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RoundTable Healthcare Partners Portfolio Company, TIDI® Products, LLC, Acquires the J.T. Posey Company

Acquisition Further Positions TIDI as a Leading Provider of Products that Helps Health Care Practitioners Care for their Patients

LAKE FOREST, IL, FEBRUARY 28, 2017— RoundTable Healthcare Partners (“RoundTable”), an operating-oriented private equity firm focused exclusively on the healthcare industry, announced today that its portfolio company, TIDI Products, LLC (“TIDI”), has acquired the J.T. Posey Company (“Posey”). Posey is a leading manufacturer of falls management and patient safety products that provide a safer environment for both patients and caregivers. The financial terms of the transaction were not disclosed.

The acquisition of Posey further advances TIDI’s product mix towards differentiated acute care products and fits squarely within TIDI’s mission of “Supporting Caregivers and Preventing Infections.”  Approximately 860 Posey team members will join the TIDI organization, including a 45-person direct sales force that will expand TIDI’s direct selling footprint to nearly 70 people across the United States.  The Posey selling organization will remain standalone and will continue delivering cost-effective and solutions-oriented falls management and patient safety products.  

Kevin McNamara, President and Chief Executive Officer stated, “This acquisition strengthens our focus on strategic growth in the acute care space, while also expanding our mission of supporting caregivers and patients.  We are excited to welcome the Posey employees to the TIDI family and we look forward to working with them to better serve our combined customer base.”

Ernest Posey, Chief Executive Officer added, “Since John Thornton Posey founded the Posey Company in 1937, the goal remains to provide a safer patient environment, reduce the risk of injuries and minimize providers’ costs. I am confident that TIDI provides Posey the ability to continue to build upon my father’s legacy and his commitment to protecting patients and serving caregivers.”

“We are extremely excited to have closed this transaction and to further invest in TIDI’s growth,” said Joe Damico, Founding Partner of RoundTable and Chairman of TIDI. “Ernie Posey has built a tremendous company and the Posey brand name is synonymous with patient safety.  We look forward to working closely with the TIDI and Posey teams to further grow these two complementary businesses.” 

To finance the acquisition of Posey and further growth opportunities, RoundTable successfully facilitated an amendment to TIDI’s senior credit facilities, as well as a private placement of subordinated notes.  The senior credit facilities were led by Capital One Healthcare.  TIDI’s subordinated notes were purchased by RoundTable Capital Partners III, RoundTable’s third captive subordinated debt fund.  RoundTable and certain shareholders of TIDI also made an incremental equity investment in TIDI as part of the transaction.

About TIDI Products, LLC

TIDI Products, headquartered in Neenah, WI, is a premier designer, developer, and manufacturer of medical devices focused on preventing infections and supporting caregivers across the acute care, alternate site and dental end-markets. The Company offers a broad portfolio of over 4,400 SKUs of Class I and Class II medical devices and serves more than 3,000 customers around the world via a combination of direct and OEM sales and distribution partners. The Company maintains global manufacturing facilities that include two FDA registered U.S. facilities, one FDA registered Chinese facility and one U.S. distribution center.  For more information, please visit www.tidiproducts.com.

About the J.T. Posey Company

For more than 75 years, Posey, headquartered in Arcadia, CA, has been the industry leader in falls management products, services and patient safety. Posey offers a comprehensive range of technologies and products to help hospitals minimize falls and related injuries. Posey’s educational and operational resources help hospitals and clinicians share insights into timely and effective solutions that create a safe patient and caregiver environment. For more information please visit www.posey.com.

About RoundTable Healthcare Partners

RoundTable Healthcare Partners, Lake Forest, IL, is an operating-oriented private equity firm focused exclusively on the healthcare industry.  RoundTable partners with companies that can benefit from its extensive industry relationships and proven operating and transaction expertise.  RoundTable has established a successful track record of working with owner/founders, family companies, management teams, entrepreneurs and corporate partners who share a vision and believe in the value creation potential of its partnership model.  RoundTable has raised $2.75 billion in committed capital, including four equity funds totaling $2.15 billion and three subordinated debt funds totaling $600 million.  More information about RoundTable Healthcare Partners can be found at www.roundtablehp.com.

Did You Know?

15 out of 17 Honor Roll Winners in the best hospitals according to U.S. News & World Report are Posey Customers? Read the full list.

David Smith runs Marathon in a Posey Straitjacket!

David Smith is a Pharmacist from Sheffield, England who recently ran a marathon in a Posey Straightjacket! He raises money for the MS Society, and over the years has run marathons under challenging situations. He is already in last year's Guinness Book of Records. He decided this year to do something even more challenging and he came up with the idea of running the marathon in a Straightjacket. So he contacted the Guinness Book of Records to formally apply for this year's event. 

His proposal had been accepted but he could only run with a "Posey Straight Jacket." He then emailed Christie Rose, never expecting to hear anything back but out of the blue, he received an email from Jaki Burton to find out all about this fundraising activity. Posey provided the Straightjacket to Repton Medical for the purpose of the marathon. In return, David had Posey and Repton Medical logos displayed on the jacket.

The marathon was a huge success. In addition, David held a Charity event on behalf of the MS Society which Richard and Jaki attended. At this event, he shared with the audience his experience in running the marathon with a Straightjacket.

Posey and Repton were seen as major supporters in making this event a huge success. Below is David's message to Posey and Repton Medical:

"You will be delighted to hear than on March 11th I ran the Blackpool Marathon wearing the Posey Straitjacket you very kindly supplied and finished in a world record time of 3 hrs. 49 min. well within the 6 hour time limit set by Guinness world records. In the process I raised £618 (approx. $1000) for Ashgate Hospice and the Multiple Sclerosis Society.

None of this would have been possible without your assistance so I would like to thank you from the bottom of my heart.

So what is it like to run 26 miles in a Straitjacket. Well the strap was my biggest concern so I applied dressings to places where it could rub and this worked well. The next problem was drinking or rather not bing able to drink. My wife gave me a few sips of water at half way but that was it. It helped me not have to go to the toilet which again was impossible.

Finally there was the problem of not being able to use your hands to wipe your nose, scratch your face or drive yourself forward as you run. In fact, I could only just about wiggle my fingers. This left the small problem of time keeping which involved asking other runners the time.

Once again thank you for your support in this venture."

Seeing is Believing – Posey Fall Management Bulk Blankets

Falls are a major issue in hospitals nationwide. It has been reported that "Among older adults, falls are the leading cause of injury/deaths and in 2005, 15,800 people 65 and older died from injuries related to unintentional falls." The cost of these falls is extensive, and one report found that "operational costs for fallers with serious injury, as compared with controls, were $13,316 more and that fallers stayed 6.3 days longer than non-fallers."2 

To help prevent falls from occurring, many facilities are utilizing color coded fall risk indicators as a fall prevention tool. These tools have proven to be effective at alerting staff that a patient is at high risk for a fall. One study reported a "9.9% system wide reduction in acute care fall rates" through the use of "visual identification of patients at high risk…visual cues were deemed extremely valuable as a tool for alerting staff to high-risk patients." 3 These cues included signs, stickers, slippers, socks and bracelets.

The Institute for Clinical Systems Improvement recommends that facilities "communicate risk factors" by identifying "those at risk by placing visual identifiers such as signs on room and bathroom, wristbands, buttons, stickers, posters, chart identifiers, door/name identifiers, etc. Members of the health care team, in all departments, should be educated in recognizing these cues. Also, all family and visitors should be educated in recognizing and understanding the identifiers and be aware of how to obtain help from appropriate staff." 4

The Posey Fall Management Blankets help meet the objectives of using visual identifiers as a fall risk tool. These products are utilized nationwide as part of many facilities fall prevention tools and fall protocols. With a variety of competitors in the market challenging our share, we recently released a new bulk part number with updated pricing.

Posey Fall Management Blankets are available in five colors and are also part of our Kits (6236 and 6238).

Fall Prevention and Safe Patient Handling...It's the Law!!!

1 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS).
2 The Cost of Serious Fall-Related Injuries at Three Midwestern Hospitals. Wong, C., et. al, The Joint Commission Journal on Quality and Patient Safety, 37(2): 81-87, 2/2011.
3 Lancaster A.D., et al.: Preventing falls and eliminating injury at Ascension Health. The Joint Commission Journal on Quality and Patient Safety. 33(7): 367–375, 7/2007.
4 Institute for Clinical Systems Improvement (ICSI). Health Care Protocol: Prevention of Falls (Acute Care). Bloomington, MN: ICSI; April 2010.

With the rising cost of healthcare, facilities are now more than ever trying to find ways to reduce the cost of patient injuries related to falls, AND reduce the costs associated with staff injuries. One tool being utilized to help reduce both caregiver and patient injuries are Gait Belts. According to OSHA Guidelines on Ergonomics for the Prevention of Musculoskeletal Disorders, it recommends "Gait belts/transfer belts" for "Transfer to and from: Bed to Chair, Chair to Toilet, Chair to Chair, or Car to Chair" (http://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html).

Many organizations are also concerned with staff injuries. The ANA (American Nurses Association) published recommendations in a document titled "Preventing Back Injuries Safe Patient Handling and Movement." In the section on "Solutions According to Dependency Level - Lifts from floor (patient assists)", the ANA recommends a "transfer belt or gait belt." In the section "INNOVATIVE PREVENTION PROGRAMS," the ANA states "Research, pilot, select, evaluate and implement lifting devices. Involve frontline healthcare workers at every step to ensure use of new equipment. When testing devices, including mechanical lifts, lateral transfer devices, gait belts, and transfer chairs, seek input from nurses, other healthcare workers and patients." 

Prompted by the ANA's Handle With Care Campaign which began in 2003, many states have also adopted "safe patient handling" laws including California, Illinois, Maryland, Minnesota, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington. Eight states require a comprehensive program in health care facilities in which there is an established policy, guidelines for securing appropriate equipment and training, collection of data, and evaluation." Health care professionals providing direct patient care are vulnerable to back and other musculoskeletal injuries related to awkward positioning when manually lifting, transferring and moving patients. These laws support the work of nurses and other health care workers by mandating the development and implementation of safe patient handling strategies and procedures for minimizing risks, including targeted training and consideration of assistive equipment and friction-reducing devices for those nurses and others engaged in patient care.

Posey Gait Belts are an effective tool for patients requiring ambulation and transfer assistance. The nickel plated metal buckles offer a maximum hold and reduce wear on the cotton webbing for increased durability. Gait Belts help prevent caregiver back injuries and are an effective fall prevention tool during patient transfer. Gait Belts are available in a wide range of colors, sizes, buckle closures and designs.

Connecting with your Respiratory Therapist

The Posey Trach Tie provides dual proposes for patients. The comfortable foam padding secures the Trach in place with a hook and loop closure, while it can also be used to hold the nasal cannula off the patient's ear. The Posey TrachTie can be used to minimize the movement of the tracheotomy tube or oxygen cannulas. The soft fabric will decrease the risk of pressure ulcers on the ear.

Did you know linear shaped pressure ulcers on the top of the ear can be attributed to oxygen tubing? Studies have shown the most common location of a medical device reference acquired ulcer is on the ears (Black JM, Cuddigan JE, Walko MA, Didier LA, Lander MJ, Kelpe MR).

We also offer three sizes to custom fit your patients: 8197S, 8197M and 8197L. If you would like an added security to the trach tie, we offer an alternative part number that includes an extra tie to ensure the trach tube is in place more securely. These include: 8196S, 8196M and 8196L.

Posey also offers a Cufflator Endotracheal Tube Inflator and Manometer (Cat. 8199). This device deflates and inflates high volume, low pressure endotracheal or tracheal cuffs. It attaches quickly and easily to the cuff inflation line and helps eliminate the need for syringes, electricity, or complicated connections required to check cuff pressure.

It is available for a free 30-day trial.

How can nurses get answers to their questions regarding the CMS Guidelines and Joint Commission Standards on Restraints?

1. Check with the Hospital Quality Department – They are the most informed on Joint Commission Standards.

2. Make sure the correct Joint Commission manual is reviewed. (Deemed vs. not Deemed)

3. The Joint Commission website has several sections where it answers commonly asked questions. Once you are on the website, type "restraints" in the search box and you will get the links.

4. Email Joint Commission through their website with any questions

Joint Commission Frequently Asked Questions about Restraints

1. Why are there variations with the use of restraints around the country?

  • Restraint policies in hospitals are also dictated by State Law and this is why there are variations with restraint use across the country.

2. What is the difference between hospital with Deemed Status and Non-Deemed Status?

  • If a national accrediting organization, such as The Joint Commission, has and enforces standards that meet the federal Conditions of Participation, CMS may grant the accrediting organization "deeming" authority and "deem" each accredited health care organization as meeting the Medicare and Medicaid certification requirements. The health care organization would not be subject to routine Medicare survey and certification process.

3. When will the new restraint standards be included in the survey process and the accreditation decision?

  • Hospitals that use Joint Commission accreditation for deemed status purposes will be surveyed on the new restraint requirements in Standards PC.03.05.01 through PC.03.05.19 from April 6 through June 30, 2009. However, non-compliance will not impact the accreditation decision.

4. What restraint standards apply to an organization that is not using Joint Commission accreditation for deemed status purposes?

  • Hospitals that do not use Joint Commission accreditation for deemed status purposes will comply with the restraint and seclusion Standards PC.03.02.01 through PC.03.03.31 in the Comprehensive Accreditation Manual for Hospitals

Developing a Self-Reported Tool on Fall Risk Based on Toileting Responses on In-Hospital Fall

Anita Ko, MHA, M Gerontology, NUM, RN, Huong Van Nguyen, MBBS, FRACP, MPH, Leemin Chan, MBBS, FRACP, Qing Shen, PhD, MBBS, MSC, Xiao Man Ding, PhD, MBBS, Daniel Leonard Chan, Daniel Kam Yin Chan, MD, FRACP, MHA, Kaye Brock, PhD, Dip Nut Diet, BSc Hons, Lindy Clemson, PhD, M App Sc (OT), Dip (OT), B App Sc (OT)

Abstract: The aim of this cohort study was to determine the predictive value of a 2-item self-reported questionnaire regarding in-hospital toileting behavior for predicting falls in older inpatients and to compare its performance with an existing state-based falls assessment scale. Between May 28, 2009 and January 30, 2010, we assessed aged care inpatients for risk of falls using the standard STRATIFY fall screening tool and the 2-item self-reported questionnaire developed for this study. The participants were then followed up, with the primary outcome being the occurrence of falls.

Conclusion: Results indicated that participants who were unable to answer the 2-item questionnaire appropriately or sensibly were 14.1 times (confidence interval [CI]: 4.4– 45, p <. 001) to 17.0 times (CI: 6.7–43, p < .001) more likely to fall than those who gave an appropriate negative or positive answer. Participants who were assessed to be at high risk of falls on the STRATIFY scale were 9.5 times (odds ratio: 9.5, CI: 1.3–72, p = .03) more likely to fall than those who were low risk. In conclusion, a simple bedside questionnaire regarding patients' toileting behavior with a careful appraisal of answers for appropriate and inappropriate answers may be used as a quick screening tool of fall risk. Geriatric Nursing, Volume 33, Issue 1, pages 9-16, January 2012

Cost of Treating Pressure Ulcers for Veterans with Spinal Cord Injury Topics in Spinal Cord Injury Rehabilitation

Kevin T. Stroupe, PhD, Larry Manheim, PhD, Charlesnika T. Evans, MPH, PhD, Marylou Guihan, PhD, Chester Ho, MD, Keran Li, PhD, Diane Cowper-Ripley, PhD, Timothy P. Hogan, PhD, Justin R. St. Andre, MA, Zhiping Huo, MS, Bridget M. Smith, PhD

Abstract: Veterans comprise almost 17% of the 250,000 persons with spinal cord injury/disorder (SCI/D) in the United States. Pressure ulcers are common complications of SCI/D. We compared annual health care utilization and costs between veterans with and without pressure ulcers in the Veterans Health Administration (VHA).

Conclusion: Veterans with pressure ulcers had more total inpatient days on average (61.00 vs 9.19;P < .001) and higher total health care costs primarily to higher inpatient costs (91,341 vs13,754;P < .05). Our results highlight the need to identify patients at risk for pressure ulcers who could benefit from targeted skin care management interventions.
Presented in October 2011 at the HSRD National Meeting

The Relationship of the Hospital-acquired Injurious Fall Rates with the Quality Profile of a Hospital's Care Delivery and Nursing Staff Patterns

Huey-Ming Tzeng, PhD, RN; Hsou Mei Hu, PhD, MBA, MHS; Chang-Yi Yin, MA Authors and Disclosures Posted: 02/08/2012; Nurs Econ. 2011;29(6):299-306. © 2011 Jannetti Publications, Inc. 

Purpose: This study was intended to determine the unique contributions of three inpatient satisfaction measures (the responsiveness of hospital staff and the cleanliness and the quietness of the hospital environment) and two nursing staff indicators (total nursing full-time equivalents [FTEs] per 1,000 discharges and the percentage of registered nurse [RN] FTEs by total nursing personnel FTEs) on the hospital-acquired injurious fall rates. The inpatient satisfaction measures served as proxy factors for the quality of a hospital's care delivery. Only patients aged 18 or older were included. Four control variables were included: (a) teaching status, (b) average case mix index value, (c) the percentage of patients with chronic conditions in two or more body systems (complex patients), and (d) the percentage of patients with dementia diagnoses. The level of analysis is the hospital. We hypothesized the three inpatient satisfaction measures and two nursing staff indicators would predict the injurious fall rates, after accounting for control variables. The current study used multiple large datasets to test the hypothesis. Results could inform policymakers and hospital administrators of meaningful hospital characteristics that predict the prevalence of injurious falls. It could also assist future development of evidence-based translational research models to prevent them.

Conclusion: Study resultsdemonstrated the higher the inpatient satisfaction levels with the quietness of hospital environment, the lower the injurious fall rates. The physical environment (quietness) of the acute inpatient care settings was a significant and meaningful determinant of the prevalence of injurious falls. Additionally, more total nursing personnel FTEs per 1,000 discharges and a higher percentage of RN FTEs by total nursing personnel FTEs would not result in better patient outcomes. However, this study was not able to generate a formula for calculating optimal nurse staffing. Also, this study could not answer whether having 100% of RN FTEs as total nursing personnel FTEs might result in fewer injurious falls than other percentages of RN FTEs of total nursing personnel FTEs. More research is needed to identify the optimal level of nurse staffing. Future research may also include additional states and patient-level data to validate whether the hospital-level inpatient satisfaction measures can predict the occurrence of injurious falls in the patient-level data. This effort may further inform policymakers and the public about each hospital's care delivery practices, which may be used as one of the adjustment factors for hospital reimbursement ratios.

Hourly Rounding Challenges with Implementation of an Evidence-Based Process

Lynn M. Deitrick, PhD, RN; Kathy Baker, MPH, RN; Hannah Paxton, MPH, RN; Michelle Flores, BSN, RN; Deborah Swavely, MSN, RN

Abstract: Introduction of an evidence-based practice change, such as hourly rounding, can be difficult in the hospital setting. This study used ethnographic methods to examine problems with the implementation of hourly rounding on 2 similar inpatient units at our hospital. Results indicate that careful planning, communication, implementation, and evaluation are required for successful implementation of a nursing practice change.

Conclusion: Results from this study indicate that translating complex evidence-based interventions into clinical practice can be fraught with challenges and unintended results. Implementation must be carefully planned and carried out with the needs of frontline staff as a major consideration. Also, a strong evaluation plan with meaningful outcomes is essential to document for staff that the intervention is working. This study provides an example of how to evaluate problems with the implementation of evidence-based practices at the unit level. Nurses and nurse managers at other hospitals should be able to replicate this work to continue the understanding of issues related to problems with the translation and implementation of evidence-based practices.
Journal of Nursing Care Quality, Vol. 27, No. 1, pages 13-19, March 2012