A quick overview of the numbers shell game of reform June 29, 2009
Posted by Paul Bond in : News , comments closedSince I took a few days off from posting, I thought I would come back with a little controversy on health care reform. I am not one for big government, nor am I one for increasing government oversight or taxes. And while I still work in health care and see that the system needs to be changed, I do not think our leaders in Washington have the capacity to do this cost effectively, nor with the patient’s best interests at heart.
With that said, let’s look at some numbers
The US census bureau estimates there are 45.7 million uninsured people in the US.
MIT estimates that 13% of these (or 5.94 million people) are undocumented immigrants (or illegally in the US).
About 43% of non elderly uninsured adults (or 19.65 million people) have an income of 2.5 times that of the poverty level (or $45,775.00 for a family of three).
That means that almost 25.6 million people (or 56%) who are uninsured either should not be eligible (are not US citizens), or could afford to purchase some type of basic coverage without government assistance but choose not to.
These numbers don’t include those people who have two jobs – one where they ARE insured, the other where they are not (if you are uninsured at any ONE job, you are counted as being uninsured).
So just how many people are REALLY uninsured who are US citizens? And how much are we thinking about spending to give BASIC coverage to these people?
More numbers to ponder:
The Commonwealth of Massachusetts (one state being used as a role model for federal legislation for health care reform) just cut 12% or $115 million dollars from their state run health care system (it’s called Commonwealth Care). These cuts came in the following areas:
Those who do not designate a primary health provider will not be covered
Dental coverage for 92,000 poor enrollees
Illegal aliens
Slowed reimbursement payments to managed care organizations
So the state being looked at by our legislative leaders who are making the decisions on health care reform for us is actually NOT paying in a timely fashion for coverage they have mandated. So they are doing exactly what they rally against in business (improper business strategies, untimely payment, etc.), AND they are lowering coverage to a bare minimum common denominator for all. In other words, they are dumbing down the system to provide minimum care for everyone……….and no one will get optimum coverage OF health care.
Is this REALLY what we want as universal coverage for the citizens of the US? Is this the type of system YOU REALLY want to work in or be covered by?
Tell me YOUR thoughts on this. I look forward to hearing from you.
Discount for joining PhoenixCE!!!! June 24, 2009
Posted by Paul Bond in : News , comments closedWhen you join at PhoenixCE, you can receive a 40% discount off the price for the archives!! Just use the code “EC36BB51″ on the sign up page and your savings will be calculated! This offer is good through August 1st, 2009 so take advantage of this savings while it’s still available!
Episode 25: Burns Part 2 June 24, 2009
Posted by Paul Bond in : News, Podcast, Site Updates , comments closedEpisode 25: Burns Part 2
In today’s episode, I announce the official opening of PhoenixCE.com. This is the sister site to the podcast, where you can receive continuing education credit for listening to it! Click over, take a look and sign up to start receiving CEU’s just for listening to the podcast!!
In the news today, I discuss two articles:
The first, from Medpagetoday.com, talks about using urine to diagnose appendicitis in children. Researchers have found biomarkers that appear to be 97% specific to appendicitis. A potentially massive breakthrough in helping to diagnose appendicitis (not to mention saving time in the ED)!
The second article is also from Medpagetoday.com and discusses cardiovascular disease, inflammation and the link to death from acute episodes. Researchers have found a link between IL6 and CRP and death from acute episodes of CVD. Another potentially major breakthrough in diagnoses and management of chronic problems.
And finally, I finish discussing burns and their treatment.
Here’s the podcast………….enjoy!!
Podcast: Download
Cover-Up Followed Death in NYC ED According to Report June 20, 2009
Posted by Paul Bond in : News , comments closed
In an article published 19 June, on EMS Responder.com, a report from the New York City Department of Investigation states that employees of a Brooklyn hospital “falsified medical records and lied to authorities in an attempt to cover up the neglect of a patient who died on the waiting room floor”. The report states that a nurse, an ED tech, and a physician all falsified medical record entries in an attempt to cover what really happened.
leukotriene synthesis inhibitors get new warning June 16, 2009
Posted by Paul Bond in : News , comments closedIn an article posted on Medline Plus on Saturday, The U.S. Food and Drug Administration on Friday requested that the makers of a class of asthma drugs called leukotriene receptor agonists place a “precaution” on the drugs’ labeling, warning of the potential for neuropsychiatric events.
Some of the many side effects include insomnia, anxiety, depression, and aggression. Click above to read more!
New form of ibuprofen on the way June 13, 2009
Posted by Paul Bond in : News , comments closedOn 11 June 2009, the FDA approved Caldolor for hospital use only. It’s an injectible form of ibuprofen.
A quote from a news release from the FDA states “In a clinical trial of 319 women who had undergone an elective abdominal hysterectomy, patients were less likely to request morphine for pain on an as-needed basis when administered Caldolor.”
Interesting stuff! Click on the link to read the entire release.
WHO Issues Swine Flu Pandemic — First in 41 Years June 11, 2009
Posted by Paul Bond in : News , comments closedFor the first time in 41 years, the World Health Orgnization has issued a pandemic alert…….for the swine flu.
In an article on JEMS.com, the writers state “On Wednesday, WHO said 74 countries had reported nearly 27,737 cases of swine flu, including 141 deaths. The agency has stressed that most cases have been mild and required no treatment, but the fear is that a rash of new infections could overwhelm hospitals and health authorities _ especially in poorer countries.
Still, about half of the people who have died from swine flu, also known by its scientific name H1N1, were previously young and healthy _ people who are not usually susceptible to flu.”
Episode 24: Burns Part 1 June 9, 2009
Posted by Paul Bond in : News, Podcast, Site Updates , comments closedEpisode 24: Burns Part 1
In today’s episode, I have some very exciting news!
First, I have a newsletter that will be published weekly on Wednesdays. On show weeks, you’ll get a reminder note that the show is out, and on off weeks, you’ll get tips and tricks culled from my 28+ years in medicine/nursing. To sign up, just come to my site and look for the sign up on the right side of the page.
Next, something many of you have been asking about since I began the show almost a year ago. Continuing education credit will be available by the next episode!! To obtain it, all you have to do is listen to the show and then sign in at the new site I’ve set up to handle the testing…….phoenixce.com. At that site, you will be able to take the test and receive your certificate. You’ll also be able to take tests on many of the previous podcasts also. And don’t worry if you haven’t ketp the files. I have the audio only files along with any PDF’s from the podcasts available for download on that site also. Each audio file will be in self extracting zip format so you can download it and listen to it either on your computer or load it back onto your iPod.
And for convenience of Florida nurses, your creditd will be automatically reported to CEBroker. For nurses from other states, you’ll need to save your certificate and do with it as you would any other CEU course.
This has been a long time coming and took a bit of extra work behind the scenes to set up, but I hope enjoy this new benefit and take advantage of it!
And in the news today:
I talk about ED mystery shoppers (PDF file), a standaradized test to diagnose diabetes, REM sleep to help solve problems, the significance of TIA’s, and one of my favorite topics recently………..the swine flu! Links and more on the site.
And finally, here it is. Burns part 1.
Enjoy!
Podcast: Download
Using our voices June 8, 2009
Posted by Paul Bond in : Tips , comments closedMy apologies once again for not posting sooner. I have been caught up in some very exciting changes coming to the site within the next couple of weeks.
Over the past few weeks, I’ve had conversations with some of the nurses I work with. The subject of some of those conversations has been the quality of nursing care and what to do when one comes across a fellow nurse who either didn’t perform a certain portion of his/her responsibility (i.e. did not document something like vital signs per facility policy, of document an assessment, etc.), or there was a delay in care for some reason.
Nurses can be very passive/aggressive and/or codependent in their nature. And, while I’m sure most are not like that in their daily lives away from work, I feel this attitude is past of nursing’s history; part of its “DNA” if you will. Traditionally, nursing has been the subservient subject of medicine. As an example, it was expected that when the physician came onto the ward, the nurse would give up her chair for him without question. Even if the nurse was documenting the care she had just given. On the floor, it was expected (and still is be some physicians) that the nurse would make rounds with the physician when he came in to see his patients………..no matter what else the nurse had to do yet. This alone could take the nurse away from her work for a few hours. These and other examples made/kept nursing in a subservient role. And while this attitude has changed/evolved over the years, it hasn’t yet been erased from our minds. In school, we are still taught this mindset. And it pervades everything we do in nursing.
I was speaking with one of the department heads of the hospital about the amount of work nursing has to do………besides actually caring for the patient (i.e. the amount of documentation we have to enter into the ePCR), and she actually told me “That’s just part of nursing….we accept what they tell us we have to do.”. The last time I looked, I had a license just like the physician does, and it meant I had the right of self governance as part of the responsibility of licensure! That also means that, as a group, nursing has the right to say no and/or share in the setup of our responsibilities and how they will be carried out. Now, before I get off on a tangent about the subject of revolt against the machine that is healthcare, let me get back on my original focus………………The point of the previous rambling is to make the point that nursing remains subservient in its nature. Any revolution against the machine has to have the support and guidance of our leaders in nursing to accomplish its goal. Individual revolts will only serve to give one the ability to find another line of work.
So back to my point for today; nursing, as a whole, remains a subservient group. And this mindset pervades how we function within the hospital. When I brought up that I needed to document the fact a fellow nurse in my department had not called respiratory therapy after placing an order for a breathing treatment (our policy is to call after entering the order since the therapists are not usually in the department and have no way of knowing when an order is placed unless we call them), one of the nurses said “Was there any harm to the patient? And if not, then you just have to overlook some things in nursing.”. Now, while I agree there was no physical harm done to the patient by waiting an extra hour for a breathing treatment that was meant more for palliative care than actual urgent treatment, the delay in caring for and discharging the patient is not something I can overlook. The ED in which I work has a goal of total time of care for discharged patients of less than 2 hours. This delay added one of those two hours to the time of this patient. Part of the problem with this is a system one. There is no other way for respiratory therapy to be notified of a new order except for the person placing the order to place a phone call to them. This poses a few potential problems……….(1) the order has to be entered and then called also (redundant)………..(2) the phone system in house has to be working properly………..(3) the actual phone the R/T is carrying has to be working and the battery not dead………..(4) the R/T has to be able to answer the phone (if they are in the middle of intubating someone, they are not going to answer)……….(5) failing the previous, the person placing the initial order hs to remember to call back and attempt to notify R/T until they actually reach them. This is NOT a streamlined system of communication. You can see there are at LEAST 5 places the system can break down. If ti continues to be “overlooked”, it won’t get changed/fixed. And it can lead to greater problems (not the least of which is longer lengths of stay for our patients) down the line. But if pointed out, the problem has a chance to be changed and made better…………unless we stay passive/aggressive and “overlook” it to not get someone in trouble. My contention is the nurse wasn’t truly at fault………the system set her up to fail. I don’t know if she knew she had to call R/T, or if she even did. Or maybe she did, and the R/T didn’t answer. I have no way of knowing. All I know is the patient sat on the bed for an hour waiting something that was never coming. And this leads to negative feedback from the patient. Now, I’ve spoken about “customer service” in healthcare before. And while I’m not one to believe the customer is always right, the customer DOES have expectations about his/her care. And if we give them the expectation that we will care for them efficiently and in a timely manner, we need to meet that expectation (we would expect the same if WE were the patient). The system needs to be adapted to make this happen. And when the system fails that, it needs to be pointed out so it can be changed.
I am quite sure the nurse who placed the order for the breathing treatment didn’t WANT the patient to sit there for an hour waiting for it; nor did she want to make the patient mad in doing so. I am sure she wanted the patient to get good, quality care. But the system set this expectation up to fail. But until “someone” points it out, nothing will change. Until someone doesn’t “overlook” it, it won’t get better.
If we continue to “overlook” the failings of our system, it won’t get any better. And our work will only get more cumbersome and redundant. And I would bet that someone from outside it (said the Federal Government or some agency appointed by it) will make changes in our system that may or may NOT be that good for it; or for US. Isn’t it time we stood up as professionals and took responsibility for what we do? Isn’t it time we started making the decisions about how we perform our jobs before someone else does it for us? Isn’t it time nursing shed the old ways of being subservient and just “take what we’re given” and actually be PROACTIVE in the change that is surely coming to healthcare in the US? If not, we will find ourselves overburdened with even MORE redundant, repetitious, menial tasks that are meant only to satisfy the monster that is the oversight of healthcare. We will continue to bow to the powers that be and (figuratively speaking) give up our seat when the doctor comes on the floor.
I thought we left that ideal far behind and became willing partners and part of the healthcare TEAM………..one who actually had a voice in it. But unless we actually USE that voice, we will continue to be told what to do and do more and more with less and less.
Hurricane Season 2009 June 2, 2009
Posted by Paul Bond in : News , comments closedWell, it’s that time of year again! I hope everybody on the East Coast and through the Gulf area has their disastr boxes ready.
Actually, forecasters are predicting a near normal season this year. They say we should expect “nine to 14 named storms, of which four to seven could become hurricanes, including one to three major hurricanes (Category 3, 4 or 5)”. That per the latest from NOAA. The link goes to an article that talks about getting prepared for natural disaster, and is a good read.
