Vickie's Legal Nurse Consulting Blog

Statistically, high-strength painkillers are the most widely prescribed class of drugs in the U.S. This is a class of drugs that, just 15 short years ago, was mostly used for post-operative pain and pain associated with cancer. Today they’re widely used to treat just about every type of pain, with chilling consequences. Patients develop tolerance to the opioids, requiring increasingly higher dosages just to maintain the same level of pain control. Use of painkillers can turn into an addiction, with accompanying symptoms of withdrawal should a patient try and taper off.

One of the inherent dangers in opioids, as with any prescription drug, is that consumers believe that any “prescription” drug is inherently safe – whether it is or not. We saw this with Ambien^® and Xanax^®.

This is not news. The New York Times reports that hundreds of thousands of Americans are on potentially dangerous dosages of prescription painkillers, many without proper medical oversight. The Associated Press analyzed DEA records for an article and an accompanying map showing the increase, not just in sales, but in dosages on a state-by-state basis. It’s actually quite chilling – especially when you consider that 40% of American teenagers have tried illegal drugs and 16% are abusing drugs by the age of 18. In fact, more Americans are addicted to prescription drugs than to illegal drugs. Drug dealers could take lessons from pharmaceutical companies and physicians.

In 2007, Purdue Frederick Co. was fined $700 million dollars by the FDA Office of Criminal Investigations, who charged the company with conspiracy to promote, market and sell the drug OxyContin^® using illegal schemes. That fine doesn’t seem to have deterred the unnecessary over-prescribing of opioids.

It’s time for healthcare professionals to do something. We are failing the American public when the first solution to pain is to prescribe a high-strength painkiller. I’m not saying that painkillers do not have their place, but there are alternative ways to address pain, especially knowing how opioids are wrecking lives.

Certified Legal Nurse Consultants can help attorney-clients with cases involving accidents, deaths and other dangers related to over-prescription of opioids. I predict we will be seeing these issues litigated in the courts for many years to come. Just one more reason attorneys need Certified Legal Nurse Consultants.

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The days of unlimited data flowing to our smartphones and tablets is ending. If you’re a Certified Legal Nurse Consultant who has had your access speeds “throttled” by your cellular service provider for uploading or downloading too much information (music, movies, podcasts, legal nurse consulting research, photos, etc.) there are solutions.

First, all modern smartphones have the ability to switch to “airplane mode,” which actually turns off access to the cellular service network. Once you’ve switched to airplane mode the newer phones allow you to turn on wireless access. With more and more CLNC^® consultants having wireless networks in their home, workplace or favorite free Wi-Fi locations they can simply use that network to download/upload your data. Just remember to switch your phone back into “phone” mode by turning airplane mode off when you’re done.

These simple steps can save the savvy Certified Legal Nurse Consultant from paying overage charges. With many hotels, airports, coffee shops and businesses offering free (or low-cost) wireless, if you’re a globe-trotting CLNC^® amigo you can take your smartphone or tablet with you (in airplane mode) and stay in touch with your attorney-clients, keep up with email, download books, music, movies and even update your Facebook status, etc. without incurring overseas data access costs (if you’re careful).

Keep on Techin’,

Tom

The electronic medical record (EMR) is becoming omnipresent in the healthcare system. But EMR tampering issues in medical-related cases are a brand new frontier. It’s rare for Certified Legal Nurse Consultants and attorneys to peek behind the EMR curtain, but in the case of Samuel Sweet versus UPMC University Hospital we get to do just that. I first ran across this case last year, when the judge ordered the trial delayed after a local newspaper article about the case and the alleged tampering was published just before jury selection.

What makes the case notable was the plaintiff attorney’s identification of possible tampering with the EMR. The plaintiff alleged that a physician altered the EMR to place a “Difficult Airway” display tag on the patient’s record three days after the patient died. Post-incident documentation like this is what I refer to as a CYA (“Cover Your Actions”) entry. The plaintiff attorney filed a motion to amend the complaint requesting punitive damages related to the alteration of the EMR claiming a cover-up. The hospital responded that the alteration was part of the QA process. The judge sided with the hospital and refused the amendment.

While this issue will not have its day in court, legal nurse consultants have the opportunity to fully explore one of the first EMR tampering allegations in a case, as well as study a court record in a medical malpractice case. You can read the pleadings, discovery and motions by following this link (enter GD-09-019407 in the case number field) and make a decision for yourself about the case and alleged tampering. I already know what I think.

This case is a must read for any CLNC^® consultant interested in EMR tampering issues.

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Consumer Reports disclosed in its May 2012 issue that many commonly used medical devices, including artificial hips, defibrillators, lap bands and surgical mesh don’t go through a rigorous testing process before being released for use to the public. Other medical devices may be “grandfathered” into approval based on prior trials conducted on “similar” devices that may or may not be similar. This results not only in recalls, but in countless injured individuals.

Information on defective devices can be elusive as the FDA itself relies solely upon voluntary, not mandatory, reporting of device failures from nearly 300 hospitals. The FDA’s “adverse-event” database about devices, deaths and serious injuries is also incomplete as many hospitals don’t consistently report those events.

Certified Legal Nurse Consultants working on cases involving allegedly defective medical devices should search the FDA website for safety warnings and recalls related to a particular medical device. A simple Internet search regarding a particular medical device can also reveal a wealth of knowledge about it.

As more and more medical devices enter the marketplace untested, litigation involving them will be a growth area for your legal nurse consulting business. If you want to get involved, be sure to search the specific device of interest and you will automatically find some of the attorneys handling these cases. Go ahead – get started today.

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Google is by far the most popular search engine for everyone including Certified Legal Nurse Consultants. Everyone that is, except true Internet professionals. The more time you spend searching the Internet, the more quickly you’ll learn that you shouldn’t rely solely upon Google.

Search results can vary according to the day you search; some results available today may not be tomorrow. Search results also vary by search engine. Bing and Yahoo! offer great alternatives for searching if you’re not satisfied with your results from Google. Additionally there are meta-search engines like Dogpile that search other search engines (way cool!) further enhancing your chances of finding the information you need. Finally, for my most daring CLNC^® amigos, there’s the experimental, computational knowledge engine WolframAlpha^®. All of these will show you what you’re missing by searching on Google only.

Smart CLNC^® consultants know that whichever search engine they choose – they don’t use it exclusively. It’s a Wild World Wide Web out there so use all the resources at your disposal to search it.

Keep on Techin’,

Tom

April 15th is just around the corner and for many nurses tax season serves as a rude awakening. This time every year we’re forced to run the numbers and take a long, hard look at our true financial picture. Unfortunately for many of us, the end result is always the same: we pony up to Uncle Sam and then push everything our tax forms revealed to us to the back of our minds… until next year. Maybe it’s time to ask these four questions instead:

Do you have the W-2 Blues?

Your W-2 can be a painful reminder that once again your income hasn’t measured up to your dreams. I’ve been there. My W-2 was a painful reminder that I was in a dead-end job and was going to have to work overtime at the hospital for the rest of my life just to pay my mortgage. If you feel stuck, you don’t have to be. My W-2 motivated me to step out and start my own legal nurse consulting business in 1982. Buck-up and take responsibility for changing your W-2. That’s the first step. I promise you’re more in control of your W-2 than you realize.

Where did your money go?

Tax season is a great reminder that unless you’re the government, you have to stop spending more than you earn. I encourage stretching way out to achieve a goal, but I never encourage living beyond your income. Living beneath my income is what helped me to be able to step out and start my legal nurse consulting business. It has also helped me to grow the business and survive the recession.

If you’re not quite ready to give up your Starbucks addiction, maybe you can pack your lunch or do without that new pair of jeans (or that cool purse). Living beneath your income cuts your stress levels dramatically and frees you to move toward your dreams as you gain more control over your finances.

Have you been underpricing yourself?

Here’s the tough part. You can love your job and the people you work with. You can even love your boss (I know I do – but wait, that’s me!). But if your W-2 says you’re getting the short end of the stick, do something about it! Don’t just accept what’s handed to you. When I got my masters degree, I didn’t get a nickel raise. So I went to work for a hospital that recognized the value of what I had accomplished. But more importantly, that situation sparked my drive to be more in control my earnings and helped to accelerate my plan to start my own business.

Do you deserve a refund?

We all love a tax refund. It’s like getting an unexpected bonus – even if it is your own money. But if you’re not getting one this year, there are many ways to refund yourself all year long. Wake up 30 minutes early just for you, not your spouse, not your kids, not your computer. Take plenty of walks. They are free and clear the mental clutter. Read a book to improve your mind.

Don’t tell me you don’t have time to take care of yourself. Disconnect from those time-sucking distractions that follow you everywhere like Facebook, Twitter, texting and Angry Birds. Make yourself the priority – not everybody else. A woman I mentored told me she waited 50 years to start taking care of herself. If you’re like her, it’s never too late to make a change. Refunding myself every day, both mentally and physically, is a big reason I love my legal nurse consulting business as much today as I did 30 years ago.

If you just can’t stand the thought of another year or more of the same – living paycheck to paycheck, stuck in a job you don’t like, stressed to the max – let this tax season be the impetus for bucking up and making the changes in your life that will bring you closer to your dreams. You can shake the W-2 blues. Get up and get started today.

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I’m deep into the Spring/Summer CLNC^® Certification Seminar season and working with students in person is always one of my favorite things to do as owner of Vickie Milazzo Institute. It’s so much fun to observe how students come in excited but nervous, especially about the CLNC^® Examination, then walk out on Day 6 proud of their accomplishments.

The CLNC^® Certification Program is intense, especially for the students who attend live. We cover an extraordinary amount of content, but successful CLNC^® consultants know the time they spend with me is just the beginning. You must commit to being a success student for life. That’s one of the primary reasons the Institute provides mentoring to all Certified Legal Nurse Consultants and offers a variety of advanced-practice building products.

It’s also why we at the Institute work tirelessly to bring you the NACLNC^® Conferences. I hope to see you March 2-9, 2013. In my New Orleans style I’m turning education into a 7-Day Weekend on the “Oasis of the Seas.” Who said education has to be boring?

Success Is Inside (and at Sea)!

P.S. Click here to learn more about the 2013 NACLNC^® Conference Cruise.

The Internet can be a tricky place and not all websites are designed equally. With the coming of HTML5 it will only become, shall we say, more challenging. Even in today’s simple world, not every website displays the same in every web browser and not every feature of every website will display; Flash^®, video, animations, etc. may work in one browser and not work in another.

Internet Explorer^® is the most widely used browser in the good ole USofA but it’s not perfect. No browser is. I don’t care if you’re on IE6, 7, 8 or 9 – some websites just won’t work. You can bring your Flash player, plug-ins and add-ons fully up-to-date and guess what? Some websites still just won’t work.

So what’s a Certified Legal Nurse Consultant to do when her prized podcast, video or PDF file won’t open? Keep multiple web browsers installed on your computer! On my PC I’ve installed Apple Safari^®, Google^® Chrome^®, Firefox^® and Microsoft IE8 browsers. When I run into trouble on a website in one, I can open up an alternate browser and view the site and its videos, graphics, etc. the way the designer intended.

So, my CLNC^® amigos – pick one or more of the following and install them today.

Apple Safari Download

Google Chrome Download

Firefox Download

Internet Explorer 8 or 9 (Windows 7 only)

Opera Download

I love Firefox but for security and safety recommend Chrome – it’s the safest, as each open tab runs in a “sandbox” for security and it seems to be the most versatile. I haven’t tried Opera yet but have heard great things. I leave it up to you to decide which one works best for you and your legal nurse consulting business. Also remember to install the updates when prompted by the browser to ensure you’re always running the latest and greatest.

Keep on techin’,

Tom

Certified Legal Nurse Consultants don’t just work with attorneys. They also apply their CLNC^® experience to corporations. Catherine Glenz, RN, BSN, CHISP, CLNC shares how her employer, Microsoft^®, recognizes the value of her CLNC^® Certification in her role as a subject matter specialist and nurse executive. Watch and listen to the variety of ways Cathy puts her CLNC^® Certification to work at Microsoft.

Congratulations, Cathy and thanks for sharing yet another way Certified Legal Nurse Consultants are making a difference in a variety of industries.

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“The impossible: what nobody can do until somebody does it.” Anonymous

Success Is Inside!