In an earlier blog, I reviewed the highlights from a federal government report, which found that up to one in five Medicare patients in skilled nursing facilities experienced an adverse medical event within the first 35 days of care.
The report, titled “Adverse events in skilled nursing facilities: National incidence among Medicare beneficiaries,” was issued by the U.S. Department of Health and Human Services, Office of Inspector General in February 2014.
Adverse events found to be common at nursing homes
The report studied data for patients who transferred from hospitals to skilled nursing facilities (SNF), to receive post-acute care. Up to 90% of skilled nursing facilities are dually certified as both SNF and nursing homes.
The term “adverse event” is used to describe four categories of harm, where the event lead to: (1) Extended SNF stay or transfer to hospital, (2) permanent harm, (3) life-sustaining intervention, or (4) death.
The adverse events found in the study were sorted into three clinical categories: Events related to medication (37%), ongoing resident care (37%), and related to infections (26%). Here is a description of the types of harms found to have occurred in each of those categories:
- Events Related to Medication – These adverse events included medication-induced delirium or other mental effects; excessive bleeding due to medication; and falls or other trauma, among others.
- Events Related to Resident Care – Types include: falls or other trauma with injury; exacerbations of preexisting conditions resulting from an omission of care; acute kidney injury or insufficiency secondary to fluid maintenance; and fluid and other electrolyte disorders (e.g., inadequate management of fluid).
- Events Related to Infections – Common infection-related events were: aspiration pneumonia and other respiratory infections; surgical site infection associated with wound care; and urinary tract infection associated with catheter, among others.
The authors of the report noted that some events, such as pressure ulcers and hypoglycemia, have been known to be a problem for post-acute caregivers. But, the study revealed “other events (such as severe gastrointestinal bleeding due to anticoagulant overdose) not commonly associated with nursing homes.”
Events leading to death
About 1.5% of Medicare SNF residents experienced adverse events that contributed to their deaths. The report noted that deaths often had multiple contributing factors in the patients underlying conditions. For example, one resident died of aspiration – this patient had experienced multiple prior strokes that likely hampered their swallowing ability.
Yet another example is a resident who died of cardiac arrest following progressive kidney failure that was not detected until the resident was awaiting discharge from the SNF.
The report leads to the obvious conclusion that these patients have serious and intricate medical needs that require a high level of skilled observation and care to adequately treat. See my next blog for details on recommendations for how these serious problems can be addressed.