myBlog

Creating safe medication prescribing processes.

admin — Tue, 27 Dec 2011 02:37:19 +0000

Patient Safety Recommendations
Creating safe medication prescribing processes and systems is a critical component in reducing the risk of adverse drug events and medication errors. For physicians working in an ambulatory clinical delivery setting and prescribing controlled substances and nonscheduled medications, important aspects of prescribing processes⁷ include the following:

Conducting a thorough examination of the patient prior to prescribing medications or renewing prescriptions, especially for an opioid medication.

Obtaining a medication history on the initial visit, entering it onto a medication log or form, and placing it in the patient’s medical chart. Include prescription medications, over-the-counter medications, alcohol and drug use, vitamins, herbal products, dietary supplements, alternative medicine, and homeopathic medications.

Updating the medication history/medication log at each patient visit.

Providing the patient with an up-to-date list of medications at the end of each encounter.

Informing the pharmacy about the patient’s comorbid conditions, allergies, weight, and date of birth when calling in the prescription orders. Spell out drugs with similar sounding names. Determine when your prescription should include the indication for the medication, such as when ordering sound-alike medications, PRN medications, and high-risk medications, and apply consistently.

Preparing a prescription label for sample medications for the patient to take home. The label must meet state pharmacy regulations.

Providing medication counseling to the patient or caregiver with consideration given to any language or literacy barrier and to any hearing or sight impairment of the patient or caregiver. Use the Ask Me 3⁸guidelines or “teach-back”⁹ method to ensure patient understanding

Obtaining and documenting informed consent.

Monitoring medication usage closely, particularly for controlled substances.

Not storing drugs (sample medications or clinic medications) that look alike or sound alike adjacent to each other.

Documenting all medications administered to the patient during the clinic visit, including vaccines and sample medications.

Asking the patient about medication allergies or sensitivities to substances at each visit or at least yearly, and documenting the information on the medication log for easy access.

Providing education to the patient on his or her medications and on any potential interactions, such as with herbal and nutritional substances. Also include signs and symptoms of untoward reactions with medications and provide instructions on whom to call for further care.

Announcing new association with constitutional rights firm on police abuse matters

admin — Thu, 15 Dec 2011 19:52:10 +0000

Our firm is proud to announce that we have associated with a notable constitional law firm specializing in the area of section 1983 litigation concerning police abuse and discrimination matters. While most police officers are honorable professionals respcting our constitutional rights, there are a minority that infringe on such rights with impunity. We are in the process of filing two major law suits in federal court against two police departments in the immediate area. It is unfortunate that citizens are falsely arrested and malicously proscuted or being assaulted in the head with an object causing serious catastrophic injuries and then covering it up.

Softball Catcher Held to Assume Risk of Injury From Collision at Plate

admin — Thu, 15 Dec 2011 19:22:25 +0000

David Cole, the primary appellant, was injured while catching during a father-son game of softball at a Cub Scout outing when a baserunner collided with him at home plate. As Wagner reached home plate, he collided with Cole, who had moved on top of the plate, thereby placing his body directly in the baseline. Wagner was running so fast that he was unable to stop or change directions in time to avoid Cole. Upon impact, Wagner flipped in the air and landed on a bat, breaking a rib. Cole suffered a closed head injury and was rendered semiconscious. He then began bleeding and went into convulsions. Cole had to be airlifted to Palmetto Richland Hospital where he spent two days in the intensive care unit. David Jr. witnessed the entire accident in fear that his father was going to die. He brought this action alleging negligence and recklessness against the baserunner and the sponsors of the game. The circuit court judge granted summary judgment to the baserunner, and affirmed by Supreme Court of South Carolina.

Appellants argue that the circuit court erred in finding Cole assumed the risk of his injury by engaging in a game of softball because Wagner’s conduct was outside the scope of the game. Specifically, Appellants argue Wagner’s behavior was inconsistent with the ordinary risks of softball because the game was intended to be noncompetitive, Wagner violated a rule of the game, and he acted recklessly.

“Primary implied assumption of risk arises when the plaintiff impliedly assumes those risks that are inherent in a particular activity.” Davenport v. Cotton Hope Plantation Horizontal Prop. Regime, 333 S.C. 71, 81, 508 S.E.2d 565, 570 (1998). The doctrine of primary implied assumption of risk “goes to the initial determination of whether the defendant’s legal duty encompasses the risk encountered by the plaintiff.” Id. To establish a claim for negligence, a plaintiff must first show that the defendant owed a duty of care to the plaintiff. Doe, 393 S.C. at 246, 711 S.E.2d at 911. Absent a legally recognized duty, the defendant in a negligence action is entitled to a judgment as matter of law. Hurst v. East Coast Hockey League, 371 S.C. 33, 37, 637 S.E.2d 560, 562 (2006).

The court held the likelihood of someone running too fast to stop or playing more aggressively than anticipated is part of the competitive atmosphere of athletics. Almost all contact sports, especially ones that require protective gear as part of their equipment, involve conduct that a reasonably prudent person would recognize may result in injury. To the extent these risks inhere in the sport involved, we hold some recklessness by coparticipants in a contact sport must be assumed as part of the game. Accordingly, a player assumes the risk of ordinary recklessness committed within the course of the game.

The court further emphasized that this holding is limited to recklessness committed within the scope of the game and does not include intentional conduct by a coparticipant of a sport, or conduct so reckless as to be outside the scope of the game. Even within the context of a contact sport, players owe reciprocal duties to not intentionally injure each other. Cole does not allege that Wagner’s conduct was intentional nor does he allege such recklessness as would fall outside the scope of the game of softball. Thus, Wagner’s conduct fell within the duty of care he owed to Cole as a coparticipant in the game.

http://www.judicial.state.sc.us/opinions/displayOpinion.cfm?caseNo=27072

Drinking and Driving: A Threat to Everyone

admin — Fri, 09 Dec 2011 20:13:43 +0000

US adults drank too much and got behind the wheel about 112 million times in 2010. Though episodes of driving after drinking too much (“drinking and driving”) have gone down by 30% during the past 5 years, it remains a serious problem in the US. Alcohol-impaired drivers* are involved in about 1 in 3 crash deaths, resulting in nearly 11,000 deaths in 2009.

Driving drunk is never OK. Choose not to drink and drive and help others do the same.

People who drink and drive put everyone on the road in danger
Certain groups are more likely to drink and drive than others.

•Men were responsible for 4 in 5 episodes (81%) of drinking and driving in 2010.
•Young men ages 21-34 made up only 11% of the U.S. adult population in 2010, yet were responsible for 32% of all instances of drinking and driving.
•85% of drinking and driving episodes were reported by people who also reported binge drinking. Binge drinking means 5 or more drinks for men or 4 or more drinks for women during a short period of time.

There are proven ways to prevent people from drinking and driving.

•At sobriety checkpoints, police stop drivers to judge if they are driving under the influence of alcohol. More widespread, frequent use of these checkpoints could save about 1,500 to 3,000 lives on the road each year. •Minimum legal drinking age laws prohibit selling alcohol to people under age 21 in all 50 states and the District of Columbia. Keeping and enforcing 21 as the minimum legal drinking age helps keep young, inexperienced drivers from drinking and driving. •Ignition interlocks prevent drivers who were convicted of alcohol-impaired driving from operating their vehicles if they have been drinking. Interlocks are effective in reducing re-arrest rates from drinking and driving by about two-thirds while the device is on the vehicle.

Premature babies have higher risk of death in young adulthood, study finds

admin — Sun, 30 Oct 2011 22:30:31 +0000

A new study published in the American Journal of Medicine has found that premature babies have a higher risk of death in early adulthood than babies born at full term. The study, conducted by Dr. Casey Crump of Stanford University, used Swedish medical records to track 674,820 births. Of these 4.1%, 27 667 babies, were preterm (37 weeks or less of gestation) births.

In addition to the long-term risks, premature deliveries may result in serious infections, pneumonia, jaundice, meningitis and respiratory distress. It may also cause birth injuries such as cerebral palsy. Many known factors exist that a doctor can look for to predict a premature baby. Failing to diagnose and resolve these factors through preventative actions or misdiagnosing the symptoms can lead to an unnecessary premature birth. When a premature delivery occurs as the result of the negligent actions of a health care provider, the health care provider’s actions may constitute medical malpractice.

Increase in traumatic brain injuries with youth sports related concussions

admin — Sun, 30 Oct 2011 22:09:33 +0000

CDC finds 60 percent increase in youth athletes treated for TBIs
Greatest numbers of visits caused by bicycling, football, and playground activities
Emergency department visits for sports– and recreation–related traumatic brain injuries, including concussions, among children and adolescents increased by 60 percent during the last decade, according to a report by the Centers for Disease Control and Prevention. CDC experts believe much of the increase occurred because more adults realized the youngsters needed to be seen by health care providers.

Traumatic brain injuries, or TBIs, rose from 153,375 in 2001 to 248,418 in 2009, said the analysis in CDC?s Morbidity and Mortality Weekly Report. Bicycling, football, playground activities, basketball, and soccer were the primary sports involved, the study said.

“We believe that one reason for the increase in emergency department visits among children and adolescents may be a result of the growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected TBI to be seen by a health care professional,” said Linda C. Degutis, Dr.P.H., M.S.N., director of CDC?s National Center for Injury Prevention and Control.

During this eight–year period, approximately 173,285 children and adolescents (from birth to 19 years) were treated for non–fatal sports– and recreation–related TBIs each year in U.S. emergency departments.

The number of sports– and recreation–related TBI emergency department visits varied by age group and gender:

71.0 percent of all visits were among males
70.5 percent of visits were among persons aged 10–19 years
Children from birth to 9 years commonly sustained injuries during playground activities or while bicycling.
Data for those aged 10–19 years varied also by activity and gender. Injuries among males most often occurred while playing football or bicycling. Females sustained injuries most often while playing soccer or basketball or while bicycling.

Research indicates that young athletes with a TBI experience longer recovery times and are at greater risk of serious outcomes compared to adults. TBI symptoms may appear mild, but the injury can lead to significant life–long impairment affecting an individual?s memory, behavior, learning, and/or emotions. Appropriate diagnosis, management, and education are critical for helping young athletes with a TBI recover quickly and fully.

“While some research shows a child?s developing brain can be resilient, it is also known to be more vulnerable to the chemical changes that occur following a TBI,” said Richard C. Hunt, M.D., director of CDC?s Division for Injury Response.
Over the last 10 years, as part of the Heads Up initiative, CDC has worked to raise awareness about TBI, including concussions, and improve prevention, recognition, and response to this injury among health care and school professionals, parents, coaches, and children and adolescents.

Most recently, with the support from the National Football League and CDC Foundation, CDC created a new online training to provide health care professionals with an overview of what they need to know about concussion among young athletes. In this course, health care professionals explore what happens to the brain and why young people are at increased risk. The goal of this course is to prepare health care professionals to diagnose and manage concussions on the sidelines, in their office, training room, or in the emergency department.

Available at no cost, this online course called, Heads Up to Clinicians: Addressing Concussion in Sports among Kids and Teens, was completed in collaboration with an expert work group and 13 leading medical organizations and includes a continuing education opportunity.

For more information about concussion, including educational materials and tools for health care and school professionals, coaches, parents, and athletes, visit www.cdc.gov/Concussion.
CDC 24/7: Saving Lives. Protecting People. Saving Money Through Prevention.

###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

20 factors to determine if worker is an employee or independent contractor

admin — Sun, 30 Oct 2011 06:17:07 +0000

1.     Instructions. A worker who is required to comply with another person’s instructions regarding when, where and how to perform the work is ordinarily an employee.
2.     Training. Training a worker indicates that the company wants the services performed in a particular method or manner, which also indicates control.
3.     Integration. Integration of the worker’s services into the company’s core business operations generally shows that the worker is subject to direction and control.
4.     Services Rendered Personally. If the worker must personally perform services for the company, this will indicate control by the company. Alternatively, if the worker is free to engage others to perform the service for the company (i.e., subcontractors), a lack of control by the company is indicated.
5.     Hiring, Supervising and Paying Assistants. Similar to #4 above, if the worker is unable to hire, supervise and pay assistants to perform services for the company, control by the company is indicated. However, a lack of control is indicated when the worker is able to hire his or her own assistants and pay them from the worker’s own funds.
6.     Continuing Relationship. A lengthy and continuing relationship between the worker and the company indicates that an employment relationship exists.
7.     Set Hours of Work. If the worker works certain hours set by the company, employment status is indicated. If the company does not control the hours of the worker, independent contractor status is indicated.
8.     Full Time Required. If the worker must devote substantially full time to the company’s business, control is indicated.
9.     Work Performed on Employer’s Premises. If the work is performed on the company’s premises, the company is considered to have control over the worker, especially if the work could be done elsewhere. Control is also indicated when the company has the right to compel the worker to travel a designated route, to canvass a territory within a certain time, or to work at specific places as required.
10.   Order or Sequence Set. If a worker must perform services in the order or sequence as determined by the company, the worker is generally subject to an employer’s control. However, if the worker chooses his or her own method for completing a job, a lack of control exists.
11.   Oral or Written Reports. A requirement that a worker submit regular or written reports is an indicator of control.
12.   Payment by Hour, Week, Month. Hourly, weekly or monthly payments generally point to an employment relationship. On the other hand, payments based on a contract or for completing a particular job or task will generally indicate an independent contractor relationship.
13.   Payment of Business and/or Traveling Expenses. If the company ordinarily pays the worker’s business and traveling expenses, the worker is ordinarily an employee.
14.   Furnishing of Tools and Materials. If the company furnishes significant tools, materials and other equipment, an employment relationship is indicated.
15.   Significant Investment. If the worker does not invest in his or her own facilities, control is indicated because the worker depends on the company for such facilities.
16.   Realization of Profit or Loss. A worker who cannot realize a profit beyond an ordinary salary or suffer a loss is generally considered to be an employee.
17.   Working for More Than One Firm at a Time. If the worker cannot perform services for more than one company at a time, the company generally controls the worker. However, a lack of control is indicated when the worker is able to perform services for multiple companies at the same time.
18.   Making Service Available to General Public. If a worker is not free to advertise his or her services to the general public on a regular basis, control is indicated. Workers who advertise their services are generally considered independent contractors.
19.   Right to Discharge. The right of the company to discharge a worker without breaching a contract indicates an employment relationship as control is exercised through the threat of dismissal.
20.   Right to Terminate. If, at any time without incurring liability, the worker has the right to end his or her relationship with the company, an employment relationship is indicated.

Drinking and driving does pay: You will pay for it !

admin — Thu, 20 Oct 2011 19:42:01 +0000

If you are going to drink and drive then you should consider the following. Drunk driving or driving while under the influence of alcohol or a controlled substance is against the law. Tennessee law will not permit a criminal to profit from his criminal act. Insurance companies have a clause in most automobile insurance policies that prohibit an insured from receiving a judgment or money for injur…ies that occurred in an automobile accident caused by drunk driving. A drunk driving exclusion is often a separate term in the policy or drunk driving could be excluded under the policy’s crime exclusion. Our firm recently recovered for a lady who was hit by a millionaire driving drunk and her settlement was 7 times her medical bills. Having it on a red light camera video helped as well. Next time you drink and drive you should consider the consequences.

Survive a hospital stay and avoid deadly medical mistakes

admin — Thu, 20 Oct 2011 19:28:55 +0000

Below is a great article in Tennessean on surviving a hospital stay and not being one of 500,000 that die anually.

http://www.tennessean.com/article/20111018/LIFE03/310180046/Surviving-hospital-stay?odyssey=mod%7Cnewswell%7Ctext%7CFRONTPAGE%7Cs

10 Ways to prevent medical errors

admin — Thu, 20 Oct 2011 19:18:24 +0000

10 Ways to prevent medical errors:

1. Expect mistakes and have an advocate with you in the hospital.
2. Check every medicine. Make sure the dose is right.
3. Be assertive. “Being nice can get you killed.”
4. When in doubt, say no. Demand an explanation.
5. Be vigilant during transitions, from one floor to another, or when shifts change.
6. Alert the nurse or “rapid response team” if something seems wrong.
7. When discharged from the hospital, get detailed instructions and contact information. Know what symptoms might signal a worsening situation or infection.
8. Hospital doctors may never speak to your primary-care physician. Take your records and don’t assume doctors already know what’s in them.
9. Double-check everything. Don’t assume no news is good news or that test results are always correct. Get copies of lab results in a timely fashion. If something seems wrong, request a repeat.
10. Take a friend or family member to doctor’s visits. Nearly every error made in the hospital can also be made in the outpatient setting. A second pair of eyes and ears can be very useful in getting instructions and spotting problems.