BAD THINGS HAPPEN IN EMERGENCY ROOMS

How many of you have not had the experience of visiting your local emergency room? I bet not many.

An astounding 115 million people in America are treated in emergency rooms every year, according to a 2007 statistic released by the Centers for Disease Control and Prevention. The more worrisome statistic is the Journal of the American Medical Association has reported that more than 225,000 people die every year as a result of medical malpractice with emergency room errors accounting for almost half of those numbers.

According to a study by Health Grades, Inc., 20-40% of emergency room patients were misdiagnosed by health professionals. It is these mistakes that can lead to further injury and wrongful death.

How do the emergency rooms in Western Virginia measure up?

Carilion Roanoke Memorial Hospital, Lewis-Gale Hospital, Memorial Hospital of Martinsville and Henry County, Danville Regional Medical Center, Stonewall Jackson Hospital, Carilion New River Valley Hospital, Montgomery Regional Hospital, Wellmont Bristol Regional Hospital, Carilion Giles Memorial Hospital, Alleghany Regional Hospital, Carilion Franklin Memorial Hospital, and Tazewell Community Hospital

ELECTRONIC MEDICAL RECORDS SAVE LIVES!

This blog is for my friends in the medical industry.

A new study provides evidence that physicians could make fewer mistakes on the job by abandoning paper-based medicine in favor of electronic health records. The study, published in the November issue of Archives of Internal Medicine, suggests that electronic health records may prevent medical errors and malpractice claims.

Researchers do know that electronic records improve communication by (among other things) making it unnecessary to decipher someone else’s handwriting, he said. Poor communication, in my experience, often lead to medical mistakes and malpractice suits.

I tip my hat to our local "healthcare giant" Carilion Health System in its progress toward the us of electronic medical records.

HOLIDAYS AND HEART ATTACKS

Last year I read this article on Holidays and Heart Attacks.

According to those in the know, we have just started Heart Attack Season - when the number of heart attacks is on the rise.

Why? Could be many reasons
- stress
- too much drinking (alcohol)
- too much eating (cheese balls, rich meats, you name it!)

Also, add in the fact that folks think their pain is just indigestion, and local hospitals will see people wait before they call for help.

So this Holiday Season - Please, remember to take care of yourself, and your loved ones. Exercise, eat less, drink less, and if you do experience pain - seek treatment immediately.

HAPPY THANKSGIVING!

PEARLS OF NURSING WISDOM

I picked up a copy of Virginia Nurses Today Magazine yesterday. Inside was a great article by a woman named Sandra Olanitori, RN, MS. Ms. Olanitori wrote the following advice to new nursing school graduates:

P - pay attention during orienation and after - be persistent.
E - Always strive for EXCELLENCE
A - Act on something that you do not understand - ASK questions
R - Continue to RESEARCH your goals
L - You will travel down the road of LIFE, Always remember your vision
S - Believe you can be SUCCESSFUL

Well - I like what she had to say, and I agree. I would have filed two fewer Nursing Home negligence cases last year if nurses had done either P or A.

So please, if you want to put Nursing Home Plaintiff lawyers out of business - Nursing home employees, this is how:

PAY ATTENTION DURING ORIENTATION and
ASK QUESTIONS
and STRIVE FOR EXCELLENCE
Its a good way to put us under!

THE POEM OF A CRABBY OLD MAN!

The story goes that this poem was found among the personal belongings of an elderly man who died in a nursing home. The resident did not have any close relatives or family and this poem was found by nurses as they boxed up his personal belongings.

What do you see nurses? What do you see?
What are you thinking......... when you're looking at me?
A crabby old man......................... not very wise,
Uncertain of habit .................... with far away eyes?
Who dribbles his food ................ and makes no reply.
When you say in a loud voice ...... "I do wish you'd try!"
Who seems not to notice .......... the things that you do.
And forever is losing .................... a sock or shoe?
Who, resisting or not ........... lets you do as you will,
With bathing and feeding ........... the long day to fill?
Is that what you're thinking? ...... Is that what you see?
Then open your eyes, nurse ..... you're not looking at me.

I'll tell you who I am ........... as I sit here so still,
As I do at your bidding, .......... as I eat at your will.
I'm a small child of Ten ....... with a father and mother,
Brothers and sisters ............... who love one another.
A young boy of Sixteen ........... with wings on his feet.
Dreaming that soon now ............... a lover he'll meet.
A groom soon at Twenty ............ my heart gives a leap.
Remembering, the vows ........... that I promised to keep.
At Twenty-Five, now .............. I have young of my own.
Who need me to guide ............ and a secure happy home.
A man of Thirty ................. my young now grow fast,
Bound to each other .......... with ties that should last.
At Forty, my young sons ......... have grown and are gone,
But my woman's beside me .......... so see! I don't mourn.
At Fifty, once more, ......... babies play 'round my knee,
Again, we know children ............. my loved one and me.

Dark days are upon me ............... my wife is now dead.
I look at the future ............... I shudder with dread.
For my young are all rearing ......... young of their own.
And I think of the years ... and the love that I've known.
I'm now an old man .................. and nature is cruel.
Tis jest to make old age ............... look like a fool.
The body, it crumbles ........... grace and vigor depart.
There is now a stone ........... where I once had a heart.

But inside this old carcass .... a young guy still dwells,
And now and again .............. my battered heart swells.
I remember the joys ................. I remember the pain.
And I'm loving and living ............... life over again.
I think of the years .... all too few ..... gone too fast.
And accept the stark fact ......... that nothing can last.
So open your eyes, people .................. open and see.
Not a crabby old man. Look closer ..... See ...... ME!!

Remember this poem when you next meet an older person who you might brush aside without looking at the young soul within ..... we will all, one day, be there, too!

DRUG PUSHERS - NO WAIT, I MEAN DOCTORS

I many friends in the medical community who I would and do trust with my life. So I wonder, how many times a day are they told by non-physicians, how to treat their patients?

Case in point: Today's Wall Street Journal reports that CVS (yes the pharmacy), with the financial support and likely organizational assistance of Merck, sent letters to prescribing physicians to recommend a new diabetes drug.

Well - what is wrong with that?

No proof of research done by CVS to support the recommendation.
The Drug is made by Merck, sent to CVS lists of physicians.
Oh, did I mention the medication (Januvia) is almost 8 times more expensive than other diabetes drugs?
Does anyone else think it is odd for a corporation to sell your doctor on a medication without any empirical date to support the recommendation?


Read Mr. Armstrong's Article CVS PUSHED COSTLY DRUG TO DOCTORS - and you be the judge

(yes, manufactured by Merck).

MEDICARE PART D - INSIGHT!

In Today's Roanoke Times is a well written, and reasoned op-ed piece about MEDICARE D. You remember the promises, right? Medicare Part D will be a purchased supplement for our needy Seniors.

The Author discusses some needed revisions to the plan, and our role as citizens to become involved and lobby for better, more transparent health care.

I tend to agree with him and recommend Ron Herring's Letter to your reading.

UNDERSTAFFED EMERGENCY ROOMS

My local newspaper contained a letter today from Mary Boothe in Radford, Virginia. Ms. Booth told repeated "horror" stories about family members and friends who arrived in area Emergency Departments with potentially serious medical problems....and waiting....and waiting....and waiting to be seen and/or treated by a doctor. She concluded her letter by urging everyone who goes to their hospital's Emergency Department to take someone with you who can assist in getting the medical attention which all Emergency Department's should provide.

Darn good advice Ms. Boothe!

I wonder what kind of care is being provided in the Emergency Departments of our local hospitals: What is the policy at Carilion Roanoke Memorial Hospital, Lewis-Gale Hospital, Memorial Hospital of Martinsville and Henry County, Danville Regional Medical Center, Stonewall Jackson Hospital, Carilion New River Valley Hospital, Montgomery Regional Hospital, Wellmont Bristol Regional Hospital, Carilion Giles Memorial Hospital, Alleghany Regional Hospital, Carilion Franklin Memorial Hospital, and Tazewell Community Hospital

DEPRESSION IN ELDERLY

I know that many American families have seen this pattern:
1. Loved one requires more care than family can give and loved one enters assisted living facility or nursing home.
2. Loved one is not adjusting well and within months, is diagnosed with depression.
3. Loved one is given "anti-depressants" to "help" with depression.
4. Within months, loved one is not as active, not walking as much, not as engaged with family - often too fatigued to talk.
5. Loved one's appetite decreases, and perhaps fluid intake decreases as well resulting in weight loss.
6. Months later your formerly active, walking, independent and continent loved one now spends most days in bed and requires a catheter or diaper.

While it is a proven fact that many elderly experience depression - Let's take the time to examine the root of the problem here. You loose your home, independence and are placed in a small room with concrete or tile floors, with a stranger - Wouldn't you be depressed?

The "anti-depressants" are likely anti-psychotics not approved by the FDA for use in elederly.

Please do your family a favor - ASK WHAT MEDICATIONS YOUR FAMILY MEMBER IS BEING GIVEN for their "depression" or "anxiety." If any of the following meds are being given - you need to be diligent in getting a second opinion;
Haldol (haloperidol)
Prolixin (fluphenazine)
Risperdal (Risperidone)
Seroquel (quetiapine)
Thorazine (chlorpromazine)
Zyprexa (olanzapine)

These meds are typically used in those suffering from scitzofrenia, and will cause drastic changes in the elderly.

I know they are being prescribed in nursing homes everywhere, and it is upsetting - I often see very alive nursing home residents over-medicated because staff doesn't have time to monitor them...

Please be aware!

CAN'T WE PREVENT FALLS IN NURSING HOMES?

This weekend my mother-in-law suffered a bad fall at her nursing home. The fall happened around 5:00 AM and resulted in an ambulance ride to the local hospital. Luckily, she didn't break any bones but did suffer a nasty gash across her forehead and two black eyes.

Each year, 1.8 million Americans over age 65 are injured in falls, according to the Centers for Disease Control and Prevention. Some rebound as if the injury never happened. But for some, the fall sets off a downward spiral of physical and emotional problems — including pneumonia, depression, social isolation, infection and muscle loss — that become too much for their bodies to withstand.

My mother-in-law's fall lead me to do a little Internet search over the weekend about the frequency and preventability of falls in the nursing home setting. I ran across a great article from the New York Times entitled, "Once Just an Aging Sign, Falls Merit Complex Care."

The article is worth reading. The issue is complex but it is clear to me that nursing homes and doctors caring for nursing home patients are doing far too little to reduce the likelihood of what can be a life-changing or even fatal injury.

Illinois Nursing Home Lawsuit Settles for $1M

Helen Menneke (83 years old), formerly of Mundelein (IL), was admitted to Winchester House in Libertyville in January of 2004, suffering from dementia. She fell several times over the course of the year, suffering a brain injury and broken bones. After one such fall, nurses implemented an alarm system for beds and wheelchairs. Injuries from a final fall in December of 2004 required surgery, and Menneke died in January 2005.

After Menneke's death, Winchester House instituted new policies requiring staff to more frequently check patients' wheelchair and bed alarms to ensure they're working properly. The resident's family was outraged by the poor care provided by the nursing home and filed a negligence suit against the facility which was settled for $1 million.

My Question: Why did an elderly person have to die before the facility "instituted new policies" to prevent such tragedies?

TENNESSEE NURSING HOME CNA WITH CRIMES

Here is an upsetting story! Joyce Stanley, 37, of Madisonville (TN) has been charged with willful and physical abuse after reportedly hitting a blind 74 year old nursing home resident with a clipboard and an incontinence pad, as well as pulling her hair and slapping her. Stanley was a certified nursing assistant at Etowah Health Care Center. Stanley is being held at the McMinn County Justice Center in lieu of $20,000 bond.

My take: I believe hidden cameras or "granny cams" would have discovered this abuse earlier and I doubt that this was the first time nurse Stanley mistreated nursing home residents.

PRECRIPTION DRUGS - I told you so!

I know, who wants to read the blog of a bragger... But it's true. We warned you! We told you that folks needed to be extra diligent when it came to their medication.

MSNBC Health is reporting today "When It Comes to Prescription Drugs, Get Smart"

A well-informed consumer will be a healthy one, too
By Dennis Thompson, HealthDay Reporter

WEDNESDAY, Nov. 5 (HealthDay News) -- Getting a prescription filled is such a routine task, most people do it without thinking about it.

And that's potentially a big mistake, according to medical experts -- one that could hamper your treatment or, in some cases, do real harm.

Pharmacists and health-care advocates are urging people to make themselves "medicine smart" by asking questions, keeping track of what medications they are taking, and building a relationship with their family pharmacy.

"Patients definitely don't speak up as much as they should," said Joel Zive, a spokesman for the American Pharmacists Association and owner of Zive Pharmacy in New York City. "Patients need to be their own best friend. They need to advocate for themselves at the prescription counter."

People who don't take the time to learn about their medications, both prescribed and over-the-counter, run the risk of misusing them in ways that could damage their health.

For instance, they could suffer a potentially dangerous interaction between two or more drugs, said Ray Bullman, executive vice president of the National Council on Patient Information and Education.

"Although it's a simple question, the related answers are really fairly profound in terms of the expectations of what a consumer can do for themselves, and their roles and responsibilities," Bullman said.

For starters, he suggests that patients keep a detailed list of all the medications they're taking, both prescribed and over-the-counter, and bring that list whenever they visit their doctor or pharmacist.

"We see it as the connection between his [the doctor's] patient and his health-care professionals," Bullman said. "Oftentimes, patients, when they have an office visit, will not have the information available about the medicines they are taking. It is important for their doctor to have that information."

To help keep track of medications, Zive also recommends choosing one pharmacy for all your prescriptions and getting to know the pharmacists there.

"Let's say you're visiting different doctors and they're prescribing you medications separately that could cause an interaction," Zive said. "If you're using one pharmacist, they'll be able to see those potential interactions and other problems, even if you are seeing different doctors."

The National Council on Patient Information and Education recommends bringing a list of questions to be answered by your doctor and pharmacist for each prescription. The questions include:

What is the name of the medicine and what is it for? Is this the brand name or the generic name?
Is a generic version of this medicine available?
How and when do I take it, and for how long?
What foods, drinks, other medicines, dietary supplements, or activities should I avoid while taking this medicine?
When should I expect the medicine to begin to work, and how will I know if it is working? Are there any tests required with this medicine?
Are there any side effects, what are they, and what do I do if they occur?
Will this medicine work safely with the other prescription and non-prescription medicines or dietary and herbal supplements I am taking?
Do I need to get a refill? When?
How should I store this medicine?
Is there any written information available about the medicine?
Patients should be ready to jot down the answers for all these questions, Bullman said.

They also should consider writing down the specific nature of their medical complaint before seeing a doctor, as well as any other questions they might have.

"It really is a crib sheet for when you go in," Bullman said. "It helps the consumer frame the particular medical problems they're having. Anecdotally, we've all heard about someone going into a physician's office and they'll be asked what's wrong and they'll respond, 'I'm fine,' without thinking."

When visiting the pharmacy, consumers should be sure to open up the little prescription vial and check out their medications before they leave, Zive added.

"Even if we fill it correctly, sometimes the prescription as written is not what they need or were told by their doctor to expect," he said. "Also, we might fill a prescription with a generic that looks different from the brand name pill, and that can cause some concern when they get home. Better to be assured at the counter."

Finally, people should understand that all drugs have risks as well as benefits, and be ready to have a frank discussion with their health-care professionals about those risks, Bullman said.

"We're encouraging them to raise that issue and have that dialogue with the prescriber about risks versus benefits," he said. "There may be an alternative medication to the one the patient is taking that would better suit their lifestyle."

More information

To learn more visit the National Council on Patient Information and Education.

SOURCES: Ray Bullman, executive vice president, the National Council on Patient Information and Education, Bethesda, Md.; Joel Zive, owner and pharmacist, Zive Pharmacy, New York City, and spokesman, American Pharmacists Association, Washington, D.C.
Copyright © 2008 ScoutNews, LLC. All rights reserved.

HOME HEALTH NURSES

I recently spoke with a lady on the telephone who was complaining her aunt had received neglectful care from a home health nurse and suffered severe injuries as a result. The caller concluded that "it is a shame she wasn't in a nursing home...because now no one can be held responsible."

For whatever reason, many people believe that home health nurses cannot be held accountable for the neglect and abuse of an elderly person when that person is residing in his/her home. Nothing could be further from the truth.

For example, the city of Seattle and a home health care agency just paid $600,000 to settle a negligence claim arising from neglectful home health care. Doctors diagnosed Patricia Leonard of West Seattle with multiple sclerosis when she was 24. She is now 51 and nearly paralyzed. Patricia resides at home but is in a city-run program that pays contracted caregivers to take care of her. Her care plan spelled out one of her most basic needs – to shift the client's weight every 15 minutes to prevent pressure ulcers or bedsores.

Unfortunately, the nurse assigned to care for Patricia did not turn or reposition her and had never been trained to do so. The result - Patricia was was neglected in her wheelchair, left for so long that she developed life-threatening bedsores (also know as decubitus ulcers) and was hospitalized for two months. Doctors operated twice on the sores they had cut through to the bone. They were also infected with MRSA, potentially life-threatening bacteria.

Bad care is not just confined to nursing homes...it can happen in your home!

ASSISTED LIVING FACILITES IN SOUTHWEST VIRGINIA

We get asked all the time, "what is the difference between a nursing home and an assisted living facility? The answer might surprise you.

Nursing homes are highly regulated by federal law and must have around the clock trained nursing care. An assisted living facility (often called an ALF) can be nothing more than a fancy hotel for the elderly. There are basically no federal or state oversight of ALFs. No surprise inspections and requirements for 24 hour trained nursing care.

My problem is that many of the people residing in ALFs should not be there because, over time, their health has deteriorated and they need more intensive nursing and medical care which they will not get at the ALF. And surprise...surprise, the ALF administrator is not eager to tell those residents and their families that they can no longer properly take care of the resident. Why? How about money! ALFs are very profitable business...some believe more profitable than nursing homes.

Southwest Virginia has over 50 ALF facilities. If you, or a member of your family, is considering moving into an ALF, you better investigate the facility first. If you, or a family member, are already living in an ALF, make sure your health issues don't require a higher level of care. You might just be betting your life on the outcome.

NURSING HOMES: WHAT IS ABUSE AND NEGLECT?

Federal law provides that all residents in nursing homes are entitled to receive quality care and live in an environment that improves or maintains the quality of their physical and mental health. This entitlement includes freedom from neglect and abuse. But what is the difference between "abuse" and "neglect?"

Neglect is the failure to care for a person in a manner, which would avoid harm and pain, or the
failure to react to a situation which may be harmful. Neglect may or may not be intentional and includes:
§ Incorrect body positioning -- which leads to limb contractures and skin breakdown;
§ Lack of toileting or changing of disposable briefs – which causes incontinence and results in residents sitting in urine and feces, increased falls and agitation, indignity and skin breakdown;
§ Lack of assistance eating and drinking -- which leads to malnutrition and dehydration;
§ Lack of assistance with walking – which leads to lack of mobility;
§ Lack of bathing – which leads to indignity, and poor hygiene;
§ Poor hand washing techniques -- which leads to infection;
§ Lack of assistance with participating in activities of interest – which leads to withdrawal and isolation.
§ Ignoring call bells or cries for help.

Abuse means causing intentional pain or harm. This includes physical, mental, verbal, psychological, and sexual abuse, corporal punishment, unreasonable seclusion, and intimidation. Examples include:
§ Physical abuse from a staff member or an intruder or visitor from outside the facility -- including hitting, pinching, shoving, force-feeding, scratching, slapping, and spitting;
§ Psychological or emotional abuse -- including berating, ignoring, ridiculing, or cursing a resident, threats of punishment or deprivation;
§ Sexual abuse – including improper touching or coercion to perform sexual acts;
§ Substandard care which often results in one or more of the following conditions -- immobilization, incontinence, dehydration, pressure sores, and depression;
§ Rough handling during care giving, medicine administration, or moving a resident.

My take: An elderly person should never be subjected to abuse or neglect. Report all acts of abuse and neglect to local police, representatives of the Department of Social Services, as well as the agency in your state responsible for the oversight of nursing homes.