CBPN cuts BSN requirement for CNOR exam in 2000

Certification Boards, Perioperative Nursing (CBPN) of Denver has decided not to require the BSN for the CNOR exam in 2000. Since 1996, the board had been informing perioperative nurses that a BSN degree would be required to sit for the CNOR examination in year 2000. With the ANA position paper in the 1960s requiring the BSN for eligibility, the requirement appeared to be in concert with professional expectations. However, a study in 1996 by the National League of Nursing showed that 66% of graduate nurses came from associate and diploma programs. Of the current 30,000 CNORs, over 63% do not hold a BSN degree, and research has failed to demonstrate levels of competence and variance with patient outcomes related to educational preparation. For more information, call Diane Howery, executive director of CBPN, at (888) 257-2667, ext. 13.

Federal law would protect patients’ info

The Medical Information Protection Act of 1998, a bill to protect the confidentiality of patient information, was introduced into Congress in October. The American Hospital Association, which supports the bill, says the bill balances the need to protect the privacy of confidential patient information with the need for that information to flow freely among providers. The bill:

• allows patients access to their records;

• establishes federal pre-emption of all state confidentiality laws and sets a uniform standard so patient information is equally protected even when providers are linked across state boundaries;

• recognizes the need for confidential information to move in a timely manner within groups and systems;

• applies not only to providers, payers, and employers, but also to law enforcement agencies;

• puts in place federal sanctions against those who inappropriately disclose medical information.

Check out AHCPR’s new CQI software

The Agency for Health Care Policy and Research in Rockville, MD, has released a new software tool for routine self-assessment of inpatient care. It’s part of a kit that also contains software disks, a fact sheet, a user’s guide, a methods manual, and other materials. The tool, called Healthcare Cost and Utilization Project Quality Indicators (HCUP QIs), helps hospitals assess outcomes by screening discharge data and identifying clinical areas appropriate for follow-up and in-depth analysis.

The 33 performance measures in HCUP QIs are designed to produce comparable statistics at the hospital, community, or state levels along three dimensions of care:

• potentially avoidable adverse outcomes;

• potentially inappropriate utilization of hospital procedures;

• potentially avoidable admissions.

Users compare rates across payer categories and patient ethnic groups. They also can compare data with groups of similar hospitals, with benchmarks such as Healthy People 2000 targets, or with the experience of a single hospital or group of hospitals tracked over time. (See related item on Healthy People 2010, p. 230.) Current users include the Colorado Hospital Association, the Maryland Hospital Association, Utah and Washington state health departments, and the Hawaii Health Information Corporation.

"Outcome, Utilization, and Access Measures for Quality Improvement" (AHCPR 98-0048) is free and can be obtained by calling the Publica tions Clearinghouse, (800) 358-9295, or by downloading it from Look for HCUP QIs in the Data and Surveys section.

Study says you can defer colonoscopy in this group

Researchers have found that patients with single tumors of 5 mm or less in the lower colon seldom had advanced polyps with greater potential for malignancy in the upper colon, the region discovered by colonoscopy, and may not benefit from colonoscopy.1 They followed a group of 4,500 older patients with no risk factors for colon cancer who were screened by sigmoidoscopy. Their conclusion: Colonoscopy can be deferred in low-risk patients with small tumors, resulting in substantial cost savings.


1. Wallace MB, Kemp JA, Trnka YM, et al. Is colonoscopy indicated for small adenomas found by screening flexible sigmoidoscopy? Ann Intern Med 1998; 129:273-278.

New law prohibits anesthesia denial

Hospital Peer Review’s August issue reported that several women in a Los Angeles hospital had been denied epidural blocks during childbirth because they were unable to pay an amount above the Medi-Cal standard. North ridge Hospi tal Medical Center was cited for breaking six state regulations and ordered to give refunds, and five other Southern California hospitals were accused of demanding cash for epidurals as well. Late this past September, California’s Governor Pete Wilson signed a bill prohibiting hospitals from such acts.

Are pneumonia patients hospitalized too long?

Researchers say inpatient stays could be shortened

More than 1 million Americans are hospitalized each year for pneumonia at a cost of roughly $9 billion. Researchers with the Pneumonia Patient Outcomes Research Team (PORT) found that many of these patients could be discharged earlier with no increased risk to their health.

PORT researchers developed evidence-based guidelines to help physicians recognize when patients reach clinical stability. Researchers based clinical stability on the following:

• vital signs;

• mental status;

• ability to maintain oral intake.

Researchers determined that most serious events that would require intensive care, such as infection, occur on the first day of hospitalization. After the first day of hospitalization, risk drops dramatically.

The PORT study also found that between 65% and 85% of patients stayed in the hospital at least one day longer after reaching stability. Projections suggest that adhering to the PORT guidelines would allow patients to be discharged sooner with a chance of serious adverse outcomes of less than 1%.

[See: Halm E, Fine MJ, Marrie TJ, et al. Time to clinical stability in patients hospitalized with community acquired pneumonia. JAMA 1998; 279:1,452-1,457.]