Proposed nurse scope-of-practice expansion to improve discharge

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For the first time in 25 years, the Centers for Medicare & Medicaid Services is reviewing more than 450 comments related to overhauling the Conditions of Participation (CoP) to expand the scope of practice for advanced practice nurses, reported Curaspan Connections.

The proposed changes could improve the often slow discharge process and facilitate efficient patient transition.

Given the lengthy delays of getting discharge orders from physicians, CMS proposes hospitals allow APNs to write discharge orders if a physician says the patient is okay to leave.

Doing so could reduce length of stay, as well as cut down on potentially avoidable days, noted Curaspan. Many potentially avoidable days come from patients waiting for a physician's discharge while everything else is ready for the referral to a post-acute provider.

The modified CoP, which could take effect this year, also enhances APNs' involvement with patients after discharge, Curaspan noted.

Such changes to the CoP could affect hospital readmissions positively. A report last fall by the New York State Health Foundation and Mathematica Policy Research found that improved discharge processes and post-discharge support can reduce readmission rates by 30 to 35 percent. The hospital discharge improvements included having nurse advocates help patients navigate the discharge process and manage their conditions, and better coordination with primary care physicians, among other benefits.

For more information:
- read the Curaspan Connections article
- here's the proposed rule (.pdf)
- check out the N.Y. report (.pdf)

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