The government recently announced that it would fund a billion-dollar government-run drug development center to help create new drugs. The National Center for Advancing Translational Sciences will be tasked with creating new drugs and, according to the Director of the NIH, “any project that reaches the point of commercial appeal would be moved out of the academic support line and into the private sector.”

I already have strong feelings about the government’s involvement in the private sector and business. I have even stronger feelings about the government spending enormous amounts of taxpayer money to get into the pharmaceutical business.

We also need to ask who will be responsible and liable for the defective or dangerous drugs that will reach the market. Who will pay for the lives damaged by the unforeseen side-effects of these government-created drugs? The federal government will certainly cloak themselves with immunity. The private sector distributors or marketers will certainly negotiate their own liability to a minimum. Does this mean that all government drugs will carry a disclaimer of liability? Has anyone asked, much less answered, these questions?

I asked my nursing and Certified Legal Nurse Consultants friends on Facebook what they thought of the announcement. Here are some of their responses:

“I work in government – it seems to me if the concern is the slow pace, putting it in the hands of bureaucrats will not help.”

“The Government has absolutely no business in the private sector. Big problem currently. I would encourage everyone to go back and read the documents of our Founding Fathers and then ask yourselves these two questions. How in the world did Americans survive and thrive for the first 150 years or so? Why are Americans becoming more unhealthy and dying at younger ages? I don’t believe the increasing health issues are related to a lack of drugs that’s for sure.”

“This stinks. How many more chemicals are we going to throw into people’s bodies? How many more heart attacks, strokes, paralysis, etc are we going to cause by using invented medicines? Maybe doing research on alternative supplements would be the better suggestion. There may be more money in prevention…wow prevention.”

“If God meant us to eat from a carton or heal ourselves from a bottle, he would have hung those items on the trees or stacked them on the forest/ocean floors for us to find!”

“My first thought is that soon we will ALL be working for the government regardless of what field we are in! From my understanding, the FDA takes a long time to approve the use of any new drugs, much longer than many other countries. I wonder if this process will speed up when the government is making the new drugs?”

“I look at it this way! Where is the government when it comes to regulating cost of insurance? Well we’ve all seen what that has cost the nursing field… more patient to nursing ratio without regards to what it cost as far as quality nursing care. I feel that it will be a great injustice to the welfare of future nurse patient care. Lord Please help us all if this comes to pass.”

“No! Government is too involved in health care as it is.”

“Government has all it can handle dealing with government. They don’t need to be involved in developing drugs, banking or any other business.”

“This can best be done in the private sector. If the government would have stayed out of healthcare to start, new drug research would continue apace. Show me anything the government has done in a cost-effective efficient manner! It doesn’t happen. And where is the constitutional authority for federal government drug development?”

“I think the government has more than enough on their plate as it is without trying to branch out into places it knows just about nothing about!”

“If the government delves into research and development, who will provide oversight?”

“Although I don’t believe that the government needs to “control” our health care, I do believe that in this day and age and in this great country everyone deserves access to quality health care! The drug and insurance companies are running-or should I say ruining our country.”

“Fiscally, there is always the catch that government is spending someone else’s money for someone else’s benefit – Never a fiscally sound arrangement!”

“We have become so dependent on pharmaceuticals in this country! We want tiny little pills to fix everything – including poor decision making! Now please excuse me while I go pour another cup of coffee and snack on some potato chips!”

“The federal government should keep their hands off of drug research. The federal government shouldn’t waste their energies but rather concentrate on economic problems pertaining to healthcare like the jobless RN professionals who settle for a meager income. Think of a decent program for the new RN grads.”

“I am an RN who has thirty years of pharmaceutical clinical research experience and this is the scariest thing that I have heard yet. People may balk about the 10 years and one billion dollars in research money that it takes to develop a drug but this is how we ensure that patients are safe and our drugs are safe. Hasn’t the government gotten in the way of enough? Who makes them experts on research? Where are the statisticians, chemists, preclinical people and clinical people to develop these compounds? Scary as all heck.”

As you can see, not a single nurse thinks this is a good decision. Here’s another interesting question: Why are nurses left out of these important decisions?

Success Is Inside!

As a Certified Legal Nurse Consultant, I focus on helping hospitals reduce Medicare denials and win more Medicare Part A appeals. My photo and short bio on my websites generate four to five calls from hospital attorneys each month.

Hospitals want to be paid and I’ve learned that the first level of preventing Medicare denials is the assessment of the patient and the physician’s documentation of medical necessity. It’s usually the lack of this information that triggers a Medicare denial of payment.

The first rule to get the physicians to buy into what you are trying to teach them is to feed them. So, I contact the hospital administrators in question and explain that I have a plan that will help them reduce Medicare denials and change their doctors’ bad documentation habits. If lunch is not within the facility’s budget, then I work with ancillary vendors who might want to participate and provide lunch.

I use exhibit posters and flip charts to present during lunch (provided by the hospital). I also use a dry-marker board and include actual excerpts from Medicare’s denial documents. The exhibits show what was missing and how to correct it. My program includes hand-outs with the information from the posters, dry board and flip charts.

This educational approach usually works and I receive calls from physicians with questions for some time after each event. The marketing benefit is that people from different hospitals talk to one another, which often generates calls from other facilities wanting presentations and I get more clients.

My marketing strategies include:

• Bulletin board teasers with movie ad-like messages: “For Doctors: Coming soon to your hospital…” posted a couple weeks before the presentation.
• Hand-outs placed in facility mail boxes at least two weeks ahead of time.
• Posters on stands just inside the entrance to the presentation room at least 30 minutes before start time.
• Enlargements focused only on the most important pieces of Medicare rules on the subject that affects physicians.

One of the most rewarding experiences occurred while I was auditing a telephone conference regarding Medicare appeals with corporate attorneys for two of my hospital-clients. One hospital administrator on the call wondered why two facilities seemed to be doing much better than the others in overturning denials. The attorney explained, “That’s because they have a Camy,” as though I were a product brand name.

Another time a different hospital-client armed with the education and hand-outs I provided, was able to make enough immediate and lasting changes that they, effectively, stopped their denials cold. Most hospitals make changes slowly and with a lot of kicking and screaming. This hospital’s collective, firm resolve made the changes using the education they paid me to give them – and won big!

Medicare is my specialty and marketing, as I learned from Vickie Milazzo, is what sells my CLNC^® services.

Guest Blogger Profile

Camy Joyner, RN, BSN, CCM, CLNC, CEO and co-owner of C. Joyner and Associates, LLC. Consults/manages Medicare Part A appeals for acute general rehabilitation hospitals. Consults for records review/audit for physician medical pertinence. Also consults in non-Medicare negligence cases.

I asked the CLNC^® Pros to share the websites they use most often for researching their medical-related cases. I invite you to bookmark your favorites.

Agency for Healthcare Research and Quality
Offers links to clinical information and current clinical research.

American Academy of Family Physicians (AAFP)
Offers links to journals, policies, position statements, references and resources pertaining to family practice.

American Association of Critical-Care Nurses (AACN)
Provides clinical resources, standards, journals, education and certification information for the critical care nurse.

American College of Physicians (ACP) PIER^® (Physician Information and Education Resource)
Comprises over 490 modules focusing on clinical topics as well as an extensive drug database and helpful patient information. Free to ACP members.

American College of Radiology (ACR)
Outlines standard of care, quality and safety resources, clinical research and news and publications.

American Heart Association
Provides statements, guidelines, clinical updates, news, continuing education, publications and statistics.

American Medical Directors Association
Supplies links to AMDA’s publications and products, news releases and resource library. Specific sections address the interests of medical directors and physicians who practice in long term care.

American Nursing Association (ANA)
Contains the nursing scope of practice including administration.

American Society of PeriAnesthesia Nurses (ASPAN)
Contains standards, education, links and publications.

Association of periOperative Registered Nurses (AORN)
Contains education, standards of practice and peer networking for the OR nurse.

Centers for Disease Control and Prevention (CDC)
Promotes health, prevention of disease, injury and disability and preparedness for new health threats. Also provides intra-agency support and resource-sharing for cross-cutting issues and specific health threats.

CINAHL
Provides the Cumulative Index to Nursing and Allied Health Literature (CINAHL^®), the most comprehensive resource for nursing and allied health literature.

Code of Federal Regulations – Title 42 – Public Health
Presents Chapter IV – Centers for Medicare & Medicaid Services, Department of Health and Human Services.

Department of Health and Human Services Office of the Inspector General
Allows you to check on the exclusion status of a healthcare provider or facility. Contains the list of sanctions and definitions of exclusions for Medicare fraud and other sanctions.

Elder Abuse Information
Helps you recognize and fight against elder abuse. Discusses different forms of elder abuse, causes and symptoms and gives the legal rights of the elderly.

Elsevier
Contains access to a variety of science and health information, books and journals.

eMedicine
Contains peer-reviewed online medical textbooks. Physicians continually update and revise this site. The standard format for each disease or condition includes diagnosis and treatment, differential diagnoses, and a list of additional references.

Federation of State Medical Boards
Contains a databank of board actions and physician disciplinary actions. Includes links to state medical boards.

Food and Drug Administration (FDA)
Helps you investigate concerns about products in the FDA database.

Harrison’s Online
Features the complete contents of Harrison’s Principles of Internal Medicine, 17th Edition.

Health Medicine refdesk.com
Contains an alphabetical list of health and disease-related links useful as a starting point for finding medical literature and other sites.

The Health Pages
Allows you to search for a physician by name and state or by specialty practice. This site has more current contact information than other physician directory sites, particularly telephone numbers. Links to state medical boards offering physician discipline information and reports on physicians and facilities are planned for this site.

Healthcare Financing Administration
Links to Medicare, Medicaid, SCHIP and other federal search resources.

Hippocrates Magazine
Contains clinical updates in primary care and practice management with access to archives and search features.

Infusion Nurses Society (INS)
Sets the standard for infusion care.

Institute for Healthcare Improvement (IHI)
Provides access to improvement knowledge and trustworthy content focused on healthcare quality across a broad array of topics.

Institute for Safe Medicine Practices
Presents links to newsletters, educational programs, medication safety tools and resources, articles, guidelines, products lists and reports.

Johns Hopkins Division of Infectious Diseases Antibiotic Guide
Provides information about infectious diseases and antibiotics. The site requires registration (free).

The Joint Commission
Accredits and certifies more than 17,000 healthcare organizations and programs in the U.S.

The Journal of the American Medical Association (JAMA)
Offers the most widely circulated, peer-reviewed, general medical journal in the world.

Manufacturer and User Facility Device Experience Database (MAUDE)
Gives links to reports of product and device failure and other information.

Mayo Clinic
Provides online resources for diseases and medical conditions, drugs and supplements and tests and procedures.

MDLinx.com
Contains links to 40 medical specialty websites for the latest developments and access to top journals. Also offers an email subscription service to alert you to news in specialties you select.

MedBioWorld
Contains links to publishers of medical and nursing journals in all fields and a complete list of all available journals worldwide.

Medical Library Association (MLA)
Provides educational opportunities, supports a knowledgebase of health information research and works with a global network of partners to promote the importance of quality information for improved health to the healthcare community and the public.

Medical Matrix
Provides ranked, peer-reviewed and annotated clinical medicine online resources for a variety of journals, texts, diseases and medical conditions.

Medical News Today – Litigation/Medical Malpractice News
Includes news and articles published daily on lawsuits, legislation, compensation claims, pharmaceutical company disputes and more.

Medicare
The official U.S. government site for Medicare.

MediLexicon
Contains searches, information, news and resources for the medical, pharmaceutical and healthcare professional, including medical abbreviations, medical dictionary, medical news, ICD-9 search, drug search, medical equipment and surgical instruments and other searches.

MedlinePlus^®
Presents health information from the National Library of Medicine.

Medscape
Supplies medical news, full-text journal articles and resource centers.

MedTerms
Clarifies difficult medical language as defined by doctors in easy-to-understand explanations of over 16,000 medical terms.

Merck Manuals Online
Contains links to search the Merck Manual of Medical Information, Merck Manual of Geriatrics and Merck Manual of Diagnosis and Therapy.

Merck Medicus
Contains information specific to your specialty, including clinical tools, specialty textbooks, journals and professional societies.

Micromedex Healthcare Series
Contains information on drugs, diseases, acute care, toxicology and alternative medicine.

Mosby’s Nursing Consult
Offers a vast array of information relevant to nurses including 38 leading nursing textbooks, 38 leading full-text nursing journals, evidence-based nursing monographs, drug information and calculators, over 370 practice guidelines, 8,000 patient handouts, 8,000 images, “Best Practice” clinical updates, dictionary, MEDLINE, Mosby’s Index and nursing and medical news.

National Association for Home Care & Hospice
Represents the interests and concerns of home care agencies, hospices and home care aide organizations.

National Cancer Institute
Contains information on cancer topics, clinical trials, cancer statistics, research and news.

National Center on Elder Abuse (NCEA)
Helps national, state and local partners in the field be fully prepared to ensure that older Americans will live with dignity, integrity, independence and without abuse, neglect and exploitation.

National Council of State Boards of Nursing (NCBSN)
Offers links to most U.S. nurse practice acts, regulations and state boards of nursing.

National Guideline Clearinghouse
Serves as a public resource for evidence-based clinical practice guidelines.

National Hospice and Palliative Care Organization (NHPCO)
Promotes access to palliative care and to maintaining quality care for persons facing the end of life and their families.

National Patient Safety Goals (NPSGs)
Delivers outlines and chapters for all applicable programs published by the Joint Commission.

National Pressure Ulcer Advisory Panel (NPUAP)
Contains online resources for pressure ulcer staging and links to public policy, education and research of pressure ulcers.

The New England Journal of Medicine
Contains a variety of clinically relevant medical information, including clinical and research articles, analysis and opinion articles and materials for both learning and teaching.

Occupational Safety and Health Administration (OSHA)
Presents comprehensive information about OSHA regulations, services, safety programs and employee training manuals with news and an online library.

Oncologic Nurses Society (ONS)
Represents over 37,000 registered nurses and other healthcare providers dedicated to excellence in patient care, education, research and administration in oncology nursing.

Pam Pohly’s Net Guide – Medical Academies & Healthcare Professional Associations
Contains links to hundreds of healthcare societies, academies, professional organizations and associations.

PubMed
Comprises more than 19 million citations for biomedical articles from MEDLINE and life science journals. Citations may include links to full-text articles from PubMed Central or publisher web sites.

Spine Universe
Contains detailed information involving conditions, treatments and wellness surrounding the spine. Additional resources include links to clinical trials, glossary of terms, recommended textbooks about spinal anatomy, videos and animations.

STAT!Ref
Offers access to cross-searchable, full-text medical, nursing and pharmacology electronic textbooks from a wide variety of reputable authors, publishers and societies.

Surgical-Medical-New Terms Glossary
Offers the most complete list of medical products, devices and pharmaceuticals, with links to manufacturers’ websites and Food and Drug Administration information on each product.

UpToDate
Provides evidence-based, peer-reviewed-information resource for clinical knowledge and improved patient care. Available by subscription.

Wound Care Strategies
Contains products, education and news related to wound care.

Wound, Ostomy and Continence Nurses Society
Represents an international society of nurses who are experts in the care of patients with wound, ostomy or continence problems.

Wrong Diagnosis
Contains links to symptoms, diseases, diagnosis, videos, tools, misdiagnosis, doctors, hospitals, drugs and articles.

Thank you to Suzanne Arragg, RN, BSN, CDONA/LTC, CLNC; Laura M. Averette, RN, MSN, CPHRM, CLNC; Dale Barnes, RN, MSN, PhN, CLNC; Nikki J. Chuml, RNC, CCE, FMC, CLNC; Larry Frace, RN, CLNC; Margaret Gallagher, RN, BSN, MSN, CLNC; Dorene Goldstein, RNC, CLNC; Sandra Higelin, RN, MSN, CS, CWCN, CLNC; Jane Hurst, RN, CLNC; Camille Joyner, RN, CCM, CLNC and Mildred Mannion, RN, BSN, CNOR, CLNC for sharing the websites they use most to research their legal nurse consulting medical-related cases.

Success Is Inside!

Earlier this month, the Journal of the American College of Radiology (JACR) published an article based on advice from the Society of Breast Imaging (SBI) and American College of Radiology (ACR) which contradicted the U.S. Preventative Services Task Force (PSTF) and stated that annual mammograms should indeed begin at age 40 and even earlier if you’re at risk. Unlike the PSTF’s earlier recommendations, the SBI/ACR based its recommendations on several different trials and studies.

It’s good to see that medical professionals are recommending what women have known for years and what is just good, common sense – if you are 40+, go get yourself a mammogram and get one annually.

Success Is Inside!

P.S. Comment and share whether you agree or not.

Hammurabi was a ruler of ancient Babylon from about 1790-1750 BC. He’s most famous for writing down one of the first and most comprehensive listing of laws that existed during his reign. Hammurabi’s writings covered both civil and criminal law ranging from general to quite specific. His code isn’t a code in the legal sense that we’ve come to think of; the laws are not broken down by subject area and some refer to fees to be paid to specific occupations.

His code was published in every city that he ruled and believe it or not, was not the only set of laws in existence in that time period. Just about every king or ruler promulgated their own laws (but didn’t have the Commerce Clause of the U.S. Constitution to even out trade). The Code of Hammurabi wasn’t just his own proclamations, it also codified common laws that existed during that time.

Several copies of the Code of Hammurabi exist, but the most complete and most famous is in Paris, safely ensconced in the Louvre. That specific stele was discovered, in what is now Iran, in 1901 by Gustav Jequier. It didn’t originate there, it had been taken to Iran as plunder during the 12th century BC. Not only did we have collections of laws during that period but we also had early art collectors.

The Code of Hammurabi

Louvre Museum Paris

What makes the Code of Hammurabi interesting to me and hopefully to Certified Legal Nurse Consultants, is that Hammurabi caused some of the first personal injury, medical malpractice and wrongful death laws to be “written in stone,” so to speak. Laws, which if they were on the books today, might make some doctors and nurses think twice about the quality of their practice. Disciplinary procedures for healthcare providers were pretty tough in those days!

Here’s some of my favorite examples from L.W. King’s 1910 translation of the Code of Hammurabi:

Personal Injury:

• If a man put out the eye of another man, his eye shall be put out.
• If he break another man’s bone, his bone shall be broken.
• If he put out the eye of a freed man, or break the bone of a freed man, he shall pay one gold mina.
• If he put out the eye of a man’s slave, or break the bone of a man’s slave, he shall pay one-half of its value.
• If a man knock out the teeth of his equal, his teeth shall be knocked out.
• If a free-born man strike the body of another free-born man of equal rank, he shall pay one gold mina.
• If a freed man strike the body of another freed man, he shall pay ten shekels in money.
• If the slave of a freed man strike the body of a freed man, his ear shall be cut off.
• If he knock out the teeth of a freed man, he shall pay one-third of a gold mina.
• If during a quarrel one man strike another and wound him, then he shall swear, “I did not injure him wittingly,” and pay the physicians.

Wrongful Death:

• If the man dies of his wound, he shall swear similarly, and if he (the deceased) was a free-born man, he shall pay half a mina in money.
• If he was a freed man, he shall pay one-third of a mina.
• If a man strike a free-born woman so that she lose her unborn child, he shall pay ten shekels for her loss.

Medical Malpractice:

• If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off.

Hammurabi also created the first medical care reform system by regulating the pay doctors would receive for certain operations.

• If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money.
• If the patient be a freed man, he receives five shekels.
• If he be the slave of someone, his owner shall give the physician two shekels.
• If a physician heal the broken bone or diseased soft part of a man, the patient shall pay the physician five shekels in money.
• If he were a freed man he shall pay three shekels.
• If he were a slave his owner shall pay the physician two shekels.

Finally, Hammurabi also dealt with judicial or legal malpractice.

• If a judge try a case, reach a decision, and present his judgment in writing; if later error shall appear in his decision, and it be through his own fault, then he shall pay twelve times the fine set by him in the case, and he shall be publicly removed from the judge’s bench, and never again shall he sit there to render judgment.

It seems to me that Hammurabi in some respects was a man ahead of his time.

Success Is Inside!

Just about every doctor and nurse in hospitals own a Sharpie^® at one time or another. Some use them for marking patients and others to label their lunch. It turns out that two different studies on infection risk found that good old fashioned Sharpies out-perform surgical markers in protecting patients from the risk of infection.

The 2008 study was conducted in Canada at the University of Alberta followed in 2009 with a study on reducing surgical site infections (SSIs) at Duke University in the U.S.

So long as an alcohol-based Sharpie is capped (and the outside properly swabbed) between uses on patients, the risks of passing on four common resistant bacteria – Staphylococcus aureus (MRSA), E. coli, vancomycin-resistant Enterococcus faecalis (VRE) and Pseudomonas aeruginosa – are much lower with a Sharpie than with a surgical pen.

Changing from surgical markers is a great way to do some cost-cutting at your facility while keeping down the risk of wrong-site surgeries. Why not kill two birds with one stone and still have a pen to make your more subtle points?

Success Is Inside!

One thing every Certified Legal Nurse Consultant knows is that a simple apology by a healthcare provider often goes a long way in disarming anger in patients. But what if a doctor or representative of a healthcare facility were to apologize to a victim of medical malpractice? Do you think that might reduce the number of lawsuits and the associated costs of litigation? It actually does (and that saves us all money)!

“Sorry Works!,” a self-professed “advocacy organization for disclosure, apology (when appropriate) and upfront compensation (when necessary) after adverse medical events” has been successfully implementing laws in 34 states which allow doctors and/or facilities and their representatives to make apologies for medical errors. Those same laws make those apology statements inadmissible in court in order to encourage settlements. Admitting a mistake to keep someone from suing you seems a little odd, but experience and research proves it actually works.

Providers disclosing medical errors to patients and, at the same or a later time, offering a sincere apology, and often compensation, results in decreased numbers of lawsuits. The New York Times reported that as little as thirty percent of medical errors are disclosed to the patients (or their survivors). It is often the concealment of the error and an accompanying unrepentant attitude that feeds the injured party’s anger and results in the filing of lawsuits.

The “apology” program proved successful at the University of Michigan Health System – lawsuits were reduced 68% over the period tracked and at the University of Illinois – lawsuits were reduced almost 50%. Both facilities also experienced drops in legal-related expenses (including settlements). The National Quality Forum in 2009 published an updated practice statement of safe practices that included standards for disclosure of unanticipated outcomes. In a terrific review article, the New England Journal of Medicine has discussed the effectiveness of such disclosures and even the Joint Commission, as far back as 2001 (when they were still JCAHO) adopted the first standards for disclosure. Since then, similar standards and guidelines have been adopted by organizations and facilities across the country. (Here’s a bibliography of articles on disclosure from the Joint Commission.)

So why aren’t more facilities allowing doctors to apologize in order to deter litigation? Part of it is reticence. Would it surprise you to know that according to the Journal of the American Medical Association doctors are either unwilling or afraid to apologize? Insurance companies and facilities still prefer to “deny and defend.” Also defense law firms, whose livelihoods depend on continued and protracted litigation, have no incentive to quickly settle a potential lawsuit.

As a legal nurse consultant working with a case involving an injured plaintiff you will want to discover whether a defendant facility had a disclosure policy in place and whether or not that policy was followed. As a defense CLNC^® consultant you may wish to do the same. It may also be time to involve your facility in this type of program as a cost-savings measure.

Here’s an interesting thought, if these types of programs work so well in medical-related cases, what other types of cases might be able to use an apology system? Perhaps you might see this in toxic torts (chemical spills) or products liability (medical-device) cases? How about simple personal injury cases? The possibilities are endless.

Success Is Inside!

P.S. Comment and share your opinion on “Sorry Works.”

Making a list,

Checking it twice,

Don’t want to kill a patient,

That wouldn’t be nice…

According to Dr. Atul Gawande, the average patient in an ICU requires “a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them poses risks. Substantial parts of what hospitals do – most notably, intensive care – are now too complex for clinicians to carry them out reliably from memory alone. ICU life support has become too much medicine for one person to fly. Any of us who’ve worked in the ICU shouldn’t be surprised by Dr. Gawande’s assertations. But what to do about it?

Here at Vickie Milazzo Institute we use checklists for everything. There’s not a major project, including the National Alliance of Certified Legal Nurse Consultants (NACLNC^®) Annual Conference (801 action items) that doesn’t have a major checklist. We find it not only keeps us from reinventing the wheel each time we start a new project (saving us time and money) but it also ensures that no moving parts are missed when we put something together. We even joke that we have checklists to make sure we have all our checklists!

Think about your life – you probably send your hubby to the grocery with a checklist. (Car keys – check. Checkbook – check. Grocery list – check). You (at least I do) pack for a trip with a checklist. (Bathing suit – check. Sunscreen – check. Mirrored shades to check out the hunky lifeguards – check). Checklists are part of everything I do and probably a large part of what you do on a daily basis also. Tom even has a checklist to make sure that he’s included all the proper clauses in the contracts that he writes (yawn).

How about using checklists to ensure safety instead of making sure you’ve got the loaf of bread, pound of pastrami and jar of mayo? This really isn’t a new idea. Since 1935 pilots have been using checklists to cover just about every aspect of flying an airplane, starting with the pre-flight inspection, taxiing, take off and landing. (Wings on – check. Wheels down – check. Dinner reservations at destination – check). Millions of passengers are delivered safely to their destinations each day thanks to simple checklists.

Now ask yourself as a Certified Legal Nurse Consultant, “how many patients are harmed because doctors (and maybe even nurses) don’t use checklists when doing complex medical procedures or simply treating patients?” The answer is, too many. Consistent protocols for patient care have been advocated by physicians since 1600 B.C. (Linen robe on – check. Snake-headed staff in hand – check. Leeches on patient – check.), but it wasn’t until 2003 that Dr. Peter Pronovost came up with a simple checklist to help reduce line infections in the ICU. That list was so successful that line infections in his hospital were reduced to almost 0%. Buoyed by this success he created other checklists which eventually were adopted by the state of Michigan for use in its ICUs. The results from implementation of those lists were so successful that Dr. Pronovost ended up publishing them in The New England Journal of Medicine in 2006.

In the almost three years since that study, not much else has happened with checklists. Apparently simple common sense just isn’t exciting enough for cutting-edge healthcare providers. You’d think that the medical and nursing professions would have expanded the use of checklists, but this hasn’t happened on a wide scale other than when you check-in at the hospital. (Insurance card – check. Ability to pay – check.)

That might be about to change though. The New England Journal of Medicine recently published the results of a study that involved using a simple, 19-item surgical checklist. The results were stunning: mortality rates in surgical patients were reduced by almost 50% and the same reduction was mirrored in nonlethal complications. With these sorts of results I hope that we’ll see a profusion of checklists in healthcare. The cost savings alone should get the attention of somebody. Perhaps checklists might be a simple way to reform healthcare. (Patient on table – check. Correct patient on table – check. Anesthesiologist sober – check.)

We know here at the Institute that a simple printed list can make a big difference, in time and money. Now healthcare providers are learning that checklists can save lives too. It’s time for healthcare to catch up with grocery shoppers. Next time you work up a case, have your attorney-client ask the healthcare providers for any checklists used in treatment of the patient. They should also ask each provider during deposition, how they ensure that they take each and every one of the proper steps in treating that patient. With such a line of questioning I can guarantee the jury will wonder why, in a world where a pilot won’t land an aircraft based solely on “memory,” a healthcare provider would do a risky procedure (e.g. brain surgery) on memory alone.

When you are consulting with attorneys on medical-malpractice cases helping to prepare interrogatories, requests for production and deposition questions be sure to ask about the use of relevant checklists in the healthcare setting.

Success Is Inside!

P.S. Comment and share checklists used in your healthcare facility.

It’s hard to believe that in my lifetime I’d ever see layoffs in the nursing field. Like many of you, I remember the good times when there were billboards around my city advertising signing bonuses for nurses at local hospitals. That’s all changing. Two recent articles in the Wall Street Journal (1) (2) and one in the Washington Post are focusing on the fact that, while there is still a nursing shortage, there is now a shortage of nursing jobs. That sounds like a contradiction in terms but it’s not.

In a March 2009 report, the AHA revealed that 53% of the hospitals surveyed were operating at a negative margin or in plain English, they’re losing money. Hospitals in some areas of the country are reducing hospital staff. Just a year ago hospitals that were taking just about any skilled nurse who walked through the door are now finding it easier to be selective in their hiring. In short, this ain’t your mother’s nursing profession anymore.

If the news from nursing wasn’t already bad enough, there’s a news story about Dean Health System which announced its intention to “immediately” lay off 90 employees. This included a nurse who was assisting in a surgical procedure and was called out of surgery to be told she was laid off! Okay, I can understand cost cutting, but don’t you think it’s a little extreme to lay someone off in the middle of a procedure? Has the world just gone crazy? What if they’d laid off the anesthesiologist? Or the surgeon? I shudder to think of the consequences (Dr. Smith, please report to HR, stat!).

The good thing about legal nurse consulting is that medical malpractice and personal injury litigation is recession proof. Now that we’re seeing financial stress on hospitals and doctors, I believe we’re going to start seeing more and more medical and nursing malpractice as well as the delivery of substandard healthcare.

A recent study in the New England Journal of Medicine, showed that a fifth of Medicare patients were rehospitalized within 30 days of their initial discharge! When the pressure is on to cut healthcare costs by reducing care, testing and length of stay; as nursing shifts come under more pressure with fewer nurses covering more patients; and as healthcare continues to devolve into what I call the “Dark Ages of Medicine;” you can be sure that Certified Legal Nurse Consultants will be on the front lines working with attorneys to redress the wrongs that are certain to happen.

One of the things I like best about being a self-employed entrepreneur is that the only person who can lay me off – is me (and that isn’t happening any time soon)!

Stay busy!

Success Is Inside!

How do you start your day? Does your breakfast contain a line of pills (and I don’t mean vitamins) longer than your middle finger? If you open your medicine cabinet too quickly is there an “orange avalanche” of pill bottles? Have you succumbed to the slick marketing of pharmaceutical companies like many of my baby boomer friends who daily whip out an array of drugs for restless leg syndrome, elevated cholesterol, reduced bone density and sleep deprivation?

If you read any magazine and look at the ads, you’ll see that the pharmaceutical companies have medicalized just about every illness, condition and quirk. Not only are drugs shamelessly marketed directly to potential “patients” but to the physicians who would and do prescribe them. My 27 years of experience consulting on products liability and medical malpractice cases as a legal nurse consultant have caused me to be very suspicious of pharmaceutical companies and the diseases they create, and of course, very agitating to my personal doctors.

My Italian grandmother lived a long life and never took a single prescription drug. In Italy, food is the drug, and she proved to me first hand that what I shove into my mouth directly impacts my energy level and the state of my health. Relax, this isn’t a blog on diet. I don’t advocate any particular diet but I try and stick to a Mediterranean diet (mainly for the spaghetti), it’s what keeps me a healthy size 4 (I wish).

I’m a small woman at 5′ 2½”. When I was diagnosed with osteopenia my physician immediately recommended Fosamax^®. Considering all the side effects of Fosamax, which I’m intimately familiar with because of products liability litigation, I rejected it outright, but I know others who haven’t and others who won’t when their time comes (good luck chewing your steak).

Instead I increased my vitamin D, calcium and vitamin K intake; hit the weights in the gym a lot harder and added a little jump roping; all without the help of estrogen (natural, artificial or otherwise). It took some serious discipline but in one year I had gained significant bone mass – at a time and at an age at which the vast majority of women lose bone mass.

My physician couldn’t believe it and in fact, seemed almost upset that I did it without her help (or her meds). Surely I was an anomaly. No matter the evidence, there was no way she was a believer. She continues to practice medicine like the typical pill-pushing physician who’s been brainwashed by the pharmaceutical companies. Thank God I’m a nurse and can think for myself.

But most consumers can’t, so that’s why the book Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs by Melody Petersen is one of my favorites on the pharmaceutical industry. Not a day goes by that I don’t read about a new drug’s serious side effects and the products liability cases generating from them. This book focuses on the institutional deception of pharmaceutical companies and is a must read for all Certified Legal Nurse Consultants who consult on pharmaceutical products liability cases, and even medical malpractice cases. The author discusses physicians’ less-than-appropriate relationships with the pharmaceutical industry and how it’s marketing, not science that drives these companies.

You won’t need this book to tell you what you probably already know, but it will help you think differently about your legal nurse consulting business and the CLNC^® services you provide to your attorney-clients in this drug-dependent age.

Add this book to your “must reads.” And be careful what you put in your mouth – remember doctors used to endorse cigarettes once upon a time.

Success Is Inside!

P.S. If you want a truly eye-opening book on food and diet, try this one: Good Calories, Bad Calories by Gary Taubes – it’s not a diet book and not a light read but will change your thinking (it got Tom off beer).