Published in July, the updated user guide incorporates guidance on Risk Management Write-Offs and payments are made by sponsors of clinical trials for complications or injuries arising out of the trials. To see the revised Guide click here to to the CMS site (external link).

A temporary revision has been announced by CMS to the Traditional Survey Process found in Appendix P of the State Operations Manual (SOM). A new version 3.0 of the MDS will be released on October 1, 2010. For further details please click here (external link).

The American College of Obstetricians and Gynecologists (ACOG) on July 21 released less restrictive guidelines for vaginal birth after cesaerian deliveries. The concern with "VBAC" delivery has been the risk of uterine rupture.

The new guidelines stress use of the TOLAC proceudure (trial of labor after cesearian) to assess the risk of future VBAC deliveries, and communicating the risks and benefits of delivery alternatives (and TOLAC) with the patient.

The ACOG press release can be viewed online here.

On July 22, the Department of Justice released technical guidance for medical providers on how to assist patients with mobility disabilities. The guidelines include provisions on clear floorspace, entryway parameters, patient lifts and other equipment for moving patients, scales and training for staff members.

The focus of this document is on exam rooms, and does not include building access, restrooms, showers, or other areas.

The document can be downloaded from the DOJ ADA website here.

Joshua Rozovsky: Although this guidance does focus on exam rooms, facilities do need to be accessible in other ways, from properly-designed and maintained ramps, to proper signage and drainage of slip-prone or wet areas. Restrooms are a major concern as well.

Also be careful not to have items mounted on walls that could be inadvertantly used as a handhold by any patient. Not all wheelchair users are experienced in transferring to and from the wheelchair, and not all patients using canes or other adjuncts are long-term users of such devices. There may be a tendency on the part of patients new to the use of these devices to be over, or under-reliant on the devices and "reach out" to grab another object if feeling unstable. Further, care providers should not assume that all patients need assistance - or are not in need of assistance. It is always good practice to ask what sort of assistance is needed, in addition to using good clinical judgement.