Posts Tagged ‘patient care’

Week in Review (May 2 – 6, 2011): The Eye Opener Health, Law and Just Interesting Stuff Blog

Saturday, May 7th, 2011

From Brian Nash (Editor)

We appreciate your stopping by to see what this past week’s posts covered in the world of law, medicine, health and safety – and then some.

You’ve been told you need to undergo treatment. The doctor tells you (hopefully) the risks and benefits of what’s being proposed. You’re wondering – “Is this my only choice?” In a non-emergency situation you usually have a choice you may not have considered – a second opinion. Theresa Neumann’s piece this past week addresses this usually available but very under-utilized resource for patient’s facing this situation.

Sarah Keogh writes about a topic that makes a lot of sense – when you stop and think about it. Who are the people on a hospital’s medical team that are with you more than anyone else? Your nurses, of course. Just how does a nurse’s working conditions not only affect him or her – how does it affect your health? Read Sarah’s piece and find out.

Asthma affects the lives of 20 million people in America. It does not discriminate since it affects the young, the old and all in between. This past week, Jon Stefanuca, who has been immersed in a case involving a young man who tragically died as a result of asthma shortly after being discharged from a local hospital, shared his “4 tips” to make sure you get the health care you need when you have an asthma problem. If you or someone close to you has asthma, take the time to consider Jon’s suggestions. As always, if there are some suggestions you could share with others, please do in the comments section.

Recently our firm started using QR Codes on our business cards. I’d heard about them but wasn’t quite sure what they were all about. After a little bit of study and discussion, I was amazed at what they can do – you will be too. So many now use their phones and mobile devices as their primary means for connecting with the world via the internet. Just download a free mobile application, snap a picture using the app and the QR Code will whisk (at a blazingly fast speed) you away to more information than you can imagine. Jason Penn, who was the first to get his QR Code business card, was apparently fascinated by this new technology, so he wrote a post this week about it and shares with you some interesting information about some others who have been using it for some time now.

Our Posts of the Past Week

Medical Second Opinions: An Under-utilized Option for Patients

By: Theresa Neumann

Today’s medical world is vast with various technologies, treatments and options.  So, if a patient is diagnosed with a medical condition, and doctor A recommends treatment A, what keeps the patient from seeking a second opinion? This is an interesting phenomenon.  After performing intake summaries and client interviews for quite a while now, it still amazes me how many people have bad outcomes from surgery simply because they never requested a second opinion. Second opinions are not simply reserved for surgery, though; cancer treatment options, medical therapies for chronic conditions like rheumatoid arthritis or inflammatory bowel disease….read more

 

Working Conditions for Nurses Impact Patient Health

By: Sarah Keogh

I suspect that anyone who has spent even as much as one day or night in a hospital knows just how critical the nursing staff is in the , health, care and comfort of a patient. A compassionate and personable nurse can put a patient at ease and help them feel better in ways that go beyond just medicine.

Recently, I wrote about how different schedules impact nurses’ lives and how they cope with shifting from day to night schedules. This week, I was drawn to write about nurses again after seeing an article on medicalnewstoday.com that spoke about a study done by the University of Maryland School of Nursing.  Read more

Having an Asthma Problem: 4 Tips for you to use to get the medical care you need

By: Jon Stefanuca

Did you know that approximately 20 million Americans suffer from asthma?  Every day, about 40,000 of them miss school or work because of this condition. Each day, approximately 30, 000 experience an asthma attack.  About 5000 patients end up in the emergency room. Asthma is also the most common chronic condition among children. Can there by any doubt it is a very serious and potentially deadly medical condition that needs equally serious understanding and attention? The good news is that with proper education and treatment, most asthmatics have active and productive lives.

Bronchospasm and inflammation: the key features of asthma

This chronic airway disease has two primary features: bronchospasm and inflammation. Bronchospasm refers to the mechanism by which airways become narrower. In asthmatic patients, the muscle within the wall of the airway contracts, thus narrowing the lumen (a cavity or channel within a tubular structure) of the airway and causing respiratory obstruction. Inflammation refers to the process by which the wall of the airway becomes thicker in response to inflammation, which also causes the lumen to narrow and produce respiratory obstruction. Bronchospasm is usually treated with….read more

Bar Codes, QR Codes and More: The Intersection of Life and Technology

By: Jason Penn

The business cards I ordered arrived yesterday.  I tore into the package to do the usual inspection.  Is my name spelled correctly?  Is the card stock heavy enough?  Did they use the desired typeface?  Yes. Yes. And Yes.  But I needed to ask one additional question: Does the QR code link correctly?   I know what you are thinking:  What is a QR Code and why is it on your business card?  Let’s try an experiment. Read more…

Don’t forget, however – you can learn about Jason but just using your QR Code reader right now….

Sneak Peak of the Week Ahead

That was it for last week. What’s coming in the week ahead? Here you go -

  • Mike Sanders has a piece about our wonderful canine friends and how they are being used for those with special needs.
  • Sarah Keogh will be investigate the role and responsibility of our schools to warn parents about potential health problems involving their children
  • Jon Stefanuca will be taking a look at ovarian cancer and suggesting some key issues to discuss with your physician
  • Jason Penn will be telling us more about stroke and a very interesting problem that his research has revealed
  • I will be writing about a brand new project we are starting to take our social networking to a whole new level – stay tuned.

Again – many thanks to all who stopped by. Take a few minutes, read our posts and maybe have some interesting topics for discussion this weekend after reading last week’s Eye Opener.

Have a great weekend, Everyone!



Nurses Switching Shifts: Does a Lack of Sleep Put Patients at Risk?

Friday, April 22nd, 2011

Image from scrubsmag.com

Many of us take it as a given that if we end up in a hospital, we will be taken care of by an around-the-clock group of health care professionals. These doctors, nurses and other staff will be awake and alert to care for us and prevent any potential problems during our stay. However, how many of you have thought about how this impacts these health care professionals on their days off? I know that I had not thought too much about this issue. I had taken for granted that if I or a loved one were hospitalized that the professionals involved in their care would be at least well rested enough to avoid major medical errors.

I have read lots of different reports about all of the rule changes for doctors in training regarding how many hours they can work in a week or at one time. I had never before read a report regarding the impact of work schedules on nurses. While I knew that most nurses worked 12-hour shifts, I have to admit that I had not thought about how this impacted their own lives or patient care. That changed when I read a recent article in medicalnewstoday.com. This article discusses a study published in Public Library of Science One that was conducted “…to examine the strategies that night nurses use to adjust between day and night sleep cycles.”

What seems obvious in retrospect, but that I had never really considered before, is that nurses who work the night shift (typically 7 pm until 7 am – or “7p to 7a” as they like to call it), normally do not stay up all night in their “non-work” lives. On their days off, they often want to live a more typical life with daytime awake hours. The ramification of this is that they need to switch their sleep schedule back and forth several times throughout the week. Can you image having to do that yourself and still perform your job properly?

The medicalnewstoday.com article explains that “[a]s many as 25 percent of hospital nurses go without sleep for at least 24 hours in order to adjust to working on the night shift, which is the least effective strategy for adapting their internal, circadian clocks to a night-time schedule.”

The “First Shift” Effect

So, the first issue in this revelation is that as many as a quarter of hospital nurses are going without sleep for at least 24 hours when adjusting to working the night shift. I shudder to think of how many nurses around the country are therefore working at least their first night shift every week while on hours 12-24 of not having slept.

While others may function better than I do without sleep, I don’t think that I would ever feel comfortable being cared for by a nurse who had not slept in the prior 12 hours before starting their shift. It seems to me that this opens up the possibility for many medical errors and patient injuries.

The Circadian Clock Effect

The second issue I had was that this is also “the least effective strategy for adapting their internal, circadian clocks” – which I take to mean that if a nurse who has not slept for that first shift is not bad enough – it also does not work very well to help them be adjusted and well rested for the rest of the week.

If the concerns about the health of the public being cared for by tired nurses is not bad enough, this can also be quite damaging to the health of the nurses themselves. These selfless individuals who are caring for others are – frankly – at risk.

A number of previous studies have found that repeated incidence of circadian misalignment the condition that occurs when individuals’ sleep/wake patterns are out of sync with their biological clocks is not healthy. Jet lag is the most familiar example of this condition. Circadian misalignment has been associated with increased risk of developing cardiovascular, metabolic and gastrointestinal disorders, some types of cancer and several mental disorders.

So, these nurses are risking their own health in addition to potentially the health of their patients.

Just how important is sleep?

Just how much does sleep matter? Well, another article from medicalnewstoday.com recently looked at sleep in a very different context. It examined a study from the Journal of Clinical Sleep Medicine, which showed that “…automobile crash rates among teen drivers…” were dramatically higher in otherwise similar school districts where teens started school earlier in the morning (a difference of about 1 hours and twenty minutes). While there is no proof yet that this connection is causal, there certainly seems to be a strong connection even after adjusting for other possible factors. The article also mentions that:

Another study in the April issue of the Journal of Clinical Sleep Medicine suggests that delaying school start times by one hour could enhance students’ cognitive performance by improving their attention level and increasing their rate of performance, as well as reducing their mistakes and impulsivity. The Israeli study of 14-year-old, eighth-grade students found that the teens slept about 55 minutes longer each night and performed better on tests that require attention when their school start time was delayed by one hour.

While teens and teenage behavior can be different from that of adults (thank goodness), I still think that these studies highlight some of the key issues of sleep deprivation. Adults seem likely to also make more mistakes, lack attention and act more impulsively when functioning on less sleep.

However, a review of a study from Nursing Economics entitled “Shift Work in Nursing: Is it Really a Risk Factor for Nurses’ Health and Patients’ Safety” suggests that other factors put nurses’ health at greater risk and that shift work does not impact the number of medical errors. The study was conducted in Israel in 2003. It is important to note that this study looked at nurses working alternating 8-hour shifts and did not directly look at the issue of nurses not sleeping in order to switch between 12-hour shifts.  The investigators in the study were surprised by some of their findings:

Shift work and organizational outcomes. In the present study, we investigated the impact of sleep disturbances on shift nurses and on two organizational outcomes: errors and incidents and absenteeism from work. Based on our literature review (Morshead, 2002; Muecke, 2005; Westfall-Lake, 1997), we expected that “non-adaptive shift nurses” would report on more involvement in errors and adverse incidents as compared to “adaptive shift nurses.” We also assumed that non-adaptive nurses, who by definition have more sleep-related complaints, would have higher absenteeism rates due to illness compared to their adaptive colleagues. Neither of our hypotheses was supported by the results of this study.

Instead the study found that:

It appears that gender, age, and weight are more significant factors than shift work in determining the well-being of nurses. Moreover, nurses who were identified as being non-adaptive to shift work based on their complaints about sleep were found to work as effectively and safely as their adaptive colleagues in terms of absenteeism from work and involvement in professional errors and accidents.

What do you think? Would you want a nurse who has been up for 24 hours to be caring for you or your loved one? Should it be the nurse’s decision whether they are alert enough for work? Should rules be created for nurses just as they were for physicians in training? What about nurses who enjoy the flexibility and freedom allowed by this sort of schedule? Have you worked as a nurse? What are your experiences and feedback on whether this is a problem?

Related Post – you may want to read:

A Surgeon’s Sleep Deprivation and Elective Surgery – Not a good (or safe) combination.

The New England Journal of Medicine published a Perspective on December 30, 2010, that screams common sense and should be embraced as a starting point to implement some new patient-safety standards of practice. Place yourself in the position of a patient getting ready to undergo an elective (i.e. non-emergency) surgical procedure. You’re wheeled into the operating room for your surgery and are greeted by your surgeon in the process. Read more…


 

Hospitals Fined Heavily for Unsafe Practices – medical malpractice pure and simple!

Tuesday, November 9th, 2010

Well this headline got my immediate attention!

HOSPITAL FINED $300,000 FOR LEAVING A DRILL BIT IN PATIENT’S HEAD.  Rhode Island Hospital (RIH) was fined by the state’s Department of Health with the largest penalty in state history and only the 3rd posed against a hospital for surgical errors.

How does such a mistake happen? I went to the article and then saw similar articles over the last year.

CALIFORNIA HOSPITALS FINED FOR ENDANGERING PATIENT SAFETY

TEMPLE TO PAY (the US Government) $130,000 TO SETTLE DRUG DIVERSION CLAIMS

BOTCHED RADIATION TREATMENTS LEAD TO FINE FOR VA

Yes, states are fining hospitals, the US government is fining hospitals, and the US government is even fining government hospitals for unsafe practices. State, regional and national news publications are breaking the stories and making the public aware of their hospitals’ most costly mistakes.  Over the last two decades, more and more states are requiring hospitals to report serious errors and fining them for failing to do so. One way or the other, hospitals pay for serious mistakes and suffer media scrutiny at the same time.

The Rhode Island Director of Health reported “a troubling pattern” of patient safety procedural violations at RIH.  On October 15th of this year, a surgical instrument was found in the abdomen of a patient who had undergone surgery three months before. This followed an August incident when a quarter inch drill bit broke off in a patient undergoing brain surgery. While aware the bit was missing, no one in the operating suite investigated where it went. The next day an MRI identified the bit in the patient’s brain. This error placed the patient at serious risk of harm during the MRI. Magnetic forces during the MRI could have moved the metal drill bit causing significant brain injury.

Clinical standards of care require all surgical instruments to be counted at the beginning and end of a procedure. If the count is incorrect, xrays are immediately taken. If found in the patient, the instrument is removed before the conclusion of the procedure. This healthcare industry-wide patient safety procedure has been in place for well over 30 years. The simpe, straightforward procedure was not undertaken according to Rhode Island news reports. In addition, the state found anesthesiologists at RIH don’t wear masks while in the operating room, and no actions had been taken to correct the behavior.

The Director of Health also reported in 2009, RIH was fined $150,000 and ordered to hire a consultant to improve operating suite procedures; shut down surgeries for 1 day to conduct mandatory training; and install audio/video monitoring devices to ensure compliance. This all happened when a surgeon operated on the wrong finger which was the 5th time a wrong body part had been operated on in 3 years at RIH.  Things have not improved in 2010. The fines are getting heftier and the Centers for Medicare & Medicaid Services (CMS)  as well as state professional licensing boards are now involved. Federal government intervention has only happened one other time in Rhode Island’s healthcare history.

Rhode Island is not alone. As the headlines above show, California, after enacting a new state law in 2007, reports that over $4.8 million in healthcare administrative penalties have been issued with $2.9 million collected to date. California news stories began breaking last January (2010) when thirteen hospitals were fined $50,000 each and another was fined $25,000 four times. In April, seven more hospitals were fined. In May, nine more hospitals $550,000 in penalties imposed.

The deputy director for public health, Kathleen Billingsley, told the press that Californians have a right to receive the minimum level of required state standards. Out of 146 penalties, hospitals were appealing 37 in an April news report. Notable infractions resulting in fines included:

  • Man hospitalized with a heart attack died after his cardiac monitor had been disconnected.
  • Woman misdiagnosed with an ectopic pregnancy was given chemotherapy drugs. She was not pregnant.
  • Two ER nurses without documented clinical competencies or life support training failed to record vital signs in a 5 month old with a temperature of 105.4.
  • An operative sponge was left in a patient and discovered a year later. Three operations were required to eventually remove the sponge.
  • A wrong knee was operated on.
  • Contrast material for radiology was given to a patient with a known iodine allergy resulting in death.
  • An oxygen tank became empty during a simple ultrasound procedure resulting in the patient’s death. The patient had waited in radiology over 60 minutes for the procedure allowing the tank to run dry.
  • A patient aspirated a laryngoscope plastic blade extender during intubation for an outpatient surgery. It was not discovered until the patient called post operatively complaining of coughing up plastic.

In March, the Department of Veteran Affairs, which oversees the Philadelphia Veterans Affairs Medical Center was fined $227,500 by the Nuclear Regulatory Commission. This was the second largest fine against a medical facility. Between 2002 and 2008, Iodine 125 seeds were placed incorrectly in 97 out of 116 prostate cancer patients. There were inconsistent doses, unintended organs and tissues radiated leading to a myriad of complications for the victims including excessive radiation. Many of the incorrect procedures initially went unreported.

While I applaud these fines and would like to see stronger sanctions, several questions came to mind after reading these reports. Are states and the federal government merely cashing-in and paying-down healthcare deficits, or putting this revenue to good use such as improving patient safety? How much of the revenue is being consumed in hospital appeal proceedings? Is this an effective incentive for hospitals to change or merely perceived by them as a cost of doing business in today’s high paced and burdened healthcare system?

What do you think?

Why don't patients ask questions of their doctor?

Monday, May 31st, 2010

My wife came back from a doctor’s appointment the other day, and immediately, I noticed that she looked puzzled and somewhat confused. So, I asked her about her appointment.  She went over her discussion with the doctor as I kept probing with questions about their conversation.  I found myself asking the following question more than any other: “Well, did you ask him about…?” Before too long, doing what I do for a living, I could not help but wonder why patients aren’t more inquisitive. Is there something about the patient-doctor relationship that makes patients not want to ask questions of their physicians?

Surely, the primary responsibility for gathering information about the patient’s medical conditions is and should be with the physicians. After all, their knowledge of medicine is vastly superior to that of the average patient. Still, when a patient has questions, there is often no good reason not to ask them. Consider a physician who orders hormone replacement for a female patient with a history of blood clots or hypercoagulability of which the physician is unaware. Consider another patient who develops a series of complications after a surgical procedure but who decides to tough-it- out and not ask any questions during follow-up appointments with the physician. In both of these examples, the patient risks developing potentially life-threatening conditions, and, if the patient knows or suspects that possibility for whatever reason, it is probably not a good idea to assume that the doctor will be the one to ask the right questions. So, why are patients sometimes reluctant to ask more questions about their medical care or condition?  I don’t presume to know the answer, but I suspect, in part, it has to do with the patient’s expectations.

For example, when I am pain, I don’t really want to have an extensive Q & A session with my doctor. I just want treatment!  It is simply mentally relaxing to just let go and have someone else take care of me. In addition, my knowledge of medicine is superficial at best. I don’t feel comfortable asking questions if I don’t know what I am talking about. My ego would rather have me in pain than allow me to question a doctor at the risk of looking like a fool.

On a subconscious level, I am probably also dealing with preconceived notions about doctors.  As long as I can remember, I have been told that doctors are intelligent and in control. After all, who else is capable of getting into medical school and then have the stamina to survive some seven to ten years of medical training? All of this makes me think that my doctor can only make the right decisions about my medical care. And then there is the medical office or the hospital. The smells, the patients (most with problems far worse than I have), the complicated machines that look like they belong in a sci-fi movie don’t exactly add-up to a familiar, comfortable environment.  I am in pain, uncomfortable, and somewhat intimidated – not exactly an environment conducive of critical thinking.

Well, if this is how other people feel, I think that might explain why patients are sometimes not as inquisitive as they should be.  What do you think?  If you are a patient or a physician, your feedback is much appreciated. Of course, everyone is welcome to comment.

Contributing author: Jon Stefanuca

Editor’s Note: This piece was written by Jon Stefanuca. My own wife has an advanced degree in pathology, did surgical pathology and autopsies. She DOES ask questions! Do you really need a medically-related degree, however, to ask the basic questions so that you have a clue what you’ve just agreed to by way of medical care? I think not. Moral of the story: be your own patient advocate! If you need help, then have a family member or a close friend accompany you if you have any doubt.

Patient satisfaction scores improve when doctors sit down – well, that's part of the answer perhaps!

Thursday, April 22nd, 2010

One of the people I follow on a daily basis is KevinMD on Twitter. Why would a medical malpractice lawyer follow a physician?, you ask.  Simply put – this doctor seems to get it.

In a blog he wrote today -Patient satisfaction scores improve when doctors sit | KevinMD.com – (we’ll call him Dr. Kevin – his name on his Twitter page is Kevin Pho, M.D.), Dr. Kevin brings yet another practical tip to his colleagues in the medical profession – when dealing with patients, the ‘act of sitting down’ can have a profound effect on patient satisfaction.  Believe it or not, this was actually the subject of a study According to the study performed at a University of Kansas Hospital.  In this study a physician documented 120 visits, half of which he conducted sitting, and the other half, standing.

What the medical community still does not seem to get is that their interactions with patients are critical many times in situations where the outcome is not good.  I simply cannot tell you how many initial client interviews share a common theme – “the doctor really gave me the bums-rush and just didn’t seem to care about me as an individual.”  I just had that very same conversation three times in the past two days alone.  One variant on this theme occurs after a bad outcome and the patient simply wants to know what happened.  Time and time again clients tell the story of trying to seek out their doctor, who dodges them, to find out what happened.  I know – doctors are concerned that if they get involved in such a discussion, this will turn out to be evidence used against them by some plaintiff lawyer.

What I can share with the medical community is that if you sit and just explain a situation to a loved one or the family in general is that this is all most people (yes – not all) want to hear.

Photo supplied by KevinMD.com

Granted – I can only speak from my limited perspective.  That being said, one of the things we look for during the initial interview is the motivation of the prospective client for being in our office.  If it’s financial – we shy away.  Those cases are always problematic.  The over-ridding theme or characteristic of a ‘good client’ is their desire to (a) just want to know what happened that went wrong or (b) make sure that what happened (which they often don’t understand because no one would tell them) doesn’t happen to someone else.  Those are the clients who are appreciative even when you ultimately reject their case following investigation.

So, Dr. Kevin, you have part of the answer right.  I might suggest you add on – actually trying to care about why you are sitting down talking to your patient, knowing what’s important to them and when something goes awry, taking the time to help them understand what happened.  Again, from my limited experience base (which is better than the 120 people in the “Kansas Hospital’ study, that time spent with your patient or the family will probably cause you to spend less time giving a deposition in your malpractice lawsuit.  In fact, you just may never have to give a deposition at all!

Keep up the good advice Dr. Kevin!  Maybe I will be able to field less calls from disgruntled patients and families if your colleagues follow some of your sage advice.