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

Commenting on Nettie's blog

I really enjoyed reading Nettie's blog about how sunlight can reduce the risk of breast cancer. I knew that you get vitamin D from sunlight, but I didn't know that it did this. This just goes to prove that anything in moderation.....

Blog 5

Door-to-Doc Patient Safety Toolkit

The Quality tool I chose this week is “Door-to-Doc Patient Safety Toolkit”. This article focused on improving the Emergency Department’s patient flow process while focusing on improving patient safety.

Anyone who has gone to the Emergency Department knows what to expect. It will most probably be very crowded and you can expect a long wait. Depending on the hospital, it can be an hour or so, or it can be many hours.

Banner Mesa Hospital decided to change this. They recognized the need for strong technological solutions. The two important aspects involved were—“Process: analyzing the process for adaption to unique patient acuities and volumes,” and “People: facilitating acceptance of the changes among the individuals affected.” Just by separating the “less sick” from the “sicker”, they were able to reduce wait time.

What I learned is that a facility can make small changes that will increase their workflow without reducing the quality of care given.

http://www.bannerhealthinnovations.org/DoortoDoc/About+D2D.htm


Effective Hospital Governance: Compliance Risk Areas

This week the article I read is about the areas of compliance risk.

According to JCAHO, each hospital should have “governance with ultimate responsibility and legal authority for the safety and quality of care, treatment, and services. Governance establishes policy, promotes performance improvement, and provides for organization management and planning.” While this sounds good in principle and I would hope that all hospitals would comply fully, in reality it is a challenge.

Because the board is ultimately responsible for ensuring the hospital takes responsibility for its safety, reports should be sent to them periodically. Some key risk areas listed are: The Antikickback/Stark Law, Billing/Reimbursement, and Other Risk Areas.

I really think that if hospitals would take responsibility for the mistakes made by their clinicians and use those incidents to find safer practices, it would make a tremendous difference.

http://www.trusteemag.com/trusteemag_app/jsp/articledisplay.jsp?dcrpath=TRUSTEEMAG/PubsNewsArticleGen/data/2005/0503TRU_DEPT_Governance&domain=TRUSTEEMAG

Commenting on Amanda's Blog

Amanda’s blog about interview tips was of real interest to me. Because it’s been more than 20 years since I’ve interviewed for a job, I really need all of the tips I can get. But, even someone who may have had several jobs can benefit from this. You can never be too prepared for an interview.

Blog 4

Quick Tips—When Getting a Prescription

My quality tool provides tips when getting a prescription.

One thing that caught my attention in this article is that the most important thing you can do for your health is to tack responsibility for your health care. You really need to be an active part of your health care team. Anytime you begin taking a new medicine, you should ask questions about that medication.

Communicating the medications you take is a very important part of your health care. Because medications can contradict, your physician needs to know everything you take—including over the counter drugs and herbal supplements. When I visit the doctor, I tell the triage nurse everything I take. If the doctor wants to prescribe a medication, I remind him of the medications I take and ask if they contraindicate.

Another tip is to check your medication after the pharmacist gives it to you. Recently I filled a prescription and when I got home I noticed it was the wrong strength. If I had checked it at the pharmacy I could have had the error corrected right then.

What’s most important is to remember that you are ultimately responsible for your health care.

http://www.ahrq.gov/consumer/quicktips/tipprescrip.pdf


Accreditation Process

Tips for Communicating Your Survey Results

Surveys can be an excellent tool for collecting data. This article is about a survey that collects information about you.

There are times when we have a problem that we don’t think is bad enough to go to the doctor to have checked out, but it is still a problem. This concerned Dr. John Wassan, a practicing physician, researcher and professor at Dartmouth Medical School and IHI faculty member. So, about 20 years ago he designed a survey to help patients take better care of themselves. The survey has evolved to keep up with healthcare and technology. Today anyone can take this survey on the internet at http://www.ihi.org/ihi/gateway.aspx?target=http://www.howsyourhealth.org.

Patients who take this survey can bring the results with them when they see the doctor. This helps the patient communicate health problems and helps the physician treat the patient.

I know that the surveys we are studying this week aren’t exactly this type of survey, I believe is a very beneficial tool in taking an active role in our health care.

I actually took this survey and am posting my results.
 
HowsYourHealth Completed http://www.howsyourhealth.org/end
Thank you for completing the Improve Your Medical Care questionnaire.
Age: 18-49
Gender: Female
BMI: 23.1
ASSETS
Provider:______________________ Date:___________ Signature:
© 1997-2008 FNX Corporation and Trustees of Dartmouth CollegeA// Rights Reserved.
1 of 1 9/18/2008 7:16PM
FUNCTION HABITS KNOWLEDGE PREVENTION
Has enough
money
Does not smoke
.
Does not drink excessively Birth control
.
Sexual diseases
Mammography/Cholesterol Had pap test Had breast cancer exam
Does breast
self-exam
NEEDS
CLINICIAN ASSESSMENTS REFERRALS/ACTIONS READINGS/EDUCATION
FUNCTION Dfficulty with pain
D/ficulty with physical fitness • Exercise and Eating Well
• Health Habits and Health
SYMPTOMS/BOTHERS Decisions
Dizziness/Tiredness • Common Medical
Back pain Conditions
• Daily Activities and
CONCERNS OR FAMILY Managing Limitations
HISTORY • Pain
Exercise/nutrition needs • Tiredness and Sleep
Preventing cancer/heart disease Problems
Ear/eye/mouth care • Women’s Health
Heart trouble/arteries
HABITS
Generally not good health habits
PREVENTION
RISK-RELATED CONSIDERATIONS
High blood pressure Major
ftinctional limit or more than three
OTHER bothersome problems
Italics Clinician Unaware

Allison's blog

I want to comment on Allison’s blog concerning medical errors. I can relate to this because my mother was a victim of a medical error. She began to have terrible stomach pains and every time she saw the doctor, he told her it was her nerves. He visited her in the hospital after she had her gallbladder removed. When he asked her how she was, she replied, “fine, now that I’ve had my nerves removed.” She endured weeks of unnecessary pain because her physician did not take her complaints seriously.

While I know that some errors are unavoidable, most aren’t. When a clinician treats a person, that patient trusts them with his/her life. That is an awesome responsibility and should be treated as such. Care should be taken that no errors occur and any steps necessary to have that should be taken.

Week 3

Collaboration: The Power of Data Aggregation

This article is about the incredible challenges in healthcare that are also changing the way health information is collected, exchanged and applied. With the advances in technology, comes challenges that make protecting information even more difficult than ever. Since this subject is so entwined with the career path I have chosen, I am intensely interested in it.

The subject of aggregating and sharing data will be debated for many years to come. There are wonderful benefits and frightening risks when our personal information is transmitted electronically. The controversies surrounding these new ideas are causing delays in technological advances. Aggregating data (which will create the first comprehensive and consistent source of data) will, I believe, improve health care enormously. Once the general population is convinced that their personal information is secure, I believe they will feel the same way.

http://www.healthleadersmedia.com/content/209949/topic/WS_HLM2_TEC/Collaboration-The-Power-of-Data-Aggregation.html



Buying Prescription Medicine Online:
A Consumer Safety Guide

The tool I’m using this week is about buying prescription medicine online. The internet has opened many doors for us that 10 or 15 years ago we never would have imagined. One of these is the opportunity to buy our prescription medication online. This has been wonderful for many people. While some may prefer to buy their medication online because of their busy schedules, some need to have theirs delivered to them. The latter may be elderly, invalid, or very chronically ill.

While buying medication online is very convenient, there are some concerns. You need to make sure you buy from a U.S. state-licensed pharmacy. Some companies won’t protect your personal information. Some sell fake medication, medication that is not developed uniformly, is expired, not FDA approved, is contraindicative with other medication, or not labeled correctly. Some websites to use as to make sure you are using an acceptable pharmacy are:

www.nabp.net - has a list of state boards of pharmacy.
www.vipps.info - where you can find a list of Verified Internet Pharmacy Practice Sites Seal.

If you stick to these, you should be safe.

If there is a problem, you can report it at www.fda.gov/buyonline and click on “Notify FDA about problem websites.”

The reason I chose this is my dad buys his medication online. He takes a lot and it is much less expensive that way.

http://www.fda.gov/buyonlineguide/

Week 2 blog

Training of Hospital Staff To Respond to a Mass Casualty Incident

I chose this week’s tool because of the exposure I’ve had at work to disaster preparedness. This article talks about needing to train hospital staff to respond to a mass casualty. I think this is a very important subject in the world we live in today. While right now we’re all focused on hurricanes, the day could come when there is another terrorist attack. Maybe the next one won’t be as huge as 9/11, but even a chemical or biological attack on a small scale could throw hospitals into chaos. I think it’s very appropriate that JCAHO requires disaster drills twice a year. While nothing can completely prepare hospitals for a disaster, the more the drill is practiced, the smoother things would run if it did happen. Something that really surprised me is that conference calls are an inefficient way to manage disaster response. I would have thought that it would have made things more organized to have everyone needed on the phone at the same time. Something that didn’t surprise me is that computer simulation and video demonstrations are both effective (and economical) was to improve disaster preparedness. While a community can never be prepared for a disaster, preparation and training can make the management of emergency staff much more controlled.

http://www.ahrq.gov/clinic/epcsums/hospmcisum.htm


Brainstorming Do's and Don'ts

This article gives great guidance to brainstorming. One really good piece of advice is to not be critical or judgmental. There’s nothing that can stifle creativity like criticism. After all, the purpose is to generate as many ideas as possible – quantity is more important than quality. Some of the best ideas can seem like the most farfetched at first.

Also, you should build off of others’ ideas. Sometimes one person’s idea may cause another idea to pop into your mind. Also, one idea alone might not be great. But, add it to others and the compilation could be wonderful.

I think one of the most important things necessary for a successful brainstorming session is for everyone to be comfortable—physically and mentally. When people feel like they are contributing, they put more effort and attention into this process.

http://ezinearticles.com/?Brainstorming-Dos-and-Donts&id=593051

Quality Improvement Projects to Improve Patient Safety and Outcomes

This article is an adaptation of an article was written about teaching quality improvement to clinicians. It focuses on Johns Hopkins’ efforts to improve the quality of the care their patients receive. I chose this article because of how it ties in with the video we watched. Romsai Boonysai, an internist at the Johns Hopkins Hospital co-wrote the original article.

One thing that really stood out in this article is that physicians are being trained in problem-solving diseases. When it comes to the health care system, they don’t identify with that aspect. I believe that while training clinicians in quality improvement is a great beginning, it’s not the only answer to the medical error problem. As pointed out in the article, a patient may receive excellent medical care, but if there is an error in the medical record, a sentinal event may occur. They also pointed out that if the person in charge of supplies mishandles an order, there could be a shortage and a patient would not receive crucial care. So, while the physician is responsible for the care of his/her patients, that care could be jeopardized by the actions or inactions of others. This makes me believe that anyone with job responsibilities that could affect a patient’s care should receive quality improvement training.

http://www.medicalnewstoday.com/articles/81686.php

Stopping Germs at Home, Work, and School

Since I am somewhat of a germ-o-phobe, this article really caught my attention. The main way illnesses are spread is through droplets that are sneezed or coughed by a sick person. If something these droplets have landed on are touched, those germs are transferred. Since some germs can live as much as 2 hours, it is very important to take measure to prevent the spread of germs. Some examples of prevention methods are:

· Cover your mouth and nose when you sneeze or cough. The schools are now teaching children to cough or sneeze into their sleeves. This will prevent the germs from taking up residence on your hands.

· Clean your hands often. While you don’t have to be obsessive, regular hand washing drastically lower the spread of infections.

· Remind your children to practice healthy habits, too.

The general rule for handwashing is to wash them with soap and warm water. This should be done for around 15 seconds. Also, if it is not possible to wash your hands, use a hand wipe or hand sanitizer.

I am including some fast facts to stop the spread of germs in schools. While they may be meant for children in school, it can apply to college students, too.

Stop the Spread of Germs in Schools Fast Facts • Approximately 1/5 of the U.S. population attends or works in schools. (U.S. Dept of Ed, 1999). • Some viruses and bacteria can live from 20 minutes up to 2 hours or more on surfaces like cafeteria tables, doorknobs, and desks. (Ansari, 1988; Scott and Bloomfield, 1989) • Nearly 22 million school days are lost annually due to the common cold alone. (CDC, 1996) • Addressing the spread of germs in schools is essential to the health of our youth, our schools, and our nation. • Students need to get plenty of sleep and physical activity, drink water, and eat good food to help them stay healthy in the winter and all year.