ProMed Closed Tomorrow for Good Friday/Easter

Professional Medical will be closed tomorrow, March 29, in honor of Good Friday/Easter. If you have any questions or concerns, we invite you to contact our Customer Care team at (800) 648-5190.

From our team to yours, have a safe and happy Easter!

CMS Posting More Deficiency Data Online

In a memo released on March 22, CMS announced that it will begin to make additional information about nursing home deficiencies available in April. 

The agency currently posts deficiency report information on the Nursing Home Compare and Five-Star Nursing Home Quality Rating System websites. The information is based on data from Form CMS-2567, Statement of Deficiencies and Plan of Correction, and goes back for 15 months. 

Beginning in April, the agency will make older information available and will provide more detail about the deficiencies cited in the reports. 

CMS does not plan post plans of correction online, but they can be requested from CMS State Survey Agencies or directly from facilities. Federal law mandates that these reports must be provided upon request. 

To read the memo from CMS, click here. 

Disinfect to Protect Your Residents

Surface disinfection, along with hand hygiene and other precautions, is key to preventing the spread of healthcare-associated infections (HAIs). When surveyors visit your facility, they will be looking to ensure that you’re adhering to the following cleaning and disinfecting protocols¹:

• Equipment in transmission-based precaution rooms is either dedicated to that resident and appropriately cleaned or is thoroughly cleaned and disinfected between residents using appropriate agents and procedures;
• High-touch surfaces in the environment are visibly soiled (i.e., contaminated) or have been cleaned and disinfected;
• Small non-disposable equipment such as glucose meters, scissors and thermometers are cleaned and appropriately disinfected after each use for individual resident care;
• Single-use items (e.g., blood glucose lancets and other sharps) are properly disposed of after one use;
• Single resident use items (e.g., basins, bed pans) are maintained to be visibly clean for use, and are disposed of after use by a single resident;
• Resident dressings and supplies are properly stored to maintain their integrity, and soiled dressings and supplies are appropriately discarded; and
• Multiple-use items (e.g., shower chairs, bedside scales, resident lifts, commodes, tubs) are properly cleaned/disinfected between use by other residents.

How you disinfect an item depends on how that item is listed in the Spaulding classification system, which groups medical and surgical equipment into three distinct categories¹: 

• Critical items are those that normally enter sterile tissue or the vascular system, or through which blood flows. Examples include needles, intravenous catheters and indwelling urinary catheters. These items must be sterile when used.
• Semi-critical items touch mucous membranes or skin that is not intact. Examples include thermometers, podiatry equipment and electric razors. Semi-critical items must be meticulously cleaned and then receive a high-level disinfection treatment using an FDA-approved chemo sterilizer agent, or they can be sterilized.
• Non-critical items come into contact with intact skin or do not come into the contact with the resident at all. Examples include stethoscopes, blood pressure cuffs and overbed tables. These items must be cleaned periodically and after visible soiling, using an EPA-registered disinfectant detergent or germicide.

Chances are, the majority of the items you come into contact on a daily basis are non-critical items that can be disinfected with EPA-registered products. These disinfectants are commonly available in both spray and wipe formulations. If your facility is currently using spray disinfectants paired with reusable cloths, you’ll need to take precautions to ensure that the cloths are not contributing to the spread of infections. Studies have shown that wiping hard surfaces with contaminated cloths can in turn contaminate hands, equipment and other surfaces.²

Professional Medical’s highly trained sales team can help you evaluate your infection prevention strategy and address any gaps in your plan. To learn more, give us a call at (800) 648-5190 or visit us online at promedsupply.com.

References

1 Centers for Medicare and Medicaid Services. State Operations Manual Appendix PP – Guidance to Surveyors for Long Term Care Facilities (Rev. 70, 01-07-11). Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed March 28, 2013.

2 Centers for Disease Control and Prevention. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. Available at: http://www.cdc.gov/hicpac/Disinfection_Sterilization/3_4surfaceDisinfection.html. Accessed February 29, 2013. 

ProMed Easter Closure Reminder

This is a reminder that Professional Medical's order cutoff for delivery before Easter was today at noon. Orders placed by noon today will be delivered by Thursday, March 28. Orders that are placed after noon will be delivered next week.

Our office will be closed on Friday in honor of Good Friday/Easter. We invite you to call our Customer Care team at (800) 648-5190 with any questions or concerns. 

FDA Proposes Clinical Trials for Emergency Defibrillators

This morning, the FDA announced that it is proposing new rules that would require the manufacturers of emergency defibrillator systems to conduct clinical trials on their products before they would receive marketing approval.

The proposal comes on the heels of increased reports of the devices malfunctioning during use.

To learn more, click here.

Congress Introduces Bills to Limit Hydrocodone Access

After receiving notice from the FDA that reclassifying hydrocodone to be a Schedule II drug (it's currently Schedule III) would be a lengthy process, Congress has taken the agency's recommendation and introduced a bill to more quickly reclassify the drug.

Bipartisan bills have been introduced in both houses of Congress. The bills are cosponsored by 42 members of both parties.

The goal of the bills is to combat growing prescription drug abuse. If the legislation passes, people will no longer be able to refill hydrocodone prescriptions by fax or phone and long-term care operators might have to store the drug differently. Opponents have argued that the reclassification will just make it more difficult for people who are in pain to receive the drug.

To learn more, click here.

SNFs Fall Short on Antipsychotic Reduction Goal, But Still Making Progress

The bad news: Skilled nursing facilities are expected to fall far short on the goal of reducing off-label use of antipsychotics by 15 percent.

The good news: They're still making progress.

CMS and the American Health Care Association teamed up with the goal of reducing off-label antipsychotic use by 15 percent by the end of 2012. According to CMS, facilities have only averaged around a 4 percent reduction. The good news, she noted, is that use is going down steadily in every region, even if the goal wasn't met.

Some facilities are meeting the goal, however, and have even reported up to a 50 percent reduction in the use of antipsychotics.

According to a 2010 CMS quality indicator report, 39.4 percent of residents nationwide who had cognitive impairment and behavioral issues but no diagnosis of psychosis or related conditions received antipsychotic medications.

To learn more, click here.

Study: Nurse Retention, Reduced Rehospitalizations Linked

A new study published in Gerontology shows that skilled nursing facilities that retain their licensed nurses are  also more likely to have fewer rehospitalizations.

The study's authors looked at staffing reports for 680 Florida nursing homes. They discovered that SNFs that increased their retention of licensed nurses by 10 percent during the study period also saw a 0.2 percent reduction in rehospitalizations, which works out to being about two fewer hospitalizations per facility per year.

To learn more, click here.

FDA Investigating Link Between Popular Diabetes Drugs and Pancreatic Cancer

The popular diabetes drugs Januvia and Byetta, which were previously connected to an increased risk of pancreatitis, are now under investigation by the FDA to determine if they are associated with pancreatic cancer.

The FDA said that researchers have found precancerous changes on the cellular level in pancreatic tissue specimens from deceased users of Januvia and Byetta.

The FDA is encouraging users of the drugs to continue taking them as directed by their healthcare providers, but they are encouraging users and physicians to be alert to adverse events and report them to the FDA MedWatch program.

To learn more, click here.

FDA: It's a Long Process to Restrict Access to Painkillers

Advocates for restricting access to hydrocodone painkillers might need to cool their heels for a while. The FDA has told lawmakers that it will be a lengthy process unless Congress takes action.

In February of 2013, a bipartisan group of five senators and two representatives urged the FDA to promptly change hydrocodone painkillers, such as Vicodin, from Schedule III to Schedule II drugs to help address the nationwide epidemic of painkiller addiction. For this to happen, the Drug Enforcement Agency (DEA) would first need to publish information about the change in the Federal Register and then wait for public comment. The FDA would also be required to conduct additional research as part of the reclassifying process.

To speed up the process, the FDA said that Congress would need to pass legislation mandating the change.

To learn more, click here.

Popular Antibiotic Azithromycin Could Lead to Potentially Fatal Heart Rhythms

The FDA issued a warning on Tuesday that azithromycin (also known as Zithromax, Zmax or the Z-Pak) can cause abnormal changes in the electrical activity of the heart that might lead to a potentially fatal irregular heart rhythm. The drug's label has been updated to include this risk.

The FDA is encouraging physicians to consider this risk when prescribing the drug to patients who are already at risk for cardiovascular events. Such patients include those with existing QT interval prolongation, low blood levels of potassium or magnesium, a slower than normal heart rate or use of certain drugs used to treat abnormal heart rhythms.

To learn more, click here.

Inexpensive Drug Can Cut Heart Patient Rehospitalizations by One-Third

A new study has shown that the inexpensive drug digoxin, also known as digitalis, can cut the risk of rehospitalization in heart failure patients by more than 30 percent.

During the study, researchers reexamined the results of a 1997 study that concluded that digoxin did not lower death rates. They found that while it might not lower death rates, it did make patients 34 percent less likely to be admitted to a hospital within 30 days. Half of the members of the trial group were 65 years or older.

The researchers are now seeking to replicate the results in a modern study.

To learn more, click here.

House Leaders Call for Hearing on CRE

On the heels of the CDC's release of new information regarding carbapenem-resistant Enterobacteriaceae, lawmakers are calling for the House of Representatives' Energy and Commerce Committee to hold hearings on the deadly bacteria. (We first wrote about the CRE threat here last week.)

The lawmakers are asking the committee to meet with healthcare providers, researchers and health agency representatives as quickly as possible to determine the appropriate federal response to the threat.

CRE is lethal in about 50 percent of cases, is resistant to even last-resort antibiotics and can spread its resistance to other germs. It has been reported in hospitals and long-term care centers in 42 states.

Good Friday/Easter Closure Notice

Professional Medical will be closed on Friday, March 29 in honor of Good Friday/Easter. Orders that are placed by noon on Monday, March 25 will be delivered by Thursday, March 28.

We invite you to call our Customer Care team at (800) 648-5190 with any questions or concerns. 

CDC: Antibiotic-Resistant CRE Bacteria On the Rise, Becoming More Lethal

According to a new report from the CDC, a lethal, drug-resistant bacteria is spreading throughout U.S. healthcare facilities. The bacteria, carbapenem-resistant Enterobacteriaceae, or CRE, has been on the rise and has become more resistant to last-resort antibiotics over the past decade.

The CDC describes CRE as a "triple threat" because of the following:

• Resistance: The bacteria are resistant to nearly all antibiotics, including the most powerful, last-resort drugs. 
• Death: CRE germs kill 50% of the patients who contact bloodstream infections from them. 
• Spread of disease: CRE bacteria can easily transfer their antibiotic resistance to other bacteria. For example, carbapenem-resistant klebsiella can spread its drug-resistant properties to E. coli, making that bacteria resistant to antibiotics too. 

CRE is typically spread person-to-person, often by the hands of healthcare workers.

According to Tom Friedman, Director of the CDC, "CRE are nightmare bacteria. Our strongest antibiotics don't work and patients are left with potentially untreatable infections. Doctors, nurses, hospital leaders and public health must work together now to implement CDC's 'detect and protect' strategy and stop these infections from spreading."

The CDC has released a CRE Toolkit that includes guidance on halting the spread of the bacteria. According to the toolkit, all long-term care facilities should observe the following eight core measures:

1. Hand hygiene 
2. Contact precautions
3. Healthcare personnel education
4. Minimizing device use 
5. Patient and staff cohorting
6. Laboratory notification
7. Antimicrobial stewardship
8. CRE screening

To learn more, click here.

Study: MRSA Peaks in Nursing Homes in February, March

Researchers at Johns Hopkins have determined that seniors are at the greatest risk of methicillin-resistant Staphylococcus aureus (MRSA) infections in the winter months.

Healthcare-associated MRSA infections most commonly affect people 65 years and older. The researchers determined that these infections typically peak in February or March. They theorize that this is tied to antibiotic use during the winter flu season. Healthcare-associated MRSA strains show a corresponding resistance to the antibiotics that are commonly prescribed during the flu season.

To learn more, click here.

Diabetics on Januvia, Byetta at Double the Risk for Pancreatitis

Researchers at Johns Hopkins have found that diabetes who take the medications Januvia and Byetta are at a significantly elevated risk of developing dangerous pancreatic inflammation. Januvia and Byetta are glucagon-like peptide-1 based drugs.

The researchers found that people taking these drugs are twice as likely as other diabetics to be hospitalized with pancreatitis within 60 days of starting the drug. They recommend that care providers be alert to the symptoms of pancreatitis, including abdominal pain, nausea and persistent vomiting.

To learn more, click here.

FDA: Osteoporosis Drug Ingredient Linked to Cancer

The FDA is warning that there is a strong possibility that calcitonin salmon, an ingredient used in osteoporosis drugs, is linked to cancer. Calcitonin salmon is a man-made version of the hormone calcitonin, which is found in salmon.

Calcitonin-containing drugs include Novartis AG's Mialcalcin injection and nasal spray and Unigene Laboratories Inc's nasal spray. There are also generic products that contain calcitonin.

The FDA said that it has concerns over the risks versus the benefits of using the drugs to treat osteoporosis in postmenopausal women. An advisory panel to the FDA is scheduled to discuss the matter on March 5 and will make a recommendation on whether to allow the products to continue to be marketed for the treatment of osteoporosis.

To learn more, click here.