Patient Safety

We Need More and Better Equipped Nurses A Perspective on Nurses and Technology

Editor’s Notes: In this article, Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety) discusses why we need more nurses and better equipped nurses to improve patient safety and care.

By Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)

Happy Nurses Week!

As an advocate for patient monitoring, I am often asked how much I value nurses. More particularly, people often ask me –  is PPAHS trying to replace nurses with technology?

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Must Reads

Rethinking Pain Management: 4 Options to Consider Articles PPAHS has been reading

Editor’s note: As the opioid epidemic rages on, we need to rethink how pain is managed. Guidelines aimed at reducing the number of opioids prescribed has had an unintended consequence.

As the opioid epidemic rages on, we need to rethink how pain is managed. Guidelines aimed at reducing the number of opioids prescribed has had an unintended consequence. In the article, “Good News: Opioid Prescribing Fell. The Bad? Pain Patients Suffer, Doctors Say,” the NY Times reports:

… in a letter to be sent to the Centers for Disease Control and Prevention on Wednesday, more than 300 medical experts, including three former White House drug czars, contend that the guidelines are harming one group of vulnerable patients: those with severe chronic pain, who may have been taking high doses of opioids for years without becoming addicted. They say the guidelines are being used as cover by insurers to deny reimbursement and by doctors to turn patients away. As a result, they say, patients who could benefit from the medications are being thrown into withdrawal and suffering renewed pain and a diminished quality of life, even to the point of suicide.”

Source: https://commons.wikimedia.org/wiki/File:Children%27s_pain_scale.JPG

We have been reading about some interesting new studies about how to better manage pain. Here are 5 to consider:

#1 – Use ‘Pain Balls’

Recovering from a C-Section can be painful. Van Reid Bohman MD, FACOG (Desert Perinatal Associates) has been using “pain balls.”

The pain ball delivers a non-addictive, numbing anesthetic through a catheter directly to surgical incisions. It’s one of a number of opioid alternatives being used to help woman who have had a C-sections deal with post-surgery pain.

#2 – Develop a Cross-Functional Response

NYU Langone Health’s department of orthopedic surgery led an institution-wide effort to rethink and reduce the use of opioids in patient care for subspecialty procedures, to make more common procedures opioid-free or opioid-light.

“NYU Langone orthopedic surgeons have collaborated closely with other hospital stakeholders, including anesthesia, pain management, pharmacy and healthcare IT, to develop a cross-functional response to the opioid epidemic,” says Joseph A. Bosco, MD, professor of orthopedic surgery and vice chair of clinical affairs at NYU Langone, and second vice president of the American Academy of Orthopaedic Surgeons.

#3 – Use Point-of-Care Ultrasound (POCUS)

Researchers at the School of Biological and Health Systems Engineering at Arizona State University tested the feasibility of a point-of-care ultrasound (POCUS) neuromodulation device in patients suffering from carpal tunnel syndrome or cervical radiculopathy.

The researchers saw improved outcomes, including reduced nerve inflammation, restored function and diminished pain.

#4 – Employ a Multimodal Analgesic Approach

Researchers at at Mount Sinai Hospital, in Chicago used a multimodal analgesic approach to post–cesarean delivery pain management. They found that using this approach decreased the number of opioid tablets prescribed at discharge by 52%, according to a retrospective chart review presented at PAINWeek 2018.

The multimodal approach consisted of analgesics with various mechanisms of action for an additive or synergistic effect in order to minimize opioid use.

 

Blood Clots

Maternal Death: the Rising National Crisis of Maternal Morbidity and Mortality

In this article, Niran S. Al-Agba, MD (Mom, pediatrician, and Associate Editor at The Deductible); Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety) and John Bianchi (Vice President, Finn Partners) discuss the maternal morbidity and mortality epidemic in the US. Seeking to stem this epidemic, The Preventing Maternal Deaths Act was recently signed into law.

Now, the question is how to reduce the national crisis of maternal morbidity and mortality. To reverse increasing maternal mortality, prioritizing venous thromboembolism — the leading medical cause of maternal death in pregnancy — will help lower maternal morbidity and mortality.

Tommy and Amber Scott

To read the article about how Tommy Scott came home from work and found his pregnant wife, Amber, unconscious after she had suffered a stroke due to a clot in her brain, please click here.

To read the article on Medium.com, please click here.

Opioid Safety, Respiratory Compromise

Preventing Opioid Overdoses and Death: Let’s Start in the Hospitals

Editor’s Note: In this article, Michael Wong, JD (Founder/Executive Director, Physician-Patient Alliance for Health & Safety) with Arielle Bernstein Pinsof, MPP, Finn Partners and Gil Bashe, Managing Partner, Finn Partners Health Practice take the position that decreasing the opioid epidemic begins in the doctor’s office and healthcare facilities.

By Michael Wong, JD (Founder/Executive Director, Physician-Patient Alliance for Health & Safety) with Arielle Bernstein Pinsof, MPP, Finn Partners and Gil Bashe, Managing Partner, Finn Partners Health Practice

The tragedy of our national opioid epidemic has gripped hearts and headlines for months now with heartbreaking personal stories, images and statistics. But the truth is, not all overdose deaths are taking place on the streets — so while physicians and lawmakers race to find interventions that work on the front lines in our communities, shouldn’t we also take concrete steps to reduce opioid overdoses in the clinical setting — where they are highly preventable — where the full range of interventions are at hand?

In this article that Michael Wong coauthored with Arielle Bernstein Pinsof, MPP, Finn Partners and Gil Bashe, Managing Partner, Finn Partners Health Practice, the authors take the position that decreasing the opioid epidemic begins in the doctor’s office and healthcare facilities – “Enabling our hospital system to treat opioid overdoses requires a medical mindset. We should equip our frontline staff with the best medical guidelines, technologies and Federal and state policy support possible. Technology and training to overcome the opioid epidemic is a demonstrated path to success. It’s time to become far more innovative and take action.”

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Patient Safety

Are Health Insurers Practicing Medicine?

Editor’s note: In this guest post, Dr. Niran Al-Agba details how a health insurer interfered with her medical practice and asks the question – Are Health Insurers Practicing Medicine?
By Niran S. Al-Agba, MD (Mom, pediatrician, and Associate Editor at The Deductible)

It’s no secret that in today’s health care market, insurance companies are calling the shots.  

As a pediatrician in private practice for almost two decades, I’ve seen insurance companies transform into perhaps the single most powerful player in today’s health care landscape—final arbiters whose decisions about which procedures or medications to authorize effectively end up determining the course of patient care. Decisions made by insurers, such as MassHealth, have literally killed patients.  But it was only when I got caught in the crosshairs of an insurance company auditor with a bone to pick that I fully appreciated their power to also destroy physicians’ careers.

My own nightmare began around two years ago, when my late father, also a physician with whom I was in practice, and I opened our Silverdale clinic on a Saturday. It was the start of flu season, and we’d just received 100 doses of that year’s flu shot. Anxiety about the flu was running high following the death of a local girl from a particular virulent strain of the virus a year before, and parents were eager to get their kids immunized as soon as possible.

Under Washington law, adults don’t even need to see their doctors to get flu shots. They can get them at Walgreens, directly from pharmacists. But because children under nine are more susceptible to rare but life-threatening allergic reactions, they must be immunized by a physician. This meant that, for convenience sake, parents often scheduled their kids’ annual checkup on flu shot day, thus allowing them to condense much of their routine care into a single visit.

That particular Saturday went off without a hitch, with my father and I seeing and immunizing around 60 patients between the two of us over a 12-hour day.

Three months later, a representative from Regence insurance company requested to see some of the patient charts from that flu clinic as part of an audit. Aimed at rooting out insurance fraud by cross checking doctors’ records, these audits have become a routine fixture in medical practices today. To incentivize their auditors to ferret out the greatest possible number of irregularities, and thus boost the corporate bottom line, auditors work on commission, being paid a percentage of the funds they recover.

The Regence auditor in charge of my case, Anke Menzer-Wallace, failed to turn up any irregularities in our documentation. But, still, Ms. Menzer-Wallace issued a stern admonition to my father and me, ordering us not to open our clinic on Saturdays to administer flu shots.

This struck me as an outrageous restriction, considering our clinic is a private entity where we set our own hours and schedule accordingly, and so I called Ms. Mezner-Wallace. But instead of backing down, she ratcheted up her rhetoric, saying she was also forbidding me from examining my patients before immunizing them—clearly, a bid to save her employer even more money. I was shocked. Ms. Mezner-Wallace’s directive amounted to practicing medicine without a medical license—which is of course illegal in the state of Washington and many other states across the nation.

I shot back that immunizing infants and small children is a serious undertaking, requiring proper caution and care, informed her there was no way I would be complying with her mandate. Following this brief exchange, Ms. Menzer-Wallace took it upon herself to report me to the Medical Quality Assurance Board–the government-backed body charged with shielding the public from unqualified or unfit doctors. The accusation levied against me? Not following an insurance company mandate—which, in her opinion, amounted to unprofessional conduct.

It didn’t matter that the charges against me were ludicrous. The potential consequences were only too real, and potentially catastrophic. Had the State Medical Board decided against me, I could have lost my license. I hired a lawyer, sinking more than $8,000 into legal fees. I was cleared last month by a unanimous committee vote. But other physicians facing similar situations may not be as lucky.

The 18 months of excruciating stress that followed my altercation with Ms. Menzer-Wallace made it patently clear that insurance companies wield far too much power. Bureaucrats are making life-and-death medical decisions without a single minute of medical training, and their auditors are terrorizing physicians, by coercing state medical boards to act as their henchman. Unfettered by any consequences for enforcing policies that fly in the face of rules protecting patient safety, insurance companies will continue to harm doctors and patients alike if no one can stop them.

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Patient Safety

We Must Get Better at Detecting Patient Deterioration ECRI’s 2019 Top 10 Patient Safety Concerns

Editor’s Note: This editorial from the desk of PPAHS’s Executive Director urges clinicians to do better at detecting patient deterioration. Patient monitoring is a combination of the use of technology in the hands of clinicians adequately trained on its use.

By Michael Wong, JD (Founder and Executive Director, Physician-Patient Alliance for Health & Safety)

ECRI Institute recently released its “2019 Top 10 Patient Safety Concerns.” In releasing its top 10 patient safety concerns, ECRI said:

This annual top 10 list helps organizations identify looming patient safety challenges and offers suggestions and resources for addressing them.

One of these 10 patient safety concerns in ECRI’s list is – Detecting Changes in a Patient’s Condition.

Why is this important?

Like a canary in a coal mine to detect carbon monoxide and other toxic gases, which alerted miners of potential dangers, being alerted to a change in a patient’s conditions provides the opportunity for clinicians to intervene.

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Sepsis

Sepsis Protocols Need Improving to Prevent Complications of Care

Editor’s Note: This editorial from the desk of PPAHS’s Executive Director encourages sepsis protocols to be revising to prevent complications of care.

By Michael Wong, JD (Founder and Executive Director, Physician-Patient Alliance for Health & Safety)

Patients go into hospital expecting to get “fixed” – to have whatever ails them to be treated. This is what we go to doctors for. In fact, this is what we go to any expert for – we go to lawyers to handle our legal problems, accountants to handle our accounting problems, doctors to handle our health problems.

Therefore, to go into hospital and contract another ailment – one unrelated to what we went in for – is concerning. For the patient, it means having to deal with this second ailment, including the related extra time, expense, and pain and suffering that that entails. For the physician, it means that something has been done or not done that has resulted in the patient getting ailment number two.

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Physician-Patient Relationship

Where Do You Get Your Medical Information? Clinicians Should Ensure Their Patients Have Access to Accurate Information

Editor’s note: In this article, Michael Wong, JD (Founder/Executive Director, Physician-Patient Alliance for Health & Safety) reminds clinicians that if they are not educating their patients, likely the internet is.

By Michael Wong, JD (Founder/Executive Director, Physician-Patient Alliance for Health & Safety)

Where Do You Get Your Medical Information?

Like most people, I simply open an internet browser and type the disease state, symptom, treatment … and I receive information … and lots of it!

According to a survey conducted by Rock Health, my using the internet to search for medical information mirrors that of the majority of people in the United States.

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Patient Safety

Memories of Gina Pugliese – A Relentless Advocate for Patient Safety A Personal Reflection on Why We Must Do More to Improve Patient Safety

Editor’s Note: In this article, Michael Wong, JD (Founder/Executive Director, Physician-Patient Alliance for Health & Safety) remembers Gina Pugliese and remembers how she pushed him to do more for patient safety.

By Michael Wong, JD (Founder/Executive Director, Physician-Patient Alliance for Health & Safety)

It is with great sadness that I learned that Gina Pugliese passed away on March 4, 2019, after a long battle with cancer.

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Respiratory Compromise, Sepsis

Should We Be Watching a Stopwatch or Wanting Better Patient Care? – The Debate over the 1-Hour Sepsis Bundle

Editor’s Note: This editorial from the desk of PPAHS’s Executive Director asks whether the debate over the 1-hour sepsis bundle should focus on improving care and not on making sure certain procedures are done within a 60-minute timeframe.

By Michael Wong, JD (Founder and Executive Director, Physician-Patient Alliance for Health & Safety)

The recent kerfuffle over the 1-Hour Sepsis Bundle has missed the point about the need for better patient care and a much needed effort to save patient lives.

In 2002, the European Society of Intensive Care Medicine, the Society of Critical Care Medicine, and the International Sepsis Forum came together and formed the Surviving Sepsis Campaign aiming to reduce sepsis-related mortality by 25% within 5 years. The goals of the Surviving Sepsis Campaign were to improve the management of sepsis through a 7-point agenda including:

  • Building awareness of sepsis
  • Improving diagnosis
  • Increasing the use of appropriate treatment
  • Educating healthcare professionals
  • Improving post-ICU care
  • Developing guidelines of care
  • Implementing a performance improvement program

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