Influenza Pandemic of 1918 • Medicare Rule Changes

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Influenza Pandemic of 1918 • Medicare Rule Changes

By Elizabeth Hanink, RN, BSN, PHN
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In 1918, It took forever to get to Los Angeles from anywhere, yet the Great Pandemic of 1918–1919 found its way. Even in rural Arizona, where there wasn’t a town with over 70,000 people, contagion reigned, and fatalities were especially high among the Navajo. In San Francisco, people blamed the position of Jupiter, while in Phoenix, people went after the obvious culprit: dogs.

This year, 2008, marks the 90th anniversary of this watershed public health event that struck in three waves and lasted almost an entire year. In all, 675,000 Americans and 50 million people worldwide died.

A second influenza outbreak in 1957 killed over 70,000 in the United States and between one and two million globally. Improved communication and technology limited its impact.

nurses flu pamdemicNow the Department of Human Services and the Centers for Disease Control are assembling the Pandemic Influenza Storybook, a compilation of personal recollections of survivors, family and friends. It’s an ongoing project and you can read some of the heartbreaking stories at

You can also submit a memory that you might have heard from a family member. The randomness of the overwhelming number of deaths affected families forever and many have passed down stories over the years, both of great loss and great courage.

Recognizing that complacency is the great enemy of preparedness, HHS/CDC planners see this storybook as a vital part of their efforts to train healthcare workers for future calamities. It is a critical feature of their Crisis and Emergency Risk Communication training.


Oct. 1 came and went, and that means a new fiscal year for Medicare. This year the date is specially significant because Medicare announced in 2007 that, starting now, it will no longer reimburse for certain conditions and events.

Why? The Centers for Disease Control estimates that patients develop 1.7 million infections in hospitals each year. These infections ultimately contribute to the deaths of about a quarter of a million people. If you view the problem from a different angle, Medicare paid $8.8 billion from 2004 to 2006 for medical errors.

Hence the list. Most of the conditions listed are preventable; some should never, ever, happen.

• Serious preventable events: object left in surgery, air embolism, and blood incompatibility;
• catheter-associated urinary tract infections;
• pressure ulcers;
• vascular catheter-associated infection;
• surgical site infection — specifically, mediastinitis after coronary bypass;
• and patient falls.

Either because no proven prevention strategies exist or because DRG coding issues persist, several other categories did not make the cut. But reviews occur yearly, so the list may expand or contract. The strategy is part of the move toward performance-based payment, and private insurances will probably copy Medicare’s example soon.

Much falls to the nurse, both in the care given and in documentation, because all these events involve elements of nursing care: sponge and instrument counts, site changes, aseptic care and, yes, turning and repositioning, to name a few. Whether in supervision or direct patient care, our work is clear.

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