Inside this LNCKRUG Newsletter issue:
Conditions of Participation
Medical Review Panel
Electronic Records Corner
EMR, EHR? IDK!
Can you interpret electronic records?
The speed of change in medical record keeping was incredible the last decade!
The American Reinvestment & Recovery Act included measures to reform infrastructure, such as the Health Information Technology for Economic and Clinical Health Act (HITECH).
Electronic health records (EHRs) went from cutting edge, to fundamental.
HITECH supported electronic health records – meaningful use (EHR-MU).
Guided by Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT, HITECH proposed meaningful use (MU) of interoperable EHRs as a critical national goal.
Do you understand meaningful use?
Meaningful Use (MU) was defined by use of certified EHRs in a meaningful way (for example electronic prescribing); ensuring certified EHRs connected in a manner that provided electronic exchange of data to improve quality of care; and when using certified EHRs, providers submitted data on quality measures to Secretary of Health & Human Services.
CMS granted incentive payment to eligible professionals or hospitals, who demonstrated efforts to adopt, implement or upgrade certified EHR technology, which prompted many health care organizations to action.
To read the entire article, please click here: EMR,EHR. IDK!
Conditions of Participation (CoP’s)
Home Care, Hospice, and Skilled Nursing are known for the numerous regulations and countless changes to guidelines; we normally operate thinking that our rules and regulations will change next week, and we will have to reeducate the staff and administration.
The truth is that Conditions of Participation or CoP’s, are the Federal Standards set up for agencies that bill Medicare and Medicaid to follow. Agencies must remain in full compliance with CoP’s to remain active in the Federal Reimbursement system.
Agencies panic about the rules and regulations, and rightfully so.
They can be very vague and up to many different interpretations based on how experienced you are with them, and of course who is auditing you. I have been through initial reviews by the State, Federal, and Accrediting agencies, and each entity has its way of looking at the rules… the bottom line is that the guidelines must always be implemented and adhered.
The consequences are steep and can result in not being able to participate in the Federal Programs.
To read the entire article, please click here: CoPs
Things Aren’t Always What They Seem Corner
What’s in a Strip?
A Fetal Monitor Strip can portray many things about a baby, and how it is tolerating pregnancy, and, subsequently, labor. When a mom is on a Fetal Monitor, the baby’s heart rate is the most important, and accurate information interpreted from what you are monitoring.
A baby’s heart tracing, while in utero, is an indication of the response of the central nervous system and how the baby is reacting to pregnancy, and labor. Knowing and understanding the variations in a fetal heart tracing is essential in caring for a mother and her baby in labor, and when assessing them in the triage unit, perhaps before labor.
Recognizing an atypical strip, and the yield sign that accompanies that, compared to the stop sign with the presence of an abnormal strip, is a nurse’s responsibility. Documenting the observation, reporting the concern, and following up with nursing interventions in the way of intrauterine resuscitation is how a nurse follows the Standards of Care in the Labor and Delivery department.
To read the entire article, please click here: What’s In a Strip?
Do You Have Dust Bunnies on Your Pending Medical Review Panel Submissions?
If you are lucky enough to practice in 1 of the 16 states requiring all medical malpractice cases be subject to an administrative process review before filing a lawsuit, then you are all too familiar with the daunting task of writing your position paper to a Medical Review Panel.
You have completed all the time-consuming work from filing petitions to deciphering the medical records and performing depositions.
Next, you need to convince three physicians, who at least 95% of the time rule in favor of the defendant, the medical provider, that your client has a viable case.
You know you need to take the time to pull it all together, but it sits on your desk collecting dust because this part of the process is not fun: It’s tedious and time-consuming.
Meanwhile, you have other appointments and depositions to tend to.
You put off the final work product because:
• You need to be able to give your full, undivided attention to this submission product and you’ve got to find the time on your calendar.
• You know that your report must be “spot on” giving you the best chance to prove your position.
• You’re ready to move on to your next case.
• Your mind is on other things, such as tomorrows depositions, and that trial fast approaching.
You think, if only I had someone who could get in my head and take this information and format it the way you visualize it, someone who knows the issues and can “speak medical” flawlessly expressing your vision, or position, to the medical review panel members.
You prefer not to pay for an expensive expert witness at this stage, but you want to save time and enhance your chance to prove that your case has merit, and/or a question of fact exist so you can confidently move on to the next stage of the litigation process.
Enter a Legal Nurse Consultant, at any stage of the case development, helping you sort out the medical issues of the case by identifying: the merits of the case, defendants, standards of care, assisting with discovery, and YES report writing.
Whatever your specific needs are, we can help move the process forward.
An LNC can be a valuable part of your litigation team saving you time and money so YOU can get to your next priority and get rid of office dust bunnies.
Attacking Chemical Tests in DUI Marijuana Cases
The primary psychoactive ingredient in marijuana is delta-9-tetrahydrocannabinol (“THC”). It can produce alterations in motor behavior, perception, cognition, and memory. THC is what makes marijuana users feel “stoned” or “high.”1
Smoking marijuana produces a very rapid high, with the highest blood concentration of THC occurring very soon upon marijuana being consumed. Typical marijuana smokers experience a high that lasts approximately two hours. After three to five hours, most behavioral and physiological effects return to their normal levels.2
Edible consumption of marijuana produces a more delayed and lower peak THC level.3
The current state of chemical testing used to determine whether or not a driver is impaired is not reliable for the following reasons:
• They do not indicate when marijuana was consumed;
• They do not indicate the quantity of marijuana consumed; and
• There is no consensus on how much marijuana leads to impaired driving.
To read the entire article, please click here: DUI marijuana
If you find this newsletter helpful, please share it with colleagues, or direct them to our website.
I am the founder and coordinator of Krug Consulting, a Legal Nurse Consulting firm. I am a Certified Registered Nurse Anesthetist (CRNA), Advanced Registered Nurse Practitioner (ARNP), and Registered Respiratory Therapist (RRT).
Contributors to this issue of the LNCKRUG Newsletter include: Sandra Krug, CRNA, ARNP, RRT, Legal Nurse Consultant; Anita Comfort, RN, Legal Nurse Consultant; Janice Dolnick, RN, BSN, LNC; Gina Johnson, RN, CLNC; and Patrick R. Stonich, BSN, BS, RN, CLNC.
Our nursing knowledge, clinical experience & integrity are invaluable assets for your team & your cases.