DC Metro Area Medical Malpractice Law Blog

Posted by: Salvatore J. Zambri, founding partner     

The New York Times, in a front-page report, announced, "To help ensure that medical radiation is safe, Medicare insists that certain highly technical cancer treatments be administered only when a patient's radiation oncologist is present or nearby." Federal officials say physicians who fail to adequately supervise technicians during radiotherapy risk patient safety. But, the issue also "raises questions about financial incentives and the overuse of high-tech, and highly reimbursed, treatments" when "less advanced and cheaper ones would have served just as well."

As a result, "Congress passed an antikickback law designed to stop doctors from" unnecessarily ordering "tests or procedures in which they have a financial interest," according to the report.  In addition, "radiation safety will be the subject of a Congressional hearing Friday." For its part, "the American College of Radiology has said that self-referral endangers patients because doctors tend to order more tests."

Before undergoing any diagnostic test or invasive procedure, your doctor should describe all benefits and  risks of the procedure and he or she should explain all alternative options as well.

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 Posted by: Salvatore J. Zambri, founding partner     

The AP (1/27, Perrone) reports, "Federal health officials announced the recall of two million medical needles Tuesday because of a risk they can push bits of silicone into patients' bodies." The FDA "said Japanese manufacturer Nipro Medical Corp. has voluntarily recalled its Exel/Exelint Huber needles manufactured between January 2007 and August 2009."   Doctors, nurses, and patients should not be using these needles under any circumstances.

Bloomberg News (1/27, Peterson) reports that the "defect...might lead to fatal blockages of the main artery of the lung, the [FDA] said." The needles, which are intended "to give food and medicine to chronically ill patients," can "dislodge 'cores,' or slivers of silicon, from 'ports' under the skin and release the material into the bloodstream, FDA officials said." Jon Casamento, deputy director of the Solid and Fluid Mechanics Division at the FDA's Center for Devices and Radiological Health, said the "defective needles...may cause tissue damage and inadequate drug delivery."

Regulators have not received reports that the needles released silicon or other foreign chemicals into patients, but the defect is difficult for doctors to detect, Dow Jones Newswire (1/27, Favole) reports.

CNN (1/27, Young) reports that the FDA "said anyone using the products should stop immediately and return any unused needles to Exelint." The agency indicated that it is conducting investigations "of needles from 20 companies," of which 10 have already been completed. "The FDA said it has sent letters to all Huber manufacturers asking them to address any design or manufacturing problems."

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 Posted by: Salvatore J. Zambri, founding partner     

ev3 Endovascular, Inc. and FDA notified healthcare professionals of a Class I Recall of the Trailblazer Support Catheter. According to the recall, "This device may crack near the radiopaque marker band. This may result in serious patient injury, including insufficient oxygen supply to the tissues, damage to blood vessels, heart attack, limb amputation, unplanned surgery, and/or death."

If using a catheter, please contact your doctor immediately to be sure it is not part of the recall.  If you know you are using a Trailblazer Support Catheter, please stop using it right away, and obtain an alternative product.

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 Posted by: Salvatore J. Zambri, founding partner     

In a blog at the California Progress Report (1/6), J.G. Preston wrote, "One of the arguments the 'tort reform' crowd uses to justify putting a cap on the amount of money a jury can award to a victim of medical negligence is their assertion that increases in the cost of malpractice insurance are driving doctors out of the business." But "there are more doctors per capita in states that don't limit the amount that can be awarded to victims of negligence than there are in states that have implemented caps. The American Association for Justice broke down the numbers and found there are 21% more doctors per capita in states that don't restrict compensation that there are in states with caps." 

And there are more doctors than ever in America.   Take a look at the most recent data published by the American Medical Association, which confirms this fact.  The publication considers data through 2008.  There were 309 doctors for every 100,000 people that year.   Compared to the 1960s, that's twice as many.  So, not only are there more doctors per capita in states without damages caps, there are also more doctors everywhere in this nation.

The lesson:  Don't let the corporate greed of certain special interest groups convince you that you need to abandon your constitutional rights to pad their pockets.  Victims of the carelessness of others need their rights. 

Be safe, and don't be fooled by well-worn rhetoric.

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 Posted by: Salvatore J. Zambri, founding partner     

Bloomberg News (12/16, O'Reilly, Feeley) reports, "Pfizer Inc. asked a judge to order the removal of an Internet video about its menopause medicines that the company says is misleading and aimed at swaying potential jurors in future trials over the pills." The video, called "Prempro News Segment," was posted on YouTube.com by "plaintiffs' lawyers who recently won more than $78 million in damages in a Pennsylvania trial over Pfizer's Prempro hormone-replacement drug."

At issue in that case was whether the "menopause drugs helped cause" the plaintiff's breast cancer. In the video, "breast-cancer victims discuss their cases," while the attorneys "accuse Wyeth of minimizing the risks of Prempro." According to Pfizer's lawyers, "Pennsylvania rules governing lawyer ethics prohibit lawyers from making pre-trial statements to the press that could 'prejudice' an upcoming case."

About the author:

 Posted by: Salvatore J. Zambri, founding partner     

A massive recall of swine flu vaccine doses drew national attention recently when it was announced by the Center for Disease Control.  ABC World News (12/15, story 6, 0:20, Gibson) reports that federal health officials "are recalling 800,000 children doses of swine flu vaccine...made by Sanofi Pasteur." NBC Nightly News (12/15, story 2, 0:35, Williams) reported that the doses "are less potent than they should have been."

The Los Angeles Times (12/16, Maugh) reports that Centers for Disease Control and Prevention director Dr. Anne Schuchat said the recall was "non-safety-related," and was "part of a routine quality assurance program." Schuchat emphasized that "children who received the vaccine do not need to be re-immunized," but the agency "wanted to make sure that doses that weren't already given won't be." The Washington Post (12/16, Stein, Laris) reports that "most of the vaccine, which was distributed nationwide in November, has probably already been used."

Bloomberg News (12/16, Randall) reports that Sanofi "began delivering swine flu vaccine in the US in September, with the bulk of deliveries expected in the fourth quarter." The United States "has ordered 75 million doses from the Paris- based company." CQ HealthBeat (12/16, Norman) reports that the problem was identified during "ongoing quality assessments" made by the drugmaker. The New York Times (12/16, A28, Mcneil) reports that Dr. Schuchat "said the vaccine was fully potent at release but dropped by about 12 percent in follow-up tests." In a story appearing in some form on over 320 news websites, the AP (12/16, Stobbe) reports that Jesse Goodman, the FDA's deputy commissioner for science and public health, said the problem may be related to the antigen sticking to the walls of children's pre-filled syringes.

USA Today (12/16, Sternberg) reports that the affected vaccine, "packaged in half-dose amounts meant for children 6 months to nearly 3 years old, represents about 1% of the nation's H1N1 vaccine supply." Sanofi spokesman Len Lavenda said the doses comprise roughly "18% of the 4.5 million doses in prefilled syringes made by Sanofi for children in that age group." Lavenda commented that officials were "baffled" by the weakened vaccine, adding "we can't remember a time when flu vaccine lost potency." The Wall Street Journal (12/16, Dooren) reports that Sanofi will be notifying providers to return any unused doses.

Reuters (12/16, Fox) also reported on this story, while Time (12/16, O'Callaghan) mentioned the recall in their "Wellness" blog.

Please be careful when taking a vaccine or allowing a loved one to be injected.  We urge you to speak with your doctor about all pros and cons of any drug before ingesting it.

About the author:

 Posted by: Salvatore J. Zambri, founding partner     

Bloomberg.com reports that GlaxoSmithKline "has settled 450 suicide cases for about $390 million and 600 birth defect cases for unspecified amounts." According to the report, "The company has also paid out about $400 million in antitrust cases since 2003."

Many people who have taken Paxil have been subjected to an increased risk for suicide and birth defects.  The extent of the increased risk has never been disclosed. 

I represent victims of dangerous products.  Far too often companies put profits over people, placing into the marketplace drugs that have not been properly tested.  We hope that companies will put people over profits and be sure their products are safe before they are sold.

Before taking any medication, be sure to consult with a physician.  Your physician should also inform you of all risks and benefits of a medication before you ingest it, so that you can make the best health decisions you can.

About the author:

 Posted by: Salvatore J. Zambri, founding partner     

 Posted by: Salvatore J. Zambri, founding partner     

The AP (12/11, Tanner) reports that "in 2005, Illinois legislators...passed a measure requiring hospitals to report the deadliest kind" of medical errors, but "the law has yet to be implemented -- and it likely won't be for at least another year." Illinois "budget woes and foot-dragging by special interests are among reasons cited for the long delay." However, "there are finally glimmers of progress. That includes the recent launch of a related state website that tracks hospital infection rates and staff levels, and the imminent start of a search for a vendor to help put the law in place."

Ten years ago, a landmark report proved that medical mistakes kill up to 98,000 Americans yearly. Only a handful of states have decided to do something about it, Minnesota being the first in 2003.  In 2005, Illinois modeled a law after Minnesota's.  Four years later, the law has still not been implemented.  Why?  Foot-dragging by special interest groups.  Finally, though, some progress is being made, including " the recent launch of a related state Web site that tracks hospital infection rates and staff levels, and the imminent start of a search for a vendor to help put the law in place."

According to the AP report, "The law will require hospitals to publicly report so-called "never" mistakes. These are mostly preventable errors with potentially life-threatening consequences -- like the wrong-knee surgery Krzysztof Kordes says Chicago-area doctors performed on him last year or the forgotten sponge left inside a Plainfield woman during breast tumor surgery."

A few things the law requires:

• hospitals required to report major medical errors within 30 days to the state's public health department
• list of hospitals and mistakes will be posted online
• hospitals required to determine cause of errors and to develop corrective plan

These kinds of laws should be in every state in our country.  Medical providers should not bow to special interest groups.  Sharing more, not less, following an adverse event is the only way to truly minimize future medical errors. 

Encourage your legislators to work hard to implement strong laws that clearly work to open communication and spur better, safer health practices.

About the author:

 Posted by: Salvatore J. Zambri, founding partner     

As a consumer justice attorney, I have the privilege of representing and helping people through difficult times every day. Oftentimes, my clients are horrifically and permanently injured due to no fault of their own. Other times, I represent families of those who have died as a result of someone else's carelessness.

This may surprise you, but it is widely accepted that approximately 98,000 Americans die each year as a result of medical negligence, more than deaths caused by guns and automobile collisions.  The yearly death toll from medical errors equates to the number of deaths that would result from two 747 airplanes crashing to the ground every day.  This alarming statistic does not even include those who have not died, but have nevertheless suffered serious permanent injuries due to a lack of appropriate medical care.

I have published a paper that addresses some fundamental, but extraordinarily important, steps necessary to properly and thoroughly evaluate a potential medical malpractice claim. By no means does the article include all investigative efforts required to analyze a case, as every claim is different and deserves special attention. 

To read my article, entitled "Evaluating a Medical Malpractice Case", please click here.

About the author:

 Posted by: Salvatore J. Zambri, founding partner     

The American Association for Justice has published a primer on the medical malpractice debate.  It comprehensively shows how special interest groups have perpetuated myths in an effort to strip Americans of their rights in order to pad their profits.  Here are some of the findings:

• Myth #1: There are too many “frivolous” malpractice lawsuits
  

• Myth #2: Malpractice claims drive up health care costs.

• Myth #3: Doctors are fleeing.

• Myth #4: Malpractice claims drive up doctors’ premiums.

• Myth #5: Tort reform will lower insurance rates.

It is widely accepted that approximately 98,000 Americans die every year as a result of medical errors.  That's like two 747 airplanes full of passengers crashing to the ground every day for a year.  Yet, some legislators want to strip innocent victims of their constitutional rights, including limiting their recoveries, instead of focusing on preventing future errors. 

Our leaders should be fighting for safer drugs, safer hospitals, better medical practices, and a safer American health system.  We must put people over profits.

To read the publication, please click here.

About the author:

 Posted by: Salvatore J. Zambri, founding partner     

The American Association for Justice has published a paper that concisely and clearly debunked the myths about medical malpractice which has been spread by business interest groups aimed at putting profits over people.  In the first of a series of papers, Public Citizen debunks the following "five myths: 

• Myth #1: There are too many “frivolous” malpractice lawsuits.

Fact: There’s an epidemic of medical negligence, not lawsuits.  Only one in eight people injured by medical negligence ever file suit.  Civil filings have declined eight percent over the last decade, and are less than one percent of the whole civil docket.  A 2006 Harvard study found that 97 percent of claims were meritorious, stating, “portraits of a malpractice system that is stricken with frivolous litigation are overblown.”

• Myth #2: Malpractice claims drive up health care costs.

Fact: According to the National Association of Insurance Commissioners, the total spent defending claims and compensating victims of medical negligence was just 0.3% of health care costs, and the Congressional Budget Office and Government Accountability Office have made similar findings.

• Myth #3: Doctors are fleeing.

Fact: Then where are they going?  According to the American Medical Association’s own data, the number of practicing physicians in the United States has been growing steadily for decades. Not only are there more doctors, but the number of doctors is increasing faster than population growth.  Despite the cries of physicians fleeing multiple states, the number of physicians increased in every state, and only four states saw growth slower than population growth; these four states all have medical malpractice caps.

• Myth #4: Malpractice claims drive up doctors’ premiums.

Fact: Empirical research has found that there is little correlation between malpractice payouts and malpractice premiums paid by doctors. A study of the leading medical malpractice insurance companies’ financial statements by former Missouri Insurance Commissioner Jay Angoff found that these insurers artificially raised doctors’ premiums and misled the public about the nature of medical negligence claims.  A previous AAJ report on malpractice insurers found they had earnings higher than 99% of Fortune 500 companies.

• Myth #5: Tort reform will lower insurance rates.

Fact:  Tort reforms are passed under the guise that they will lower physicians’ liability premiums. This does not happen. While insurers do pay out less money when damages awards are capped, they do not pass the savings along to doctors by lowering premiums. Even the most ardent tort reformers have been caught stating that tort reform will have no effect on insurance rates."

It is widely accepted that approximately 98,000 Americans die every year as a result of medical errors.  That's like two 747 airplanes full of passengers crashing to the ground every day for a year.  Yet, some legislators want to strip innocent victims of their constitutional rights, including limitibg their recoveries, instead of focusing on preventing future errors. 

Don't let your legislative representatives takes your rights away just so some special interest groups can pad their profits.  Fight for safer hospitals, better medical practices, and a safer American health system.  We must put people over profits.

About the author:

Posted by: Salvatore J. Zambri, Esquire

As reported in the Washington Post, a federal task force has concluded, "Women in their 40s should stop routinely getting annual mammograms, and older women should cut back to one scheduled exam every other year." 

The report notes that higher than "182,000 women are diagnosed with breast cancer each year in the United States, and the disease kills more than 40,000, making it the second most common cancer after skin cancer and the second leading cause of death from cancer among women after lung cancer."  Consequently, challenging the usefulness of a long-used screening procedure--mammogram--has spurred heated debate among, physicians and academics.

The task force cites evidence that harms attendant to annual exams beginning at age 40 outweigh the potential benefits.  As the Post report states, mammograms "produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes-disfiguring biopsies, and unneeded treatment, including surgery, radiation and chemotherapy."  Having said that, the American Cancer Society, the American College of Radiology, and others assert that the benefits greatly outweigh the potential dangers. 

According to the report, the American Cancer Society has not indicated a desire to change its guidelines, but the National Cancer Institute said it would re-evaluate its recommendations.

We urge our readers to speak with their doctors and make individual decisions about what is best for your health.  It may be appropriate if not necessary for some women to have annual mammograms in light of their family history, for instance.  Others may be doing more harm than good by exposing themselves to annual mammograms.  Doctors should know what is best for each individual and should advise their patients accordingly so that women can make the best decisions that they can, and so their long-term health can be promoted.

To read the full Post article, please click here.

About the author:

Posted by: Salvatore J. Zambri, Esquire

The New York Times reported that according to the US Food and Drug Administration (FDA), "Vials of five different Genzyme drugs for rare diseases may be contaminated with tiny particles of steel, rubber or fiber that could potentially harm patients."  However, "the FDA and Genzyme said that there had been no reports of patients being harmed by particles and that the problem affected less than one percent of the vials."  Although Dr. Jason Woo, an FDA official, stated, "We do not believe this is a wide-scale problem, but we do not have information that fully defines the scope," patients and doctors are concerned.

According to the report, the FDA has confirmed that "the products would remain on the market, because there are few alternative treatments," the AP (11/14, Perrone) reported. The agency has strongly advised physicians to "closely inspect vials for particles before injecting them into patients."  If exposed to contaminated vials, patients may experience "potential allergic reactions, blood clots, and other problems," states the report. 

 About the author:

Posted by: Salvatore J. Zambri, Esquire

Doctors fail to report clinically significant findings to their patients in more than seven percent (7%) of the cases, according to the Associated Press, relying on a new study published Monday in the Archives of Internal Medicine.  Physicians' use of electronic medical records tended to lower instances of failures to inform.  The frequency of errors is higher in practices that used a combination of electronic and paper records, as opposed to practices that relied on only paper or only electronic records, reports Nicholas Bakalar of the New York Times.    

We encourage doctors to utilize the electronic technology now available to better communicate with patients and other physicians regarding a patient's symptoms and conditions.  Reckless record-keeping leads to needless deaths and injuries.  There is a crisis in this country--too many Americans die each year as a result of hospital and doctor errors.  Nearly 100,000 people die every year as a result of hospital mistakes alone.  Safety needs to be a priority as we move forward.

About the author:

Posted by: Salvatore J. Zambri, Esquire and Catherine Bertram, Esquire

According to MercuryNews.com, technologists monitoring the threat have determined that hundreds of medical devices used at hospitals throughout the country are infected by the computer worm known as "Conficker".  The infected devices include MRI machines and hundreds, if not thousands, of other medical devices.  Manufacturer of the devices told investigators that "none of the machines were supposed to be connected to the Internet — and yet they were. And because the machines were running an unpatched version of Microsoft's operating system used in embedded devices they were vulnerable," states the report.

The report explains that "Conficker spreads by copying itself onto machines running Microsoft's Windows operating system that lack the security patch from October. Conficker installs itself and periodically reaches out for directions from its maker that cause it to rewrite its code, increasing its capabilities for malicious action and decreasing its chance of detection."  Apparently, patients have not yet been harmed, but it is clear that these infected devices place patients at risk.

To read the entire article, please click here.

Many Americans are injured or killed each year due to defective products.  For information about your legal rights, please click here or contact us at Regan Zambri & Long, PLLC at 202-463-3030. 

According to statistics reported by the U.S. Centers for Disease Control and Prevention (CDC), almost one in three Americans will develop shingles (herpes zoster) during their lifetime.  The disease is particularly dangerous to people over age 60 and those who are immunocompromised.  Fortunately, there is a way to reduce the risk of developing shingles and the long-term pain that often follows an outbreak of the disease.

The Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services (HHS), recently issued a 10-item advisory for hospitals and healthcare facilities designed to improve patient safety and reduce medical errors.  Though AHRQ primarily supports research designed to assist health administrators and medical personnel, this knowledge of best practices in patient safety can also benefit the public by enabling patients and their families to advocate for safer medical care.  Following are the 10 recommendations, re-posted in their entirety:

According to a recent report from the Centers for Disease Control and Prevention (CDC), it appears that more people in the United State now die from Methicillin-resistant Staphylococcus aureus (MRSA) than from Acquired Immune Deficiency Syndrome (AIDS). MRSA, which is typically hospital acquired, or nosocomial, was responsible for an estimated 94,000 life-threatening infections and 18,650 deaths in 2005, while, in that same year, approximately 16,000 deaths were attributable to AIDS. The report is set forth in the October 17, 2007 issue of The Journal of the American Medical Association (JAMA).

Oral health and physical well-being are closely related in senior citizens, according to the World Health Organization (WHO).  Reduced mobility often makes it harder for older adults to maintain their oral health, and the resulting dental complications then can lead to poor nutrition.  That poor nutrition contributes to lower overall health, they warn.  Beyond this, complicated regimens of prescription drugs can also affect the oral health of seniors.  A common side effect of many drugs, for instance, is dry mouth, and a perpetually dry mouth poses hazards such as susceptibility to fungal infections.

Methicillin-resistant Staphylococcus aureus (MRSA) is almost ten times more prevalent in the U.S. than had been suspected by health officials.  The finding is part of a first-ever nationwide study of the super-infection published by the Association for Professionals in Infection Control and Epidemiology (APIC).  In their survey of more than 1,000 hospitals covering all 50 states, researchers found that 46 of every 1,000 U.S. patients are infected or colonized with MRSA -- a national rate of nearly 5%.  As many as 1.2 million patients could be infected each year.  Another unexpected finding in the study is that the intensive care areas of medical facilities are not necessarily the most prone to infection -- a finding with profound implications not only for hospitals, but also for long-term care settings such as nursing homes.  Authors of the study point out that transmission of the organism is preventable, and hope that the report serves as a wake-up call for hospitals and patients alike.  

A report issued by the Institute of Medicine, stated that 1.5 million Americans are negatively affected by mistakes in the prescribing and administration of medication. The report suggests that implementation of electronic prescribing programs which are capable of cross checking  the myriad of factors that can determine a patient’s reaction to a drug will decrease those negative outcomes. Furthermore, the report recommends measures to increase the amount of drug information accessible to the public.  Most importantly, the report called for an enhanced dialog between patient and physician in order educate patients regarding to their medications. 

A bill in the U.S. Senate would provide more federal oversight of crimes against elders who rely on a healthcare provider. The Elder Justice Act of 2006 would create a variety of programs, including:

• an Office of Elder Justice in the Department of Health and Human Services
• an Office of Elder Justice in the Department of Justice
• a federal database of data collected nationally regarding elder abuse
• reporting crimes in federally funded nursing homes and other facilities

Summary of the Senate Bill

District of Columbia’s Adult Protective Services

Virginia’s Adult Protective Services

Maryland Elder Abuse Resources

Patients are almost 70 percent less likely overall to die in a top-tier hospital as they are in a bottom-tier one, according to a recent comprehensive HealthGrades study of Medicare patients aged 65 and older undergoing certain emergency procedures. HealthGrades is a healthcare-ratings firm, with data from 2003-05.

Meanwhile, in 2005, there was only one geriatric medicine specialist for every 5,000 Americans over age 65, and only nine out of the nation’s 145 medical schools offered a department of geriatrics, according to an article in the New York Times.

In a statement by Dr. William Plested, III, the president of the American Medical Association, he  warns that a cut to Medicare reimbursements, proposed by Congress, will send even more doctors away from the specialty.

The average national cost for Class 1 nursing home care rose 1.5 percent over last year, to $206 per day for a private room, according MetLife’s 2006 survey of nursing home and home healthcare costs. The cost for a semi-private room rose by almost four percent, to $183 per day.

Average costs for private and semiprivate rooms, respectively, for local regions surveyed included:

DC: $260, $247

Silver Spring, MD: $220, $189

Baltimore, MD: $220, $192

Northern Virginia: $251, $208

A new study in Nursing Forum found that while nursing home staff are aware of almost all medication errors, just five percent of those errors are ever reported to the facility's management.

The study also found that preventable errors are the eighth most common cause of death.  Medication errors may contribute to a large percentage of these preventable deaths because elderly patients are often frail and especially susceptible to changes in their medications.

If you or a family member believes that you have a case involving nursing home negligence, please contact us on-line at Regan Zambri & Long or call us at 202-463-3030 for a free consultation.  If you would like to receive our complimentary electronic newsletter, please click here.

The Centers for Medicare and Medicaid Services, the federal agency that regulates nursing home safety, has proposed a rule that would require all nursing homes to install sprinkler systems.

The proposed rule was promulgated in response to a Government Accountability Office investigation of two nursing home fires in 2003, in Hartford and Nashville, that together claimed 31 lives. The report also found that there were, on average, 2,300 nursing home fires per year between 1994 and 1999, resulting in five deaths per year.

If you or a family member believe that you have a case involving nursing home negligence, please contact us on-line at Regan Zambri & Long or call us at 202-463-3030 for a free consultation.  If you would like to receive our complimentary electronic newsletter, please click here.  

According to a recent study and surveys conducted by Consumer Reports, “not-for-profit nursing homes generally provide better quality of care for residents than for-profit facilities.”

According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) , hospitals and nursing homes need to reconcile each patient's current medication orders with the medications the patient has been taking in order to prevent potentially fatal errors.  Reconciliation must be done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.

According to the JCAHO Sentinel Event Alert, reconciliation should be done at every transition of care. Transitions in care include changes in setting, service, practitioner or level of care. The process includes five steps:  1) make a list of current medications; 2) make a list of medications to be prescribed; 3) compare the two lists; 4) make clinical decisions based on the comparison; and 5) communicate the new list to the providers and to the patient.   Communication seems to be the key to patient safety.

A pharmacy at one hospital reported a reduction in potential adverse drug events of 80 percent when they required detailed medication histories for all patients scheduled for surgery.

You might be interested to learn that the Joint Commission's sentinel event database includes more than 350 medication errors resulting in death or major injury. JCAHO believes half of those could have been avoided through effective medication reconciliation. Approximately, 63 percent involved problems with communication among providers.

The Institute for Safe Medication Practices (ISMP) has received many reports of medication reconciliation errors.  Please click on ISMP above to review their Medication Safety Alert newsletter of April 21, 2005, which includes a sampling of such errors that resulted from failed communication.

Ask your doctor or nursing home administrator whether their facility has implemented this critical safety procedure.

• seeking cancer treatment,
• making informed medical decisions,
• questions to ask before having surgery,
  
• medical record management requirements,
• disability rights laws,
• guide to choosing health care,
• guide to community and online support groups.

Consumer Reports has released a guide to nursing homes. The report highlights the top ten percent and the bottom ten percent of homes in each state based on staffing levels, deficiencies cited in the past three state reports, and quality indicators (such as proportion of those who were at risk for various maladies to those who actually had them). Twelve of the homes have been on the bottom ten list every year since 2000. 

Consumer Reports offers the general advice that not-for-profit homes typically provide the best care, and that independent homes are typically better run than those in a chain. When selecting a home, be sure to check out the state report, which, by law must be on “readily accessible” in the lobby.

ISMP suggests several ways to prevent errors with tablet splitting:

"• Be sure that the tablet in question is suitable for splitting. If in doubt, check with the manufacturer.

• Ensure the patient has the understanding, skill and motivation to split the tablets. You may have to enlist a family member or caretaker to do this.

• If the tablets are to be split at home, provide the patient or family with a tablet splitter to improve accuracy.

• For inpatients, the pharmacy staff should dispense the tablets already split, rather than relying on nurses to do this on the floor.

• Prescribers should order the strength in milligrams when possible, to avoid misreading an order for "1/2 tablet" for "1-2 tablets."

Additional Information:

ISMP Medication Safety Alert. Tablet Splitting: Do it only if you "half" to and then do it safely. May 18, 2006
http://www.ismp.org/Newsletters/acutecare/articles/20060518.asp

If you are looking for Eldercare Services, you can use the U.S. Administration on Aging Eldercare Services Locator.  These experts will help you locate state and local resources that specialize in care and programs for the elderly. They have a toll free number (1-800-677-1116).  The service is available from 9 a.m. until 8 P.m. (EST) during weekdays.  Spanish speaking assistants are available as well,

The Joint Commission on Accreditation of Healthcare Organizations, commonly known as JCAHO or the Joint Commission, has published its 2007 Assisted Living National Patient Safety Goals.  These patient safety goals apply to all accredited assisted living facilities.

"The 2007 National Patient Safety Goals continue to target critical areas where patient safety can be improved through specific actions in health care organizations,” says Dennis S. O’Leary, M.D., president, Joint Commission.  “Organizations that truly integrate these requirements into their daily operations will realize major opportunities to improve patient safety.”

The annual updating of the National Patient Safety Goals is overseen by an expert panel that includes patient safety experts, as well as nurses, physicians, pharmacists, risk managers and other professionals who have hands-on experience in addressing patient safety issues in assisted living and other health care settings.

The 2007 goals are:

Improve the accuracy of patient identification.

• Use at least two resident identifiers when providing care, treatment or services.  
• Prior to the start of any surgical or invasive procedure, conduct a final verification process, such as a “time out,” to confirm the correct resident, procedure and site, using active—not passive—communication techniques. 

• For verbal or telephone orders or for telephonic reporting of critical test results, verify the complete order or test result by having the person receiving the information record and  “read-back” the complete order or test result.
• Standardize a list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout the organization.
• Implement a standardized approach to “hand off” communications, including an opportunity to ask and respond to questions.

• Comply with current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.
• Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care-associated infection.

• There is a process for comparing the resident’s current medications with those ordered for the resident while under the care of the organization.
• A complete list of the resident’s medications is communicated to the next provider of service when a resident is referred or transferred to another setting, service, practitioner or level of care within or outside the organization.  The complete list of medications is also provided to the patient on discharge from the facility.

• Implement a fall reduction program including an evaluation of the effectiveness of the program.

• Develop and implement a protocol for administration and documentation of the flu vaccine.
• Develop and implement a protocol for administration and documentation of the pneumococcus vaccine.
• Develop and implement a protocol to identify new cases of influenza and to manage an outbreak.

As most people know, the Center for Medicare has a website that allows families to compare nursing homes in their region. This site also includes comparisons of nursing homes who participate in medicare, details on nursing home inspections, staffing and other quality measures.  

Here is a brief summary of what other information may be available regarding facilities in DC, MD and VA:

District of Columbia

For nursing homes in the District of Columbia, the D.C. government does not provide nursing home report cards on-line. You can access the information by using the Medicare Nursing Home Compare tool. You can also obtain some information on the District of Columbia on line nursing home directory. For additional questions or concerns about D.C. nursing homes, you can call the District's long-term care ombudsman at 202-434-2140.

Maryland

The Maryland Health Care Commission has a Nursing Home Performance Guide that is a pretty comprehensive resource with facility specific information such as number of beds, resident characteristics and details of deficiencies, if any, found during recent state inspections. You have also call the Maryland long-term care ombudsman office at (410) 767-1091.

Virginia

Virginia does not provide its nursing home report cards on line. However, you can use the Medicare Nursing Home Compare Tool. The Virginia Department of Health's Long Term Care Directory provides a list of licensed nursing homes with contact information. Virginia Health Information (VHI) also offers two nursing home directories. One includes rate information; the other includes bed counts and other financial data. VHI also has a comprehensive long -term care guide.   You can also call the Virginia long-term care ombudsman at (804) 565-1600 and they can also provide numbers for local ombudsmen.

One of the most difficult decisions someone may face is selecting a nursing home facilty for their loved one. There are a number of resources available that aid in the selection. Larry Wheeler, a reporter for USA Today, recommends contacting a hospital discharge planner, social worker, or local agency on aging. The article "Tips on Choosing a Nursing Home" offers suggestions as to questions to ask potential facilities, as well as particular items to investigate.

For the complete article, please click here.