National Guideline Clearinghouse | Hospital-Acquired Conditions

Hospital-Acquired Conditions
Section 5001(c) of the Deficit Reduction Act of 2005 requires the Secretary of Health and Human Services to identify conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a diagnosis related group (DRG) that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines.

If at discharge, there is a selected condition that was either not identified by the hospital as present on admission, or could not be identified based on data and clinical judgment at admission, it is considered hospital-acquired. To encourage hospitals to avoid hospital-acquired conditions, beginning October 1, 2008, Medicare no longer pays hospitals at a higher rate for the increased costs of care that result when a patient is harmed by one of the listed conditions if it was hospital-acquired. Medicare prohibits the hospital from billing the beneficiary for the difference between the lower and higher payment rates. The inpatient prospective payment system fiscal year (IPPSFY) 2009 Final Rule is available from the Centers for Medicare and Medicaid Services (CMS) Web site .

Listed below by condition are evidence-based guideline resources available on NGC to assist users in the prevention of the CMS-identified hospital-acquired conditions.

Foreign Object Retained After Surgery (1)

Prevention of unintentionally retained foreign objects during vaginal deliveries. Health care protocol

Stage III and IV Pressure Ulcers (3)

Pressure ulcer prevention and treatment. Health care protocol Preventing pressure ulcers and skin tears. In: Evidence-based geriatric nursing protocols for best practice Guideline Synthesis: Pressure Ulcer Prevention
Falls and Trauma including fractures, dislocations, intracranial injuries, crushing injuries, burns, and electric shock (6)

Falls
Fall management guideline Preventing falls in acute care. In: Evidence-based geriatric nursing protocols for best practice Prevention of falls (acute care). Health care protocol Guideline Synthesis: Fall Prevention in the Elderly Trauma
Practice advisory for the prevention and management of operating room fires Reducing adverse drug events. In: Evidence-based geriatric nursing protocols for best practice
Manifestations of Poor Glycemic Control (3)

American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Diabetes management in the hospital setting Diagnosis and management of type 2 diabetes mellitus in adults Standards of medical care in diabetes. VIII. Diabetes care in specific settings
Catheter-Associated Urinary Tract Infection (UTI) (5)

Best practice policy statement on urological surgery antimicrobial prophylaxis Catheter-associated urinary tract infections. In: Guidelines on urological infections Management of suspected bacterial urinary tract infection in adults. A national clinical guideline Prevention of catheter-associated urinary tract infections. In: Prevention and control of healthcare-associated infections in Massachusetts Strategies to prevent catheter-associated urinary tract infections in acute care hospitals
Vascular Catheter-Associated Infection (6)

(1) Care and maintenance to reduce vascular access complications. (2) Care and maintenance to reduce vascular access complications 2008 supplement Antibiotic prophylaxis in surgery. A national clinical guideline Guidelines on the insertion and management of central venous access devices in adults NKF-KDOQI clinical practice guidelines for vascular access: update 2006 Prevention of bloodstream infections. In: Prevention and control of healthcare-associated infections in Massachusetts Strategies to prevent central line-associated bloodstream infections in acute care hospitals
Surgical Site Infection (7)

General
Prevention of surgical site infections. In: Prevention and control of healthcare-associated infections in Massachusetts Strategies to prevent surgical site infections in acute care hospitals Surgical site infection: prevention and treatment of surgical site infection Following Coronary Artery Bypass Graft (CABG) - Mediastinitis
Antibiotic prophylaxis in surgery. A national clinical guideline Following Bariatric Surgery
Antibiotic prophylaxis in surgery. A national clinical guideline Following Orthopedic Procedures Specific to Spine, Neck, Shoulder, and Elbow
Antibiotic prophylaxis in spine surgery Antibiotic prophylaxis in surgery. A national clinical guideline
Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) following total knee replacement and hip replacement (8)

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National Guideline Clearinghouse | Hospital-Acquired Conditions