Tuesday, August 23, 2016

Monday, August 22, 2016

Preventing pressure ulcers has been a nursing concern for many years. In fact, Florence Nightingale in 1859 wrote, “If he has a bedsore, it’s generally not the fault of the disease, but of the nursing”4 (p. 8). Others view pressure ulcers as a “visible mark of caregiver sin”5 (p. 726) associated with poor or nonexistent nursing care.6 Many clinicians believe that pressure ulcer development is not simply the fault of the nursing care, but rather a failure of the entire heath care system7—hence, a breakdown in the cooperation and skill of the entire health care team (nurses, physicians, physical therapists, dietitians, etc.). From: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 12 Pressure Ulcers: A Patient Safety Issue Courtney H. Lyder; Elizabeth A. Ayello.

Thursday, May 19, 2016

'Dear potential wheelchair patient'

The process is causing me anxiety, and I'm not even the person who needs a wheelchair. After calling and being transferred no fewer than seven times, getting voicemail twice, and calling back for two weeks, I finally reached someone who was supposed to be making appointments for Wheelchair Clinic. Apparently at this famous rehabilitation center, disabled persons are first believed to be guilty of fraud and they have to go through scrutiny and screening even with a prescription in order to get an appointment to get a wheelchair. In America. Where even those charged with a crime are innocent until proven guilty in an appropriate court of law. Can you imagine being paraplegic? You cannot walk. You cannot move. You cannot feel any sensory stimulus below the injury. You cannot go from here to there or there to here -- even in the same room -- without a wheelchair. And it has to be a properly configured wheelchair. It can't just be any wheelchair or you might not have enough support and you might flop out of the wheelchair and hit your head. Or your limbs might be at risk of injury. Imagine you spent nearly two years ill in hospitals and skilled nursing facilities and deteriorating and experiencing reduced muscle tone so that your paralyzed legs are now falling off the sides of your eight year old wheelchair and people routinely knock into your feet injuring you. Can you imagine then going about making appointments with doctors, getting prescriptions from your Physiatrist for a Wheelchair Clinic because you are paraplegic from spinal cord injury T-6 complete, that is, you cannot move or feel stimulus below the T-6 level of your spine, and then when you contact one of the most famous centers to make an appointment, you cannot make an appointment because according to the person who is the Coordinator of the Wheelchair Clinic, there is so much fraud in the wheelchair clinic that you have to go through a formal screening process to see if you might perhaps be committing fraud by trying to get a wheelchair. I just can't understand why on Earth a disabled person who is already on Social Security Disability and Medicare for the permanent spinal cord injury and paralysis and who already has prescriptions from a Physiatrist at one of the major Spinal Cord Injury Centers in the United States would have to first be considered to be guilty of fraud and then pass some process to prove he or she is not committing a crime -- in order to make an appointment for a wheelchair clinic. It wouldn't be so bad if the phone call or the form made any sense at all. But during the conversation on the phone, the intake person said she doesn't know anything about how the screening and decisions are made. Yet when I received the forms, the person I spoke with is listed as the Coordinator of the Wheelchair Clinic. How is it possible that there is a person who is the Coordinator, and who tells the caller all about the fraud, and then provides an anecdotal story to prove that insurance won't just pay for wheelchairs -- she tells the story of a person with CP who walks 12 city blocks and therefore is considered by the insurance company to be unqualified for a wheelchair. What on Earth does that have to do with an individual case? There is also no way to know from the description on this form how long if ever you will ever hear back from any of these people. They tell you to keep the form and to call with questions, yet I already called and the person who takes the calls and who is the Coordinator of the Wheelchair Clinic didn't know the answers and then provided information about a different situation, so why would anyone think there should be a reason to call again? If she didn't know anything the first time you called, why would you think she would know anything the second time you call? The other Center in the area, Kessler which is famous for having the Christopher Reeve Center, is scheduling people for wheelchair clinic six months and longer from now. That makes the process useless. If you need a wheelchair and you have to wait six months, you might as well have absolutely no services whatsoever. This is the terrific medical care people brag about in the United States. Really. Saying the American healthcare system is the best in the world. No wonder being paralyzed is a risk factor for suicide. Why are rehabilitation facilities permitted to lump disabled patients into a category where they must be systematically screened to determine whether they might be criminals committing fraud before being given appropriate and necessary services?

Tuesday, March 8, 2016

Not Dead Yet | The Resistance

Not Dead Yet | The Resistance

Fentanyl Indications -- Not as Reported by Death by Fentanyl

Death by Fentanyl -- The New Documentary is Filled with Inaccuracies

 I was awake in the middle of the night and watched this Documentary which left me disturbed as I'm guessing the creators intended -- however, I was disturbed because of the impact it might have including increasing discrimination against patients who have pain management issues. I decided to fact check. I called the FDA and checked out the statements in the video. I learned the statements were inaccurate and luckily, the FDA Drug Info person didn't have to rely on my memory because the Fusion people documented the inaccuracies on their web site. One example:

'Fentanyl is 50 times stronger than heroin. It’s so potent that an amount
the size of three grains of sugar is lethal to an adult. First
synthesized in the 1960s by Janssen Pharmaceuticals, fentanyl was
initially used as a general anesthetic during surgery. Its only
acceptable, “on-label” use is for reduction of severe pain in
cancer-sufferers.'

The fact that the Attorney General of the Commonwealth of Massachusetts Maura Healy appears in this video lends credibility to the message contained. However, it would have been a good idea if Mrs. Healy or her staff would have fact checked before appearing in the video. Now patients in the Commonwealth of Massachusetts will be subjected to discrimination for using appropriately prescribed medications such as Fentanyl. It is already challenging to deal with pain management in conditions such as Spinal Cord Injury without having to deal with a Media Campaign to discredit patients who have pain management issues. 





Death by Fentanyl

Sunday, March 6, 2016

Skilled Nursing Violated Mass Health Rules by Billing for Co-Pays and Days Patient was in Other Facilities and for Holding the Room in Case Patient Wants to Return

On 27 February we reported about Golden Living Skilled Nursing facility billing for Co-Pays and for 'holding the room' for 20 days while patient was in a hospital then in a rehabilitation center as an inpatient. In addition, South East Massachusetts skilled nursing facility also billed the same patient for Co-Pays for other inpatient dates. It's not like they don't know the patient has Medicare and Medicaid (Mass Health). They obviously had this information and didn't deny having it when I called them. After multiple calls to billing centers that indicate the bills to be correct, and repeated mailings of bills, and calls from these skilled nursing facilities, I contacted Medicare and Mass Health and learned these facilities inappropriately billed the patient. The Skilled Nursing billing person said they expect patients to pay their Co-Pay and it's usual for the Skilled Nursing facility to charge for 'holding the room' when the patient has gone off to a hospital with deep vein thrombosis and pulmonary embolism. Really. Mass Health indicates that Skilled Nursing facilities know they are not permitted to bill when the patient is in the hospital, another facility, or to 'hold the room'. They are also not allowed to bill for 'Co-Pay' except for a nominal charge -- something like $3. I really would like to know what compels people at these Skilled Nursing facilities to behave in such a way. I wonder what else they do that they know they are not supposed to do because this one is so obvious and leaves many records. Fortunately, Mass Health intervened and called the Skilled Nursing facilities to 'correct' them on how to follow the 'contract' they have with Mass Health. We are greatly relieved. It is disturbing to learn that large organizations that are under contract with Federal Medicare and State Medicaid Mass Health are willing and actually do bill inappropriately and then fail to correct their errors when patients and their representatives call to investigate. Having bills (as you might have noticed nearly $5,000 in the case of Golden Living, and others from SE Massachusetts) and then checking with the institution sending the bills and having them give inaccurate information, then threatening to attach the patient's Social Security check, is disturbing. Deeply disturbing. I wonder how many other people fall victim to these unscrupulous tactics by skilled nursing facilities billing people.

Tuesday, March 1, 2016

Center of Innovation for Complex Chronic Healthcare Home

Center of Innovation for Complex Chronic Healthcare Home

Physician Quality Reporting System - Centers for Medicare & Medicaid Services

Physician Quality Reporting System - Centers for Medicare & Medicaid Services

Introducing Jerry Smith -- All Things Accessible

To put a face to All Things Accessible, I would like to introduce Jerry Smith. Some people provide inspiration and information. Jerry Smith is one of those people. Together, Jerry and I will be posting interesting and hopefully useful information about all things accessible and related articles, topics, and resources. Specifics will evolve. We will begin with mobility and hearing related subjects. We will share experiences, travels, and anecdotes as well. We hope you will find the observations to be helpful. We hope they will provide insight for All Things Accessible.

Sunday, February 28, 2016

New Enthusiasm for All Things Accessible

It has been some time since I have been blogging. There are some events that remind me that there are very important issues and I hope to share information in this blog and elsewhere. The current issues occupying time, energy, thoughts involve accessible equipment and reasonable accommodations. In particular, issues surrounding hearing impairments and chronic spinal cord injury are at the top of the list. At the moment, we have been attending to issues surrounding healthcare for people with chronic spinal cord injury. I have been surprised to discover that ADA is not as effective in inspiring accessible equipment and reasonable accommodation. In particular, healthcare continues to pose a confusing network of disjointed issues and ineffectual solutions that fail to form a gestalt or appropriate situation for many with chronic spinal cord injury. I don't believe individual patients are being singled out. I consider the likelihood that if one person has an experience involving no accessible equipment on multiple occasions at the same provider, that it is the policy of that provider not to accommodate. I also believe there are some people who can be educated to accommodate but that it should not be the person with the disabling condition who should be required to beg the healthcare provider to comply. To me that is not justice. My dear cousin Jerry Smith has been experiencing an unbelievable sequence of healthcare encounters since suffering a T-6 complete spinal cord injury. My eyes have been opened. I never would have imagined such things could take place in 21st Century, let alone in the United States. During a recent intense encounter at a hospital, Jerry was denied a wheelchair, an accessible bathroom, a bedside commode, vomit receptacle, and was threatened to be carried out of the hospital instead of being provided with care. It's so difficult to imagine. I personally spoke with the Case Manager at the hospital who insisted they knew Jerry very well and knew his needs and they would be provided for. I exhaled. I believed the Case Manager. Now when I realize what happened and when I review the medical records from that 28 day encounter in the hospital, I am shocked that I did not realize -- that I did not rescue my dear cousin from that situation. I believed the Case Manager. What was I thinking? Jerry and I had attempted to communicate with the Case Manager, Nurses, Physicians, managers, and even the Chief Experience Officer at that hospital. Yet still, even the basic care was denied. We spoke with management about other health related care, because I thought the Case Manager was taking care of all Jerry's needs for accessibility. Who would ever imagine a Hospital in the United States that knows the patient for 6 years of frequent encounters, knows him to be paraplegic wheelchair bound and requiring accessible toilet and who was resident in the Hospital for 28 days -- yet they never provided a wheelchair -- not even his own wheelchair -- nor a toilet or bedside commode for that entire time. And to make matters worse, when the Case Manager who knows Jerry very well, planned his transfer to another facility and specifically checked the box indicating he did not need the accessible toilet for his bowel program. I was embarrassed to talk with people about this issue that is so essential to people with disabling spinal cord injury. I thought I had covered this issue with the Case Manager and that was all there was to it. I am remorseful more than I can say. I hope people out in blog land will hear me when I say that there may be many more people out there who have needs that are not being heard. And that there are many needs that are embarrassing to speak or write about. In addition to not planning for Jerry's bowel program, the referral form filled out by the Case Manager declared that Jerry did not have C Diff. I didn't know what the implications were when I first read the form. I will be writing and posting a lot about this. It is an epidemic in the healthcare setting. We must pay attention to this issue for everyone who uses healthcare services. Also, the Case Manager failed to indicate Jerry was using a wheelchair -- she neither checked the box indicating he needed a wheelchair, nor checked the box that his wheelchair was being sent to the new facility. Now that I have seen these records, many more issues Jerry has suffered from many other healthcare encounters make much more sense. The Hospital in question refuses to provide records, test reports, etc. until 30 days following discharge. By then, the records are of no practical use in provision of healthcare or intervention when issues come up. Who would imagine I would see the Case Manager did not express Jerry's needs on her documents. I'm not accustomed to grilling people about how they do their job. But now I realize that is exactly what must be done to protect persons who are living with disabling conditions such as paraplegia. The consequences of poor care are too great. I will be writing about this and filing complaints for as long as it takes. I will be asking for everyone and anyone's help. I will make it a habit when I see something that has gone wrong -- of telling people who are not doing right by persons with disabling conditions -- that they should avail themselves of a different job, because it appears they have no particular skill at doing the one they are currently in. I will no longer believe people when they say they 'know' something without fact checking and double checking and checking again. I will do my best not to do be shy about speaking about the needs of people with disabling conditions. So be prepared.

Southcoast Hospitals Physicians Believe, 'Autonomic Dysreflexia Does Not Exist -- and if it does, then it is only experienced by persons with Acute spinal cord injury...' They might want to do some fact checking.

Autonomic Dysreflexia in Spinal Cord Injury Author: Ryan O Stephenson, DO; Chief Editor: Robert H Meier, III, MD more... Updated: Jun 25, 2015 Overview Pathophysiology Causes of Autonomic Dysreflexia Prognosis Patient education Consultations Prevention Epidemiology History and Physical Examination Physical Therapy Occupational Therapy Recreational and Speech Therapies Treatment of Autonomic Dysreflexia Prevention of Autonomic Dysreflexia Show All Multimedia Library References Overview Autonomic dysreflexia is a potentially dangerous clinical syndrome that develops in individuals with spinal cord injury, resulting in acute, uncontrolled hypertension. All caregivers, practitioners, and therapists who interact with individuals with spinal cord injuries must be aware of this syndrome, recognize the symptoms, and understand the causes and treatment algorithm.[1] Briefly, autonomic dysreflexia develops in individuals with a neurologic level of spinal cord injury at or above the sixth thoracic vertebral level (T6). Autonomic dysreflexia causes an imbalanced reflex sympathetic discharge, leading to potentially life-threatening hypertension. It is considered a medical emergency and must be recognized immediately. If left untreated, autonomic dysreflexia can cause seizures, retinal hemorrhage, pulmonary edema, renal insufficiency, myocardial infarction, cerebral hemorrhage, and death. Complications associated with autonomic dysreflexia result directly from sustained, severe peripheral hypertension. (See the image below.) (A) A strong sensory input (not necessarily noxiou (A) A strong sensory input (not necessarily noxious) is carried into the spinal cord via intact peripheral nerves. The most common origins are bladder and bowel. (B) This strong sensory input travels up the spinal cord and evokes a massive reflex sympathetic surge from the thoracolumbar sympathetic nerves, causing widespread vasoconstriction, most significantly in the subdiaphragmatic (or splanchnic) vasculature. Thus, peripheral arterial hypertension occurs. (C) The brain detects this hypertensive crisis through intact baroreceptors in the neck delivered to the brain through cranial nerves IX and X. (D) The brain attempts two maneuvers to halt the progression of this hypertensive crisis. First, the brain attempts to shut down the sympathetic surge by sending descending inhibitory impulses. These impulses are unable to travel to most sympathetic outflow levels because of the spinal cord injury at T6 or above. Inhibitory impulses are blocked in the injured spinal cord. In the second maneuver, the brain attempts to bring down peripheral blood pressure by slowing the heart rate through an intact vagus (parasympathetic) nerve; however, this compensatory bradycardia is inadequate and hypertension continues. In summary, the sympathetics prevail below the level of neurologic injury, and the parasympathetic nerves prevail above the level of injury. Once the inciting stimulus is removed, reflex hypertension resolves.

Appropriate Specialized Healthcare Improves Quality of Life in Chronic Spinal Cord Injury

Mortality and Longevity after a Spinal Cord Injury: Systematic Review and Meta-Analysis Jonviea D. Chamberlain a, b Sonja Meier a Luzius Mader a, b Per M. von Groote a, b Martin W.G. Brinkhof a, b a Swiss Paraplegic Research, Nottwil , and b Department of Health Sciences and Health Policy, University of Lucerne, Lucerne , Switzerland Mortality and Longevity after a Spinal Cord Injury: Systematic Review and Meta-Analysis Jonviea D. Chamberlain a, b Sonja Meier a Luzius Mader a, b Per M. von Groote a, b Martin W.G. Brinkhof a, b a Swiss Paraplegic Research, Nottwil , and b Department of Health Sciences and Health Policy, University of Lucerne, Lucerne , Switzerland Abstract Background/Aims: Mortality and longevity studies of spinal cord injury (SCI) are essential for informing healthcare systems and policies. This review evaluates the current evidence among people with SCIs worldwide in relation to the WHO region and country income level; demographic and lesion characteristics; and in comparison with the general population. Methods: A systematic review of relevant databases for original studies. Pooled estimates were derived using random effects meta-analysis, restricted to traumatic SCI. Results: Seventy-four studies were included. In-hospital mortality varied, with pooled estimates of 24.1% (95% confidence interval (CI) 14.1-38.0), 7.6% (95% CI 6.3-9.0), 7.0% (95% CI 1.5-27.4), and 2.1% (95% CI 0.9-5.0) in the WHO regions of Africa, the Americas, Europe and Western Pacific. The combined estimate for low- and middle-income countries was nearly three times higher than for high-income countries. Pooled estimates of first-year survival were 86.5% (95% CI 75.3-93.1), 95.6% (95% CI 81.0-99.1), and 94.0% (95% CI 93.3-94.6) in the Americas, Europe and Western Pacific. Pooled estimates of standardized mortality ratios in tetraplegics were 2.53 (2.00-3.21) and 2.07 (1.47-2.92) in paraplegics. Conclusion: This study found substantial variation in mortality and longevity within the SCI population, compared to the general population, and between WHO regions and country income level. Improved standardization and quality of reporting is needed to improve inferences regarding the extent to which mortality outcomes following an SCI are related to healthcare systems, services and policies. © 2015 S. Karger AG, Basel

Study about Morbidity and Mortality in Chronic Spinal Cord Injury

Mortality in patients with traumatic spinal cord injury: Descriptive analysis of 62 deceased subjects Roland Thietje 1 , M.H. Pouw 3 , A.P. Schulz 2 , B. Kienast 1 , Sven Hirschfeld 1 1 Centre for Spinal Injuries, BG Trauma Hospital Hamburg, Germany, 2 Dept. of Biomechanics and Orthopaedic Research, University Hospital Lübeck, Germany, 3 Spine Unit, Department of Orthopedic Surgery, Radboud University Nijmegen Medical Centre, NL Study design: Retrospective study. Objective: To investigate the causes of death in patients who were ≤ 50 years at the time of traumatic spinal cord injury (tSCI). Setting: Convenience sample of a tertiary rehabilitation center. Methods: All deceased patients with tSCI who survived a minimum of 10 years post-injury, were included. In addition, causes of death were compared between subjects surviving < 10 years and ≥ 10 years. Neurological assessments were performed according to the American Spinal Injury Association scale. Data on causes of death were analyzed using the ICD-10 classifications. Differences were calculated using the Mann – Whitney and chi-square tests. Results: A total of 100 patients, with 38 and 62 surviving < 10 and ≥ 10 years, respectively, were included. No significant differences in causes of death were identified between these two groups. In patients surviving ≥ 10 years, paraplegia was associated with a higher life expectancy compared with tetraplegia, 34 and 25 years ( p = 0.008), respectively, and the leading causes of death were septicemia ( n = 14), ischemic heart disease ( n = 10), neoplasms ( n = 9), cerebrovascular diseases ( n = 5), and other forms of heart diseases ( n = 5). Septicemia, influenza / pneumonia, and suicide were the leading causes of death in tetraplegics, whereas ischemic heart disease, neoplasms, and septicemia were the leading causes of death in paraplegia. Conclusion: Our monocentric study showed that in 62 deceased patients with SCI, the leading causes of death were septicemia, cardiovascular diseases, neoplasms, and cerebrovascular diseases. In addition, no significant differences were identified between causes of death among patients surviving < 10 years and ≥ 10 years post-injury. Keywords: Spinal cord injuries

Saturday, February 27, 2016

24 Hour Hotline Disabled Persons Protection Commission to Report Abuse or Neglect

I guess they don't mean 24 Hours In A Row! Because you can't reach them by telephone. Seriously. I'm quite discouraged by the experiences and interactions with the Commonwealth of Massachusetts. It's disappointing. I contacted a Foundation that provides assistance to people with disabling conditions and asked about resources to help my cousin with issues. The Foundation Resource Representative explained to me that what I was describing was that my cousin was 'severely mistreated' and I should call and report it. I searched on the words, 'severely mistreated' and 'disabled' and 'Massachusetts' and found the Disabled Persons Protection Commission DPPC with a 24 Hour Hotline to Report Abuse or Neglect. There are descriptions of abuse and neglect, how to recognize, abuse and neglect, who is mandated to report, etc. After reading a lot of stuff on the web site, I tried to contact the 24 Hour Hotline to Report Abuse or Neglect. Nobody answered. Seriously. I called back. Again, nobody answered. There's no option on the web site to report online. No online chat. The regular office number suggests calling 911 in an emergency. You have to wonder about all the calls people get at 911 if everybody refers people to call 911 because they just don't answer the phone in some other office that's supposed to be doing something that appears to be important. At least it appears to be important to the people who are disabled and who are being abused or neglected.

Who Would Ever Believe a Skilled Nursing Facility Would Bill the Patient Co-Pay for Days He Was In Another Hospital and Rehab?

Oddly, we can see here an Invoice from Golden Living Oak Hill including dates when the patient was actually in Beth Israel Deaconess Jordan Hospital beginning 6 July 2015, then Reliant (Spaulding Rehabilitation) beginning 15 July 2015. I actually spoke with the billing people on the phone and they insist there's nothing wrong with the bill. They said the patient had used up all his days for the benefit period and he has to pay. Really? For days when he was elsewhere? How does that work?

Tuesday, February 16, 2016

Why Not Provide a Visual Cue to Inform People of the Patient's Needs?

It's interesting to see how many Icons are present on this Information Board in the Patient's Room at a Hospital. Also, it's surprising to notice that there is no Icon to inform the staff the patient has T-6 Complete Paraplegia and is paralyzed below his injury with altered sensations. There is absolutely no visual cue. Also, there is no Wheelchair in the room. There are no notes on the board about what people 'should know' about the patient. The staff might get the idea the patient can get up and use the restroom, or fetch a bucket to vomit, or attend to some other need by himself. If there is an emergency, staff might think a young man can fend for himself and get out of the building by emergency exits. When I was visiting this patient in the hospital, I noticed there was no sign indicating need for wheelchair and there was no wheelchair for this paralyzed patient. I tried to find out who the Case Manager was. Nobody could put me in touch with the Case Manager. So I called the Brewster Ambulance Company that transported the patient to the Hospital and asked how to get the patient's Wheelchair to him at the Hospital. The Dispatcher explained to me that the Case Manager is responsible for informing the Ambulance Company that a patient is in need of a Wheelchair and then it's transported. The fabulous dispatcher organized to fetch the wheelchair upon my call. Fabulous. I thank Brewster Ambulance and wish I had known this before because for five years the patient has had a continual problem getting any wheelchair in any hospital or rehab or nursing home. Which I find to be very strange indeed. I finally wrote a few notes on the Information Board. Never heard a reply, but I think the staff realized someone was involved in advocating for the patient, and the Case Manager arranged a very nice transfer to an appropriate Rehab facility where he got the care he needed once his health issues were under control.
Once the Wheelchair showed up, at least there was a Visual Cue present in the room with the Patient. Hopefully, at least the presence of the Wheelchair would provide some kind of information to let the staff recognize what the patient needs, although it might be more effective if the need for a Wheelchair had been included in the ICONS and any other notes and planning for in the room Information.

Model System Centers

Model System Centers

Monday, February 15, 2016

T-6 Complete Paraplegic Spinal Cord Injury with History of Altered Sensations -- Suddenly Acquires Normal Sensations in Medical Record!

WOW! Did the patient suddenly recover? Why would the NP use Homan's Sign to look for Deep Vein Thrombosis in a person known to have altered sensations? It's not like this healthcare worker does not know the patient has Spinal Cord Injury -- although it is also documented here. So why does this person use a test inappropriate for a person with altered sensations? Then note the patient does not have Normal Sensations? How does this happen?

Patients Need Advocates Who Can Help Them Review Their Records to Improve Patient Safety

Interestingly, progress notes are more challenging than one might expect. Notice the notes excerpt from the Progress of an inpatient T-6 Complete Paraplegic Patient. The creator of the notes indicates: 'Patient denies: leg pain, pain with walking... Patient denies: pain, weakness... Patient denies: PARALYSIS... tingling, numbness, tremors.' Perhaps if it appeared on one page then there would be a clerical issue to deal with that might lead to inappropriate care or measures taken. But these notes appear over and over again in the patient's notes.

Sunday, February 14, 2016

Operative Records Indicating NO Antibiotics Were Given

Patient with Spinal Cord Injury and Implanted Metal Rods Receives NO Antibiotics During Invasive Surgical Procedure

Kitty Campaign: I think it's important to Patient Safety for all documents that caregivers use during procedures and interactions with Patients to be ACCURATE in particular, accurate with regard to the Facts about the Patient and the Patient's health history, physical condition, etc. In that way, the people who have direct contact with the patient, nurses, physicians, phlebotomists, etc. might have appropriate information to direct their work and care. There are some obvious problems you can identify easily when you look through your own records. It's not so difficult. After reading a few records yourself, you will become familiar with how the documents are organized and what is in the documents. It will be easy to notice how important information can be omitted, carried over from other patient documents, or incorrectly noted in the chart. When a medical staff person has limited time, and goes from patient to patient, with workflow interrupted many times during a shift and across days while a patient is resident in a hospital or nursing home, there are many opportunities for confusion and errors to occur. A popular example involves medications errors. It's very easy to follow the flows of medication errors and many efforts are made to avoid these errors. However, there are many other easy to detect situations where errors can occur; even though systems have not been designed to avoid these errors. For example, this PROCEDURE document from the HOSPITAL indicating that the patient having a procedure has NO IMPLANTS. I find it curious since the HOSPITAL'S RADIOLOGISTS CONTINUALLY IDENTIFY METAL RODS AND IVC FILTERS IN the same patient's studies. This is one way that the care and management of the patient's case is continually going awry. Precautions should be taken with anybody who has an implant to avoid infections and the HOSPITAL RECORDS for this Patient NEVER IDENTIFY that the patient has IMPLANTS. In this chart, the patient was already resident in the facility for 18 days, yet nobody corrected the facts of the patient's condition and risk factors. The patient has also been diagnosed with resistant organisms during this inpatient stay, yet physicians have noted in the chart they are of no importance and may represent COLONIZATION. The nurses have inserted catheters to flush out the patient's ileal conduit bypass during this inpatient stay. If the chart had indicated a metal implant, the nurse would have a chance to correct the oversight of ordering flushing of the ileal bladder without prophylaxis antibiotics and notify the physician the patient needs antibiotics prophylaxis for the procedures. Metal implants can become infected very easily with few bacteria. Bacteremia is an indication for antibiotic care when a patient has an implant including 'metal rods in the spine'. It's very difficult to get infected metal rods out of the spine of a patient with a spinal cord injury and has an infection. It's a serious complication of care. The patient has infection and no antibiotics. In addition, the patient might be taken accidentally to the MRI for radiological studies. If the notes in the chart accurately indicated the metal rods implanted or the IVC filter, anyone ordering a radiology study would be made aware. Anyone transporting the patient to radiology would be aware and correct any order for MRI. The fact the chart does not indicate metal implants also prevents the physician from considering infected implant when diagnosing the patient's symptoms, and counseling the patient about how to avoid infections that might compromise his life.