MADD MEDICINE

Progress & Changes

noreply@blogger.com (Marinna Cook, RN, CLNC) — Fri, 30 Dec 2011 04:26:00 +0000

We are currently going through a few growing pains, so please excuse our current progress. Our primary phone number has now changed. Our phone number is now 1-877-347-6557. We now have three locations to better serve our clients across the country. Our office locations are now in California, Alabama & Florida. Our business operations will resume on Monday, January 2, 2012, and we look forward to a new year with our clients. We wish everyone a happy and safe new year.

The Role of Cytotec in Obstetrics

noreply@blogger.com (Marinna Cook, RN, CLNC) — Mon, 25 Apr 2011 01:56:00 +0000

As a legal nurse consultant who has also been a labor & delivery nurse for more years than I care to count, I review many medical malpractice cases where the underlying issue is Cytotec. For those of you who do not work in labor & delivery, Cytotec is also known as Misoprostol and was FDA approved for gastric ulcers many years ago. It is also an effective drug when used properly for the induction or augmentation of labor which is also known as "off-label use".

The problem with Cytotec often occurs when obstetrical caregivers become complacent with its use. First, they seem to forget that Cytotec's use in obstetrics is not FDA approved for that purpose. This creates controversy surrounding the use of the drug and liability issues when careful scrutiny is not taken to ensure the indication for its use in obstetrical practice is consistent with current standards of care. Nurses must realize they will have to answer serious questions at deposition regarding the indication and monitoring of patients who have received Cytotec for induction or augmentation purposes.

Next, Cytotec is widely used in obstetrics primarily for its ability to produce rapid labor progression. It is often referred to in obstetrical circles as "Cytoblast" which offers an indication of how the drug can effect labor progression. Nurses should always be aware of the role this drug plays in uterine contractions and the response of the fetus to it. Close monitoring of the fetal heart tracing as well as contraction pattern should be maintained after administration of Cytotec.

Third, Cytotec should never be used for induction or augmentation on pregnant women who have had a previous cesarean section. The risks of uterine rupture creating significant liability issues are far too great. Nurses should also question physicians who order Cytotec with an admitting dignosis of a "non-reassuring fetal heart rate". This could also create liability issues down the road if the outcome is not good. For any other questions or concerns regarding the use of Cytotec in labor, you may contact us at 1-877-347-6557 or email at mcook@cook-legalnursing.com.

IV Infiltration Injuries in Infants

noreply@blogger.com (Marinna Cook, RN, CLNC) — Thu, 10 Mar 2011 15:46:00 +0000

An IV infiltration or extravasation injury to an infant or child while hospitalized can be devastating. You trust every precaution will be taken to ensure your child's safety when you place your child in the care of medical professionals.

When it comes to IV therapy, hospitals and medical professionals have a duty to follow certain standards of care to protect patients, especially infants, from IV infiltration and extravasation injuries. These standards of care include:

Following proper procedures for IV placement and insertion
Routine and frequent monitoring and assessment of IV site
Applying transparent dressing over IV site
Properly securing the IV catheter to extremity
Diligence in checking the IV site for coolness, swelling, or color changes.
Ensuring proper function (infusion or flow) of IV fluids
Checking for signs of infiltration

The following are terms and definitions that may help you better understand the types of injuries associated with IV infiltration:

IV Infiltration
When an IV slips out of the vein and the fluid escapes into the surrounding tissue. This may cause injuries from a small amount of edema (swelling) in the affected area or severe, causing tissue death.
Extravasation
Occurs at the IV site and surrounding tissue when there are actual changes in appearance or temperature. There may be edema along with blanching, coolness, blistering, discoloration and tightness to the area. The severity depends on the type of fluids and/or medications that have infiltrated the area as well as the length of time before the infiltration was discovered.
Compartment Syndrome
When the compartments around the affected site become filled with fluid restricting the muscles, nerves, and vessels within the compartments. This can result in severe pain and tissue death.
Fasciotomy
Surgical Procedure done to relieve tension or pressure as a result of compartment syndrome and treat the resulting loss of circulation to the area of tissue or muscle.

IV infiltration and extravasation injuries to children can be more severe and harder to detect than injuries to adults. Children cannot express pain or irritation the same as an adult. Often they cry because the IV hurts but the medical staff attributes their crying to something else and fails to check the IV site. As a result, IV infiltration or extravasation can go undetected for a longer period of time. If timely assessment of the IV site is not performed, harmful fluids and medications infiltrate into the tissues surrounding the IV site rather than the bloodstream. The longer the infiltration goes undetected, the worse the injury becomes.

Without medical training or experience, it is difficult to assess the care surrounding an IV infiltration injury and determine if a breach of the standard of care occurred. A review of the medical documentation must be done by someone trained to evaluate the medical evidence. This is usually done after you have consulted with an attorney. A legal nurse consultant will usually review the records to determine whether you have a cause of action against a negligent doctor, nurse, or hospital. The attorney will then advise you of your rights and provide straightforward information about how to proceed.

If you have any questions regarding IV infiltration, you may contact us at mcook@cook-legalnursing.com or call us at 1-877-347-6557.

Monday Med Mania

noreply@blogger.com (Marinna Cook, RN, CLNC) — Mon, 28 Feb 2011 19:56:00 +0000

Handwashing Reviewed

It's not that I like bringing up old topics that seem to be worn into the ground, but every so often I find it necessary to emphasize the importance of handwashing. Unwashed or improperly washed hands are a very common way of spreading nasty critters that cause disease such as colds, flu, ear infections, strept infections, staph infections, diarrhea, vomit viruses and other intestinal problems.

It is the routine things we do every day without even thinking about it that pass along these germs and viruses such as handling food, touching doorknobs, shaking hands, and even talking on the phone. However, the single most important thing we can do to keep these uninvited guests from invading our lives is proper handwashing.

First, frequent handwashing is extremely important expecially when the following is involved:
Before handling food or eating

After using the bathroom
After sneezing, coughing or blowing your nose
After taking out the trash
After handling money
After changing a diaper
After handling uncooked meat
After playing with a pet
Before touching your face, eyes, mouth or ears

Proper handwashing includes:

Using hot or warm running water
Lathering hands with soap
Rubbing hands togethor for at least ten seconds
Washing the back of the hands, between fingers and under fingernails
Rinsing with warm water
Patting hands dry
Turning off the water using a paper towel

According to the U.S. Centers for Disease Control and Prevention (CDC), handwashing is the most avilable "low-tech" prevention of illnesses. Developing a routine habit of frequent handwashing will help transfer that habit to others and prevent illnesses and infections in households as well as pofressional offices, restaurants, medical facilities and clinics.

Monday Med Mania

noreply@blogger.com (Marinna Cook, RN, CLNC) — Mon, 14 Feb 2011 17:00:00 +0000

Time Out Procedure

I consulted on a case that rested solely on the "Time Out" procedure used in the operating room. All the documentation was neatly in order, yet somehow the patient ended up having the wrong part removed. Finally, inconsistent stories emerged as each inidividual member of the surgical team was deposed. The deviations in standards of care surrounding the "Time Out" procedure were clearly identified:

The operating was noisy during the "Time Out"
The attending physician was not even present when the "Time Out" took place
A right-left distinction was never identified during the "Time Out"

Surgical team members must remeber that the "Time Out" procedure was put in place for a reason. We don't do "Time Out" just to satisfy Joint Commission requirements - We do it to protect the patient. The attending physician has to be present, and the "Time Out" must take place just prior to the surgery in a quiet room. A right-left distinction must be clearly identified, and if the surgery requires more than one procedure, a new "Time Out" must be done before each individual procedure. This process eliminates the risk of wrong site, wrong procedure or wrong person surgery.

I came across one facility's Universal Protocol on the internet for "Time Out" procedure which identifies the process that must be followed: Universal Protocol - Time Out. This may help those that need clarification with the process. There are also some helpful videos on YouTube that actually simulate the process as well. For more information on "Time Out" Procedures or other Universal Protocols you may email us at mcook@cook-legalnursing.com.

Monday Med Mania

noreply@blogger.com (Marinna Cook, RN, CLNC) — Mon, 07 Feb 2011 19:50:00 +0000

Pain Assessment Doesn't End with Pain Scale

As a legal nurse consultant I review massive amounts of medical records. Part of that review includes pain assessments of which I can say without hesitation hardly ever provide a sufficient description of patient pain. I'm sure all nurses understand that pain scale was integrated into nursing documentation to help standardize an important part of pain assessment; however, many nurses still do not grasp the concept that pain assessment does not end with pain scale.

I review many medical records that will note a pain scale above zero describing pain intensity and/or severity which then leaves me hanging with many questions regarding a more descriptive evaluation of pain:

Where is the pain?

When did the pain start?

Is this pain the same as previous pain or something new?

Is the pain constant or intermittent?

How long does the pain last?

How long is the absence of pain?

What type of pain is it? Burning, Stabbing, Dull, Cramping, Pulling, Tearing, Throbbing, Tingling, Aching, etc.?

Is the pain deep or superficial?

Can the patient describe if the pain feels like it originates from bone, muscle, organs or skin?

Does the pain radiate or is it isolated to one specific area?

What relieves the pain?

What exacerbates the pain?

Is the pain associated with anything specific? Food, Activity, Exposure, etc.?

Are there any associated symptoms with the pain?

What are the nonverbal signs? Facial Expressions, Crying, Body Movements, Guarding, Position, etc.?

What are the paitient's current vital signs?

If all these questions can be answered within a pain assessment then there is sufficient documentation regarding patient pain. Even when patients are admitted for pain, a nurse must never assume the paitient's complaint of pain is derived from the same origin as the presenting complaint. An adequate pain assessment is required routinely to determine if the pain is the same or something new, and that can not be determined with a pain scale alone.

Monday Med Mania

noreply@blogger.com (Marinna Cook, RN, CLNC) — Mon, 31 Jan 2011 06:40:00 +0000

Coordination of Response to Obstetrical Emergencies

Since my area of specialty is high risk obstetrics, I spend a lot of time reviewing and analyzing medical records relative to obstetrical malpractice cases. As an obstetrical nurse for almost twenty years it really gives me a lot of grief when I review medical records to realize coordination of response to obstetrical emergencies has been mismanged to the point of malpractice. This seems to be a constant within almost every malpractice case I review.

The major elements that fall within this issue include:

Failure to anticipate and prepare
Failure to commuicate
Failure to fully understand responsbilities

Obstetrical nurses must understand that the possibility of obstetrical emergencies can occur at any time, especially when high risk patients and/or use of induction agents are involved. A poorly coordinated response results in panic and chaos ultimately creating a situation that places both mother and baby in danger. A poor outcome is then directly contributed to events that were both avoidable and incompetent.

The use of emergency simulation drills on obstetrical units does help to better prepare for obstetrical emergencies; however, all staff including physicians must be on board to effectively coordinate the response. On the other hand, if the obstetrical staff fails to acknowledge the reality of a high risk situation, then simulation drills are rendered useless.

For coordination of response in obstetrical emergencies to be effective there are four seperate and distinct factors that must take place:

Anticipation
Preparation
Communication
Delegation

These are the four factors I identify within medical records of an obstetrical malpractice case. I really hate to say it, but most of the cases I am asked to consult for will reveal a breakdown in one or more of these four areas. With the number of obstetrical law suits escalating, it is imperative that obstetrical nursing supervisors properly educate their staff the significance of obstetrical emergency response.

For more information on this subject matter and obstetrical staff education, contact Marinna Cook, RN, CLNC at mcook@cook-legalnursing.com or call (661) 368-2290.

Monday Med Mania

noreply@blogger.com (Marinna Cook, RN, CLNC) — Mon, 24 Jan 2011 17:23:00 +0000

Self-Serving Notes: What are They?

I recently had someone ask me to explain a self-serving note. She had heard the word thrown around by an attorney relative to a medical malpractice case, but was too nervous to ask the attorney what a self-serving note really was. A self-serving note is just as it sounds. Chances are if you read something in a medical record that appears as if the writer swooped down from the sky like a super-hero wearing a cape and a Big "S" on their chest to save the day, it was probably a self-serving note.

I am sure you have heard the old cliche, "If it sounds too good to be true- it usually is!" The same goes for a self-serving note.
Self-serving notes will always appear to be appropriate, because they have been meticulously drafted after a catostrophic occrrence. Instead of presenting the facts as they occurred, the information within the note will actually be "too perfect."

As a legal nurse consultant, I can tell you that we can spot those immediately within the medical records of a medical malpractice case. If a procedure goes terribly wrong but the note written by the physician or nurse appears as if every single intervention was done perfectly then it was probably self-serving documentation.

It seems to be human nature to want to cover your tracks in the face of catastrophe. Afterall, the general rule within the medical community has always been if it was not documented it was not done. However, as a legal nurse consultant I see things much differently. I guess it is my skepticism that allows me to have this different perspective - Just because it was documented, does not mean it was actually done. It is my job to piece together the facts, and if the facts don't fit the documentation there is probably self-serving activity involved.

As a medical provider you don't have to be guilty of any negligence or medical malpractice to be guilty of self-serving documentation. Elaborate narratives embelished to create intriguing stories are usually self-serving after an unusual event has occurred. This will look extremely suspicious to a legal nurse consultant who will investigate the matter further, and probably have you answering questions regarding that story at deposition. So, a word of advice for documentation after a catastrophic event, just stick with facts, don't embelish and don't pretend to know something that you don't.

Monday Med Mania

noreply@blogger.com (Marinna Cook, RN, CLNC) — Mon, 17 Jan 2011 18:13:00 +0000

What is Informed Consent?

I have actually consulted on several medical cases that related to the issue of informed consent. What patients as well as physicians need to realize is that consent is much more than just a patient's signature on a authorization form. It is actually a legally binding contract between the patient and the physician. In order for consent to be provided three seperate and distinct elements must be validated:

The patient must be competent and able to provide consent of their own free-will.
The patient must have an understanding of what they have agreed to.
The patient must have enough information on which to base a decision.

When I first became a nurse many years ago we were expected to give the patient all the required information and have them simply sign the consent. Those days are no more. Physicians who continue to practice in this manner are asking for serious liability issues. It is the physician's sole responsibility to inform the patient of the risks, benefits and alternatives associated with the specific procedure or treatment. Any failure to disclose a small piece of that information by the physician can render consent as invalid.

The most recent case I worked on involved a situation where the physician failed to mention to the patient that the procedure was actually contraindicated under the circumstances. The consequences were devastating for the patient and family. The physician thought he was covered by documenting the patient's understanding of the risks involved with the procedure. However, the physician's failure to disclose that the procedure was contraindicated rendered the patient's consent invalid. In this case there was not enough information for the patient to base a decision.

Physicians need to understand that selective inclusion of information does not qualify as adequate information for informing the patient of risks, benefits and alternatives. The prevailing standard of care is that a physician must inform the patient of whatever a reasonable physician would inform the patient under the same or similar circumstances. In some cases this may require expert testimony from expert physicians to determine what a reasonable physician would do.

However, some states are now forgoing expert testimony in favor of new standards which require a physician to provide whatever information is needed for the average patient to make an informed decision. Whatever the case, patients need to be given the facts and not an opinion. Informed consent should allow patients to participate in their own healthcare decisions and not manipulated into them.

Monday Med Mania

noreply@blogger.com (Marinna Cook, RN, CLNC) — Mon, 10 Jan 2011 20:57:00 +0000

What's Up With Darvocet?

I was first prescribed Darvocet back in 80's for pain after removal of my wisdom teeth. I didn't know a lot about pain medicine back then, but I remember thinking that my Darvocet didn't work very well as far as relieving my pain. I think I actually took three tablets out of the bottle and the rest sat in my parents medicine cabinet for years. Three months later I was diagnosed with a heart murmur. I have no way of knowing if those three Darvocet tablets contributed to my diagnosis, but the recent recall of Darvocet does give a reason for concern.

The FDA's recommendation and health alert requested that companies voluntarily withdraw propoxyphene (Darvocet or Darvon) from the market. The FDA also issued a statement, "the safety risks to patients outweigh its benefits for pain relief at recommended doses." Therefore, if you are currently taking these drugs it would be in your best interest to contact your physician as soon as possible.

If you are still unsure about what to do if you are taking Darvocet, the FDA recommends the following guidelines:

Talk to your healthcare professional about discontinuing propoxyphene (Darvocet or Darvon) and switching to alternative pain medication.
Talk to your healthcare professional about any concerns you may have.
Contact your healthcare professional immediately if you experience an abnormal heart rate or rhythm, palpitations or other symptoms including dizziness, lightheadedness or fainting.
Report any side effects with propoxyphene to the FDA's MedWatch program using the link provided.

For questions regarding disposal of unused propoxyphene in your household, follow the recommendations outlined in the Federal Drug Disposal Guidelines.

Let Us Help You Obtain Your Social Security Disability Benefits

noreply@blogger.com (Marinna Cook, RN, CLNC) — Sun, 09 Jan 2011 07:40:00 +0000

If you are disabled and unable to work we can provide the assistance you need to obtain the benefits you deserve. Don't waist your valuable time trying to file your claim alone - we can help! Click the link below to find out how we can help you win your benefits:

Get My Social Security Disability Benefits!

The Resolution Revolution

noreply@blogger.com (Marinna Cook, RN, CLNC) — Wed, 05 Jan 2011 08:21:00 +0000

The start of every year is filled with new resolutions usually regarding health. Many will vow to stop smoking, lose weight, swear off sugar, start an exercise program or simply increase overall fitness. I have to admit I am usually one of the many who vow to lose weight and fail miserably well before the year’s end only to declare the same resolution for the next year. Unfortunately, failure is actually a very ugly connotation for me. I never like to admit I have failed at anything; therefore, I chose to consider my lack of success thus far a loss of several battles in the resolution revolution.

For 2011 I have developed a different plan of attack. Rather than declaring the same resolution with the same end result I am simply focusing on taking baby steps toward changing my eating habits. Like many business people, my time is a huge issue which tends to frequently undermine my ability to eat healthy. This year I am really focusing on changing my strategy to planning ahead.

Since every day of my business week begins with a well constructed to-do list, I certainly believe I can incorporate my meals into that same list.This will certainly involve a little extra effort on my part, but it is a much better solution than the same old diet and exercise plan that seems to fail every year. By focusing on planning ahead to change eating habits, the ease of implementation becomes part of my daily routine. The goal is to accomplish this one task and transition into the next.

By revealing my resolution for 2011 I hope I can help someone else develop a plan for their health this year. Health and healthcare are major issues for Americans to think about this year, and we all need a goal that is simple and realistically doable. Success at small goals creates the inspiration and motivation to battle the large ones. Good luck in 2011 with your resolution!

Monday Med Mania

noreply@blogger.com (Marinna Cook, RN, CLNC) — Mon, 03 Jan 2011 18:11:00 +0000

Focus on Healthcare in 2011

Now that we have swept away all the confetti, cleaned up the remnants of fireworks and washed away the stickiness from spilled champagne, it is time to focus on 2011. As we move into the new year we know healthcare will in fact be a primary concern. As our nation struggles with healthcare reform we know that three major provisions have already taken effect as of the first day of our new year:

Insurance companies are now required by law to spend more of the premiums to pay claims and improve health rather that pocketing such enormous profits.
Seniors will now receive a break on the cost of prescription drugs.
Seniors will also receive some free preventive services such as annual wellness visits and personalized prevention plans.

In reveiwing these provisions it seems that our government is beginning to understand that keeping people well is the key to truly providing healthcare reform. One would think that insurance companies would have realized a long time ago that providing assistance to keep people healthy rather than waiting for them to get sick would have increased their bottom line. Time can only tell what the insurance industry's response will be to such a major reduction in profits, but at least some are starting to get on board with wellness promotion.

Happy Holidays from Cook & Associates

noreply@blogger.com (Marinna Cook, RN, CLNC) — Wed, 22 Dec 2010 19:54:00 +0000

We will be out of the office to celebrate the Christmas and New Year holiday from Thursday, December 23 until Monday, January 3. We will resume regular business hours, 8:30 am to 5:00 pm on Monday, January 3, 2011. We wish all of our wonderful clients a happy holiday and hope you and yours ring in a happy new year!

Monday Med Mania

noreply@blogger.com (Marinna Cook, RN, CLNC) — Mon, 20 Dec 2010 22:26:00 +0000

Be On The Lookout for "Monday Med Mania" by MADD MEDICINE.

Mondays are kind of dreary for everyone as they begin the start of a new work week. In an effort to move Mondays along with some interesting facts related to medical, nursing or healthcare issues, we will begin providing "Monday Med Mania" starting Monday, January 3, 2011. We want you to join us as we bring in the new year with helpful information to guide you through those boring Mondays, so be on the look-out for our "Med Mania" information.

WE WILL SEE YOU THERE!

When Nurses Lose Their Way

noreply@blogger.com (Marinna Cook, RN, CLNC) — Wed, 15 Dec 2010 18:56:00 +0000

I remember years ago when I first entered the nursing workforce, I was full of such ideals and optimism. Like most new nurses, I always had high aspirations and approached each day with enthusiasm and a smile firmly in place. Unfortunately, my aspirations were soon crushed when I met a nurse of thirty years who's lousy attitude caused me to rethink my future.

I didn't understand at first how a nurse with so much experience and knowledge to offer could be such a difficult person to get along with. Her dreadful personality was so contemptuous that even the physicians went out of their way to avoid her. She was rude, intimidating, insulting and just outright nasty.

It wasn't until her behavior began to cross the boundaries of patient satisfaction that administration began to take notice. After mounting patient complaints administration could no longer ignore, the nurse with a lifetime of experience was let go. At first, I was left with the question of how this nurse could have gotten so lost in her own insolence. Unfortunately, as time went on, I began to see a pattern emerge.

Nursing is an extremely harsh area for a long term career. It completely sucks the life out of many who dare challenge its enormity. The values that nurses hold dear are persistently tested as their internal conflicts seem to endlessly collide with their external controversies. Nurses who get lost in the wake are not at all uncommon to the profession, and "burnout" is the end result. This leaves some with bitter emotions feeling as if there is no way out.

When this does occur, I think it is time for the nurses with a lifetime of experience to take time to learn from the new nurses entering the work force. It is time to sit back and remember the ideals that brought us into nursing in the first place. Our opportunities to grow are endless but only if we allow them in. So, in those futile moments when we think we will self destruct, we must remind ourselves why we are there and understand that our presence never goes unnoticed by those who need us most.

Managing Medications in the Elderly

noreply@blogger.com (Marinna Cook, RN, CLNC) — Tue, 14 Dec 2010 04:10:00 +0000

As people age they become much more vulnerable to medication mistakes. An increase in illnesses with age means more trips to various physicians as well as pharmacies with multiple prescriptions and/or possible double dosing. This creates a potentially dangerous situation if the medications are not managed properly.

The aging population is usually a group that is diligent in compliance with their treatment regimen. They want to feel better; therefore, they take every medication prescribed to them without quesiton. Unfortunately, this can be a risky circumstance if the medications are not carefully scrutinized.

Here are some simple tips and facts to keep in mind when managing medication for the elderly:

Always bag medication and take it to every physician visit. This includes all prescription, over-the-counter medications, vitamin supplements and herbal remedies. The Ohio Patient Safety Institute has a great "tool kit" for a medication review.
Try to use the same pharmacy and/or pharmacy chain as much as possible. Pharmacists can only monitor medications they have documented, so it is always best to be consistent.
Be aware that some medications have more than one name. For example, the extremely potent cardiac medication, Digoxin, is also known as Lanoxin, Lanoxicaps, Cardoxin and Digitek. There have been cases where elderly patients were found to be double-dosing on the same medication but with different names.
Understand that physiological effects of aging render some medications inappropriate for use in elderly paitients. The Beers list is the best source for information regarding medications that are inappropriate for use in the elderly.
Be aware that the effectiveness of some medications change over time as well as the potential for adverse reactions. The patient may benefit from a medication at the beginning of treatment with no side effects; however, the benefits may be much less over time with increased side effects.
Read the package inserts of all medications and identify potential adverse reactions and any possible reactions with other medications.
When in doubt always question the physician or pharmacist.
Be aware of any physical changes or changes in behavior or mood after adding a new medication to the treatment regimen.
Use the internet to gain information about the medication. The internet is invaluable for obtaining information about pharmaceuticals but always review and compare several sources in the process.

For family members and caregivers attempting to manage medications in the elderly, it is always much easier to follow a systematic approach including the above guidelines when developing a plan. All family members and caregivers should work togethor as a team in medication management to ensure every one is on the same page. For more information on medication management in the elderly you may email us at mcook@cook-legalnursing.com. We will answer you questions promptly.

Surgical Fires Do Happen

noreply@blogger.com (Marinna Cook, RN, CLNC) — Sat, 11 Dec 2010 00:29:00 +0000

Although surgical fires are extremely rare, the devastating consequences are still severe. Every healthcare facility should educate and prepare their surgical staff on surgical fire prevention. When I was a nurse traveler at different facilities, some of the facilities required surgical fire education as part of the orientation process. Others considered it a rare occurence and did not even address the matter.

The ECRI Institute offers simple but efficient downloadable instructions on surgical fire prevention as well as emergency procedures for extinguishing fires. For more information on preventing surgical fires you may contact me at mcook@cook-legalnursing.com.

Surrender Your Stockpile

noreply@blogger.com (Marinna Cook, RN, CLNC) — Thu, 09 Dec 2010 01:25:00 +0000

How many bottles of old pain killers do you have hiding in your medicine cabinet? That's a question most people don't think twice about until some unsuspecting addict finds their way into it.

As compliant patients most of us gladly fill our prescriptions for opiate pain killers after a surgical procedure but actually consume only a few, leaving the rest to sit unobtrusively in the medicine cabinet. Unbeknown to most of us, our medicine cabinets have actually been flashing targets for drug addicts waiting to consume the left overs.

For those of you who think this can't happen to you - think again! A few years ago my best friend was suffering from diabetic neuropthy and would have periods of severe pain. Her physician prescribed Methadone, a synthetic opiod, which she only took for her most severe moments. For the most part, the bottle remained in the medicine cabinet until the day a new housekeeper showed up.

Upon emerging from the bathroom, the housekeeper was suddenly found to be incoherent and unable to get up off the floor. Thinking that the housekeeper was having a stroke, my best friend called an ambulance. It wasn't until the ambulance arrived that the empty bottle of Methadone was discovered in the trash.

Methadone is an extremely potent pain killer and is also used in the detoxification process for heroine addicts. Unfortunately for my best friend, she had no idea the new housekeeper was an addict. The housekeeper did recover from her overdose but never to clean houses again.

As incidents like this one have become more prevalent, police departments across the country are setting up events to "take-back" narcotics and potentially harmful medications that no longer serve a useful purpose in our medicine cabinets. Everyone is encouraged to surrender your stockpile to prevent these medications from falling into the hands of addicts, drug dealers or overly curious children and teenagers.

For information on how you can safely "Surrender Your Stockpile", contact your local law enforcement office.

Is There A Consent For That?

noreply@blogger.com (Marinna Cook, RN, CLNC) — Tue, 07 Dec 2010 04:51:00 +0000

I don't think when a preoperative patient is given risks, benefits and alternatives by the surgeon that leaving a surgical instrument behind is the alternative the patient has in mind. Leaving the patient with "souveniers" to remember the occasion is not a memorable experience patients should be left with, yet it is a reality behind the confines of operating rooms across the country.

The actual statistics for this problem are unknown since a barrier of silence exist among staff members. Physicians never like to admit they are human, and nurses don't want to lose their jobs.

The current mechanism in place to prevent retained surgical objects in the operating room is in itself flawed due to one major problem: Human error. Counts of all instruments and sponges have to be taken preoperatively, perioperatively and just before closing; however, in some cases counts have been noted as correct when in fact there were retained surgical objects. Consistency in adherence to patient safety protocols seems to be deficient in these circumstances as surgical team members become too complacent with routine standards.

The cost to remove retained surgical objects can run thousands of dollars making the expense of human error a most costly as well as hazardous circumstance. The patients are ultimately the ones who suffer the consequences. There have even been some cases where surgical objects were not found until months or even years later.

Interruptions, distractions and chaos seem to play the biggest roles as the underlying causes of retained surgical objects. During my clinical career, most of the cases I have been aware of involved emergency cesarean sections with massive blood loss along with too many staff members in the operating room creating chaos.

Unfortunately, there is no room for error when is comes to surgical counts. The established standards of care should never be compromised with human oversight. As the challenges of manual counts continue with complicated cases, many facilities are searching for new technology to prevent such errors in the future.

Until then, the surgical team should always obtain an x-ray to reveal any foreign bodies at the end of complicated cases or when any question is raised regarding counts during the procedure. It is a simple, yet time-consuming solution. However, in these circumstances the entire surgical team must prioritize patient safety over impetuous completion. The surgical team needs to remember that the patients sign surgical consents based on the understanding they will receive compentent treatment, and somehow I don't think retained surgical objects ever fit into the category of competent treatment.

Introducing OB Insider

noreply@blogger.com (Marinna Cook, RN, CLNC) — Sat, 04 Dec 2010 21:31:00 +0000

Cook & Associates is officially announcing our latest project, OB Insider. The quarterly newsletter will offer a glimpse into the world of obstetrics revealing what goes on behind the scenes as well as provide educational information.

The one page newsletter is short and openly candid but promises to enhance the knowledge of those who want to delve into the heart of obstetrics. To obtain your free subscription visit us at www.cook-legalnursing.com or email us at mcook@cook-legalnursing.com.

Medicare's Muddle

noreply@blogger.com (Marinna Cook, RN, CLNC) — Wed, 01 Dec 2010 20:38:00 +0000

As a legal nurse consultant one of my many jobs is determining Medicare's interest and developing allocation reports for Medicare Set Aside arrangements in workers' compensation cases. The complexity of Medicare rules and regulations have about as much attention grabbing appeal as listening to a lecture on cold fusion. Most people don't get it nor do they really want to.

This confusing as well as debatable topic continues to have even attorneys perplexed as some still have not fully grasped the concept of the Medicare Secondary Payer Act of 1980. So, how does a law that was passed in 1980 still get overlooked in 2010? The truth is enforcement of this law has been historically lax until recently. For a couple of decades attorneys were allowed to walk workers' compensation settlements through the court system without addressing Medicare's interest, leaving Medicare to pick up the tab for billions of dollars.

We all know how government "red tape" delays processing, so I guess it took the federal government a few decades to realize how much money they were actually losing in the maze of secondary payer mandates. As the Centers for Medicare and Medicaid (CMS) contrive to avert further losses, proactive enforcement has now become a multi-edged sword aimed at all parties involved in worker's compensation cases.

The federal government has now made it abundantly clear that the age-old expression, "That's not my job," will no longer be an acceptable excuse when addressing Medicare's interest. If Medicare's interest is not addressed in workers' compensation settlements the end result can be harsh penalties not only for the claimant, but for the attorneys, medical providers, insurer and employer as well.

With the obligation to protect Medicare's interest now firmly established as a contributory responsibility, the process of determining exactly what that interest is lies with those who enjoy the art of collective reasoning. For those who are new at this perpetual paper chase it's time to sit back and buckle up - it's going to be a long ride.

For more information on Medicare Secondary Payer issues or Medicare Set Aside visit my website: www.cook-legalnursing.com or test your Medicare Secondary Payer knowledge on my Hubpage now.

Beware of Internet Health Information

noreply@blogger.com (Marinna Cook, RN, CLNC) — Wed, 01 Dec 2010 17:18:00 +0000

Have you been looking for information about your new diagnosis on the internet? If you have, here are a few words of caution, "Not All Internet Health Information Is Created Equal." It would be wise never to take the first internet health information you come across at face value.

I spent many years as an obstetrical nurse, and I can't even begin to tell you the number of times patients asked me questions regarding information found on the internet that turned out to be complete myths. The problem with "Old Wives Tales" plastered all over the internet is that they can actually be harmful to your health.

Several years ago I had a patient show up in triage vomiting profusely. She was around 30 weeks gestation. Initially, I thought she had contracted a virus; however, as I began to question her the story became really bizarre. It seems she was extremely sensitive to cold, and the weather had been quite chilly for several days. In an attempt to warm herself up the patient looked to the internet for information. Well, she found it. I was in utter disbelief to realize the patient had ingested four jars of Vicks VapoRub® for the purpose of "melting the chill off her bones." I won't elaborate on the rest of the story other than to say the patient was extremely sick for several days due to misguided information.

As you can see, internet health information should always be approached with caution. Any and all information that requires the ingestion of a substance should be carefully scrutinized and discussed with your physician. If you do not understand how to identify fact from fiction on the internet, I have created a simple guide available for free referred to as The COPC Patient Guidelines to WWW. This guide will allow you to easily navigate internet health sites to determine their validity.

Greetings Everyone

noreply@blogger.com (Marinna Cook, RN, CLNC) — Wed, 01 Dec 2010 01:17:00 +0000

Welcome to my new blog, MADD MEDICINE. I have, in fact, chosen this title, because the healthcare industry can be quite madd at times. As a legal nurse consultant it is my goal to educate and provide awareness of subject matter as well as offer my perspective on medical, nursing and healthcare related issues. The content will at times be ludicrous, meniacal, confusing or controversial but will always be informative.

I hope you will find the information within this blog both interesting as well as useful. For any questions related to information within this blog you may visit my website or email me from my profile link.

Thanks for visiting.

noreply@blogger.com (Marinna Cook, RN, CLNC) — Tue, 30 Nov 2010 22:28:00 +0000