It is not uncommon to find this phrase, "You may be uncomfortable providing this type of care" only in the section addressing toileting assistance. Speaks volumes about the "yuk" factor associated with toileting? Yet another indication that improvements in toileting caregiving/carereceiving are long past due.
Monday, August 4, 2014
Tuesday, July 29, 2014
Hopefully, companies will grow in their willingness "to play with others" to get cross-cutting improvements in healthcare interventions to market. No longer do the solutions sit within the domain of any one sector!
Monday, July 28, 2014
In a study of 13 years of worker compensation costs in a large tertiary hospital and affiliated community hospital setting, "patient-handling injuries (n=1543) were responsible for 72% of MS injuries and 53% of compensation costs among patient care staff. Mean costs per claim were 5 times higher for those over age 45 than those <25 years of age. Physical and occupational therapy aides had the highest cost rates ($578/FTE) followed by nursing aides ($347/FTE) and patient transporters ($185/FTE). There was an immediate, marked decline in mean costs per claim and costs per FTE following the policy change and delivery of lift equipment." Evaluation of direct workers' compensation costs for musculoskeletal injuries surrounding interventions to reduce patient lifting. Lipscomb HJ1, Schoenfisch AL, Myers DJ. http://www.ncbi.nlm.nih.gov/pubmed/22199366
A 2009 review of the published literature on use of lifting equipment found "16 individual and 45 environmental barriers and facilitators . . . The most important environmental categories were 'convenience and easy accessibility' (56%),'supportive management climate' (18%) and 'patient-related factors' (11%). An important individual category was motivation (63%)." Determinants of implementation of primary preventive interventions on patient handling in healthcare: a systematic review. Koppelaar E1, Knibbe JJ, Miedema HS. http://www.ncbi.nlm.nih.gov/pubmed/19228679
As reported in the Herald Sun, Melbourne, Australia: "A graduate nurse who says she injured her back moving an obese patient is suing the hospital amid a raft of similar complaints, [charging that the] injuries [were] triggered by trying to shift the “unco-operative” patient in a faulty commode have left her unable to work. The suit comes as the nursing union warned that nurses and midwives were at serious risk of injury if hospitals failed to follow safe handling guidelines for obese patients. The nurse says her injury from the December 2008 incident was exacerbated after she slipped on a wet floor, as well as through other heavy and repetitive duties during her time at *** Hospital, [alleging that] the hospital was negligent because [she] wasn’t given any help or instruction on how to heave the patient on her own and wasn’t warned the person was stubborn. http://www.heraldsun.com.au/news/victoria/nurses-sue-hospitals-for-injuries-from-moving-patients/story-fni0fit3-1227003459175
MAYBE IT IS TIME TO DESIGN DEVICES THAT CAN BE SELF-MANAGED BY MORE CARE RECIPIENTS, REDUCING THE NEED TO LIFT SOME PATIENTS AT ALL? As with many challenges in healthcare, the big toileting issues will be addressed only through targeted sub-population interventions.
Saturday, July 26, 2014
Although they primarily relied on doctors and nurses to perform medical caregiving, Boomer caregivers found themselves quite involved in personal caregiving needs, such as:
- Assistance with eating (79%)
- Assistance with getting in and out of bed (78%)
- Assistance with using the toilet (69%)
- Assistance with dressing (68%)
- Assistance with bathing (56%)
Thursday, July 24, 2014
" . . . but when is someone independent or dependent in ADLs? In nursing homes, . . . locomotion on the nursing home unit, is described . . . as: “how the resident moves from place to place in the room or hall using whatever device is appropriate or needed.” The device can be a thing like a wheelchair, walker, cane, feet, prothesis, or scooter. So if the nursing home resident did the activity completely on their own without cueing or supervision, then they are described as “independent”. If they need just some oversight or cueing then they are described as needing “supervision”. More help than that is “limited assistance” where the staff do some of the activity, and more help than that is “extensive assistance” where the staff do most of the activity. Lastly, complete dependence is where staff do all of the activity for the nursing home resident.
The other important thing to know is that functional status in this study is based on self-performance as observed across all nursing shifts over a 7-day period. So a resident is independent in an ADL if the resident is able to perform that activity “without help or oversight or requiring help or oversight only 1 or 2 times over 7 days”. The same thing goes with total dependence, the resident needs to require staff to do all of the ADL for all 7 days to be described as dependent.
Why is all of this important? Although these definitions are standardized, a nursing home resident’s self-performance can change shift-to-shift, day-to-day, and week-to-week based on things like their mood, an acute illness, or even just their relationship to their nurse. So one week you may be “dependent” and another week you may be “limited assistance.”
Wednesday, July 23, 2014
Tuesday, July 22, 2014
Saturday, July 19, 2014
Yet, seems like the environment is changing in ways very favorable to getting a toileting improvement to market.
The Accountable Care Act is changing the incentives for providers and health plans. The smart ones will realize that HME is their "last mile" for reaching patients to avoid unnecessary hospitalizations and ED visits, support telemedicine and remote patient monitoring, and keep the mobility challenged with chronic conditions well and at home. Improved HME design will also provide respite to both paid and unpaid caregivers as users are better able to manage their assistive devices for themselves. And there will be plenty of work to go around as we baby boomers age; in fact, we will need this type of self-managed equipment to be able to handle the growing demand for caregiving.
Over the next weeks and months, I'll be posting short reports of our progress. Stay tuned,