When it comes to reducing patient readmission rates and avoiding financial penalties, infections can be a home health agency's worst nightmare. One particularly dangerous type of infection, sepsis, has grown more prevalent in recent years and often leads to rehospitalization.
What HHAs need today are robust infection control policies and procedures. While some agencies were previously not required to implement such programs, the new Medicare conditions of participation (CoPs) have made it mandatory that all HHAs have a comprehensive infection control protocol.
Let's take a closer look at what this new mandate means for your organization:
Understanding infections in the home health – hospital relationship
Researchers from the Columbia University School of Nursing conducted a study of 199,462 patients at 8,255 home health care agencies. They found that 3.5 percent of patients developed infections during their stay, and that 17 percent of unplanned hospitalizations were due to infections.
The study was published in the American Journal of Infection Control in 2016. While it found a relatively small incidence of infections in HHAs, there has been a notable surge in sepsis in hospitals. As a referral partner, this increase presents a greater need for sepsis monitoring and vigilance in home health agencies.
The rise of sepsis in hospitals
The number of sepsis cases in the U.S. has been rapidly rising in recent years. Between 2005 and 2014, the incidence of hospital stays due to sepsis nearly tripled, according to a report by the Healthcare Cost and Utilization Project published in June of last year. Sepsis is now the No. 1 reason for hospital stays, according to new data from the Agency for Healthcare Research and Quality, Bloomberg reported.
To deal with the rise of sepsis, New York State now requires all health care agencies to implement new evidence-based screening and treatment protocols. As a result of the new processes, sepsis mortality has decreased nearly 16 percent in the past two years. Other states have followed suit, with Illinois, Wisconsin and Ohio implementing infection protocols modeled after the New York program.
Thornberry Ltd. also updated its NDoc® solution to better address sepsis, adding additional patient screening questions and expanding the Signs and Symptoms table to capture more detailed information relating to the condition. With these tools, providers can institute more effective evidence-based treatment protocols.
Changes to the Medicare CoPs
Infection control has always been a part of HHAs' provisions of care, as mandated by their state's requirements. Those that were accredited by the Joint Commission or CHAP already had to have infection control policies and procedures in place. However, CoPs changes have now made it mandatory that all HHAs have an infection control program. Read the release on the final rule here.
"CoPs changes have now made it mandatory that all HHAs have an infection control program."
Enhanced infection protocols in EMRs
The sepsis protocols highlight a need for HHAs across the country to have more robust infection control programs in place. Many EMRs only give nurses the option to document Yes/No as to whether the patient exhibited signs of an infection, and reports simply gave the the option to show if the patient had a catheter and if they were on an antibiotic.There was no report to calculate the number and type of infection.
However, Thornberry Ltd. has introduced enhanced infection control protocols. In NDoc®, clinicians can now fill out a new section that captures more information about current and potential infections and easily coordinate additional lab work and cultures. Then, they can run a report for the number and types of infections for all of the agency's patients to quickly get a better idea of infection risk and trends and determine whether the infection was likely agency-acquired.
These new processes give a more detailed picture of what an agency has done to prevent and treat infection. This information can then be used for performance improvement initiatives and staff training.
The number of documented sepsis cases has been increasing, but with improved infection control protocols now mandated for use by all providers by the new CoPs, HHA are better equipped to identify, treat and ultimately prevent infection.