Sunday, March 9, 2014

Adverse Events for Nursing Home Residents

The Office of the Inspector General for HHS has issued a new report, Adverse Events in Skilled Nursing Facilities:  National Incidence Among Medicare Beneficiaries.  (OEI-06-11-00370, Feb. 2014). The study is a follow up to the study the OIG did on hospital adverse events (defined on page 2 of the report as "harm to a patient or resident as a result of medical care" and which includes not only errors but "more general substandard care that results in ... harm" but aren't always limited to preventable acts or negligence (citations omitted)). 

The report examines SNF post-acute care, which is "intended to help beneficiaries improve health and functioning following a hospitalization and is second only to hospital care among inpatient costs to Medicare." The executive summary describes the OIG findings: approximately 22% of Medicare beneficiaries had an adverse event while in the SNF with another 11% with temporary harm.  Doctors who reviewed these concluded that 59% of both the adverse and temporary harm occurrences were either preventable (clearly) or likely could have been prevented.  The doctors pointed to a number of factors, including "substandard treatment, inadequate resident monitoring, and failure or delay of necessary care." More than 50% of these SNF residents were rehospitalized for care.

The OIG report makes several recommendations, including that the Agency for Healthcare Research & Quality (AHRQ) and CMS both increase awareness of the need to improve SNF resident safety and also to adopt safety efforts such as those used by hospitals.  The report suggests collaborations that lead to the compilation of a list of events in SNFs that would help SNF staff understand and identify harm.  The report also recommended that CMS should also require state surveyors to look at SNF practices for preventing adverse events.

The report includes comments from AHRQ and CMS, which agreed with the recommendations. CMS also included information about what is currently being done and its plans to increase resident safety. CMS did conditionally agree with the OIG sub-recommendation about reporting incidents to patient safety organizations, because of concerns about preserving confidentiality and privileges.  The comments are included in Appendix G.

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