LNC Krug

Legal Nurse Consultant Sandra Krug

LNCKRUG Newsletter Quarterly Vol 1 2018

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Inside this LNCKRUG Newsletter issue:

 

Electronic Records
 
Conditions of Participation
 
Fetal Monitoring
 
Medical Review Panel
 
DUI marijuana

 

 
 

 

 

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!

 

 

 

 

 

Standards Corner

 

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.

 

Call Krug Consulting today to review your cases where injury is in question.
Click to call us at 1 (844) LNC-KRUG • or Contact Us via email

 

 

 

 

 

 

Criminal Corner

 

 

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.
 

Did You Know That Noise In The OR Can Actually Be Devastating? – Newsletter vol 8 2017

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Risks are associated with noise and distractions in the OR

Operating room (ORs) are locations where health care teams do high-risk, complex tasks demanding situational awareness, concentration, and communication among team members. Given the host of medical equipment in use and multiple team members present, ORs also are prone to high levels of noise, which serves as a distraction, increasing risk for error and presenting unsafe conditions for patient safety. Noise and distractions make it hard to hear, discern information and communicate effectively.

 

It is well documented that ineffective communication is a leading contributing factor to adverse events. Within an OR, noise levels have been associated with ineffective communication, diminished signal and speech intelligibility, poor performance of complex tasks, poor cognitive function and concentration (slower time-to-task completion), stress, fatigue and anxiety. There are many sources of noise and distraction within an OR with the most common being non-case relevant conversations, telephone calls, pagers, and music.

 

The Environmental Protection Agency’s (EPA) recommended level for continuous background noise in hospitals is 45 decibels (dB), which still interferes with concentration. A study measuring noise levels in OR trauma procedures found an average noise level of almost double the recommended EPA level — 85 dB, ranging from 40dB to 130dB. Orthopedic surgery and neurosurgery procedures are among those with higher sustained continuous background noise levels as compared to other procedures, with intermittent peak levels exceeding 100dB more than 40% of the time.

 

Studies focused on anesthesia found the noisiest periods during surgery are associated with induction and emergence of anesthesia. Noise negatively impacts concentration and work among anesthesiologists, and reduces the ability to detect signals from monitors and other equipment. A 17% drop in accuracy of anesthesia residents noticing changes in saturation on a pulse oximeter was found in a laboratory study simulating OR background noise.

 

When you have clients that have bad surgical outcomes, do you ever consider the noise in the OR as a line of questioning during depositions? It can be a key part of the incident. Let our legal nurse consultants assist you with this element of your case. We will help determine if there was a distraction during the procedure, and if it affected your client’s outcome.

 

 

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Pulmonary Embolism – Newsletter vol 7 2017

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This Is What Happens With Pulmonary Embolism

A clot from one part of the body traveling the bloodstream to another part of the body is an embolus. Pulmonary embolism (PE) is abrupt blockage of arterial circulation in the lungs, when an embolus obstructs blood flow in an artery. This occurs in the main pulmonary artery, carrying blood from the heart to the lungs, or in one of the smaller arteries.

 

In 50% of cases, blockage is a blood clot initiating in the deep veins of the body, usually the legs, called deep vein thrombosis (DVT). The DVT goes to the right side of the heart, and lodges in the pulmonary artery. Other sources are an air bubble from a central vein catheter, amniotic fluid dislodged in labor, foreign bodies like talc used during IV drug use, septic emboli as in acute endocarditis, or tumor cells. When a large bone (like a thigh bone) breaks, fat from bone marrow in the blood, reaches the lungs, and can cause PE.

 

PE causes lung damage from death of lung tissue (pulmonary infarction). A massive PE puts stress on the right ventricle and stops the entire circulatory system, triggering cardiopulmonary arrest and death. Left untreated,  30 % of patients die, and 3% – 8% of those who are treated die within 30 days. Those who die do so within the first few hours of the event.

 

Symptoms include: shortness of breath (dyspnea), rapid breaths (tachypnea), chest pain, coughing or coughing up blood (hemoptysis), leg pain and/or swelling, low-grade fever, bluish skin (cyanosis), wheezing, sweating, anxiety, fainting (syncope), rapid pulse (tachycardia), arrhythmia (irregular heartbeat), abnormal lung sounds (rales) or an abnormal fourth heart sound. With a massive PE, there may also be signs of shock (cold and clammy skin, weak pulse, low blood pressure). Some people have feelings of impending doom (anxiety, dread, light-headedness, fainting, tachypnea, sweating, tachycardia).

 

Computed tomography (CT) scans look for blood clots. Dye injected that is into an arm vein makes blood vessels in the lungs and legs show up on x-ray images. The patient lies on a table, and an x-ray tube will rotate around them. The tube takes pictures from many angles. This test allows doctors to detect most cases of PE. The test only takes a few minutes. Results are available shortly after the scan is done.

 

Thrombolytic medications dissolve clots, but theses medicines can cause sudden bleeding and are used only in life-threatening situations. Doctors may use a catheter inserted into a vein in the groin or arm and threaded to the clot in the lung. They use the catheter to remove the clot or deliver medicine to dissolve it. Rarely, surgery may be needed to remove the blood clot.

 

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June is National Safety Month – Newsletter Vol 6 2017

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June is National Safety Month

 

Injuries are a major origin of disability for individuals of all ages – and they are the principal cause of death for Americans ages 1 to 44. Personal injury is a vital matter that can radically disturb your health, your career, your family and your future.

 

Nevertheless, there are numerous things people can do to stay safe and prevent injuries. Make a change: Spread the word about ways to diminish the hazard of injuries.

 

Inspire communities, workplaces, families, and individuals to recognize and report safety risks.

 

How can National Safety Month make a difference?

 

We can all use this month to increase awareness about significant safety issues like:

  • Medication safety and prescription painkiller abuse
  • Driving, biking, and working safely
  • First aid and emergency preparedness
  • Preventing slips, trips, and falls (A slip and fall accident is the most common kind of premises liability accident, happening when a visitor or occupant falls on a slippery surface. A fall attributed to a break or irregularity in flooring is commonly denoted as a “trip and fall.”)

 

Every person can get involved in reducing the hazard of injuries.

 

Together, we can share data about steps individuals can take to guard themselves and others, because the inability to work and accumulation of medical bills can add financial strain to the stress of injury.

 

If a person suffers an injury because of someone else’s carelessness, they need a knowledgeable personal injury attorney by their side. The attorney needs a well- informed legal nurse consultant by their side.

 

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Traumatic Brain Injuries – Newsletter Vol 3 2017

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Traumatic Brain Injuries in Females

A traumatic brain injury (TBI) occurs from a strike, jerk, or penetrating object interrupting normal brain functioning. Causes include slip and falls, motor vehicle collisions, sports-related blows, and penetrating injuries. The CDC estimates there will be 1.7 million TBI’s this year. These may be mild (concussion), serious (long-term complications) or anywhere between.

 

The most common TBI is the concussion. It happens when the head, or body, rapidly shifts backwards and forward, as seen during a motor vehicle collision or sports injury. Concussions are referred to as mild TBI, because they are usually not life-threatening. Nevertheless, these mild TBI’s can cause serious problems. Research proposes that frequent concussions are particularly dangerous.

 

Concussions in football players, high school to professional, have gotten a lot of attention in the media lately. One 2015 study found that concussion diagnoses more than doubled between 2007 and 2014, most notably in children and teenagers. It is not known if this is because of an increased awareness about concussions, or if there were more young people receiving injuries.

 

The researchers tracked over 1,200 athletes from Columbia University between 2000 and 2014.This study included over 800 male, and almost 400 female athletes playing sports believed to present a higher risk of concussions. For males, sports initially included just football but then added wrestling, basketball and soccer. For females, the sports included field hockey, soccer, basketball, softball and lacrosse.

 

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