Becker's Hospital Review

142 CMO / CARE DELIVERY Ochsner pressured 8 COVID-19 patients to accept hospice care, families say By Mackenzie Bean M any hospitals in New Orleans sent older COVID-19 patients home to die amid a surge in cases this spring, with some families claiming employ- ees pressured them into accepting hospice care, according to an investigative report from ProPublica. e nonprofit newsroom analyzed coroner records of more than 460 COVID-19 deaths that occurred in New Orleans through early May. Fiy-five deaths occurred outside a hos- pital, nursing home or assisted living facility. ProPublica spoke to the families of 35 such patients who died at home. Twenty-five families said their loved ones died aer seeking care at hospitals in the city. While some patients were told they were not sick enough to be admitted, 18 patients were hospitalized and then sent home to die un- der hospice care, families said. Most of these patients came from facilities affiliated with New Orleans-based Ochsner Health, which treated 60 percent of the region's critically ill COVID-19 patients, according to ProPublica. Eight families claim Ochsner employees pressured them into accepting hospice care for their loved ones, and three said employ- ees told them there wasn't enough space to continue treating the patient at the hospital. Families say they were forced to care for their loved ones without adequate personal protec- tive equipment or regular visits from hospice workers, who limited in-person interactions this spring. Mortality data shows 17 percent of patients ages 85 and older died at home in New Or- leans, compared to just 4 percent nationwide. CMO Robert Hart, MD, said Ochsner did move patients around the system due to bed space this spring, but never rationed care. "We did fine managing patient flow and had available beds for patients," he told Becker's. While some of Ochsner's routine hos- pice agencies said they could not take COVID-19 patients during the surge, Dr. Hart said the system proactively worked to identify the ones that met CMS require- ments and were adequately equipped to take COVID-19 patients. "Our team is very experienced at having con- versations about palliative care and hospice with families, and we do everything we can to ensure there is a comfortable hand off and transition into hospice," he said. When asked about families' claims that they felt pressured into hospice care, Dr. Hart said families were at times taken by surprise with how quickly patients decompensated. "It can take families time to process this in- formation," Dr. Hart said, adding that visitor restrictions, the anxiety around COVID-19 and the need to make difficult decisions took a toll on both clinicians and family members. "is has been a difficult time for everyone," he said. "A lot of people have lost loved ones. at's always a terrible thing for families and caregivers to deal with. I am proud of how our group has stepped up to deliver incred- ible care in such trying times." n 10 tips for preventing medication errors during COVID-19 surges By Mackenzie Bean S urges in COVID-19 patient volume place significant physical and emotional demands on clinicians, which can lead to an onslaught of preventable medication er- rors, according to the Institute for Safe Medication Practices. Below are 10 tips from the institute for leaders on how to identify, prevent and respond to medication errors during COVID-19 surges. 1. Anticipate that medication errors may occur during surges due to altered workflows and hectic care environments. 2. Implement a confidential, clear and easy-to-use reporting system for clinicians. 3. Work to maintain clinicians' trust and allay fears that they will be blamed or punished for reporting an error. 4. Provide rapid and useful feedback to clinicians after they report an error. 5. Standardize to a single concentration or dose rate of certain IV infusions when possible. 6. Use premixed solutions for common infusions that are visually distinct from one another. 7. Clearly label critical care infusions when dispensing a nonstandard concentration or a paralyzing agent. 8. Implement safety huddles and create a process for staff to conduct independent double checks before administer- ing infusions. 9. Use open communication and ensure employees feel supported. 10. Set expectations with staff that "blaming and shaming" is not acceptable after a medical error. n

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