology’s new guidelines a step forward but point to flaws in applying its risk calculator.

In their commentary, Dr. Paul Ridker and Nancy Cook of the Center for Cardiovascular Disease Prevention at Boston’s Brigham and Women’s Hospital raised questions about applying the guidelines for primary prevention in people without a history of heart disease, stroke and few risk factors.

Unlike the previous guideline that focused on cholesterol levels, the latest edition uses a risk calculator based on factors such as age and high blood pressure. But estimates from the new calculator were roughly double the actual heart attacks or strokes observed in three major cohort studies, Ridker and Cook said.

“Reliance on the new risk prediction algorithm could put many primary prevention patients on [cholesterol lowering] statin therapy where there is little trial evidence while potentially denying the drug treatment to others where there is evidence,” the pair said in the commentary.

Full story of heart attacks and stroke at CBC News

Dicephering a stroke patient’s message

I had been working as a nurse practitioner in stroke/neurology for three years when I encountered Mr. B, a 67-year-old patient who came to our hospital with acute onset of right-sided weakness and aphasia following a moderately-sized left-middle cerebral artery stroke.

Mr. B’s course was typical of an acute stroke patient, and we proceeded through our work up and evaluation as usual. Since Mr. B’s language center was in the left side of his brain, he was suffering from language deficiencies that included profound expressive aphasia. During his stay in our hospital, he worked with our skilled therapy team. It was evident to all of his healthcare providers that he was extremely frustrated with his inability to communicate.

The day before we had scheduled to send him to acute rehab, I entered the room for daily rounds with another nurse practitioner on our team. Mr. B again seemed agitated and frustrated as he tried to communicate his wishes to us. I grabbed my notebook and a dry erase marker, which he was able to grip in his right hand.

To our surprise Mr. B was able to write, but the letters were jumbled, and we set the notebook page aside feeling unsuccessful in our attempt to communicate.

An hour later we were called back to Mr. B’s room by his daughter. It turns out that when she was a child, her father had used mirror image writing to communicate with her as a special code. She saw the notebook page from earlier that morning lying on his bedside table and recognized the pattern immediately. We grabbed a mirror and were able to decode the message.

Full story of a stroke patients message at Clinical Advisor

Insurance type tied to dying dementia patients’ care

The chance that nursing home residents with advanced dementia will receive inappropriate care may be related to their insurance coverage, a new study suggests.

Insurance Type Tied to Dying Dementia PatientsFewer dying people with dementia were moved to the hospital for possibly unneeded care when their insurance coverage paid on a per-patient basis, rather than for every test and treatment, researchers found.

NYU School of Medicine’s Keith Goldfeld said so-called managed care organizations are motivated to stop people from receiving unnecessary and costly care.

People with advanced dementia won’t usually benefit from being hospitalized during the last months of life for acute ailments like pneumonia, Goldfeld, the study’s lead researcher, said. The focus should be on making the person comfortable.

“When the focus is on comfort, the idea is to try to limit the type of care that could be burdensome for the patient and costly,” he said.

Nursing homes may want to send very sick residents to hospitals because it shifts the cost of treating them from the homes to the hospitals and Medicare, the government-run health insurance for the elderly and disabled.

Full story of insurance and dementia care at Reuters

Photos courtesy of and copyright PhotoPin,

Nurse practitioners play an important role in preventing errors

Nurse Practitioners Play Important Role in Medical Error Prevention“To Err is Human: Building a Safer Health Care System,” was published in 1999 by the U.S. Institute of Medicine (IOM) and brought attention to the need for the reduction of medical errors in the US health-care system.

As a result of this publication, efforts were made at both the macro and micro levels of health care to improve patient safety. Hospitals implemented policies for improved medication administration. Surgeons were encouraged to adhere to “time out” procedures prior to initiating surgical interventions, during which they state the name of the patient and the duties of each clinician present. State licensing boards require continuing education be completed on the prevention of medical errors prior to licensure and again on renewal.

A medical error is defined by the IOM as “the failure to complete a planned action as intended or the use of a wrong plan to achieve an aim.” Awareness of the responsibility to prevent medical errors and improve patient safety is widely discussed and is addressed in the curriculum for registered nurses. Registered nurses are usually encouraged to be the patient’s advocates through this role, and much of the time they are the last line of protection against an error. This background often makes nurse practitioners better at completing the planned action as intended and using the correct plan to accomplish an aim.

Full story of nurse practitioners and error prevention at The Clinical Advisor

Photos courtesy of and copyright PhotoPin,