OASIS Alert

Don’t overlook environmental risks.

Falls are the leading cause of fatal injury among older adults and taking every effort to mitigate fall risk will help keep your patients safe. Make certain you’re considering these key areas when assessing for fall risk.

Medication Issues: A blog post at the Collaboration for Homecare Advances in Management and Practice (CHAMP) website (www.champ-program.org) offers the following list of medications that increase the risk of falls in the home health population:

Warfarin and other anti-thrombolytics

Oral chemotherapy agents such as methotrexate when used for non-oncologic indications such as arthritis

Oral hypoglycemics and SQ insulin

Digoxin

Narcotics/opiates

"Consider this list, when setting up a drug utilization review system, as a first step in customizing a review process relevant to your agency’s population and services," said Dennee Frey, pharmacy expert with CHAMP.

Gait and Balance Disorders: While normal aging can cause gradual gait changes, muscle weakness, sensory input impairment, and joint contracture can put your patients at greater risk of falls, according to an article in American Nurse Today. Assessing your patient’s functional status with one of the standardized assessment tools such as the Timed Up and Go test or the MAHC-10 can help you to determine whether he is at risk.

Cognitive Impairment: Patients with cognitive impairment or dementia are less likely than those in good mental health to recover well after a fall, the American Nurse Today article points out. These patients are also more likely to suffer a serious injury.

Assess patients with dementia for cognitive and perceptual limitations so you can plan and implement a rehabilitation program to improve functional safety and ability to perform activities of daily living (ADLs), the article advises.

Poor Nutrition and Limited Activity: Being physically active can greatly reduce the risk of falls in the elderly population. And "research shows vitamin D and calcium supplementation significantly reduce older adults’ fall risk," the American Nurse Today article notes.

Environmental Risk Factors: An unsafe home can greatly increase the risk of a fall. Scatter rugs; inadequate lighting; slippery bathroom fixtures; and obstacles in walking routes can all promote falls.

Read the American Nurse Today article here: www.medscape.com/viewarticle/762687_1.

• The Hospice of North Idaho will pay $50,000 to the U.S. Department of Health and Human Services’ for a "breach of unprotected electronic protected health information affecting fewer than 500 individuals," according to a Jan. 2, HHS press release.

"This action sends a strong message to the health care industry that, regardless of size, covered entities must take action and will be held accountable for safeguarding their patients’ health information," said HHS Office for Civil Rights Director Leon Rodriguez in the release.

The action comes following an investigation by the OCR after HONI reported the theft of an unencrypted laptop, in June 2011, containing the electronic protected health information of 441 patients. The organization regularly uses laptops containing ePHI for field work.

"Over the course of the investigation, OCR discovered that HONI had not conducted a risk analysis to safeguard ePHI. Further, HONI did not have in place policies or procedures to address mobile device security as required by the HIPAA Security Rule," the press release added.

To see the release, go to: www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/honi-agreement.pdf.

• What do you think about the various audit contractors? The Government Accountability Office wants to know. The GAO is requesting provider feedback on post-payment claims reviews conducted by Medicare Administrative Contracts, Recovery Auditors, Zone Program Integrity Contractors, and Comprehensive Error Rate Testing Contractors.

The GAO is working on a report about the Centers for Medicare & Medicaid Services’ oversight of these four contractors. NAHC is also soliciting this feedback for the GAO, and you can send your comments to Mary St. Pierre at mts@nahc.org.