a Legislation

Get involved in plans to revamp grants for health programs W Block grants may be the “most important health issue of coming years,” one politically active nurse says. Some 57 to 74 federal health programs have been combined into seven of these grants, which will be turned over to the states to run. In addition, overall funding for the grants has been cut.

The issue may seem far away from operat- ing room nursing, but it will have a profound effect on health care for allof us, Susan Grobe, RN, believes. An assistant professor in the School of Nursing at the University of Texas, Austin, she has been active in health affairs in her state. She spoke about block grants at the 1982 AORN Congress in March in Anaheim, Calif.

A major part of the health system is being redesigned. State governments must decide how the grant money is to be spent. No longer will they be told, for example, how much goes for mental health, alcoholism treatment, or ve- nereal disease prevention. States must set up and run their own programs.

“The success of the block grant system de- pends on how well organized communities are,” Grobe said. Nurses should be in the forefront because they work closely with pa- tients and understand their needs.

“Networks and coalitions are essential,” Grobe pointed out, since no one group can take on this massive project alone.

At first, it seems like a good idea to bring funding back closer to the people. But Grobe thinks the political problems could be sticky.

How will the state decide which programs to keep and which to eliminate? How will cuts be made? Will all programs be cut or will some be eliminated? Agencies will have to compete for dollars. For example, mental health for the el- derly may be pitted against mental health for children. A state might decide to offer only limited family planning services or none at all.

How can you begin getting involved in such a large and important effort? Grobe says each state must have a public report about its block grant goals and activities. You are entitled to examine a copy. To do so, you need to find out who is responsible for compiling the report- the governor’s office, the state legislature, or a state agency such as the health department. You also need to know what the deadline is for developing a state plan and when the public may comment.

Who has the answers to these questions? The best place to start is by calling your state representative or senator. If they don’t know, they can tell you who does.

Grobe also suggested joining forces with other community organizations. Those that have been active on block grants are United Way, the League of Women Voters, Common Cause, the Gray Panthers, and the Women’s Political Caucus. They may be sponsoring public meetings you can attend.

W New Hampshire nurses pulled their board of nursing and nursing practice act out of the fire. In March, the governor signed a new act, providing continuing authority for the board. Last summer, the state legislature had failed to renew the act before it was due to expire in a sunset review. The act was due to terminate at the end of March. Passing a new law required a special legislative session.

1326 AORN Journal, June 1982, Vol35, No 7

“We were very pleased with the results,” said Lois Murphy, executive director of the New Hampshire Nurses Association, “despite some scary moments” as the deadline ap- proached. The new law was one sponsored by a state coalition of nursing organizations.

Without a nursing practice act, the state would have had no authority to license nurses or accredit schools of nursing.

“Sunset review” is a phrase nurses are be- coming wary of. Some 35 states now have a law that provides for regular review of boards and commissions. If the state legislature fails to vote renewal of a board within a deadline, the “ sun sets” on its legislative authority. The board goes out of existence. This is what hap- pened in New Hampshire.

Is the battle over? we asked Murphy. No indeed, she replied, although sunset review does not come up again until 1987. The sunset process was, in fact, a vehicle forthe reorgani- zation of licensing boards, and the legislature will probably bring up a new reorganization proposal during its next session in 1983.

With every reorganization plan, Murphy said, there is likely to be a renewed threat to the autonomy, authority, and resources of the board of nursing.

The American Nurses’ Association (ANA) is opposing Reagan Administration proposals for cutting the Medicare and Medicaid pro- grams. The two government health programs are the focus of health care savings this budget year because their costs have been soaring. Medicare provides health coverage for those over 65, and Medicaid covers the needy and certain other groups.

ANA believes the Reagan approach is to place a greater burden on those who benefit from the programs. The nursing group charges the Administration “with taking money out of the pockets” of the elderly and poor rather than seeking basic reforms.

The President and many members of Con- gress insist they have to do something, be- cause Medicare costs “are a disaster.” Mas- sive outlays contribute to the worrisome fed- eral deficit.

With last year’s budget cuts of $1 billion in Medicare plus inflation, beneficiaries had their deductibles rise by at least 25%, ANA reports. The program now pays only 38% of an elderly

person’s total health bill. Medicaid covers “only 53% of the people

with incomes below the poverty level,” says ANA. Of these, 35% are children, and 40% of expenses are for poor elderly persons.

Under Reagan’s cost-cutting plans, these beneficiaries would have to pay for a greater share of their care. For example, there would be “copayments” for home health care visits to elderly patients and services to Medicaid pa- tients. That means the patient would have to pay for part of each visit out-of-pocket.

ANA believes this would discourage home health care, which it sees as a sound alterna- tive to institutionalization. And it believes copayments by Medicaid patients would be “forcing them to pay for care they simply can- not afford.”

Rather than increasing the burden on beneficiaries, ANA proposes, among other things, increasing the federal excise tax on alcohol and tobacco and eliminating the new federal policy that allows Medicare to reim- burse hospitals for their costs in opposing union activities. ANA also believes the gov- ernment could save money by reforming Med- icare and Medicaid.

The government has, in fact, been working on plans to overhaul the system, but they are still on the drawing board. A federal task force is working on a “prospective reimbursement” plan. This would change the way hospitals are paid for Medicare patients. Instead of being reimbursed for their costs after care is given, hospitals would receive an allocation in ad- vance at a set rate.

Another long-term reform, the Adminis- tration’s “competition” proposal is facing an uncertain future. The business community and organized labor were lukewarm to the idea, which would have injected free-market incen- tives into the health insurance industry. With- out their support, the proposal probably couldn’t go far politically.

Patricia Patterson Associate editor

1330 AORN Journal, June 1982, Vol35, No 7

Product Information COLLASTAT"

ABSORBABLE COLLAGEN HEMOSTATIC SPONGE

Lacrtptlon >OLLASTAT'". absorbable CDlla en hemostat 1s a Sot1 whlte, pllabte. nomtrlabls. 3bsorbent sponge. 0 3 Cm in %chness Because Of 11s non4nable. coherent jponge S~IUC~UR. the application of COLLASIAT . lo the site where hemmtaSlS I S JesIred IS eadv controlled Unwanted dlsesrsal over the operative site IS not . """ """

The basic material from which the hemoStaIic sponge IS fabricated IS collagen ibtalned from bovine deep flexor tendon (achilles tendon) The tendon 1s hnown to i e one 01 the purest S O U ~ C ~ S tor collagen that can be readily obtained and mcessed m CommerCial amounts COLLASIAT " beinq derived from this tendon

lrom one appiication lo the next

Indications COLLASTAT " Should be used 8" surgical procedures a5 an adlunct to hemostasis *hen control 01 bleeding by ligature or c~nventional procedures IS ineffe~tive or mpractlc.3 The product may be left In sltu because implant studies have demonstrated in animals COLLASTAT " lo be absorbed with tissue reaction ~lrnllal lo that observed with Other absorbable hetnoStatlC agents

Information for Use In contact Wlth blood collagen IS known I0 cause aggregation 01 plateletS Platelets deposit in large numbers On the collagen structure disintegrate and IRieaSe Coagulation factors that enable together Wlth plasma factors the lormstlon 01 fibrin The spongy structuIe of COLLASTAT . provldea lac the addibonal strength ening of the clot COLLASTAT " IS designed lo be totally absorbable 11 left In situ alter hem0StaSIs If desred recovery Of the sponge after hemostasis 15 easily aCCOmpliShed

toreign body reactl6n CCLLASTAT'" had been evaluated in v i tm for th" enhancement of bacterlal

rowh 01 Staphylococcus aufeus and Escherlchla 5011. Enhancement 01 !acleriaI growth did not occur tor either organism In vlvo studies using guinea pigs Showed that incidence 01 infection (absCeSS1 01 incision s~les 8nOculated with StephyioCoCcus aumus was not enhanced by the presence 01 COLLASTAT " when compared to another collagen hemostatic agent However extent Of wound infenion tended to be greater than control With CCLLASTAT " and anather collagen hemostatic agent tested This tendency IS Obseived with many toreign substances

PreCB"t10" As with Othar hemostatic agents, !I IS not recommended that COLLASTAT ~ be left in 8" infected or canlaminated space Safety 01 this product has not been established in pregnant women therefore. It Should On1 ;e used when benefit lo rlsk clearly warrants 113 use The use 01 COLLASTAT In Neurosurgical and UroIogicaI procedures IS under clinical investigation COLLASTAT"' Should nat be let1 In sltu on the ureter lo eliminate the polent~al for post-operative UrRlRral co"5tr1ct1o". It has been reported wlth another collagen hemOStat that I" llllln POrOSltieS 01 Cancellous bone. collagen may reducethe bond 01 streAgth 01 meth$methacrylate COLLASTAT " 8s not intended lo be used lo treat Systemic COBgUlatlOn disorders. Long term effects 01 leaving COLLASTAT'" In d t u are unknown.

in bit", whenever necessary

Adverse Reactions Adverse reactions reported with a microtibrillar collagen hemostatic agent that were possbly related to (1s use were adhesion formation. allergic reaction, toreign body reaction and subgaleal seroma (report 01 a s q l e Cme) The "be of micrafibrdtar collagen in dental extraction sockets has been reported to increase the mdence ot atveolalala Since COLLASTAT " is a colla en based producl adverse reactions experienced with the microtibrillar collagen 8emostat may be related

HOW SuppllOd Slcmle COLLASTAT * , an abSOrbabts collagen hemostatic sponge 1s supplied In

161 1 medical specialties division

Synthetic sutures resist infections Synthetic suture materials are more resistant to infection than natural materials. In a study in the January issue of Surgery, William V Sharp, MD, and colleagues compared 16 types of suture materials and their resistance to gram-positive and gram-negative infections.

of the synthetic sutures in all areas," Dr Sharp said. He found that synthetic monofilament and braided absorbables perform better than synthetic braided nonabsorbables.

The synthetic sutures tested included Dacron, nylon, polypropylene, stainless steel, and the synthetic absorbable sutures of polyglycolic acid.

Natural sutures tested included cotton, silk, linen, and catgut. The catgut was the only absorbable natural material. Nylon, polypropylene, and stainless steel were tested in their monofilament states. All the other materials, including nylon and stainless steel, were tested in multistrand form, eg, braided, woven, or twisted.

In the testing, suture implants were placed in backs of mice and exposed to Staphylococcus aureus and Escherichia coli bacteria. The mice were killed four days later and the flap of skin with the suture implant removed.

After gross and microscopic examinations of the skin flap specimens, the investigators gave a point grade to samples based on degree of gross purulent infection and inflammatory reaction.

On the basis of the grading system, the synthetic monofilament sutures were far superior to any of the braided sutures, and the synthetic sutures were better than the natural sutures. An absorbable polyglycolic acid suture had the best overall score. Coatings for lubrication had no effect on the tolerance to infection.

According to the authors, "Natural sutures performed poorly and should not be used in wounds that are potentially susceptible to infection."

The results "demonstrated the superiority