because Leign Ann nothing in healthcare changes unless the
almighty reimbursement dollar is lowered or raised. DRG's were a perfect
example of how the government forces us to consider how we practice. Why
would we change to offer better care if they paid us for the substandard care we
already gave? Thought to ponder
kathy
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From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of
[EMAIL PROTECTED]
Sent: Wednesday, August 16, 2006 8:46 PM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Re: Vanco infiltration
Sent: Wednesday, August 16, 2006 8:46 PM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Re: Vanco infiltration
Nadine:
I worked in home care/home infusion during the days when we were paid by the visit, for all visits we could reasonably justify. Those PIV home antibiotic patients wore us (the RNs only) out, especially with those middle of night restarts 40 miles from my house, after working all day, only hours before I have to return to work all day. Even then, many home care agencies did not work at much of a profit. Most of our patients were Medicare and Medicaid, which were cost reimbursed. The negotiated prices for private insurance patients was not that much. When home care reimbursement changed, some agencies went out of business or seriously downsized. None in our area could afford to take patients with unreliable venous access (as they have to pay nurses for these extra visits, and there is no money for it), and we were forced to demand reliable access prior to discharge. Rarely could we be paid by insurance (never by the government programs) for a PICC insertion, so we had to rely upon the hospitals to do it prior to discharge. Home care was the biggest initial driver of PICC use in our area.
I worked in home care/home infusion during the days when we were paid by the visit, for all visits we could reasonably justify. Those PIV home antibiotic patients wore us (the RNs only) out, especially with those middle of night restarts 40 miles from my house, after working all day, only hours before I have to return to work all day. Even then, many home care agencies did not work at much of a profit. Most of our patients were Medicare and Medicaid, which were cost reimbursed. The negotiated prices for private insurance patients was not that much. When home care reimbursement changed, some agencies went out of business or seriously downsized. None in our area could afford to take patients with unreliable venous access (as they have to pay nurses for these extra visits, and there is no money for it), and we were forced to demand reliable access prior to discharge. Rarely could we be paid by insurance (never by the government programs) for a PICC insertion, so we had to rely upon the hospitals to do it prior to discharge. Home care was the biggest initial driver of PICC use in our area.
Looking back, I wonder why we didn't think of this before the reimbursement
changes, when it would have benefitted our patients, my sleep, my children, and
all of society who had to deal with me the day after I was on call.
Leigh Ann
-----Original Message-----
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]; [EMAIL PROTECTED]
Sent: Tue, 15 Aug 2006 2:58 PM
Subject: RE: Vanco infiltration
Does NHIA have a position on accepting patients for home infusion with just
a peripheral IV? It seems that ALL the home pharmacies we refer to REQUIRE
reliable venous access for home infusion, preferably a PICC line, unless it is a
one time infusion. There are always exceptions, but it seems to be a
general requirement. The PICC team is always under fire here to get
that PICC in so the patient can be discharged to home or alternate care
facility. Discharge is held off til the PICC is in and tip is
confirmed.
Nadine Nakazawa, RN, BS,
OCN
PICC Program
Coordinator
Stanford University
Hospital and Clinics
Stanford University
Medical Center
From: "Autym Didsbury" <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED], [EMAIL PROTECTED]
Subject: Vanco infiltration
Date: Tue, 15 Aug 2006 09:25:19 -0600
Hi all-I am coming to the group for a couple of suggestions. We continue to get tremendous pressure from physicians to give peripheral vancomycin, phenergan, and other potentially dangerous meds. In addition, the "powers that be" at our agency are not supportive either- we are basically told to take whatever is referred for fear of "alienating referral sources." (Yes, I know) To further complicate the situation, I am not getting a lot of support from my infusion pharmacy either- they are GREAT, but complacent with the issue of peripherals despite the potential risk. Our "risk management" person is not a clinician, and doesn't grasp the implications at all. What I am looking for is any references specifc to vanco infiltration and potential complications, as well as information regarding treating various extravasations. Any suggestions would be greatly appreciated. The concept of approp riate vascular access planning has not gained much ground in this community, and I am hoping that it doesn't take a disaster to get everyone's attention.Thanks as always-Autym Didsbury, RN, BSN, CRNIHome Health ManagerPartners in Home Care2687 Palmer St. Suite BMissoula, MT 59808(406) 327-3717 Fax 327-3727
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