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From Which Inpatient Facility Was Your Patient Discharged?

Are you still having difficulty determining the most accurate answer to M0175? Has your patient had multiple inpatient discharges in the last 14 days but you can't determine the exact dates? While these seem like simple questions they are often difficult to answer because there are payment implications associated with them. The Office of the Inspector General is checking to make sure agencies are answering correctly.

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Medicare is trying to help by producing a special edition of Medlearn Matters for agencies to use as a resource to increase the accuracy of its responses. A 14-day quick look-up reference table is also included. The publication can be found on the CMS Web site and also provides detailed descriptions and instruction related to Medicare inquiry screens found on the common working file including six different common scenarios. The complete report can be downloaded from the CMS Web site at


To V.A.C. or Not to V.A.C.? That Is the Question

A new clinical guideline published as a supplement to the April 2004 edition of Ostomy Wound Management provides concrete guidance for the use of negative pressure wound therapy (NPWT) by using the Vacuum Assisted Closure (V. A. C.) therapy (Kenneth Concepts, Inc., San Antonio, TX) on diabetic foot ulcers. The publication provides the length of therapy; necessity of debridement; efficacy on small, superficial wounds; and combination of the V.A.C. with other therapies. The supplement also provides a comprehensive overview of other NPWT topics such as the pathophysiology of diabetic foot ulcers, the basic science of NPWT, and contraindications for its use.


Source: Armstrong, D. G., Attinger, C. E., Frykberg, R. G., Kirsner, R. S., Avery, R. S., & Mills, J. L. (2004). Guidelines regarding negative wound therapy (NPWT) in the diabetic foot. Ostomy/Wound Management, 50 (4, Suppl. B), 3S-27S.


Insulin Errors on the Rise

The Institute for Safe Medication Practices (ISMP) reports that 11% of all serious medication errors involve insulin orders or incorrect administration. The increased errors are due in part to the many new types and combinations of insulin now available to patients and their physicians. ISMP reports than errors continue to result from confusion and mix ups between Humalog Mix 72/25 and Humulin 70/30 and Novolog Mix 70/30 and Novolin 70/30.

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Transcription-related errors often occur where the "u" (units) is mistaken for a zero, resulting in patients receiving 10 times the intended dose. Additional information can be found at


A Workout Without the Work

A Franklin Massachusetts-based company has developed a revolutionary exercise bicycle designed specifically to assist people who do not possess the strength or endurance to participate in conventional in-home rehabilitation programs.


Will Your Alzheimer's Patients Benefit From Artificial Hydration and Nutrition?

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The Theracycle provides the patient with a full body work out even if they lack the strength to actively participate. The Theracycle requires the patient to place his or her feet in adjustable pedals and hold the handle bars. Once the motor speed is set the Theracycle will either allow the patient to participate in an active customized work out of the arms, legs, knees, and elbows or a passive (assistive) mode. Information related to the purchase of a Theracycle can be found on the company's Web site at Increasingly, the families of patients with advanced Alzheimer's disease are calling upon the home care nurse to assist them in their deliberations related to the use of artificial hydration and nutrition through a feeding tube. According to Lisa M. Byrd, MSN, CFNP, CNOR (2004) families are often asked to make these decisions "without having adequate knowledge or realistic expectations."


For mildly demented patients there may be some benefits and opportunities to improve the patient's quality of life through the use artificial hydration and nutrition; however, for patients with advanced Alzheimer's disease there may be potential disadvantages and risks. Patients with advanced disease may be more likely to experience infections, bleeding, and complications related to the traumatic dislodgement of the tube by a confused elder.


Byrd's article published in Topics of Advanced Practice Nursing provides a decision making algorithm to guide nurses and family to make the most appropriate decision for the patient. The entire article is available online at


Source: Byrd, L. M. (2004). The use of artificial hydration and nutrition in elders with advanced dementia. Topics in Advanced Practice Nursing eJournal, 4 (2). Retrieved May 3, 2004.


ONS Offers Web Course on Safe Handling of Hazardous Drugs

The Oncology Nursing Society (ONS) is offering a new strategic educational course aimed at protecting healthcare workers. A working group of experienced professionals met through ONS to develop a course containing the latest information about best practices to ensure worker safety. Safe Handling of Hazardous Drugs is the new Web-based training course; it is self-paced and enables the learner to interact with experienced faculty through e-mails, chat forums, and ongoing evaluation of assignments.


Objectives for this comprehensive course include: the ability to define hazardous drugs, describe the potential health risks of handling hazardous drugs in oncology nursing practice, and identify the appropriate personal protective equipment needed for safe handling of hazardous drugs during preparation, administration, disposal, and spill containment. For information on course schedules and registration visit


ONS also offers the publication Chemotherapy and Biotherapy Guidelines and Recommendations for Practice, which covers basic safe handling issues and procedures. For more information visit


HHN's Clipboard is coordinated by Stephanie Mello Gaskell, MS, MBA, RN, VP of Clinical Services, VNA of Southeastern Massachusetts, Inc., 502 Bedford Street, Fall River, MA 02720 (