Commenting on Amanda's Blog

This week I am commenting on Amanda's blog concerning posting malpractice lawsuit information on the internet. I totally agree with this practice because I think we need all the information possible to make decisions concerning our healthcare. If a physician has had an abundance of malpractice suits against him/her, I would have to research very carefully before trusting that physician with my health.

Blog 9

Good Questions for Your Good Health

http://www.npsf.org/askme3/pdfs/Patient_Eng.pdf

The AHRQ tool I chose this week talks about questions you should ask every time you talk to a doctor, nurse, or pharmacist. These questions are:

· When to ask questions?

o You see your doctor, nurse, or pharmacist.

o You prepare for a medical test or procedure.

o You get your medicine.

· What if I ask and still understand?

o Let your doctor, nurse, or pharmacist know if you still don’t understand what you need to do.

o You might say, “This is new to me. Will you please explain that to me one more time?”

· Who needs to ask 3?

o Everyone wants help with health information. You are not alone if you find things confusing at times. Asking questions helps you understand how to stay well or to get better.

This tool was designed to help any of us when we interact with each of these medical professional. When we’re ill or even just speaking with them, we can get really anxious and forget questions we might have. We can use this tool to keep track of questions for healthcare providers so that when we are in that position, we have it on paper and don’t have to worry about remembering. This is another tool to help patient’s take responsibility for their own healthcare.

The three questions listed to ask your doctor are all you really need to initiate the dialogue necessary to gain information about your health. These questions are:

· What is my main problem?

· What do I need to do?

· Why is it important for me to do this?

I really think if you ask these questions, it will lead to discussions that will provide most of the information you need.

Supreme Court Decision Makes It More Difficult to Sue Medical

Device Manufacturers

http://www.himss.org/rhio_connection/BlankRomeMarchHealthLawUpdate.pdf

This week I’m writing about an article from the HIMSS website that discusses tort law concerning medical device manufacturers.

This year, the Supreme Court ruled in favor of Medtronic, the manufacturer of a balloon catheter. In 1996, Charles Riegel was undergoing a balloon angioplasty when it burst, causing a severe injury. Mr. Riegel sued Medtronic, “contending that the catheter had been designed, labeled, and manufactured in a manner that violated New York state law, and that those defects had caused severe and permanent injuries to him.” Mr. Riegel lost his suit because the catheter had been given premarket approval by the FDA, thus protecting the manufacturer from legal liability. The Supreme Court based its decision on the 1976 law that prevents states from imposing “any requirement” related to a device that was “different from, or in addition to” the federal requirements. The Court felt that “any requirement” includes state tort law that claims to burden manufacturers with extra responsibilities of care not required by the federal law. The key to this ruling is the fact that the device had premarket approval.

I have very mixed feelings about tort law. On one side, if manufacturers or healthcare providers aren’t held responsible for their actions, patient safety is jeopardized. On the other hand, if manufacturers and clinicians aren’t provided with some protection against high-value lawsuits, manufacturers will stop developing the very devices that can save our lives, and there will surely be a shortage of physicians. There must be a balance between the two.

Blog 8

Independent Review Supports Transparency

http://www.psqh.com/sepoct08/peer.html

The article I'm blogging on this week speaks about how hospitals are realizing how important transparency is. The CMS has started publicly reporting 30-day mortality measures for acute myocardial infarction, heart failure, and pneumonia. JCAHO even has standards to monitor safety and quality of care concerns. This article also cites the 5 Million Lives Campaign that we watched a video on.

One of the tools they focused on is "independent peer review". I agree with the use of this tool because someone outside is much less likely to be biased. If physicians review each other, they could either be friends or not like each other. Either of these situations will give inaccurate results.

"With independent peer review, medical records may be reviewed for standard of care, experimental/investigational procedures or treatments, mortalities or sentinel events, physician practice patterns, or medical necessity." In this case, people's opinions and feelings would not influence the review.

Some of the issues that would warrant an Independent Review are:

Ethical Issues
Systems Issues
Clinical Credentialing Issues
Clinical Outcomes Issues
Documentation Issues
Professional/Interpersonal Behavior Issues
Clinical Competency/Privileging Issues

As we saw in the movie, "The Doctor," physicians will cover for their fellow physicians when there is trouble. I would rather know my physician was given an impartial review. If a doctor thinks he/she can hide something, I might not get the level of care I would if they knew someone was watching them closely and not going to cover for their mistakes.

Ten Ways To Recognize Hearing Loss

http://www.nidcd.nih.gov/NidcdInternet/Templates/InternetTopicNavigation.aspx?NRMODE=Published&NRNODEGUID={ECB057D5-6F29-4F03-B835-D391CAE99F0F}&NRORIGINALURL=%2fhealth%2fhearing%2f10ways.asp&NRCACHEHINT=NoModifyGuest

The AHRQ tool I chose this week has to do with hearing loss. It is basically a questionnaire to determine if you have hearing loss. The reason I chose this tool is because I've been wondering if I now have some hearing loss.

The questionnaire is as follows:

The following questions will help you determine if you need to have your hearing evaluated by a medical professional:

Do you have a problem hearing over the telephone?
Yes No

Do you have trouble following the conversation when two or more people are talking at the same time?
Yes No

Do people complain that you turn the TV volume up too high?
Yes No

Do you have to strain to understand conversation?
Yes No

Do you have trouble hearing in a noisy background?
Yes No

Do you find yourself asking people to repeat themselves?
Yes No

Do many people you talk to seem to mumble (or not speak clearly)?
Yes No

Do you misunderstand what others are saying and respond inappropriately?
Yes No

Do you have trouble understanding the speech of women and children?
Yes No

Do people get annoyed because you misunderstand what they say?
Yes No

If you answer yes to 3 or more of these questions, you probably need to have your hearing checked. For those who know me well, I don't even have to report my results.

This week I want to comment on Rajni's blog. She wrote about the benefits of the intranet. I agree that the intranet is a very good communication tool for facilities. This is a way of communicating with employees without exposing information to outside eyes.

Peer Blog Review

I want to comment on Nettie's blog about the HPV vaccine. While I do vaccinate my children, this is one that I feel like I should watch. Idon't think it has been around long enough to be sure there won't be any major side effects. I say this even though I have had cervical cancer which is caused by the HPV virus. We just need to do what we think is best for us and our children.

Blog 7

Facts about Joint Commission accreditation standards

My article this week is on the facts about JCAHO accreditation standards.

JCAHO evaluations measure, assess and improve organization performance. They are looking at things that will improve patient safety. I think a very important thing to remember (as HIM professionals) about JCAHO audits is that they are objective. The evaluations are done by people with opinions. So, I will always remember to be nice to JCAHO auditors (plus try to remember that anyone could be an auditor).

One thing I wasn’t aware of is that standards are developed from the input of health care professionals, providers, measurement experts, consumers, government agencies and employers.

The steps to the standard development process are:
1. The need for new standards is identified by accredited organizations, professional associations, consumer groups and others.
2. The Joint Commission prepares draft standards using input from external task forces, focus groups and experts.
3. The draft standards are reviewed by field-specific Professional and Technical Advisory Committee(s) and a committee of the Board of Commissioners.
4. The draft standards are sent to the field and other stakeholders for review.
5. The draft standards are revised and reviewed by the appropriate PTAC(s) and the Board.
6. The approved standards are published for use by the field.

While most HIM professionals may cringe at the thought of a JCAHO audit, we need to remember that they are in place to help keep patients safe. We all are patients at one time or another and then we appreciate these strict precautions.

http://www.jointcommission.org/Standards/facts_about_accreditation_standards.htm


Your Guide to Preventing and Treating Blood Clots

When I saw this quality tool on the AHRQ website, I knew this would be one that I could speak to personally. While I’ve never had a blood clot, by brother-in-law did and he almost died. His blood clot was caused by a genetic condition called Factor V Leiden. He didn’t know he had a blood clotting disorder. Therefore, knowing about blood clots can benefit everyone.

Anyone who doesn’t move around a lot is at risk for a blood clot. Some other people who can get blood clots are people who:

• Have had recent surgery.
• Are 65 or older.
• Take hormones, especially for birth control. (Ask your doctor about this).
• Have had cancer or are being treated for it.
• Have broken a bone (hip, pelvis, or leg).
• Have a bad bump or bruise.
• Are obese.
• Are confined to bed or a chair much of the time.
• Have had a stroke or are paralyzed.
• Have a special port the doctor put in your body to give you medicine.
• Have varicose (VAR-e-kos) or bad veins.
• Have heart trouble.
• Have had a blood clot before.
• Have a family member who has had a blood clot.
• Have taken a long trip (more than an hour) in a car, airplane, bus, or train.

Symptoms of a blood clot are:
• New swelling in your arm or leg.
• Skin redness.
• Soreness or pain in your arm or leg.
• A warm spot on your leg.

To help prevent blood clots you can:
• Wear loose-fitting clothes, socks, or stockings.
• Raise your legs 6 inches above your heart from time to time.
• Wear special stockings (called compression stockings) if your doctor prescribes them.
• Do exercises your doctor gives you.
• Change your position often, especially during a long trip.
• Do not stand or sit for more than 1 hour at a time.
• Eat less salt.
• Try not to bump or hurt your legs and try not to cross them.
• Do not use pillows under your knees.
• Raise the bottom of your bed 4 to 6 inches with blocks or books.
• Take all medicines the doctor prescribes you.

While this isn’t a subject we think about often, it’s one that could save a life.

http://www.ahrq.gov/consumer/bloodclots.htm

Peer blog review

I really enjoyed reading Rajni's blog about the 5 W's. I think this is a very critical part of patient safety. There is no reason to have an error in this category. I witness the prevention of this mistake when my husband had knee surgery. They made him write "operate on this knee" on his leg. There's no way to mistake that.

Get a Mammogram: Do It for Yourself, Do It for Your Family

The tool I read this week is about getting a mammogram. I know I’m the only student that is old enough to worry about mammograms right now, but some day the rest of you will. If you think you’re not at risk, think again. Just getting older puts you at risk.

“Breast cancer is the leading cancer among women of many Asian and Pacific Islander groups in the U.S.” Unfortunately, many women don’t find out they have breast cancer until it’s advanced. So, if you’re wondering why you should even think about getting a mammogram, it’s because the key to surviving breast cancer is catching it early.

Just to reinforce how important mammograms are, I’m including a table of statistics.
A woman's chance of being diagnosed with breast cancer is:
By age 40 ... 1 out of 257
By age 50 ... 1 out of 67
By age 60 ... 1 out of 36
By age 70 ... 1 out of 28
By age 80 ... 1 out of 24
Ever ... 1 out of 8
Source: National Cancer Institute Surveillance, Epidemiology, and End Results Program, 1997
While I can say from personal experience getting a mammogram is not exactly fun, I love my family (and life) too much to not get one.

http://www.cancer.gov/cancertopics/breasthealth/allpages



Medication Errors: Focus on Legibility

The article I’m writing about this week is about medication errors caused by illegibility.
By definition, a medication error is preventable and these are among the leading causes of preventable errors. There are many reasons for unsafe medication practices, including poor access to information, poor communication, and inadequate knowledge or experience.

The senior management of a multi-hospital healthcare system in the southeastern U.S. became concerned about medication errors and asked for a study. What they found really concerned me. Legibility was a major issue in medication errors. This is a bone of contention with anyone having to read the physician’s handwriting. There is really no reason for this. If they would just slow down and write where it is readable, many errors could be prevented. I believe my life (and, really, every other patient’s life) is worth the time it takes to write legibly.

http://www.psqh.com/janfeb06/mederrors.html