Avoid ‘sundowning’ in elderly hospital patients

It’s a serious concern at many hospitals: the “sundowning” phenomenon. In the evening hours, elderly patients, disoriented by their surroundings, start behaving erratically – yelling, rambling, wandering away from their hospital beds. This behavior can take a serious toll on their recovery. 

ThinkstockPhotos-122552779An article from Boston’s NPR outlet, WBUR, discusses sundowning in detail. According to the article, many experts agree that older patients are more prone to this behavior during the nighttime and early-morning hours. But few explanations exist as to why.

There’s also debate about whether this behavior is another form of delirium. Some say it’s related, while others consider sundowning its own separate condition.

Whatever the cause, it’s tough for facilities to get a handle on it.

The condition’s most prevalent in elderly patients with memory problems or dementia, but it can strike any older person. It’s likely the biggest trigger is being in unfamiliar surroundings.

And per Dr. Sharon Inouye, an expert on aging quoted in the article, biological factors that play a role in sundowning include “disruptions in circadian rhythms, nadirs in cortisol, stress hormones, sympathometic neurotransmitters, melatonin or fluctuating cytokines.”

In other words: Changes in sleep patterns and hormone fluctuations may lead to big problems for hospitalized older patients.

HELPing hand

The best strategy for hospitals to decrease the likelihood of sundowning in older patients (or to identify problems more quickly) is to take a preventive approach.

Some hospitals have specific protocols in place to keep elderly patients from developing any signs of sundowning or delirium. For example, Dr. Inouye developed the Hospital Elder Life Program (HELP), which is currently being used in over 200 hospitals worldwide.

Under HELP, clinical staff members are specifically trained on caring for older patients. HELP mainly focuses on making sure the elderly are aware of their surroundings. Staffers are told to regularly remind patients that they’re in the hospital, along with what day it is, the specific date and the time of day.

Other tactics used to keep patients oriented with their surroundings include:

  • making sure glasses and hearing aids are within their reach
  • getting them out of bed and walking regularly
  • ensuring they’re hydrated and well fed
  • avoiding the use of medications known to cause confusion
  • managing their pain, and
  • reducing hospital noise to improve their sleep.

HELP’s been beneficial for hospitals where it’s been implemented, according to another WBUR piece.

In fact, a study of the program showed that patients were 50% less likely to develop delirium or symptoms of sundowning than patients who weren’t treated using the program. Patients also had a 62% lower chance of falling while in the hospital.

Need for elder-care standards

Your nurses may be using similar tactics with elderly patients. Regardless, it’s beneficial to have a formal program in place at your hospital for elder care.

Creating a standardized protocol ensures your clinicians are on the same page regarding elder care. And chances are, having a formal process in place will improve patient outcomes – an important component of the value-based care initiatives affecting hospital reimbursement.

Plus, it’s easier to get families involved in the process if it’s standardized. They can play a critical role in keeping sundowning at bay by reinforcing the efforts of staff. In addition, they can let clinicians know about the patient’s normal behavior, which can help doctors and nurses spot any sudden changes.

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5 healthcare technology trends to watch for in 2016

ThinkstockPhotos-491119888Trends about where an industry is headed, especially one as large and complex as healthcare technology, should best be thought of as trajectories rather than binary “did/did not happen” events. But make no mistake, a lot can happen in a year – even in healthcare technology. In this guest post, Mark Ott, director of product at a cloud-based care management system provider, highlights five trends hospital executives can expect to see unfold in 2016.


1) Value-based train picks up steam, especially for those slow to embrace alternate payment models.

We all know the official timeline the Centers for Medicare & Medicaid (CMS) laid out in early 2015 – 90% of payments would shift from fee-for-service to value-based payments by 2018. Despite the clear, unambiguous move to value, some in the industry have been slow to transition their organization. However in 2016, expect to see these organizations finally make clear moves to alternative payment models. The significance of this shouldn’t be understated, especially as it pertains to technology adoption.

2) Care Management/Coordination Record rises in importance, as team-based care models expand.

Some call it a Care Management Medical Record and others call it a Care Coordination Record. Regardless of the term, the concept is essentially the same. Electronic medical records (EMRs) excel at capturing in-person encounters, but as care expands beyond those encounters, capturing and tracking what happens between patient visits will be of utmost importance. In addition, enabling care teams to stay on the same page about a patient’s care plan, track action steps and reduce the friction of working together, will be crucial to succeeding in a value-based world. Expect to see the Care Management Record concept start catching fire in 2016.

3) Terms ‘care coordination’ and ‘patient engagement’ continue to be abused, misused and watered down.

These terms by themselves have become almost meaningless. There are countless healthcare vendors claiming to deliver on one or both of these capabilities. Seemingly, most companies use these terms “in name only” in an attempt to capture market interest. The onus is on every product company to be very clear just how it enables patient engagement or care coordination. In 2016, the market will start weeding out those products that are patient engagement and care coordination in name only, while rewarding those companies that are actually able to deliver clear value.

4) Integrating devices and device data into care delivery processes will remain a niche activity.

The enthusiasm around wearables, trackers and remote monitoring is exciting, and there’s enormous potential for device data to impact the delivery of care in ways that benefit both patient and provider. But the technology hasn’t caught up with the promise of what it can be, and that won’t change in 2016. Not only is the technology not yet able to deliver, but the incentives and processes to support wide-scale deployment aren’t in place yet. Although all signs point to wearables becoming an integral part of delivery of care, this won’t happen next year.

5) Demand increases for consumer-grade user experiences in healthcare enterprise software.

For so long, clinicians on the frontlines of care delivery have struggled with software that’s hard to use, difficult and downright frustrating. The biggest culprit for poor user experiences in healthcare software has to do with the enterprise purchasing process. Often, vendors build for buyers who aren’t the end users. If the end user and the buyer were the same, you’d see healthcare software vendors value user experience like what we see in other B2B industries, not to mention B2C industries. Regardless, in 2016 we will see more buyer-value products with consumer-grade user experiences. Much of this has to do with end users’ reluctance, and sometimes outright resistance, to adopting technology in their work life. Clinicians often get a bad wrap for being technology averse. But in reality, it’s not that they’re averse to technology; it’s that they’re averse to bad technology.

Mark Ott is director of product at RoundingWell, a cloud-based care management system provider.



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How cloud computing tech can improve hand hygiene

Monitoring whether doctors and nurses are following best practices for hand hygiene can be an inexact science. But new technological innovations are changing the game, making it easier to track just how often staffers are washing or disinfecting their hands. 

ThinkstockPhotos-476703610These developments are coming about due to the rise of the Internet of Things (IoT), a concept where ordinary items are upgraded to include Internet connectivity. This gives them the ability to communicate information in real-time.

A project designed by Microsoft and Gojo, the company that makes Purell hand santizer, measured how often hospital workers were washing their hands using IoT technology. Their experiment was detailed in an article from Time magazine.

How it worked

The experiment took place at John Peter Smith Hospital, located in Fort Worth, TX.

As part of the project, the system installed at the hospital had two components:

  1. a ceiling-mounted sensor to monitor the flow of foot traffic, and
  2. soap and hand-sanitizer dispensers with sensors to track when they were used.

These two devices sent their data to Microsoft Azure, a cloud-based computing service, via the Internet. The software stored and analyzed the information, as described in a video about the project. This gave researchers a clear picture of how many times people washed their hands upon entering and exiting the area.

Researchers performed the project in phases, according to the Time article. During the first phase, the devices collected baseline data to see how often workers washed their hands without knowing they were being monitored. At this time, the hand-washing compliance rate was only 16.5%.

In the next phase, researchers made everyone in the hospital aware they were conducting a study about hand washing, even patients and visitors. The result: Compliance rates nearly doubled, climbing to 31.7%

Researchers stopped reminding people about the project during its last phase to see whether they got the message about remembering to wash or disinfect their hands. While compliance was lower than it was during the second part of the project, hand-washing rates were still at 25.8% – much higher than they were initially.

Effective tracking

Overall, the cloud-connected system was able to detect 90,000 instances where people should’ve washed their hands. It’d be extremely difficult for a facility to make similar observations without an automated system in place.

And because the data was stored in the cloud, researchers were able to easily access the information using an Internet browser on a computer or mobile device.

Similar technology could boost your hospital’s hand-washing rates. While Microsoft and Gojo haven’t announced plans to take this particular system public just yet, innovations like these are happening faster due to growing advancements in IoT technology and cloud computing.

With that in mind, you may want to get together with IT and find out whether your hospital’s existing network infrastructure is able to accommodate more Internet-connected devices and tools down the line.

If not, you can start brainstorming about what you’d need to do to make that possible. This’ll help you ensure your facility’s a step ahead of new technological developments, which means you can take advantage of them more easily in the future.

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Details announced on CMS bundled payments for joint replacement

It’s official: The Centers for Medicare & Medicaid Services (CMS) has set a date for when bundled payments will begin for hip and knee replacements. The agency’s also released the new structure it’ll use for reimbursement – and there are quite a few changes from its initial proposal.  

487098007Hospitals can mark their calendars for April 1. That’s when bundled payments will start.

The CMS announcement, which will be available on the Federal Register on Nov. 24, was discussed in-depth in an article from U.S. News & World Report, as well as in a news release from the Department of Health & Human Services (HHS).

Under the new payment system, officially dubbed the Comprehensive Care for Joint Replacement (CJR) model, facilities will face more financial risk regarding patient outcomes for each procedure.

Originally, CMS planned to implement the CJR model in January. But, due to several comments from hospitals and other healthcare providers asking for an extension, the agency pushed back the start date to give them more time to get ready.

Purpose & objectives

According to CMS, the ultimate goal of the new CJR model is to test whether giving hospitals one lump-sum payment for hip and knee replacements will improve quality while reducing Medicare costs. The agency is also looking to:

  • improve the coordination and transition of care
  • encourage more provider investment in changing care processes to boost quality
  • improve the coordination of items and services that are reimbursed through Medicare, and
  • incentivize hospitals to provide higher value care to patients from admission to post-discharge.

As of now, CMS plans the CJR model as a pilot program. It’ll evaluate the model’s effectiveness over a four-year period (or five CMS “performance periods”), ending Dec. 31, 2020.

But unlike other CMS bundled payment pilot programs, which asked hospitals to volunteer, the agency is requiring all hospitals in the targeted geographic areas that provide hip and knee replacements to participate. It’s hoping to gather data about improving quality of care in all kinds of facilities, so it wants a wider range of participants.

CMS did, however, scale back the scope of the program slightly. Instead of requiring participation of all hospitals in 75 metropolitan statistical areas, facilities in 67 of these areas will be paid via the CJR model.

Another big change: CMS won’t be using a “target price” methodology for determining how much hospitals will be paid for joint replacement.

Instead, it’ll base payments on whether hospitals measure up with meeting a yet-to-be-determined quality score methodology. This way, reimbursement will be tied more closely to quality, further emphasizing the shift to value-based payments.

Gradual repayments

Under the CJR model, CMS will also implement a more gradual transition for hospitals to assume higher financial risk than it proposed in its initial announcement. This is designed to make the adjustment even easier. Per CMS, the limits will be as follows:

  • No repayment responsibility for hospitals in performance year one
  • A stop-loss limit of 5% in performance year two
  • A stop-loss limit of 10% in performance year three, and
  • A stop-loss limit of 20% in performance years four and five.

And in years two and three, CMS will allow hospitals to be eligible for a reduced discount percentage for repayment responsibility. So they may not be on the hook for the full repayment penalty.

Rural hospitals, Medicare-dependent hospitals, rural referral centers and sole community hospitals will be exempt from these stop-loss limits.

Hospitals’ next move

Although the CJR model is technically a pilot project, hospitals across the country should be prepared for similar initiatives from Medicare and other payors as time goes on.

Value-based care is quickly becoming the norm. And bundled payments won’t be far behind. So it’s critical to start working on improving your hospital’s quality of care for joint replacements and other procedures, even if your facility isn’t located in one of the targeted geographic areas for the CJR model.

Laying the framework for high-quality, low-cost care right now will make your facility better poised to survive in the future healthcare climate.

CDC raising awareness of antibiotic use in hospitals

Although there’s been some progress, hospitals still need to make more of an effort to curb the overuse of antibiotics when treating patients. As a result, the Centers for Disease Control and Prevention (CDC) is urging hospitals to be more proactive with prescribing antibiotics. 

ThinkstockPhotos-493887466 (1)According to the CDC, around 2 million people in the country are infected with antibiotic-resistant bacteria every year, including infections like C. diff. And these infections cause at least 23,000 deaths.

These problems can be directly traced to the overuse of antibiotics. Per the CDC, 50% of the antibiotics administered to patients aren’t appropriate for their conditions.

To raise awareness, the CDC has designated Nov. 16 to Nov. 22 as “Get Smart About Antibiotics Week” and it’s using the occasion to urge hospitals to adopt specific antibiotic stewardship programs.

Only around 39% of hospitals currently have such a program, according to an article from the American Hospital Association’s Hospitals & Health Networks, but it’s essential to ensure that antibiotics are only prescribed as necessary.

Starting a program

Antibiotic stewardship programs encourage clinical staff to follow best practices when prescribing and administering antibiotics. There are several resources available for hospitals to get started. The American Hospital Association has created a toolkit about creating an antibiotic stewardship program, and the CDC has information and examples of successful programs on its website.

The CDC also has a checklist of elements that an effective antibiotic stewardship program must include, such as:

  • Leadership support. Hospital executives must come out in full support of any policies and procedures designed to reduce unnecessary antibiotic use. They must also make appropriate funding available to support the program.
  • Accountability. A physician leader or other point person should be responsible for any outcomes of your antibiotic stewardship program.
  • Drug expertise. Besides physician representatives, a knowledgeable, high-ranking member of the pharmacy team should be closely involved with your program.

Other key elements include specific actions to support optimal antibiotic use (e.g., requiring all doctors to specifically document the need for antibiotics), interventions to improve antibiotic use (e.g., getting pre-authorization from a pharmacist before administering antibiotics), and systems to monitor antibiotic use over time in a hospital.

Facilities that don’t have a specific program in place to reduce antibiotic use should get started on creating one right now.

Not only is antibiotic resistance a public health issue, it’s a big problem for hospitals when trying to lower patients’ risk of contracting infections. If a patient’s infected with a “superbug” that doesn’t respond to traditional antibiotics, hospitals have fewer options for treating the patient – and the outcome may be dire.

Make an App, As Easy as Pie; Using Appy Pie

As you guys know that 21st century is an era of innovations. Every other day we came to know about new entry in technology. Same is the case with Smartphone. Every next day we came to know about new smart phone and thousands of new Apps. Hence in this era the race of App is so fast and everyone is trying to compete it. People want App according to their changing need. No doubt App making procedure is difficult and expensive too. But here in the article I am going to solve your problem by simply telling you About Appy Pie.


Appy pie is the new entry in the App development industry. It was introduced in India in the year 2013 and gain popularity all over the country. The developer of Appy pie believes that, it will make app development as easy as eating a slice of Apple. Appy pie offers its users a number of built in templates for usage, like restaurants templates, hospital templates and etc. It also provide support from Amazon cloud and surely is the best option for the people who are planning to own the app development risk.  Following are the Pros and cons of Appy pie. Have a look on them.


Ease of use:

Appy pie offers a user friendly interface enabling you to design your own professional App in seconds. It easy and simple interface offers few buttons and clicks that are easily understandable even if you are using this App for the very first time. Moreover Appy pie supports Android, Windows and iOS system to create and publish customizable mobile Apps.  It supports 26 different languages including Chinese, Dutch, English German, Italian, Japanese and more.


The best thing about Appy pie is that, it has its own private market place. It means that it is going to publish your app without any extra charges on their own market place. Hence giving popularity to your App.


Appy pie starts its pricing plan from$ 7.00. You need to subscribe the plan suitable to your requirements. By using Appy pie you can develop your very own business and can develop Apps for your customers.



Not Stable Version:

One of the drawbacks of Appy pie is that it is still in beta phase. So you might suffer from different viruses and bugs.

 No Support For App store:

Appy pie do not provides any support for App store or play store. Once you are done with development of your App you need to submit it manually.


Since Appy pie is the new App in the market it do not still have the option of user reviews.


Currently Appy pie is the most famous and affordable App for the people who want to develop their own professional looking Apps. It comes with hundreds of extra ordinary features that are requirement of a classy and cool App. So I am highly recommending Appy pie for new as well experienced customers. Yes on more thing if you are scared about your money and do not want to risk your $ 7.00 there is free version of Appy pie too. Avail the free version and decide whether you are satisfied with it or not.

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