Preventing Hospital-Acquired Conditions (HACs)

Preventing Hospital-Acquired Conditions (HACs)

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.

1. Foreign Object Retained After Surgery
1.1.Prevention of unintentionally retained foreign objects during vaginal deliveries.
1.2.Health care protocol

2.Air Embolism
2.1.Access device guidelines: recommendations for nursing practice and education

3.Blood Incompatibility
There are no guideline resources available on this condition at this time.

4.Stage III and IV Pressure Ulcers
4.1.Pressure ulcer prevention and treatment following spinal cord injury
4.2.Preventing pressure ulcers and skin tears. In: Evidence-based geriatric nursing protocols for best practice
4.3.Risk assessment & prevention of pressure ulcers
4.4.Skin safety protocol: risk assessment and prevention of pressure ulcers. Health care protocol

-Guideline Synthesis: Pressure Ulcer Prevention

5.Falls and Trauma including fractures, dislocations, intracranial injuries, crushing injuries, burns, and electric shock
5.1.Falls

5.2.Changing the practice of physical restraint use in acute care
5.3.Fall management guideline
5.4.Preventing falls in acute care. In: Evidence-based geriatric nursing protocols for best practice
5.5.Prevention of falls (acute care). Health care protocol
5.6.Prevention of falls and fall injuries in the older adult
5.7.Trauma

5.8.Practice advisory for the prevention and management of operating room fires
5.9.Reducing adverse drug events. In: Evidence-based geriatric nursing protocols for best practice

-Guideline Synthesis: Fall Prevention in the Elderly

6. Manifestations of Poor Glycemic Control
6.1.American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Diabetes management in the hospital setting
6.2.Diagnosis and management of type 2 diabetes mellitus in adults
6.3.Standards of medical care in diabetes. VIII. Diabetes care in specific settings
Type 1 diabetes in adults. National clinical guideline for diagnosis and management in primary and secondary care

7. Catheter-Associated Urinary Tract Infection (UTI)
7.1.Best practice policy statement on urological surgery antimicrobial prophylaxis
Catheter-associated urinary tract infections. In: Guidelines on the management of urinary and male genital tract infections
7.2.Management of suspected bacterial urinary tract infection in adults. A national clinical guideline
7.3.Prevention of catheter-associated urinary tract infections. In: Prevention and control of healthcare-associated infections in Massachusetts
7.4.Strategies to prevent catheter-associated urinary tract infections in acute care hospitals
7.5.Urinary tract infection

8. Vascular Catheter-Associated Infection
8.1.(1) Care and maintenance to reduce vascular access complications. (2) Care and maintenance to reduce vascular access complications 2008 supplement
8.2.Access device guidelines: recommendations for nursing practice and education
8.3.Antibiotic prophylaxis in surgery. A national clinical guideline
8.4.Guidelines on the insertion and management of central venous access devices in adults
8.5.NKF-KDOQI clinical practice guidelines for vascular access: update 2006
8.6.Prevention of bloodstream infections. In: Prevention and control of healthcare-associated infections in Massachusetts
8.7.Strategies to prevent central line-associated bloodstream infections in acute care hospitals

9. Surgical Site Infection
9.1.General

9.2.Prevention of surgical site infections. In: Prevention and control of healthcare-associated infections in Massachusetts
9.3.Strategies to prevent surgical site infections in acute care hospitals
9.4.Surgical site infection: prevention and treatment of surgical site infection
9.5.Following Coronary Artery Bypass Graft (CABG) - Mediastinitis

9.6.Antibiotic prophylaxis in surgery. A national clinical guideline

9.7.Following Bariatric Surgery

9.8.Antibiotic prophylaxis in surgery. A national clinical guideline

9.9.Following Orthopedic Procedures Specific to Spine, Neck, Shoulder, and Elbow

9.10.Antibiotic prophylaxis in spine surgery
9.11.Antibiotic prophylaxis in surgery. A national clinical guideline


10.Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) following total knee replacement and hip replacement
10.1.American Academy of Orthopaedic Surgeons clinical guideline on prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty
10.2.Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults
10.3.Prevention of deep vein thrombosis
10.4.Prevention of venous thromboembolism. American College of Chest Physicians evidence-based clinical practice guidelines (8th edition)
10.5.Prevention of venous thrombosis
10.6.Steps to reduce surgical risk. In: I guidelines for perioperative evaluation
10.7.Venous thromboembolism prophylaxis
10.8.Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital (not yet published to NGC)

abrir aquí para acceder al documento NGC AHRQ general y desde allí a los vínculos de interés:
http://www.guideline.gov/resources/hac.aspx