Christine A. Trisch, RN, BSN, CCM, from HealthPlus of Michigan, shares views and best practices on various topics:
What do you think the number-one prevention method is to reduce multi-drug resistance in healthcare settings?
Answer: The number one prevention method to prevent/reduce drug resistance is to teach our patients the correct way to take the antibiotics that are prescribed for them. We must do excellent discharge planning and education of patients to assure they understand their medications and how to take them properly. We must also teach them the consequences of stopping their antibiotics “early” because they “feel better.” And, of course, the number-one way to prevent the spread of disease has never changed — it is good hand washing and aseptic technique by healthcare providers.
Please provide an example of how your involvement in the process as a case manager helped ensure the plan of care was streamlined and cost-effective.
Answer: As a telephonic CM, I work daily with members of our health plan who are in the process of organ transplant. I work with the member and the transplant facility CM to assure that all required testing is done in the appropriate setting — which is not necessarily always at the transplant facility. Routine blood work is one area where I intervene frequently and redirect our members to the appropriate facility. Refills of post-transplant medications is another area where I am able to intervene to assure the member has the Rx filled at the proper pharmacy. These minor interventions can add up to an enormous savings plan-wide at the end of every year. By doing this, it allows our health plan to better utilize the dollars it has.
Request: One of the areas where case managers can show positive outcomes is in the area of patient education and empowerment. This type of study provides a baseline for both managed care and provider-based case managers to measure improvement. Please read the report, and then give us a few examples of things you’re doing to reduce complications related to medical care.
Answer: I am a CM for a managed care organization with a membership of almost 200,000. Needless to say, we have very active disease management and case management departments. One way that I am able to help reduce complications related to medical care is by calling my members who have been in the hospital after they have been discharged and reviewing with them their medications and discharge instructions. I follow up with them to assure they are able to make their follow-up appointment with their doctor and if they are not, I will make the appointment for them. I also assist them with transportation if needed, review all of their medications and do education on each drug. If I see any that have contraindications, I will alert the pharmacist and the member’s physician. I do in-depth medication teaching with my members on insulin, coumadin, ASA, etc. I also request medication profiles from our pharmacy department and compare the drugs the member says they are taking with the drugs they are actually having filled. By doing this in-depth look at discharge, I am able to intervene before a “bad situation” arises.
Question: Obesity is out of control. What unique steps can case managers implement in their communities to turn this epidemic around? How can we turn research into practice and engage the public to take action?
Answer: As CMs, we can talk with the parents of our “littlest” members and teach them ways to prevent obesity in their children. Simple ideas such as shoo them outside to run and play for an hour after school each day. When I talk to parents about their children, I discuss and educate on diet and ways to get kids to eat more fruits and vegetables. But, in order to get kids to do this, it has to be something they live at home, not just something they hear from their parents. If the parents are overweight (or even if they are not), I encourage them to walk daily and to follow a low-fat/low-calorie diet as an example to their children on living a healthy life. I talk to parents about eating out vs. eating at home where they can control the amount of fat and calories their children consume in the foods they eat. I encourage parents to keep fresh apples, grapes, melon, carrot and celery sticks, etc. handy for kids to grab for snacks. We can engage the public in this plan, one child/family at a time if necessary. When neighbor kids come over to play and see that they have fresh apples for a snack and find out how delicious they are, they then request them at their house and so it goes. Children learn what they live, so we need to let them “live” healthy! We can organize a playground day every week and parents can take turns supervising play and planning activities such as tag and kick ball that encourage kids to run and play. Parents can donate healthy snacks for kids for this day, such as juice and fruit. We can also encourage kids to drink plain water — which is something very few kids get enough of — by keeping a cooler of iced-water bottles available for them at the playground. The bottom line is we need to teach parents to not allow their kids to vegetate in front of a TV or computer all day so we as parents need to get up and get moving too! Lead by example!
Liz Zemke, RN, CCM from Fresno, CA offered some great answers to several questions:
Question: What do you think the number-one prevention method is to reduce multi-drug resistance in healthcare settings?
Answer: Prevention and prevention of the spread of resistant bacteria can be enhanced by proper hand washing and using gloves appropriately. Also, regarding infection control and surveillance strategies, a case manager with a background in infection control can be helpful in implementing and performing the surveillance of the CDC guidelines with patients.
Request: If you practice case management in a hospital setting, please share with us some of the innovative ideas you are working on to ensure safe, quality, cost-effective care within your organization.
Answer: At our local hospitals and acute rehabilitation centers we have a voluntary peer visitation program which I think positively impacts on outcomes. Heart patients are visited by a “mending hearts group.” As an amputee, I visit the new amputees, and cancer survivors visit those diagnosed with cancer. Case management obviously, is always the answer to improving outcomes — in my opinion. I Would like to see more one-on-one field case managers rather than telephonic management.
Request: Please provide an example of how your involvement in the process as a case manager helped ensure the plan of care was streamlined and cost-effective.
Answer: We all have networks, but the providers in the networks can vary greatly in the quality of services that they provide for the buck. A field case manager who works in the community where the patient lives can “direct” care towards those providers who offer the highest quality of care, within the network-negotiated price. But also, I’ve negotiated with other great providers — maybe not in the network — for a lower price, and medically justified it to an adjustor in order to save money yet improve quality.
Request: Please read the report, and give us a few examples of things you as a case manger can do to reduce complications related to medical care.
The following are samples of creative things I do as a case manager to reduce medical complications:
- I have a subscription for a drug program on my computer where I can not only check information on any drugs that my clients are on, but interactions, side effects, etc. It’s a great program and resource that case managers should use.
- Also, case managers need to implement the case management adherence guidelines (CMAG) from CMSA.
- Case managers for elderly would be so valuable. This would help keep seniors as independent as possible — a low cost to pay to prevent costly hospitalizations and nursing home placements.
- Also, on osteoporosis education, we need to be aggressive in educating those patients at risk, and be able to screen and institute treatment when needed. Last night I visited a lady at acute rehab who had recently had an amputation. She also has osteoporosis and has not had a bone density test, nor is she on any treatment or intervention. But the worst case was a patient next to her — a 56–year-old lady who was “old” beyond her years. She overheard my conversation and asked about osteoporosis. She sees a doctor regularly, has a pain manager (after 4 spinal fractures and loss a loss of three inches in height since high school), has never been offered a bone density test, had a hysterectomy very early, is not on estrogen, has not been to take vitamin D and Calcium — nothing. And, she’s not weight-bearing all of the time because of a fractured ankle. I’m convinced that a case manager who can pull all the person’s conditions together and look at a person holistically and totally, rather than at the one problem that brings them into a facility, will work to improve outcomes.
- I work with a local hand surgeon that is not going to be accepting any patient without a case manager, as we can do all the preliminary paper work and preparation; anticipate what authorizations are going to be needed; facilitate scheduling in record time; educate and inform the provider about all co-morbidities, drugs, issues that might impede healing, or would be contraindications for surgery; or identify problems that need to be addressed by the doctor.
