The federal government has cited numerous nursing homes in Kansas for serious failures to prevent the spread of sepsis and causing an increased risk to the residents. The failures involve insufficient staffing, care of catheters, feeding tubes and bedsores. Federal citations of a “most serious level” ranking may be an indicator of a facility’s providing substandard quality of care which may result in the submission of false claims.
Compliance Perspective – Sepsis Infection:
The Compliance and Ethics Officer with the DON, the Infection Preventionist, and the Administrator will review the facility’s protocols regarding infection prevention and control and, treatment/services to prevent and heal pressure ulcers, urinary tract infections and the process in place to ensure adequate staffing levels. Staff must be educated and trained to observe stringent adherence to infection control protocols in providing care for residents with catheters and feeding tubes. Education must also be focused on the need to shift and reposition immobile residents frequently to prevent formation of bedsores and to facilitate healing when bedsores are present. Staff will be trained regarding urinary tract infections (UTIs) and the importance of keeping residents hydrated, providing proper care of catheters and helping residents maintain good personal hygiene. The nurse supervisor/designee will be educated regarding the importance of posting the shift report and maintaining the appropriate records to be provided to the CMS demonstrating that the required number of nurses and CNAs are available on each shift. The DON and the Infection Preventionist will ensure that body audits are done on all the residents to determine if there are any undocumented bedsores/ulcers or non-healing bedsores/ulcers that require more intensive care. Completed audits will be evaluated for potential areas where attention may be required.
Since 2015, the federal government has issued citations to numerous Kansas nursing homes for practices that increase the residents’ risk for a sepsis infection. This infection attacks almost two million people in the U.S. annually and is deadly to more than 225,000 of those infected.
Sepsis happens when a person’s body is fighting off an infection, and the chemicals in the bloodstream trigger adverse life-threatening reactions—sometimes leading to organ failure.
Elderly nursing home residents with diminished capacity and those with limited mobility are particularly vulnerable. Urinary Tract Infections (UTIs) frequently lead to sepsis and may be due to a resident having a catheter or lacking proper hygiene.
An expert on sepsis from the University of Kansas Medical Center made this statement, “Sepsis is one of the most common causes of death if you’re in a nursing home.”
The citations the nursing homes received involved infection prevention and control, catheters, feeding tubes and bedsores. These deficiencies were ranked on a scale with the most serious ranking being “immediate jeopardy to a resident’s health or safety.” Eight of the numerous nursing homes cited received this most serious level ranking.
Insufficient staffing levels in nursing homes have also been linked to the risk for residents developing infections that lead to sepsis.
Residents who are immobile need to be turned and repositioned frequently to prevent bedsores. It is recommended by the Mayo Clinic that persons in wheelchairs should shift their weight every 15 minutes.
Being immobile is not the only reason that nursing home residents are especially vulnerable to sepsis. Elderly residents often have weakened immune systems and sometimes their bodies do not give clear warning signals, i.e., high temperatures and elevated heart rates, things that would normally indicate a problem. It is also often difficult for an elderly person to describe when they are experiencing discomfort.
Another indicator may involve a resident who is usually clear headed but who begins to be confused and unable to relate ordinary things.
The University of Kansas Medical Center is working with Kansas nursing homes to educate staff about noticing the early warning signs of sepsis that can save a resident’s life.
