Archive for July, 2009

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Reform Watch: Insider Exposes Insurance Industry’s Practices; Obama Says Nurses Know Health Care Best

July 21, 2009

Kaiser Health News draws attention to a WSJ story about a former health insurance PR insider who’s been speaking out against insurance practices and the industry’s attack campaign against health care reform:

A former health insurance spokesman speaks out against insurance practices. The Wall Street Journal/Dow Jones reports: “Wendell Potter, former chief spokesman for health insurer Cigna Corp., describes himself in his Twitter bio as a ‘journalist who spent 20 years undercover as HMO PR flack, now writing all about it.’ While Potter chuckles about the line, he is serious about his foray into the U.S. health reform debate, where he is campaigning for a public health-plan option and, with mild delivery and tough words, targeting what he calls ‘deceptive and dishonest’ tactics of a for-profit health insurance industry that’s fighting such a plan.” 

And in an interview with NPR (full transcript here), President Obama calls nurses ”the people who know health care best” and says they are among those who know why we need health care reform:

JIM LEHRER: And you’re not — you will not be satisfied by somebody or some group or somebodies that say, “Well, OK, let’s do it — but we can’t do it now; we have economic things to do. We have other things in the economy to deal with; let’s wait a year, let’s wait six months. Forget it, huh?”

PRESIDENT OBAMA: If not now, when? We have literally been waiting 50 years and we still haven’t gotten it done. And the longer we delay, the more those special interests that benefit from the system as it is, the more they are going to fight change. And when you’ve got doctors, nurses, hospitals, the AARP and even the drug companies — as well as major employers like Wal-Mart — saying now is the time for us to bring about some change, I think it’s time for us to bring about some change.


Interested in joining an American Nurses Association (ANA) campaign that’s getting nurses involved in fighting for health care reform? Click here.

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IOM Commission on Future of Nursing: Help or Waste?

July 21, 2009

Today, Modern Healthcare published an article (free, but registration required) on the new Institute of Medicine’s Commission on the Future of Nursing, noting that some people believe that it is misguided because it doesn’t include a union representative or staff nurse, and that we already know what is needed to improve nursing and the lot of nurses. It’s clear from the composition of the Commission that the members were not intended to represent specific organizations. The fact that there is a new (2008) graduate who is a member speaks to the need for fresh insider perspectives. While we’ve emphasized acute care in the profession, health care reform is expected to shift more of the care to the community and primary care. So maybe the nurse midwife on the committee is a good selection. Read the rest of this entry ?

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Is Health Information Technology a HIT with Nurses?

July 20, 2009

HITarticlescreenshot
“Don’t design an information system and then say, ‘OK, now let’s change our workflow to make the system work.’ First, design the most effective workflow that delivers safe, efficient, high-quality patient care. Then ask ‘How will this system enable me to do that?”‘ —Linda Burnes Bolton, vice president and chief nursing officer at Cedars-Sinai Medical Center in Los Angeles

Health information technology (HIT): it’s a hugely complicated topic and, with $19 billion in federal stimulus funds accelerating its adoption by medical offices and hospitals, it’s going to have an increasing impact on the way nurses do their jobs over the next few years. Read the rest of this entry ?

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Readers Comment on Vicodin, Percocet Ban

July 17, 2009
pillsinspace

By wonker, via Flickr.

In his July 6 post on the proposed Vicodin, Percocet ban, AJN editor Jacob Molyneux wrote, “A number of clinicians and patients have expressed alarm at the potential loss of Vicodin and Percocet, both of which are mainstays of pain management in the U.S.” He cited pain expert Carol Curtiss’s concern that such a ban could have “even more drastic implications than most people yet understand,” then asked readers, “Should we worry?”

Some commenters think so:  nester writes

If suddenly the combos become unavailable and pain relief is that much harder to come by, every Tom, Dick, and Harry with a sprain is going to flock to the ER for the good stuff… not once, but daily until the pain is gone or they are refused treatment.  If you can’t go to just any doc to get narcotic pain relievers, the pain relief specialists will have lines out the door also.

And Abigail Nobel says, “Educate before banning these affordable, essential components of pain control. Why should everyone suffer for the carelessness of a few?”

But Judy Newberger says that although she initially agreed with the ban, an interview with an elderly patient who was given Percocet and was already taking acetaminophen changed her mind.

Labels were not read, discharge papers were not thoroughly reviewed. Did no one review what meds he was on before they sent him home? I now am FOR removing Rx and OTC combination pain and other combination meds with acetaminophen.

Thanks to all for your thoughts. There will undoubtedly be more to say, and as always, we invite you to say it here.

–Sylvia Foley, AJN senior editor

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Vaccine Wars Ensue as H1N1 Mutates – Just Alarmist Sci-Fi Fantasy?

July 16, 2009
From Sidelong, via Flickr

From Sidelong, via Flickr

From an AP story about the H1N1 flu vaccine that was widely syndicated today:

Countries with flu vaccine plants might decide to seize all vaccines and ban their export, thus breaking the pharmaceutical contracts promising other countries vaccine supplies. These private contracts are not binding international law between two countries . . .

Picture this: in early September of this year, the novel H1N1 influenza virus mutates into a strain that can quickly lead to wracking fevers, violent vomiting, respiratory failure, dehydration, and death. It is also highly resistant to existing antiviral agents. The first cases of this new strain are identified after a spate of deaths in a Kansas City nursing home as well as among members of a church choir in the same city. The new strain quickly shows up in a number of major metropolitan areas in the U.S. and then in several European countries. As hospitals are swamped and the number of deaths rises unabated, borders are sealed between countries—but it’s too late to stop the new strain from spreading as the fall and winter flu season gets into full swing. 

Luckily, the U.S. has long-standing contracts with several major pharmaceutical companies for the flu vaccine, which has by mid-September entered mass production in several locations. The only problem: up to 80% of the this vaccine is being produced outside the U.S. borders, and the people of the countries in which it is being produced don’t believe their leaders have any right to let those companies honor their contracts with the U.S. if it means a large portion of those countries’ populations will have to wait another several months for vaccination.  Read the rest of this entry ?

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Obama’s Deal with Hospitals – What Does It Mean for Nurses and Patients?

July 16, 2009
From boliston, via Flickr

From boliston, via Flickr

On July 8, vice president Joe Biden announced that in striving to gain support for its health reform plan, the White House reached an agreement with the key hospital groups, including the American Hospital Association, the Federation of American Hospitals, and the Catholic Health Association of the United States.

The deal is a quid pro quo deal: according to the AHA Web site, the associations agreed they will not fight $155 billion in cuts in Medicare and Medicaid payments, in return for assurances that the cuts are linked to expanded coverage. Additionally, if health reform legislation turns out to include a public insurance plan, then hospitals will receive payments higher than the traditional Medicare and Medicaid rates. The idea is that losses from the reduced payments would be offset by insurance payments from the increased numbers of patients who will be covered. Hospitals will have fewer “pro bono” patients to deal with.

So how will this affect patient care and nursing services? Read the rest of this entry ?

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Historic Moment for Health Care – Time to Put Cynicism Aside?

July 16, 2009

Timothy Egan at the NY Times says we’ve reached a historic legislative moment in the U.S. He’s talking about the actual possiblity that health care reform will be passed by Congress. It probably won’t be the version of reform that everyone wants—even so, he argues, it may still lead to a health care system that Americans will someday take for granted and come to see as absolutely essential to their security and quality of life.

Politics is so often a salon sport, with its up-and-down arrows, weekly winners and losers, and reliable hypocrisies providing sustainable entertainment for the permanent class in Washington. But every now and then elected officials do something that has deep and lasting consequences — a generational life-changer.

This happened 44 years ago, with the creation of Medicare, the socialized health care plan for the elderly. At the time, the poorest Americans were more often the oldest Americans. And half of all seniors had no health care coverage.

Are you too cynical at this point to care, do you want things to stay just as they are, or do you actually feel some real hope?

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H1N1 Planning and Response: 10 Steps from the CDC for Medical Offices and Outpatient Facilities

July 15, 2009
CDC Arlen Specter Headquarters and Emergency Operations Center, Atlanta

CDC Arlen Specter Headquarters and Emergency Operations Center, Atlanta

The following was released yesterday by the CDC:

It is critical to assure that medical offices and other outpatient facilities (e.g., outpatient/ambulatory clinics, outpatient surgery centers, urgent care centers, physical therapy/rehabilitation offices or clinics) that provide routine, episodic, and/or chronic healthcare services can manage an increased demand for services in the midst of a novel H1N1 influenza outbreak. Ensuring a sustainable community healthcare response will be important for a likely recurrence of novel H1N1 flu in the fall. See CDC’s H1N1 website for up-to-date information.

1. Develop a Business Continuity Plan – Novel H1N1 flu outbreaks will impact your organization, employees, suppliers of critical materiel, and your family. Identify your office/clinic’s essential functions and the individuals who perform them. Make sure you have trained enough people to properly work in these essential functions and allow for potential absenteeism. Develop a plan that will sustain your core business activities for several weeks. Make sure you have alternate plans for critical supplies in case there is disruption in your supply chains. For information about planning see: http://www.ready.gov/business/plan/index.html.

2. Inform employees about your plan for coping with additional surge during pandemic – Provide clear and frequent communication to ensure that your staff are aware and understand the plan. Explain any policies and procedures that will be used to protect staff and your patients, and to manage a surge of patients. Improve the resiliency of your staff by advising that employees have a pandemic family plan or personal plans.  Read the rest of this entry ?

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Low-Tech Strategies That Significantly Reduce Hospital Infections

July 15, 2009


Sometimes it’s the most basic care that has the greatest impact on health outcomes. A recent article on CNN.com highlights Dr. Alfonso Torress-Cook’s work to reduce the rates of health care–associated infections (HAIs). (Click on the video above to watch a Fox news report about Torress-Cook.) This is a big deal because, according to a 2007 CDC report, there were 1.7 million HAIs in 2002; these were associated with approximately 99,000 deaths in the U.S. That’s a rate of 4.5 infections per 100 admissions, or one in 22 patients.

Torress-Cook’s strategy includes meticulous hand-washing by the staff, head-to-toe cleaning of the patients (including under their nails and oral care), daily cleaning of hospital rooms, giving antibiotics only when cultures prove they are necessary, and feeding yogurt to patients to replenish bacteria in the gut.

In the last year, AJN has featured articles on several of these, including hand-washing, oral care, and appropriate antimicrobial use.

Based on your own experience, what other relatively simple procedures might significantly improve outcomes in the workplace?

Christine Moffa, AJN clinical editor
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Keeping Patients Safe from Criminal Nurses; Keeping Nurses Safe from Assault by Patients

July 14, 2009

In Massachusetts, legislators are making it a crime to assault nurses:

The Joint Committee on Judiciary has scheduled a hearing on Tuesday, July 14, 2009, beginning at 12 noon for testimony on a bill sponsored by State Rep. Michael J. Rodrigues (D-Westport) and Sen. Michael Moore (D-Worcester) that will make it a crime, punishable by up to two years in prison, to assault a registered nurse while s/he is providing health care.

On the other side of the coin, Diana Mason wrote here yesterday about continuing delays in holding criminal nurses accountable in the state of California. Yesterday evening, Governor Schwarzenegger finally took action to remedy the problem:

Late Monday, Calif. Gov. Arnold Schwarzenegger replaced nearly everyone on the state’s Board of Registered Nursing, “citing the unacceptable length of time it takes to discipline nurses accused of egregious misconduct.” The move came a day after a ProPublica and Los Angeles Times investigation into the board’s activity was published.

July 16. This update just in: “The longtime executive officer of the embattled California Board of Registered Nursing resigned Tuesday, ensuring almost entirely new leadership for the agency as it strives to revamp its oversight of hundreds of thousands of caregivers.”

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