Tuesday, January 23, 2018

Prevention and Management of Medical Errors

Is it truly the 3rd leading cause of death in America?

According to the CDC, in 2015, 633,842 people died of heart disease, 595,930 died of cancer, and 155,041 died of chronic respiratory disease—the top three causes of death in the U.S.  However, according to Dr. Martin Makary, MD, M.P.H a professor at John Hopkins and a recent study he conducted may prove the CDC wrong putting medical errors as the cause of death behind cancer but ahead of respiratory disease.
Dr. Martin goes on to state that;   “Incidence rates for deaths directly attributable to medical care gone awry haven’t been recognized in any standardized method for collecting national statistics,” says Martin Makary, M.D., M.P.H., professor of surgery at the Johns Hopkins University School of Medicine and an authority on health reform. “The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used.”

Dr. Martin is not suggesting that these medical errors are due to "bad doctors" or nurses but maybe systematic errors or errors in the method of data collection. 

 "Medical error has been defined as an unintended act (either of omission or commission) or one that does not achieve its intended outcome,3 the failure of a planned action to be completed as intended (an error of execution), the use of a wrong plan to achieve an aim (an error of planning),4 or a deviation from the process of care that may or may not cause harm to the patient.5 Patient harm from medical error can occur at the individual or system level"

Pamela Clark as Certified Registered Nurse Infusionist (CRNI) with over 28 years experience has created an online CE course to help nurses understand the risks of giving medications and what steps to take to prevent medication errors from a nursing standpoint.

Upon completion of her online course the nurse will learn:

  • Define medical error, adverse event, “never event” and sentinel event.
  • Discuss the scope of medical errors in the United States in terms of monetary cost and lives affected.
  • Explain at least two system analysis models.
  • Discuss national/state mandatory error reporting requirements.
  • List at least 5 types of medical errors and their causes.
  • Describe SBAR.
  • Recognize appropriate and inappropriate documentation.

Pamela Clarks experience spans multiple infusion settings including: acute care, long-term care, home infusion, and ambulatory infusion care. She also has experience in oncology and oncology research.

To learn more about "Prevention and Management of Medical Errors" click on any of the links and it will take you directly to her course.  Pamela's course will not only provide you with excellent nursing information but continuing education hours as well.

Friday, January 12, 2018

Social Media Rules for Nurses

Well it is safe to say that society and nurses have come along way since the 1800's where smoke signals were a form of communication.   Then in 1844 the telegram was invented; and soon after came the telephone in 1876.

In 1978 the first email spam was sent to 393 users by Gary Thuerk. However, with the launch of Facebook in 2004 not to mention Twitter, Pinterest, Instagram, etc, etc.  Nurses and other healthcare professionals have been in trouble for social media use at work and away from work.

The Risk

According to the Nurses Service Organization (NSO); social media is a "Real Risk" for nurses and healthcare professionals.  NSO presents real stories in which healthcare professionals are getting fired, or worse losing their licenses to work due to social media use/abuse.  

One story they present is about a physical therapy (PT) licensing board receiving complaints about a PT using his/her cell phone to send emails, texts, and used social media applications during the patients treatment sessions.

The actual complaint caused the board to issue a subpoena of the PT's telecommunication provider for the PT's cell phone use and activity.  This gave the PT board the information needed to confirm that the PT had in fact been using his/her cell phone during the entire Physical therapy session.   Due to this subpoena they also discovered fraudulent billing, and due to this investigation the PT was place on probation for 3 years and is now required to work supervised and have all treatments completed signed off.  

How to help Your Staff

It is probably safe to say that most of us are used to having our cells phone on us at all times and use it throughout the day without even realizing it.   If you as a company or leader want to help your staff; provided them with real life situations and cases on a regular basis.  Teach them how to avoid getting reprimanded or even fired; and in the worst case scenario losing their professional licenses.  Healthcare Professionals are governed not only by HIPPA and HITECH, but by local and state laws as well.  

Establish a Social Media Policy

A social media policy can go a long way to not only protect patients and the facility; but it will provide a guideline and set a tone in the workplace for when, where, and how to use social media. Diane Evans is Publisher of MyHIPAAGuide.com has developed an awesome continuing education course that will help healthcare professionals learn how to navigate the social media scene while working at the hospital, home care, or wherever you profession takes you.

Diane Evans is Publisher of MyHIPAAGuide.com, a news and information service that helps HIPAA-covered organizations understand their responsibilities.

MyHIPAAGuide.com offers resources for self-conducted Security Risk Assessment, templates for security policies and "Meaningful Consent" Patient Privacy Notices, and much more in an online catalog of 40+ carefully-picked federally produced resources.

Provide Education

As a leader you may feel that your healthcare professionals should already know the rules and regulations; but that is not a fair assumption.  There are so many laws and regulations to follow and they change often.  Providing education serves two purposes.  It educated the staff on what is new and relevant and it protects you as an employer.  Content of education should include:

  • Rules and Etiquette of using Social Media
  • Potential Legal Issues
  • HIPPA and Patient Confidentially
  • Disciplinary Actions for misuse of social media
  • Setting Boundaries for Social Media use

Discipline Consistently

If a leader and organization does not use consistency across the board it will lead to a culture failure and higher turnover rates.  Of course, it is human nature to like some and not others.  However, in business and the professional setting consistent discipline across the board will help alleviate any legal issues and help retain the highest functioning professionals in your area of expertise.

Social Media Expectations

Social media can benefit us all; including the workplace.  However, as a leader and company we must set the expectations before the employee begins working so there are no miscommunication errors or lost expectations.  Learn now how to navigate the social media rules for healthcare professionals and save yourself time and hassle of getting fired or worse going in front the board.  

Thursday, December 28, 2017

Legal Issues with Code Blue

Did You Document?

This is one of the biggest issues we face in nursing. 

I truly feel nurses are awesome at what we do when it comes to actual hands-on.  However, when it comes to documentation; We Suck!  
Every nurse I know and have worked with; I would say that less than half; has ever wondered about the legal ramifications of an in-hospital cardiac arrest (code blue). Code blue events happen fast, and documenting the entire event correctly may be a difficult and daunting task.

Unfortunately,  in today's nursing environment; especially with the arrival of the EHR(electronic health record) nurses are becoming more vulnerable to legal actions.

If you don't document it wasn't done.  

Yeah Yeah!!  I know you have heard that a million times; but do you really listen? Nurses are being named defendants in malpractice lawsuits, according to the Nurses Service Organization(NSO).  "Of the 549 nurse closed claims, 88.5 percent involve RNs and 11.5 percent involve LPNs/LVNs." (NSO. 2015) If you work in the Emgerncy Room where a lot of code blues happen; those RN's see about 10.7% of claims against nurses.  

Professional liability insurance safeguards you against allegations of malpractice. While your employer may provide coverage for you, it may not be enough to cover you in all cases. Your employer's policy is designed to preserve the employers' needs and interests first.

When a code blue does have a negative outcome, the patient’s family may turn to the documentation for proof that the highest quality care was provided, or if errors were committed in order to seek justice.
An accurate documentation of timing is crucial. It’s important to know when each dosage is administered, and when the next should occur. Usually, the recorder keeps time as well as performs a majority of the legal documentation on the code sheet. 

"Over 30% of Code Blue paper charts are lost before they can be transcribed into an EMR. Of the paper charts not lost, 63% still contain substantive errors or are missing critical data." (Grigg, et al. 2014)  Any event in which a medical record containing sensitive patient information disappears constitutes a HIPAA violation.  The documentation needs to be placed in the EHR as quickly as possible, or your facility may not be providing adequate patient care.
Also, without a signature; any medication administered during the code blue event was given without a doctors order; this is why the code blue sheet has a spot for the medical doctor to sign. This in itself can constitute its own legal issue.  The signature also provides anyone who views the document with proof that the event was overseen by a trained healthcare professional. 

What to Do?

In order to improve ourselves in code blues overall; here are some tips to remember:

  1. Improve code blue documentation
  2. Improve your own personal documentation
  3. Be familiar with your hospitals own code blue sheet
  4. Learn to use your crash cart before a code happens
  5. Take an Advanced Cardiac Life Support (ACLS) certification class
  6. Hold Debriefings after the code blue
  7. Initiate and Maintain a Code Blue Committee
  8. Create Code Blue Teams and Roles
Code Blue can be scary and chaotic; however, this is the profession we chose to be in and if we want to make our profession stand out above and beyond the rest.  We must hold ourselves to a higher standard and decrease our documentation errors.

To learn more on how to protect yourself against law-suits and improve your patient safety.  Download the NSO Claim Report Here.

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Monday, October 9, 2017

American Heart Association's E-Cards

IT's COMING!! January 2018

The AHA's eCards will be mandatory starting January 2018.
If you are not ready; then get ready.  

Visit http://heart.org/cpr/mycards

-- Electronic course completion cards

Beginning January 1, 2018, all US-based AHA Training Centers will be required to use AHA's ecards for the issuance of course completion cards to providers and students who successfully complete the requirements of AHA courses.
  • eCards reduce the risk of counterfeits, improve the efficiency of card management, ensure the identity of the issuing TC and Instructor, and allow students to store proof of their course completion electronically.
  • This will be a significant change for students & providers
  • The American Heart Association eCards offer a simple, secure, and efficient way to provide students with their credentials after they complete a course.

eCard features and benefits:

  • Electronic course completion cards are viewable online, and offer a valid alternative to printed course completion cards
  • Can be presented to employers as proof of successful completion of an American Heart Association course, and employers can verify the eCard online
  • Valid for 2 years
Once students have been assigned an eCard, they will receive an e-mail notification with a link to claim their eCard online. From there, students will need to review their student profile page to update and confirm their contact information, set up a security question, agree to American Heart Association's standard Terms of Use, and complete a brief survey. They will then be able to view their eCard.

As a student, you must create an account at www.heart.org/cpr/mycards
Once you do, this will be where all your certifications will be kept for you to share and download.

What Do I Do if I did not receive my eCard? 

  • Check your email or spam folder for an email from: ahainstructornetwork@heart.org
  • Follow the directions to view your card.
  • If still cannot view, call us at (559) 765-0306.

Monday, April 18, 2016

Respiratory Therapist;more than just Breathing Treatments

Is a Respiratory Therapist (RT) more than just a breathing treatment provider?

So I have had experience in nursing for over 20 years and have specialized in Infusion Therapy for over 6 years.  Recently, I was teaching an IV class in which the facility was using a Respiratory Therapist to insert and maintain their PICC's.  I was a little taken aback by this discovery as I have never heard of such a thing.

Well I contacted the California Board for Respiratory Therapist and they responded back fairly quick and the following was their response;

"Good afternoon Mr. Stansbury.

The Respiratory Care Board of California (Board) often receives inquiries related to PICC and central line insertion.   In its responses the Board has stated that that licensed respiratory care practitioners are authorized to insert and care for PICC lines, so long as appropriate training, guidelines, and competencies are provided/documented by the licensed health care facility to ensure these services are conducted in a safe and competent manner when administered to the public.

With regard to central line placement, the respiratory care scope of practice was amended in 2004 to allow for the insertion of central lines, "in whole or in part, to provide ventilatory or oxygenating support."  Provided the insertion of a CVC is for the purpose, in whole or in part, to provide ventilatory or oxygenating support, it is within an RCP's scope of practice.  Having said that, the Board would caution any facility allowing an RCP to perform this function to tread cautiously.  The RCP should be well trained and skilled in this function.  Failure to perform the procedure correctly could easily be life threatening.  Further, because a common repercussion of this procedure is pneumothorax, it is especially important that qualified personnel are IMMEDIATELY available to address this situation, since treating a pneumothorax requires cutting the tissues and RCPs are clearly not authorized to do this.  The facility should ensure emergency procedures are in place as a matter of patient safety.

For your reference, below please  find links to the pertinent sections of law.  Please let me know if you require additional information.  Thank you for your inquiry.


I also checked around and Arizona is another state that allows RT's to insert PICC lines. RT's in California are not only authorized to start PICC's but peripheral IV's as well. Let me know your thoughts in regards to this discovery and how we have progressed and moved many practitioners along in their scope of practice.  Is the RT not an important part of a multidisciplinary team?
Email me at: kstansbury@morethancpr.com or respond to this blog on our Facebook page.