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Conclusions - by the very nature of culture and humanity, humans tend to be group animals -- they thrive in groups, coalesce into groups, indeed, the very process of moving from hunter-gatherer to cities was part of a group behavior. Group norms are internal rulings that are followed by individuals so that the synergistic effect of the group will be more efficient. These values usually focus on the way members of that group look and behavior towards themselves, and the hierarchical structure they tend to set up to "police" their efforts. Norms help groups solve problems, define and address new situations, make better decisions, and even process their daily work. Groups, in this case members of the medical community, join these groups in order to reflect specific notions and values associated with the overall group. Normative behavior in the medical field is covered by a willingness to help, to "do…
Physicians Want to Learn from Medical Mistakes. (2008, January 9). Retrieved November 2010, from Agency for Healthcare Research and Quality: http://www.ahrq.gov/news/press/pr2008/errepsyspr.htm
Error Disclosure. (2009, March). Retrieved from Agency for Healthcare Research and Quality: http://psnet.ahrq.gov/primer.aspx?primerID=2
Improving America's Hosptials. (2010, March). Retrieved November 2010, from the Joint Commission's Annual Report on Quality and Safety: http://www.jointcommission.org/NR/rdonlyres/D60136A2-6A59-4009-A6F3-04E2FF230991/0/2010_Annual_Report.pdf
Dewar, D. (2010). Essentials of Health Economics. Philadelphia, PA: Jones and Bartlett.
Large health care systems with multiple facilities can track as many as 1,000 events each month" (Berntsen, 2004, p. 44). That is an amazing number of cases that came extremely close to becoming medical errors, and they were only stopped by caregiver response or sometimes by chance. Near misses are an extremely important part of the healthcare facility's treatment program, because they can indicate just how accident and error-prone a facility is, and they can even indicate which departments and individuals may be the most error-prone.
How does a staff effectively reduce medical errors in their facility? Authors Turner and Kurtz believe debriefing of the team is key to reducing errors. They write, "Effective debriefing is the key to long-term sustainable improvements in patient safety and care. It is only through debriefing that an organization, team, or individual will improve consistently over time" (Turner, and Kurtz, 2008). Debriefing, the authors…
Berntsen, K.J. (2004). The patient's guide to preventing medical errors. Westport, CT: Praeger.
Turner, S.H., and Kurtz, W.D. (2008). Debriefing for patient safety. Retrieved 28 Nov. 2008 from the Patient Safety & Quality Healthcare Web site: http://www.psqh.com/novdec08/debriefing.html .
Legal Aspects of Medical Errors
Various factors in the health care system are reported to be contributors to medication errors. This work reviews a case study discussed in 'Hospital Pharmacy' (Smetzer and Cohen, 1998) which provides a clear example of the complex nature of the health care system and the process of medication use and how this interrelates to medication safety and quality. The nurse made the decision to administer the medication by IV. The syringe was labeled IM use only. The administration of the medication by IV would prove to be lethal since the drug is insoluble and obstructs blood flow the lungs needed for transferring oxygen to the individual's airways. The baby after it had died was found to not be in need of the treatment after all.
There were 50 latent and active failures that had occurred during the medication-use process and the majority of these failures…
ASHP Technical Assistance Bulletin on Hospital Drug Distribution and Control (2011) Drug Distribution and Control: Distribution -- Technical Assistance Bulletins. Retrieved from: http://www.ashp.org/DocLibrary/BestPractices/DistribTABHosp.aspx
Institute of Medicine. (2007). Understanding the causes and costs of medication errors (Case on the death of the day-old infant). In P. Aspden, J.A. Wolcott, J.L. Bootman, & L.R. Cronenwett (Eds.), Preventing medication errors: Quality chasm series (pp. 43 -- 4-5)Retrieved from http://books.nap.edu/openbook.php?record_id=11623&page=43 .
Pharmacist's Manual Section IX -- Valid Prescription Requirements (2012) Office of Diversion and Control. DEA. Retrieved from: http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm
educing Medical Errors in the Modern Healthcare Setting
One of the biggest challenges impacting healthcare providers are the total number of medical errors that occur on a regular basis. These areas are problematic, as they are adversely effecting the safety and quality of care provided. This is because nurses are often overwhelmed from the increasing number of responsibilities and regulations. (Orgeas, 2010)
For example, a study that was conducted by Orgeas determined that the most critical departments (such as: the ICU) are facing these challenges with him saying, " Identifying medical errors (MEs) that serve as indicators for iatrogenic risk is crucial for purposes of reporting and prevention. An observational prospective multicenter cohort study of these MEs was conducted from March 27 to April 3, 2006, in 70 ICUs; 16 (23%) centers were audited. Harm from MEs was collected using specific scales. Fourteen types of MEs were selected as indicators;…
Boyle, D. (2011). How Medical Errors Effect Physicians Emotionally. AAOS. Retrieved from: http://www.aaos.org/news/aaosnow/nov11/managing8.asp
Cole, B. (2009). Overworked Nurses are Hurting Patient Care. Health Related Media. Retrieved from: http://www.healthleadersmedia.com/content/LED-235900/Overworked-Nurses- Are-Hurting-Patient-Care- and-Outcomes##
Davis, D. (2011). The Adult Learner's Companion. Boston, MA: Wadsworth.
Encinosa, W. (2008). The Impact of Medical Errors. Health Service Residential, 43 (6), 2067-2085.
Ethics and Legalities of Medication Error Disclosure
As Philipsen and Soeken (2011) note, it is the nurse's duty and ethical responsibility to inform the patient of any medical error in treatment, even if the error is "insignificant." The patient still has a right to know, as do all individuals who are impacted by the error (staff as well). This allows the medical community to remain transparent, which is a foundation of trust in the staff-patient relationship. Thus, the ethical implications of disclosure and non-disclosure are clear: to not disclose a medical error is to act unethically and without the transparency and loyalty that is owed the patient as well as the members of the staff. The legal implications of disclosure vs. non-disclosure are also clear. The severity of the error is what is most likely to affect the outcome if the error becomes known and there was no disclosure made…
Anderson, P. (2010). Medication errors: Don't let them happen to you. American Nurse Today, 5(3).
Edwin, A. K. (2010). Non-disclosure of medical errors an egregious violation of ethical principles. Ghana Medical Journal, 43(1): 34-39.
Kentucky Revised Statutes. (n.d.). Kentucky Board of Nursing. Retrieved from http://kbn.ky.gov/practice/Documents/aos34.pdf
Philipsen, N. C., Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practicioners, 7(9): 740-746.
appease the allegation that medical errors beset the healthcare industry and generate major risk to patients. As with any matter posing a potentially significant impact on a population, the government has a sizable interest. Lately, the government decided to take action toward enacting quality of care and patient protection regulation. In an optimal setting, this would appear easy to execute, but reality indicates such top-down regulatory answers to health care quality and patient safety lead to negative domino effects, including increased health care costs, unforeseen conflicts with pre-existing regulation, and decline of provider self-governance.
egulation carries its weight in gold through its function ratio of benefits to costs. In regards to the cost side of the equation, it includes costs to the government, consumers, and regulated entities. A study conducted in 2002 to assist research in understanding the estimated comprehensive value of health care regulation found the figures led to…
Ellig, J. (2012, March 27). Healthcare Law Highlights Problems With Regulatory Process - Economic Intelligence (usnews.com). Retrieved from http://www.usnews.com/opinion/blogs/economic-intelligence/2012/03/27/healthcare-law-highlights-problems-with-regulatory-process
McGuire, T., Newhouse, J., & Sinaiko, A. (2010). An Economic History of Medicare Part C.Milbank Q, 89(2), 289-332.
Mekel, M. (2010). Emerging Issues in Health Care Regulation: Protecting Patients or Punishing Providers? Journal of Legal Medicine. doi:10.1080/01947641003598138
Pittman, D. (2013, August 26). Medicare's DME Bidding Program Criticized. Retrieved from http://www.medpagetoday.com/PublicHealthPolicy/Medicare/41184
Majority of the medical errors take place in the patient's handoffs. A shift among the doctors is a common practice. There are a number of old patients who approach around 16 different doctors in a year, while young patients who are healthy refer to normal physicians and to specialists as well (Philibert, 2008). In a hospital normally, less attention is given to the patient by his primary doctor, while the trainees and the hospitalists are more involved in that patient. Patients are rotated to different doctors with an average of fifteen times in a five day stay at the hospital. Young doctors often accept appointments of more than 300 patients in a month, in their initial training period just because of time pressure (Chen, 2009, p. 1).
Alteration that have been brought about in the patients care have increased the quality of the services that are offered to…
Centers for Medicare & Medicaid Services. (2010). Electronic health records overview. Retrieved from http://www.cms.gov/EHealthRecords/
Chen, P.W. (2009, September 3). When patient handoffs go terribly wrong. The New York Times. Retrieved from http://www.nytimes.com
Decision support systems may reduce inappropriate medical tests. (2011). Retrieved from http://www.theexigencegroup.com/news/intelligence / article:decision-support-systems-may-reduce-inappropriate-medical-tests-/
Encinosa, W.E., & Bae, J. (2011). Health information technology and its effects on hospital costs, outcomes, and patient safety. Inquiry, 48, 288-303. doi:10.5034/inquiryjrnl_48.04.02
Health Care Situation: Medical Error Due to Doctors' Bad Handwriting
Identify a health care news situation that affects a health care organization such as a hospital, clinic or insurance company.
I have identified the following health care news situation as the topic of my paper: "Poor Handwriting of Doctors and its implied risks for the Patient, Hospital and Medical Malpractice Insurance." Poor handwriting of physicians resulting in poor legibility of entries into patients' medical records carries very dramatic risks for all above-mentioned interest bearers. It can result in severe health danger for the patient and - in extreme situations - even cause a patient's death. Doctors' bad penmanship has long been seen a problem within organized medicine and the patient safety movement. Three American Medical Association (AMA) policies dating back to 1992, urge doctors to "improve the legibility of handwritten orders for medications" and review all orders for accuracy and…
Berwick, Donald M. & Winickoff, David E. (1996). The truth about doctors' handwriting: a prospective study. BMJ Vol. 313 (21-28 December 1996). 1657-1658. www.bmj.com/content/313/7072/1657.full, accessed 21 August 2011.
Bruner, Anne & Kasdan, Morton.L. Handwriting Errors: Harmful, Wasteful and Preventable.
1-4. www.kyma.org/uploads/file/.../Harmful_wasteful_and_preventable.pdfSimilar, accessed 22 August 2011.
Gallant, Al. (22 November 2009). For a secure electronic health record implementation, user authentication is key. 1-2). searchhealthit.techtarget.com/.../User-authentication-is-critical-for-pl.., accessed 24 August 2011.
Medical ID Theft and Securing EPHI
Medical Identity Theft
Medical information can be stolen by 1) the bad guys getting sick and using a victim's information to obtain services, 2) friends or relatives use another friend's or relative's information to obtain treatment, 3) when professionals, such as physicians, fabricate services that did not exist, 4) organized crime, and 5) innocent or not so innocent opportunists (Lafferty, 2007). ad guys that get sick can take a victim's insurance information to obtain services for treatment. Professionals can fabricate false claims to cover medical errors. Opportunists have access to patient data and the ability to steal, use, or sell that information.
Effective security requires clear direction from upper management (Whitman). Assigning security responsibilities and access controls with audit controls to organizational elements and individuals helps to place accountability on individuals. They must formulate or elaborate security policies and procedures based on the organizational…
HIPAA Security Series. (n.d.). Retrieved from HHS.gov: http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/techsafeguards.pdf
Hoffman, S. & . (2007). SECURING THE HIPAA SECURITY RULE. Journal of Internet Law, 10(8), 1-16.
Lafferty, L. (2007). Medical Identity Theft: The Future Threat of Health Care Fraud is Now. Journal of Healthcare Compliance, 9(1), 11-20.
Whitman, M. & . (n.d.). Case B: Accessing and Mitigating the Risks to a Hypothetical Computer System, pages B1-B24 .
In this case, that power dynamic was only exacerbated by the fact that the entire MSICU nursing team had never received training in management of the type of clinical issues presented and by the fact that they were excluded from any consultation in connection with a post-operative management plan.
Therefore, it is recommended that the institution immediately implement a policy of "see something, say something" according to which all members of healthcare teams are encouraged to speak up irrespective of power differentials. Furthermore, that protocol must include a statement of policy insulating any member of a healthcare team who does voice a legitimate concern in good faith from any retaliation or other negative response that could conceivably deter such diligence. Finally, the record of this case also indicates the immediate need for protocols requiring all members of the healthcare team to identify themselves to other members of the team, especially…
Bosk, Charles L. (2003). Forgive and Remember: Managing Medical Failure.
Gawande, Atul. (2008). Better: A Surgeon's Notes on Performance.
Groopman, Jerome. (2008). How Doctors Think.
Timmermans, Stefan. (2003). The Gold Standard: The Challenge of Evidence-Based
Personal Critique and Lessons Learned from the Article:
The article was well-written with many studies to back up the findings of the usefulness of the error management system discussed. It was interesting to see so many parallels between two diverse fields of occupation.
The stress levels, risks to human life, and the importance of teamwork were highlighted examples of similarities. However, it was the differences that were the most intriguing.
Clearly aviation accidents are more highly publicized than the individual medical accidents that occur each year; yet, it was startling to learn that it is estimated that up to nearly 100,000 people die each year from medical accidents, far less than aviation accidents. Although not as highly publicized, litigation following medical accidents, in the form of malpractice suits, would lead one to believe that the medical profession would be motivated to institute the types of processes and protocols that the…
Helmreich, R. "On error management: Lessons from aviation." BMJ 320 (2000, Mar 18): pp. 781-785. September 26, 2006 http://bmj.bmjjournals.com/cgi/content/full/320/7237/781?ijkey=C.kPjYhV51IB .
One of the major challenges impact healthcare providers is medical errors. These issues are challenging, as they will have an adverse impact on quality and safety. In the case of the ICU, these challenges are becoming more pronounced. This is because of the different conditions and large number of patients they are working with. A good example of this can be seen with insights from Orgeas (2010) who said, "Although intensive care units (ICUs) were created for patients with life-threatening illnesses, the ICU environment generates a high risk of iatrogenic events. Identifying medical errors (MEs) that serve as indicators for iatrogenic risk is crucial for purposes of reporting and prevention. We describe the selection of indicator MEs, the incidence of such MEs, and their relationship with mortality. We selected indicator MEs using Delphi techniques. An observational prospective multicenter cohort study of these MEs was conducted from March 27…
Data and Statistics. (2014). CDC. Retrieved from: http://www.cdc.gov/hai/surveillance/
Marcucci, L. (2012). Avoiding Common ICU Errors. Hoboken, NJ: Wiley.
Marino, P. (2012). ICU Book. Thousand Oaks, CA: Sage.
McClean, S. (2011). Intelligent Patient Management. New York, NY: Springer.
Errors and oot Causes
Why do Errors Happen? How Can We Prevent Them? (Dr. Lucian Leape's video)
Error is defined as the failure of a planned series of physical or mental activities to attain its planned outcomes, when these failures cannot be attributed to possibility. Errors do not just happen in institutional or inpatient surroundings, but in all surroundings. Errors frequently occur as a result of convergence of several contributing factors. In almost all industries, one of the main contributors to accidents is simply human error. Majority of the errors happen because of equipment failure. Errors could be avoided by: redesigning of the respective equipments to default, a safe mode; minimizing the variety of device models bought; applying clear procedures for checking the respective supplies, equipment and many more; orientation and training of new personnel with the team(s) with which they shall work with, offering a supportive surrounding for recognition…
Mastal, M., Joshi, M., & Schulke, K. (2007, December). Nursing Leadership: Championing Quality and Patient Safety in the Boardroom.Retrieved January 30, 2016.
O'Daniel, M., & Rosenstein, A. H. (2008). Chapter 33. Professional communication and team collaboration. Patient safety and quality: An evidence-based handbook for nurses. Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality, Rockville, MD.
Wolf, Z. R. (n.d.). Retrieved January 30, 2016, from http://www.ncbi.nlm.nih.gov/books/NBK2652/
These examples highlight that technology is always a tool, a way of enhancing human judgment -- we must not mistake it as a replacement for good nursing practice.
After all, the use of a computer is no substitute for a medical education. Anyone who works in a hospital can see this -- the increased accessibility of information through the Internet also means that patients often come in, convinced that they are suffering from a serious illness, allergy, or condition, based more upon a diagnosis Googled on WebMD, rather than upon the fact that they saw a doctor! If a computer alone was required to diagnose, everyone would have a degree!
Don't get me wrong -- I use technology every day in my life, and thank my lucky stars, and my patient's lucky stars, that it is so ubiquitous. When health care providers wish to communicate, the use of cell phones…
Medical Use of Marijuana
Increasing use of medical marijuana
Having looked at the various areas that medical marijuana has been brought into use and the various forms in which marijuana is administered, it is also important to take note of the various challenges that come with it. There have been various researches that have been conducted that covers the medical as well as the ethical side of the medicinal marijuana, and there have been a dilemma in the balance of the two sides on whether to institutionalize the drug or to stop it, and even on whether the medicinal use can be made to work without the proneness to abuse as is the case at the moment.
Medicinal marijuana has neither medical nor ethical standing within the contemporary society where drug abuse is one of the biggest worries of governments across the world and the alternative medicines that medical research…
In spite of research gaps, medical robotics is a growing trend in the United States.
Advances in Medical Robotics (Diana, 2011)
Hybrid Assistive Limb 5 (HAL5) is an artificially powered ecoskeleton that helps double the amount of weight someone can carry unaided.
DaVinci Si HD Surgical System performs minimally invasive surgery through superior visualization and greater precision, with incisions of one to two centimeters causing less pain and speedier recovery. It reduces the hospital stay to one half and costs one third less.
Sofie incorporates force feedback allowing a surgeon to feel the pressure they apply making sutures and pushing tissue aside. Sofie is expected to develop in five years.
Cyberknife Robotic Radiosurgery System is a non-invasive alternative to surgery for treatment of cancerous and non-cancerous tumors.
Nursebot is designed to specifically help elderly deal with daily activities allowing them to live at home.
RIA is designed to…
Davies, B. (2006). Essay: Medical robotics -- a bright future. The Lancet, vol 368, doi:10.1016/S0140-6736(06)69929-7, S53-S54.
Diana, a. (2011, Jan 29). 12 Advances in Medical Robotics. Retrieved from InformationWeek Healthcare: http://www.informationweek.com/healthcare/patient/12-advances-in-medical-robotics/229100383
Huang, G.P. (2006). Robotics and clinical research: Collaborating to epand the evidence-based for rehabilitation. JRRD, 43(5), xiii-xvi.
Seaman, a. (2013, Jan 4). Racial gaps in access to robotic prostrate surgery. Retrieved from Yahoo Health: http://health.yahoo.net/news/s/nm/racial-gaps-in-access-to-robotic-prostrate-surgery
How can eliminating abbreviations reduce errors?
In the medical profession, time is everything. To make documentation as expeditious as possible, a series of abbreviations have been accepted in records. This has been considered an acceptable practice as much as calling a registered nurse an "RN." The problems occur when people are unclear about the abbreviations mean or if a set of letters can have more than one meaning. For example, there is the abbreviation "CA" which means cancer and then "Ca" which is calcium. Another example is "a" which can mean both "artery" and "before" (Medical 2011-page 1). It is very easy to misread abbreviations when medical staff is in a hurry. Imagine the problem if a "q.w." which is take weekly was confused for a "q.v." which is take as one wishes. If the terms were written out rather than abbreviated, these potentially dangerous situations could be…
Berman, Jules. (2008). "Specified Life." Biomedical Informatics.
Greenall, Julie (2006). "Safe Medication Practices." Hospital News.
"Medical Abbreviations Glossary." (2011). JD-MD.
Nurses are required to make many immediate decisions in their assigned duties. Unfortunately, in recent years, patient care has often been compromised as a nursing shortage crisis has escalated to epic proportions. Increased patient loads have resulted in often hasty nursing decisions as responsibilities and hours worked have increased. Although precious time must be spread thin to accommodate higher numbers of patients, nurses must exercise their morals through consistency in ethical behaviors. According to Peggy Chinn (1), "Many ethical issues, such as end-of-life decision making, have increased in complexity. Other issues, such as advocacy and choice, have changed in certain respects but are more clearly centrally situated within nursing's ethical domain."
As a result, nurses are held accountable for a variety of decisions in nursing practice and in many instances, a patient's life depends on such decisions to survive. Gastmans (496) states that "Generally, the goal of nursing…
Chinn, P. (2001). Nursing and ethics: the maturing of a discipline. Advances in Nursing Science
Erlen, J. (2001). Moral distress: a persuasive problem. Orthopaedic Nursing 20(2): 76-80.
Erlen, J. (2001). The nursing shortage, patient care, and ethics. Orthopaedic Nursing 20(6):
Gastmans, C. (2002). A fundamental ethical approach to nursing: some proposals for ethics education. Nursing Ethics 9(5): 494-507.
As mentioned earlier, the desired outcome of nursing care is comfort and there are many articles in which the researchers have talked about the needs of the patients and the things that alter the comfort of the patients. Kolcaba suggested that the cancer patients who are terminally ill can benefit from comfort care as it pays attention to the perspective and needs of the patients. Through such kind of care, the patient is not only provided with pain relief, but the depression of the patient is also addressed adequately. As she said that patients who are not in pain but are depressed seek comfort in the transcendental sense as well as in the psycho-spiritual sense (Kolcaba, 1992 p 4). In some of her works, she has explained the use of the instruments and their application by the nurses. Kolcaba reckons that the instruments presented by her to evaluate the comfort…
Kolcaba K. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(10): 1178-1184.
Kolkaba, K. (1992). Holistic comfort: Operationalizing the construct as a nurse-sensitive outcome..Advances in Nursing Science, 15 (1), pp. 1-10.
Kolkaba, K. (1997). The primary holisms in nursing..Journal of Advanced Nursing, 25 pp. 290-296.
Kolkaba, K. And Fisher, E. (1996). A holistic perspective on comfort care as an advance directive..Critical Care Nursing Quarterly, 18 pp. 66-76.
A chain of communication needs to be established for future cases.
More concrete recommendations for the organization include a clear system for assigning and determining a physician-in-charge for every admitted patient at all times, such that there is never a situation where emergency care is being directed through a cell phone, where there is not a clear hierarchy during medical response, and where there is clear accountability after the fact. Even simply signing at the top of a chart or on a room board can become an assignation of responsibility, and a simply rule that a physician must remain in the building until their patients have been signed over to someone else would ensure that care decisions are being made with immediacy and accountability in the future. More extensive training programs and requirements regarding proficiency testing should also be put into place for special types of cases before units are…
Bosk, C. (2003). Forgive and Remember: Managing Medical Failure. Chicago: University
of Chicago Press.
Gawande, a. (2008). Better: A Surgeon's Notes on Performance. New York:
Role of Nursing Staff in Eliminating Medical Errors
The article focuses on the role that nurses play in eliminating errors in various medical situations. The research focused on the relationship between the number of nurses and the prevalence of medical errors. The study unveiled many reasons why medical errors occur. Some medical errors are caused by interruption of the nurses while working or understaffing in various healthcare facilities. The study reveals that the nurses play an important role in reducing the medical errors because they are responsible for administering the medication and monitoring the progress of the patients. Major medical errors are common when few nurses are made to handle many patients. The study shows that when the workload is high, the nurses tend to take short cuts to ensure they deliver the service. As a result, medical errors result from omission of some steps, missing the proper order of…
Nurses' Practice Environments, Error Interception Practices and Inpatient Medication Errors (2012)
Null hypothesis: There is no significant relationship between nurses' error interception practices and their practice environment.
Alternative hypothesis: There is a significant relationship between nurses' error interception practices and their practice environment.
Two frameworks were used in developing the theoretical foundation of the study: Error Theory and Nursing Organization and Outcomes Model.
Error Theory is a framework developed to explain errors that occur in different organizational settings. In the hospital/medical setting, errors are identified as medical errors, defined as "any preventable event that may lead to inappropriate medication use or patient harm" (Flynn et al., 2012, p. 181). In essence, error theory posits that in preventing errors from occurring within an organization, there must be a system established and implemented that could detect, determine, and deter any preventable errors/events. Further, the theory's proponent, J. eason, posited that within the…
Flynn, L., Y. Liang, G. Dickson, M. Xie, and D. Suh. (2012). "Nurses' Practice Environments, Error Interception Practices and Inpatient Medication Errors." Journal of Nursing Scholarship, Vol. 44, No. 2.
Medical Death Investigative Systems
Past and Present Systems
Death investigation of some sort has existed in all countries for centuries, but not always performed by medical professionals (Committee, 2003 as qtd in Moldovan, 2008). The link between law and medicine traces back to the ancient Egyptian culture in 3000 .C. This was followed by the English coroner system in around the 12th century. The 194 Articles of Eyre first used the term "coroner" by the English until brought by the first colonists to the New World, America as basis for a legal investigative function. A medical examiner replaced the coroner system in 1890 then functioning in altimore. A medical examiner is a trained medical specialist in pathology. The field of death investigation became more and more sophisticated in cities and States, like New York. The Office of the Medical Examiner was established in 1918. Its main…
National Academy of Sciences (2003). Medico-legal death investigation system workshop. Committee for the Workshop on the Medico-legal Death Investigation
System. Institute of Medicine: National Academy of Sciences Press. Retrieved on October 12, 2010 from http://books.nap.edu/openbook.php?record_id=10792&page=12
Moldovan, E (2008). The medico-legal death investigator. ProQuest: ProQuest LLC.
Retrieved on October 12, 2010 from http://www.csa.com/discoveryguides/medicalegal/review.php
Interoperability of Electronic Medical ecords
Electronic Health ecords (EHs) are patient-management tools that have been created in the health sector to help coordinate patient care. These tools or system focuses on capturing patient-generated health information from outside the clinical setting and incorporating it into the patient's medical history. Electronic health records were developed to help improve patient care through sharing patient information seamlessly. However, for EHs to have the ability to share patient information seamlessly, an interoperable health information technology environment should be established. This essentially means that an interoperable health IT environment is mandatory for electronic health records to be effective.
What is Interoperability?
Interoperability is a term used to refer to the level with which devices and systems can share data and interpret it (Healthcare Information and Management Systems Society, 2013). This means that two devices or systems are considered interoperable when they exchange data seamlessly and eventually…
Healthcare Information and Management Systems Society. (2013). What is Interoperability? Retrieved November 7, 2016, from http://www.himss.org/library/interoperability-standards/what-is-interoperability
Schiller, D. (2015, November 30). EHRs and Healthcare Interoperability: The Challenges, Complexities, Opportunities and Reality. Retrieved November 7, 2016, from http://www.healthcareitnews.com/blog/ehrs-healthcare-interoperability-challenges-complexities-opportunities-reality
Stroupe, M.P. (2011, May). What is EHR Interoperability and Why Should I Care? Retrieved November 7, 2016, from http://www.nethealth.com/wp-content/uploads/2013/11/What-is-EHR-Interoperability.pdf
omen's Health -- Focused on prevention and care for breast health, mammography, etc.
Transplant Programs - Swedish is one of seven kidney transplant centers and one of just four liver transplant centers serving the entire Pacific Northwest. The Organ Transplant Program at Swedish is at the forefront of new advances in transplantation surgery, including pancreas transplants and transplants between unrelated living organ donors and recipients (Swedish Medical Center, 2011).
Service design, operational activities, strategic decisions- Swedish is nothing but on the move -- strategically and tactically. In October, 2011, Swedish opened a new full-care facility with a 550,000 square foot campus in the city of Issaquah, southeast of Seattle city proper. This new facility was designed to be an entirely new hospital experience. Some of the operational innovations include a new Childbirth Center with eight new Labor/Delivery/Recovery rooms that include sleeping areas for partners, iPod access and a hotel room…
Arnold, E. (2007). Service-Dominant Logic and Resource Theory. Journal of the Academy of Marketing Sciences, 36(1), 21-24.
Crosby, J. (2011, November). Human Resource - Swedish Hospital.
Institute of Medicine. (2000). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press.
King, D. (2008). Designing the Digital Experience: How to Use Experience Design. Medford, NJ: Information Today Press.
Barnsteiner JH. Medication reconciliation: transfer of medication information across settings -- keeping it free from error. Am J Nurs. 2005;05(3 Suppl):3-6.
This article evaluates the need for proper medication reconciliation across various nursing settings. This article is important as emphasis is placed on error free reconciliation which is very important for proper client service and treatment.
Bullough, Vern L. and Bonnie Bullough. The Emergence of Modern Nursing (2nd ed. 972)
This reference emphasized modern nursing and many of the practices and advances of nursing over the years. This is important as it provides a historical perspective of medical reconciliation. A historical perspective is needed to better understand improvements that will need to be made in the future.
D'Antonio, Patricia. American Nursing: A History of Knowledge, Authority, and the Meaning of Work (200), 272pp
This reference provides further evidence into the history of medical reconciliation and recommendations on improvements that should…
13. Rogers G, Alper E, Brunelle D, et al. Reconciling medications at admission: safe practice recommendations and implementation strategies. Jt Comm J Qual Saf. 2006;32:37-50
14. Snodgrass, Mary Ellen. Historical Encyclopedia of Nursing (2004), 354pp; from ancient times to the present
15. Sullivan C, Gleason KM, Rooney D, et al. Medication reconciliation in the acute care setting: opportunity and challenge for nursing. J Nurs Care Qual. 2005;20(2):95-98
Describe briefly your topic of interest (15 possible points):
According to the United States Department of Health and Human Services (2013), medical reconciliation is "the process of comparing a patient's medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions." The process of medical reconciliation falls within the rubric of electronic medical records, which enable medical reconciliation. Medical reconciliation saves lives, improves the efficiency of hospital administration and of the healthcare team, and is simply necessary for providing quality of care.
#1 Database (or collection) (30 possible points):
Title of source:
"Electronic Health ecord (HE)"
Location of source (UL): http://www.ihs.gov/ehr/index.cfm?module=medication_reconciliation
Owner or publisher:
Indian Health Service
The Indian Health Service (2013) offers an overview of what medical reconciliation is, and how it applies to both individual and community health.…
"Electronic Health Record (EHR)," (2013). Indian Health Service. Retrieved online: http://www.ihs.gov/ehr/index.cfm?module=medication_reconciliation
"Medical Reconciliation," (2013). Greater Baltimore Medical Center. Retrieved online: http://www.gbmc.org/body.cfm?id=617
United States Department of Health and Human Services (2013). Electronic health record (EHR). Retrieved online:
against experimentation on animals, and some are more compelling than others. Some people suggest that the practice is immoral because choosing to experiment upon animals is directly analogous to racial or sexual discrimination; or more closely related to discrimination on the basis of mental capacity. Others contend that it is wrong because, by their estimations, no clear advances in medical research have been made through animal experimentation, and alternative modes of research are emerging. Doubtlessly, animal experimentation is a delicate moral issue, but asserting that animals should enjoy the same rights as humans within a society is a weak claim. Arguments have been formed differentiating animals from humans depending upon both their moral status and biological status. Yet, the most obvious line of reasoning is associated with the fact that granting animals the same rights as humans within society leads to many logical contradictions.
One question that needs to be…
1. Dunbar, Daniel. "The Confinement and Use of Non-Human Animals in Scientific and Medical Experiments is Morally Unacceptable." Ithaca University, 2005. Available: http://www.ithaca.edu/faculty/cduncan/250/ddunbar.doc .
2. Mitchell, Graham. "Guarding the Middle Ground: the Ethics of Experiments on Animals." African Journal of Science, Issue 85, May 1989. Available: http://www.garfield.library.upenn.edu/essays/v13p114y1990.pdf .
Medical and Billing Claims
I certainly do not agree with Tina's way of filling out an insurance claim. In fact, her method appears extremely suspect and potentially noxious to the company that both she and Tim are working for. The reason that I do not agree with Tina's way of filling out an insurance claim form is because she leaves far too much room for error. The fact that she would rather make an educated guess about the veracity of a claim based on unclear handwriting or terms she is ignorant about certainly does not bode well for her career -- or the degree of business that the company she is working for has. The billing and coding specialist position in the medical record field leaves little room for error.
There are a couple of rules or guidelines I would suggest Tina adhere to when attempting to fill out a…
Hobbes, T. (1651). Leviathan. www.Oregonstate.edu Retrieved from http://oregonstate.edu/instruct/phl302/texts/hobbes/leviathan-contents.html
Machiavelli, N. (2006). The Prince. Project Guttenberg. Retrieved from http://www.gutenberg.org/files/1232/1232-h/1232-h.htm
Medical Errors and Doctor Intimidation
Medical errors are an important challenge and concern facing medical professionals. Although not a new phenomenon the incidences of medical errors are estimated at about 200,000 per year. It is also expected that about 1/3 of medical errors go unreported and the same amount of hospital visits lead to hospital related injuries (Corrigan, Donaldson and Kohn, 2000). It doesn't take a mathematician to realize that the amount of medical errors is unnecessarily high, as it is suggested that 44,000 preventable deaths occur each year from medical errors, making it the 8th leading cause of death (Corrigan, Donaldson and Kohn, 2000). Should hospitals take steps to reduce medical errors? Absolutely, doing anything less would be sheer negligence. Far too many lives are at stake to not take all necessary steps to prevent avoidable errors. This paper will address challenges faced in the quest to reduce medical…
Beyea, S.C. (n.d.). Intimidation in health care settings and patient safety | AORN Journal | Find Articles. Find Articles | News Articles, Magazine Back Issues & Reference Articles on All Topics. Retrieved March 2, 2012, from http://findarticles.com/p/articles/mi_m0FSL/is_1_80/ai_n6113196
Buerhaus PI, Needleman J. Policy implications of research on nurse staffing and quality of patient care. Policy Politics Nurs Practice 2000; 1(1):5-15.
Spigel, S. (n.d.). Information Technology and Medical Error Reduction. Connecticut General Assembly . Retrieved March 2, 2012, from http://www.cga.ct.gov/2004/rpt/2004-R-0125.htm
To Err Is Human: Building a Safer Health System. (n.d.). The National Academies Press. Retrieved March 1, 2012, from http://www.nap.edu/openbook.php?record_id=9728&page=1
Factors related to hospitals and the patient population influence incidents of discharge Against Medical Advice, also known as AMA (Karimi et al., 2014). There is a high rate of discharges against the doctor’s advice after admission into emergency units. There is a need to probe the reasons behind such a trend (Shirani et al., 2010). It should be noted with concern that AMA is a healthcare institutions’ problem across the world because, in cases where children are discharged in such a manner, the blame cannot fall on these children. Children do not contribute to such decisions (Mohseni et al., 2013). Figures show that out of every 65 to 120 discharges from general hospitals across the world, one is a case of AMA. Such action is prone to dire consequences including litigation (Devitt et al., 2000). The scenario is a challenge to physicians across the globe (Taqueti, 2007). It is…
Electronic Certificates of Medical Necessity: A Proposal
Medical billing can now become a relatively painless process for the personal in a medical facility through the electronic filing of certificates of medical necessity (e-CMN). Manually filling out paperwork is very time consuming, and is not very cost effective. However, the technological advancements created in the area of medical billing are very efficient. While many offices now fax the CMN's, the incorporation of e-CMN's into the medical office and billing process, decreases overhead costs, reduces paperwork, and helps substantially with the on-going battle to comply with the ever-changing Medicare requirements. While each of the previous reasons is enticing enough to consider incorporating e-CMN's into the office routine, the increase of revenue is certainly a major benefit and is the direct result of the time reduction with the filing process.
Billy Tauzin, chairman of the U.S. House Committee on Energy and Commerce, clarified…
Bachenheimer, C. (2001, Aug. 1). Something out of nothing. Home Care Magazine. Retrieved April 13, 2004 at http://homecaremag.com/ar/medical_something_nothing/index.htm .
Business Wire. (2004, Feb. 13). American association for homecare and Trac Medical Solution agree on industry wide ecmn solution. ProQuest Document: 545984641 http://gateway.proquest.com/openurl-url_ver=Z39.882004&res_dat=xri:pqd&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&genre=article&rft_txri:pqd:did=000000545984641&svc_dat=xri:pqil:fmt
McClinton, D. (2001). E-CMN's. Home Care Magazine. Retrieved April 13, 2004, at http://homecaremag.com/ar/medical_ecmns/index.htm .
Sociology -- Medical Dominance on the Profession of Nursing and How is the Profession of Nursing Challenging Medical Dominance in Australia
In the context of medical practice, the contemporary medical society is representing a change in the increasing issues of domination between medical professions. The focus of each practice's attention is on exploring its goals in providing integral contributions and impact to the framework of health care services. Each dimension of medical interest, specifically the doctors and nurses, are developing their respective paradigm and uniqueness to establish skills and authority in the field of health service.
This paper aims to do an informative research on medical dominance over the profession of nursing in Australia. As the industry of medicine progresses, the issue of domination among medical doctors and nurses in health care institutions are associated with competencies and authority over the other. The power and privileges of the profession is…
Andrews, I., Hale, A. (2000). The Division of Labour in Health Care Delivery.
Retrieved Sept 23, 2003, from Faculty of Health Sciences. The University of Sydney.
Web site: http://www2.fhs.usyd.edu.au/bach/1107/topic9.htm
Duffy, E. Evolving Role and Practice Issues: Nurse Practitioners in Australia.
Organizational change plan
Introducing electronic medical records (EM)
Along with expanding health coverage to more Americans, one of the goals of recent federal policy has been the widespread adoption of electronic medical records (EM) by healthcare providers across the nation. "The federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records" (Abelson, Creswell, & Palmer 2012). Having EMs can be used by providers to gain swift access to comprehensive information about a patient's health history. Some patients forget their history of diagnoses or the medications they are on; sometimes patients must be treated when they are in a mental or physical state where they cannot be forthcoming with information and their friends and families are not nearby. Also, there is the problem of patients attempting to obtain more pharmaceuticals or drugs which they should not be taking. "Electronic…
Abelson, Reed, Julie Creswell, & Griff Palmer. (2012). Medicare bills rise as records turn electronic. The New York Times. Retrieved:
Change theory by Kurt Lewin. (2012). Current Nursing. Retrieved:
Poor medical safety practices result in over 40,000 deaths per year, of that 7,000 deaths are attributed to medication-related medical errors. There is no excuse for negligence when it comes to human lives. It is imperative that the medical community introduce sound medication safety best practices to eliminate adverse outcomes related to medication prescriptions. Best practices include the implementation of standardization and protocols in addition to the use of technology to reduce errors.
Medical Safety Practices
Medical practitioners are relied upon to provide solutions, acting as the first and many times, last hope of those in dire need. But despite this great responsibility to patients whose lives are entrusted in medical staff studies show that out of every 100 patients admitted to a medical facility 2 patients will experience a medical error due to incorrectly prescribed or administered medication. The results can be mild but can also be…
Bates, David W.; Spell, Nathan; Cullen, David J., et al. (1997).The Costs of Adverse Drug Events in Hospitalized Patients. JAMA. 277:307 -- 311.
Centers for Disease Control and Prevention (National Center for Health Statistics). (1999). Births and deaths: Preliminary data for 1997. National Vital Statistics Reports.
Grissinger, M., Globus, N.J. (2004). How Technology Affects Your Risk of Medication Errors. Nursing2004. 34(1), 36-41.
Institute of Medicine. (2000). To Err Is Human: Building A Safer Healthcare System.
She had been struck several times in the head with a Toney Penna golf club -- so ferociously that the club had shattered into multiple pieces -- and then stabbed in the neck with the broken shaft the club's handle and part of the shaft had vanished. (Kennedy Jr., 2003, Martha Moxley section, ¶ 1)
From evidence retrieved from the autopsy, police determined Moxley's murder occurred at approximately10:00 P.M..
On July 10, 1998, 23 years after Moxley's murder, "Connecticut authorities convened a one-man grand jury consisting of Judge George Thim. The state's attorney Jonathan Benedict took over the Moxley case and began a multimillion-dollar effort to convict Michael Skakel" (Kennedy Jr., 2003, Mark Fuhrman section, ¶ 5). Until this time, Greenwich police and state investigators considered Ken Littleton as the primary suspect for the murder of Moxley (Fuhrman, cited in Kennedy Jr., Mark Fuhrman section, ¶ 7). According to prosecutors'…
Caldwell, Lori. (2004, June 8). Post-Tribune. Gun missing as evidence, so Gary man acquitted. Post-Tribune (in). Retrieved November 20, 2008 from HighBeam Research database.
Givens, Ann. (2006). Evidence bungled?: Blood work in DWI death trial might have been mishandled, according to testimony of troopers, others. Newsday (Melville, NY). McClatchy-Tribune Information Services. Retrieved November 20, 2008 from HighBeam Research database.
Caldwell, Lori. (2004, June 8). Post-Tribune. "Gun missing as evidence, so Gary man acquitted." Post-Tribune (in). 2004. Retrieved November 20, 2008 from HighBeam Research: www.highbeam.com/doc/1N11032253A4EBD8A1C.html
Complete coverage: Limo crash. (2008). Retrieved November 20, 2008 at http://www.newsday.com/news/local/longisland/ny-licrashsg,0,390101.storygallery?coll=ny-linews-headlines
Nursing Leadership and Management
Organizational Analysis -- The Organization
The hospital is well recognized and has been named a top 100 Heart hospital and top 100 hospitals nationally. The organization also has a nationally ranked children's hospital that has newborn and pediatric intensive care services. Sanford Medical Center is a level II trauma center that is supported by AirMed transport services that cover a three-state area. The services offered within the facility include:
• 3D Mammography
• Allergy & Immunology
• Behavioral Health
• Breast Health
• Dermatology & Cosmetic Services
• Diabetes & Endocrinology
• Ear, Nose & Throat
• Emergency Medicine
• Family Medicine
• Palliative care
• Laboratory and Pathology
Sanford Medical Center is a not-for-profit rural health facility. The facility does partner with the community to bring health and healing to the…
In terms of communication within the hospice setting, this might occur by means of communicating with patients and their families to determine whether they experience their care setting in an optimal manner. If this is not the case, strategies are implemented to address the commonly experienced difficulties.
In conclusion, communication is a vitally important part of any care setting. Patients and their families must feel that they are the recipients of patient-centered care, and that they receive sufficient information to help them through difficult times. It is suggested that the PDSA model will be an effective way to accomplish this, along with process mapping. A logical sequence of steps must first address the underlying reasons behind the lack of effective communication among staff and patients. This can relate to the stress factors and harsh work schedules that practitioners often face. To work in such an emotionally eroding environment makes…
IHI.org. (2011). Improvement Methods. Retrieved from: http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/
Leavitt, M.O. (2009). Report to Congress on the Evaluation of the Quality Improvement Organization (QIO) Program for Medicare Beneficiaries for Fiscal Year 2006. Retrieved from: http://www.cms.gov/QualityImprovementOrgs/downloads/2006RtCQIO.pdf
Melinkovich, P. (2011). Adoption of Rapid Cycle Improvement Process From Toyota Increases Efficiency and Productivity at Community Health Clinics. AHRQ. Retrieved from http://www.innovations.ahrq.gov/content.aspx?id=1807
Victorian Quality Council. (2007, June.) Process Mapping. Retrieved from: http://www.health.vic.gov.au/qualitycouncil/downloads/process_mapping.pdf
Quality Improvements in Emergency Services
Consumers in the form of patients and other stakeholders are increasingly demanding for proof that the care being delivered or rendered to them is of high quality. In general, the public is cognizant of, demand quality from the medical sector or industry, and anticipates action and improvements to be undertaken when quality is not existent. There are very clear expectations and anticipations for improved health, improved efficiency and in overall improved quality. It is important for an Emergency Medical Services agency or organization to have programs and agendas in place that not only analyze, evaluate and assess the manner in which the organization and its employees are operating. The purpose of this paper is to analyze the aspect of quality improvement in Emergency Medical Services. The paper will take a look into the background of quality improvement and advancement in the emergency medical services sector.…
Angelini, K., Klein, S. (1989). The QA guarantee. Emergency, 20-23.
Bingaman, D. (1994). Continuous quality improvement in emergency service: what and why. Dallas: American College of Emergency Physicians.
El Sayed, M. J. (2011). Measuring quality in emergency medical services: a review of clinical performance indicators. Emergency medicine international.
Estepp, M., Crabtree, S. (1988). Quality assurance in EMS. Fire Command, 20-23.
Statistics in Healthcare
The author of this report has been presented with a case study scenario that involves one Ben Davis and another man named Juan de Pacotilla. The former is a young student who has just completed a Statistical Thinking for Business Improvement course and the latter is a pharmacy manager who is ostensibly about to lose his job due to a glut of errors relating to the dispensing of medications that are either the wrong drug or the wrong dosage of the right drug. Juan has spoken to another statistician but the person has been less than helpful in relation to this problem and Juan is now desperate. He sees Ben as a closer ally because Ben actually works in the pharmacy and thus sees thing first-hand. The ostensible task that Ben has been given is to nail down precisely what is going wrong using statistical data and…
HRSA. (2015). How does e-prescribing work?. Hrsa.gov. Retrieved 31 October 2015, from http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/ElectronicPrescribing/epreswork.html
THA. (2015). Prescription Verification Tips for the NEW Pharmacist or Student -- The Honest Apothecary -- . Thehonestapothecary.com. Retrieved 31 October 2015, from http://www.thehonestapothecary.com/2015/01/22/prescription-verification-tips-for-the-new-pharmacist-or-student/
Appendix -- Process Map
job aid that reduces human error and lack of attention to detail by providing a list of policies, procedures, or items that are needed to produce a consistent job or product. There are checklists used in transportation to ensure the vehicles are ready, in clinical medical practice to organize charting and patient history, in software engineering to check process compliance and code, in litigation to deal with the complexity of discovery, in biology/science to list standardized practices and names, and even in everyday hobbies and life to organize materials, shopping, or contents. This tool of organization and operation may seem simple, but it provides a template and framework for innumerable tasks in almost endless ways (Gawande, 2007). It is interesting to note that this simple tool -- so logical and valuable, has saved so many lives in medical care (e.g. surgery, medication, etc.) by simply trying to understand a multistage…
Felder, K. (1996). One of these things is not like the other. NCSU.edu. Retrieved from:
Gawande, A. (December 10, 2007). The Checklist. The New Yorker. Retrieved from: http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
Gopalan, P. (April 29, 2011). Avoiding the checklist monkey. On Product Management. Retrieved from: http://onproductmanagement.net/2011/04/29/avoiding-the-checklist-monkey/
Stated to be barriers in the current environment and responsible for the reporting that is inadequate in relation to medical errors are:
Lack of a common understanding about errors among health care professionals
Physicians generally think of errors as individual that resulted from patient morbidity or mortality.
Physicians report errors in medical records that have in turn been ignored by researchers.
Interestingly errors in medication occur in almost 1 of every 5 doses provided to patients in hospitals. It was stated by Kaushal, et al., (2001) that "the rate of medication errors per 100 admission was 55 in pediatric inpatients. Using their figure, we estimated that the sensitivity of using a keyword search on explicit error reports to detect medication errors in inpatients is about 0.7%. They also reported the 37.4% of medication errors were caused by wrong dose or frequency, which is not far away from our result of…
Discussion Paper on Adverse Event and Error Reporting In Healthcare: Institute for Safe Medication Practices Jan 24, 2000
Patient Safety/Medical Errors Online at the Premiere Inc. page located at: http://www.premierinc.com/all/safety/resources/patient_safety/downloads/patient_safety_policy_position_2001.doc
Medstat / Shortell, S. Assessing the Impact of Continuous Quality Improvement on Clinical Practice: What It Will Take to Accelerate Progress.
Health Policy Monitor (2001) A Publication of the Council of State Governments Vol. 6, No. 1 Winter/Spring 2001 PO18-0101
S.W.O.T. For Community South Medical Center
Needs of Community South Medical Center
The identified strength of Community South Medical Center is that of the array of services it offers and the level of excellence of those services. The weakness of Community South Medical Center is that of its older facilities and infrastructure. The Opportunity for Community South Medical Center is that of the potential of new program development and the abundance of physicians at the medical center. The Threat of Community South Medical Center is that of its lack of interfacing software and the new electronic record data that is being adopted by other medical facilities across the country. The conversion of paper files to digital records is reported as being expensive. There is presently federal stimulus bill funding funneled toward the institution of electronic medical records however, it is reported that this funding will be provided in "increments over…
EMR 2012: The Market for Electronic Medical Records (2012) TMC.net. Retrieved from: http://www.tmcnet.com/usubmit/2012/06/28/6403890.htm
Gambon, J. (2011) 5 key barriers to adopting electronic medical records today. Mass High Tech. Retrieved from: http://www.bizjournals.com/boston/blog/mass-high-tech/2010/04/5-key-barriers-to-adopting-electronic-medical.html?page=all
HIMSS Analytics (2008) The Premier EMR Adoption Assessment Tool. Retrieved from: http://www.himssanalytics.org/docs/emram.pdf
U.S. Electronic Medical Records (EMR - Physician Office & Hospital) Market - Emerging Trends (Smart Cards, Speech Enabled EMR), Market Share, Winning Strategies, Adoption & Forecasts till 2015 (2011) Markets and Markets. Retrieved from: http://www.marketsandmarkets.com/Market-Reports/us-emr-market-401.html
Typically, accurate documentation assists in limiting errors. (Stanford Hospital & Clinics, 2012).
Car et al. (2008) point out that integrating of electronic health within a healthcare organization enhances quality and safety of patients. The author argues that electronic health record assists the healthcare provider to readily access comprehensive information in order to minimize the incident of error as well as enhancing patient safety and quality of healthcare delivery. While Stanford Hospital and Clinics has made several efforts to enhance quality healthcare delivery and patient safety within the hospital environment, however, the issue of medical errors is still rampant within the healthcare sector in the United States. Meanwhile, there are several ways the issue of error incidents can affect the healthcare delivery.
Impact of Error incident on Healthcare Delivery
A major effect of error incident within the health sector is the decline in the quality healthcare delivery and the issue could…
Ballard, K.A.(2003). Patient Safety: A Shared Responsibility. ANA Periodicals. 8(3).
Car, J. Black, a. Anandan, C. et al. (2008). A Systematic Overview & Synthesis of the Literature. Report for the NHS Connecting for Heath Evaluation Programme.
Library Index (2012). Challenges Change and Innovation in Health Care Delivery -- Safety.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century-Summary. Washington, DC: National Academy Press, 2-4.
None of the findings are not surprising to a lot of experts. Apart from large systems that are integrated, like Kaiser Permanente in California and the Veteran's Administration, a lot of doctor practices are adopting different EMs. Also in so many different situations they do not talk to one another (Sittig & Singh 2012). So, a doctor's record is not necessarily able to get access notes from his regional hospital if different systems were utilized. A lot of doctors in that condition could just re-order a test, instead of going through all of the changes of finding the records from the hospital.
Actually many experts make the point that the true power of digital records come when using a sole, unified system that can be retrieved by altered health sites. With the exclusion of large combined health arrangements, there sometimes can be fragmented EMs. Experts mention that perhaps with the…
Cook, P.J., Lawrence, B.A., Ludwig, J., & Miller, T.R. (1999). The medical costs of gunshot injuries in the United States. JAMA, 282(5), 447-54.
Eckman, B.A., Bennett, C.A., Kaufman, J.H., & Tenner, J.W. (2007). Varieties of interoperability in the transformation of the health-care information infrastructure. IBM Systems Journal, 46(1), 19-41.
Heselmans, a., Aertgeerts, B., Donceel, P., Geens, S., Van, d. V., & Ramaekers, D. (2012). Family physicians' perceptions and use of electronic clinical decision support during the first year of implementation. Journal of Medical Systems, 36(6), 3677-3684.
Simons, W.V., Mandl, K.D., & Kohane, I.S. (2005). The PING personally controlled electronic medical record system: Technical architecture. Journal of the American Medical Informatics Association, 12(1), 47-54.
Government Created a Committee
An electronic health record is a digital record of a patient's health information generated from every medical visit a patient makes. This information includes the patient's medical history, demographics, known drug allergies, progress notes, follow up visits, medications, vital signs, immunizations, laboratory data and radiological reports. The EH automates and streamlines a clinician's workflow. (Himss, 2009)
Due to the multiple advantages of an EH, health care agencies have been aiming to push up this technology. In 2004, the FDA approved of an implantable EH microchip into patients. Each microchip has a specific code which is identified through sensors. The device is implanted under the skin, in the back of the arm, requiring a twenty minute procedure, without needing the use of sutures. ("Fda approves computer," 2004)
According to the Center for Disease Control and Prevention, deaths due to preventable medical errors rank as the fifth most…
CDC. (2011, October 24). Deaths and mortality. Retrieved from http://www.cdc.gov/nchs/fastats/deaths.htm
Fda approves computer chip for humans. (2004, October 13). Retrieved from http://www.msnbc.msn.com/id/6237364/ns/health-health_care/t/fda-approves-computer-chip-humans/
Himss. (2009, September 2). Implanet using ibm software to protect patients in the event of medical device recalls. Retrieved from http://www.healthcareitnews.com/press-release/implanet-using-ibm-software-protect-patients-event-medical-device-recalls
Prutchi, D. (2011, December 30). Verimed's human-implantable verichip patient rfid. Retrieved from http://www.implantable-device.com/2011/12/30/verimeds-human-implantable-verichip-patient-rfid/
Fault: An Alternative to the Current Tort-Based System in England and Wales
The United Kingdom
statistics regarding claims
THE NATIONAL HEALTH SYSTEM
OBSTACLES TO DUE PROCESS
THE CASE FOR REFORM
THE REGULATORY ENVIRONMENT
THE RISING COST OF LITIGATION
LORD WOOLF'S REFORMS
MORE COST CONTROLS
THE UNITED STATES
THE INSURANCE INDUSTRY
TORT REFORM IN AMERICA
STATISTICS FOR ERROR, INJURY AND DEATH
THE CALL FOR REFORM IN 2003: A FAMILIAR REFRAIN
THE UNITED STATES SITUATION, IN SUMMARY
NEW ZEALAND CASE STUDIES
THE SWEDISH SCHEME
COMPARISON: WHICH SYSTEM IS BETTER?
FIRST: UNDERLYING DIFFERENCES
TALKING TORT: AMERICAN PECULIARITIES
AMERICANS CONSIDER NO-FAULT
BRITAIN CONSIDERS NO-FAULT
Appendix A THE UNITED KINGDOM
At issue is the economic effectiveness of tort law in the common law legal system of England and Wales, as applied to medical and clinical negligence and malpractice cases. In response to economic concerns and a continual…
1852). He states that fear might also limit a person's capacity for self-disclosure and this fear includes: "fear of embarrassment by colleagues, fear of patient reaction, and fear of litigation" (p. 1852).
Disclosure has now come to occupy an important place on political policy-making agenda. Most people now believe that they must have access to information about a professional or procedure that is likely to cause serious harm. IOM's recommendations in this regard propose access to information and states that "requests by providers for confidentiality and protection from liability seem inappropriate in this context." (Kohn, et al.: 102) Some professional health-care institutions are now looking forward to making disclosure mandatory. While the process would take some time to complete, Veterans ffairs (V) Medical Center in Lexington, Kentucky, has started working on it. Steve Kraman of the Lexington V hospital explains why disclosure was made mandatory, "We didn't start doing this…
Altman, I., Vinsel, A., & Brown, B. (1981). "Dialectic conceptions in social psychology: An application to social penetration and privacy regulation." In L. Berkowitz (Ed.), Advances in experimental social psychology (pp. 107-160). New York: Academic.
L.T. Kohn, J.M. Corrigan, M.S. Donaldson, eds, (2000) To Err is Human: Building a Safer Health System (Washington, DC: National Academy Press).
N. Osterweil, "Truth or Consequences: Does Disclosure Reduce Risk Exposure?: Admitting Errors Makes Process Less Adversarial, MDs, Lawyers Agree," WebMD Medical News
The most common cause of pancreatic cancer is smoking which accounts for 25 -- 30% of cases (urveillance, Epidemiology and End Results Program). Other factors include hereditary pancreatic cancers, adults with diabetes of minimum duration two years, hereditary pancreatic, and a history of other family cancers (GUT. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas). The Consensus Guidelines of the International Association of Pancreatology advises that patients with a genetic history of pancreatic cancer should be referred to specialist centers where they can receive diagnosis of pancreatic diseases, genetic counseling, and advice on secondary screening (Ulrich et al., 2001).
Most pancreatic cancers (about 90%) originate in the ductal region and are usually discovered when they are locally advanced. They are called ductal adenocarcinoma. Others (80-90%) occur in the head of the gland (GUT). Lymph node metastasis is common as well as…
Doheny, K ( July 2, 2012) Medication Errors Affect Half of Heart Patients WebMD http://www.webmd.com/heart/news/20120702/half-of-heart-patients-make-medication-errors
GUT. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas http://gut.bmj.com/content/54/suppl_5/v1.full
Surveillance, Epidemiology and End Results Program. http://seer.cancer.gov/faststats/html/inc_pancreas.html
Neoptolemos JP, Dunn JA, Stocken DD, et al. (2001) Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet;358:1576-85
Hand-held devices and portable digital assistants (PDAs) are being integrated into the health care setting in the United States. It is important to understand which devices are being used, how they are being used, what they are being used for, and why. Understanding the role that hand-held devices and other portable electronics play in health care can help to inform organizational policy, and help health care administrators better implement electronic medical records.
History of use
The first documented PDA was the Newton MessagePad, issued by Apple in 1993. It was described as being "revolutionary" (Wiggins, 2004, p. 5). Palm, Inc. developed the next big handheld device: the Palm Pilot, in 1996. By the late 1990s, PDAs were equipped for Internet access, and memory capacity and other features improved with each product release. Microsoft also entered the portable electronic devices marketplace in the 1990s. The devices were not yet being…
Alerndar, H. & Ersoy, C. (2010). Wireless sensor networks for healthcare. Computer Networks 54(15): 2688-2710.
Fornell, D. (2008). PDAs bring hand-held solutions to healthcare. Acuity Care Technology. Retrieved online: http://www.soti.net/PDF/PDAsBringHandHeldSolutionsToHealthcare_Article.pdf
Garritty, C. & El Emam, K. (2006). Who's using PDAs? Journal of Medical Internet Research 8(2).
Huang, V.W. (n.d.). PDAs in medicine. Power Point Presentation Retrieved online: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&ved=0CF4QFjAB&url=http%3A%2F%2Fwww.cs.princeton.edu%2Fcourses%2Farchive%2Fspr02%2Fcs495%2Fpda.ppt&ei=xxqAUsq_NtTFqQG25IHwAQ&usg=AFQjCNE4Wf4YrX7slTbcdYJwxujV3rwgog&sig2=Uee9rvdDYwY0uYM33n1ZBg&bvm=bv.56146854,d.aWM
Hospital Case Study
If the first requirement of any successful case study is a detailed and analytical examination of the situation, the emotional component of so called "high stakes" issues can make this requirement difficult, indeed. The simple fact, however, is in order to find good solutions and policies regarding the problem presented in the case study, one must apply the three main questions of "situation," "remedy/s," and "method/s." Although this may seem difficult in some situations, the emotional component must not be considered.
A good example of this fact occurs in the examination of an unfortunate case involving the botched heart/lung transplant of a 16-year-old girl, much like the recent incident at Duke Hospital. In this case, a young girl died as a result of receiving miss-matched organs. Unfortunately, in this case, all of the supposed safeguards of the system, imposed to assure that proper blood typing of both…
Chibbaro, Lou. (2004) Victory Claimed in HIV Suits. Washington Blade. Web site. Retrieved on August 8, 2004, at http://www.washblade.com/print.cfm?content_id=2771
Colorado State University Writing Center. "Case Studies." Retrieved from Web site on August 2, 2004 http://writing.colostate.edu/references/research/casestudy/com2a1.cfm
CTDN. California Donors Network. (2004) Facts about organ and tissue donation. Web site. Retrieved on August 8, 2004, at http://www.ctdn.org/resources/faqs.php?id=3&NoHeader=1
Duke University. (2004). UNOS and DUH Safeguards for Organ Transplant Safety. Duke Medical News. Retrieved on August 7, 2004, at http://dukemednews.org/filebank/2003/06/28/UNOS%20and%20DUH%20Safeguards%20for%20Organ%20Transplant%20Safety.doc
Err is Human: Summarize how informatics has assisted in improving health care safety in your organization and areas where growth is still needed.
The 1999 report "To Err is Human" shocked the medical establishment with its reports of high levels of medical errors in hospitals throughout the country. Patients were worried about how fallible health providers could be, and the extent to which they often denied or ignored the fact they were at fault. However, the report always stressed that improved safety was the primary concern of the report, not to blame doctors and nurses. Today, more than ten years since the report was issued, providers are searching for ways technology can be used to improve patient safety through creating an additional barrier against error for the healthcare provider.
One of the most frequently-cited justifications for electronic medical records is the extent to which they can improve accuracy of diagnosis…
Donaldson, Molla Sloane. (2008). Chapter 3: An overview of To Err is Human: Re-emphasizing the message of patient safety. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved:
Patients deserve as much time and attention as a nurse can possibly provide but when a nurse is in charge of eight patients at once she or he can only spend a few minutes with each one. When a patient requires additional care, nurses are unable to provide it. Therapeutic care is ultimately compromised when nurses have a high case load. Nurses can be more attentive to each patient when case loads are low. When nurses spend more time with each patient, symptoms are noticed earlier, allowing for more rapid diagnoses and recovery times.
Health care administrators should consider lowering the nurse-to-patient ratio for the best interests of both patients and nursing staff. Patient care is compromised when nurses do not have enough time or energy to devote to all patients, especially those requiring special attention or care. Employee satisfaction and patient satisfaction both suffer when nurses care for eight…
(the pulse of health care is wireless: The future medical enterprise)
The Pocket PCs and the PDA's are just only the tools but it is the software that drive these hand held devices that allow for providing better health care services. Starting from an individual medical practitioner and moving on to the communities of professional the use of these hand held devices allow them to work cooperating with each other and through the health care enterprise. The Electronic Medical ecords - EM, Clinical Drug eferences, Patient Management Systems - PMS, Patient Scheduling Systems, e-Prescription writers and such other enterprise functionalities can be made more widely available to the medical professionals by the use of Pocket PCs and PDA's. These combinations of the Health care enterprise functionalities and the medical professionals aided by these handheld devices would go a long way in providing the best practice of health care service for…
Freudenheim, Milt. Digital Rx: Take Two Aspirins and E-Mail Me in the Morning. March 2, 2005. Retrieved at http://www.freerepublic.com/focus/f-news/1353923/postsAccessed on March 8, 2005
Horrigan, Darren. Pocket PCs advance on Palm. October 15, 2002. Retrieved at http://www.theage.com.au/articles/2002/10/13/1034222638972.html?oneclick=true Accessed on March 8, 2005
Sciannamea, Michael. Duke Caregivers Leveraging PDAs for Patient Care. October 6, 2004.
Retrieved at http://telemedicine.weblogsinc.com/entry/1805781712401103/. Accessed on Shah, Sandeep. The pulse of health care is wireless: The future medical enterprise. Mobile Computing News. December 16, 2003. Retrieved at http://searchmobilecomputing.techtarget.com/originalContent/0,289142,sid40_gci941579,00.html . Accessed on March 8, 2005
Operational Plan and Correlating Budget
The 4 West is an organization that delivers health care for the community. ecently, the organization has decided to replace the existing medical-surgical unit into a new acute care oncology unit. The oncology is a specialty in medicine that deals with cancer. The CNO (Chief Nursing Officer) has informed the nurse director that 4 west is to become a specialized oncology unit. Since the hospital is planning the transition from the medical-surgical unit to the oncology unit, the hospital will need a new operational plan and correlating budget to assist the hospital to deliver high quality healthcare at lower costs.
Objective of this project is to develop an operational plan and correlating budget for the hospital to assist in effective transition from the medical-surgical unit to the oncology unit,
Project Details and Data
To start the budget plan, it is critical to use…
Bureau of Labor Statistics.(2014). Healthcare Occupations. Occupational Outlook Handbook. USA.
Clarke, S.P. & Donaldson, N.E. (2010). Chapter 25. Nurse Staffing and Patient Care Quality
Goodman, A.(2012). Oncology Nurse Staffing Is Variable and Multifactorial. Nursing News.
Political Analysis of Establishing the Baccalaureate Degree as Minimum equirement for Nursing
Establishing the baccalaureate degree as minimum requirement for nursing
Identifying and analyzing the problem
The challenges of the modern healthcare environment have grown increasingly complex and diversified. The skills required for a competent nurse have grown and expanded with changes in technology; also, cost-cutting by many major healthcare institutions have shifted duties once solely confined to physicians onto the shoulders of nurses. Given the additional roles and responsibilities assumed by nurses, there have been increasing demands that nurses have at least a baccalaureate degree as minimum requirement for entering the nursing profession. At present 39% of all nurses have degrees from four-year colleges (Perez-Pena 2012:2).
Outlining and analyzing proposed solutions
Despite the nursing shortage, many hospitals have begun to demand that nurses now have a B.A., causing many seasoned nurses to have to return to school. "That shift…
Ingeno, L. (2013). Who will teach nursing? Inside Higher Ed. Retrieved from:
Maitland, R. (2013). Schools adapt to nursing faculty shortage with creativity. Chronicle of Higher Education. Retrieved from: http://www.chron.com/jobs/article/Schools-adapt-to-nursing-faculty-shortage-with-3949965.php
Perez-Pena, R. (2012). More stringent requirements send nurses back to school. The New York
training plan for the implementation of EH (electronic health record) that St. Joseph Hospital has launched on May 2012. The training program will consist of approximately 1500 hospital employees and physicians. The implementation of the training program will take 6 months to complete and the program will assist St. Joseph Hospital to deliver a quality healthcare to patients.
Present competitions within the healthcare market environment have made healthcare organizations to continue searching for innovation to capture the opportunities and overcome obstacles as well as surviving within the present competitive environment. Training and education has become a critical tool that healthcare organizations employ to achieve competitive advantages. Implementing training and education for employee assists healthcare organizations to eliminate medical errors associated with healthcare practice which consequently enhances quality healthcare delivery.
Fundamental objective of this paper is to provide training and development for new and existing employees of St. Joseph Health System.…
Bohlander, S. (2011). Managing Human Resources. Cengage Learning. Canada.
Brokel, J.M. & Harrison, M.I. (2009). Redesigning Care Processes Using an Electronic Health Record: A System's Experience. The Joint Commission Journal on Quality and Patient Safety. 35 (2): 82-92.
Gomez-Mejia, L. Balkin, D. & Cardy, R. (2010). Managing human resources. (6th ed.). Upper Saddle River, Nj: Prentice Hall.
Bar code medication administration (BCMA) is one of the keys to minimizing medical errors in a manner consistent with evidence-based practice (Poon et al., 2010). However, universal embrace and utilization of BCMA remains stagnant. easons for resisting the transition to BCMA include nurse perceptions. Holden, Brown, Scanlon, & Tzion-Karsh (2012), for instance, found nurses reporting low perceived usefulness of BCMA in spite of the wealth of evidence supporting the technology. Perceived ease of use of BCMA was moderate, suggesting that it is mainly attitude factors preventing nurses from implementing BCMA in their institutions. When perceptions of the usefulness of BCMA increase, then compliance with BCMA standards can become more widespread. Any program that attempts to increase the utilization of BCMA must focus first on human factors including attitudes. This requires that all nurse leaders, as well as nurse educators, prepare advance practice nurses for using BCMA as a matter…
Duffield, C.M., Roche, M.A., Blay, N., & Stasa, H. (2011). Nursing unit managers, staff retention and the work environment. Journal of Clinical Nursing, 20(1-2), 23-33.
Roberts, B.R. (2013). Doctor of nursing practice: Integrating theory, research, and evidence-based practice. Clinical Scholars Review, 6(1), 4-8. doi: http://dx.doi.org/10.1891/1939-2095.6.1.4
However, this might turn competent healthcare professionals away, who were angry that they no longer could exercise discretion over their treatment, in conference with their patients. Patients might refuse to come to the hospital. And those that did would cause costs to escalate, as they stayed longer, received more extensive care, and thus exhausted their insurance benefits.
A summary presentation of a comprehensive solution that would cover all of the issues
Firstly, the board of directors should be convened to establish a policy about what the religiously founded hospital considers to be a quality life and an ethical system of evaluating critical patients, when dispensing care. Doctors, nurses, and other involved personnel must be convened to discuss various issues that continually arise and a uniform policy must be established, so that such ethical decisions are not solely the burden of patients and healthcare providers in the field.
A press release…
National Coalition on Health Care. (2004) "Health Insurance Cost." Retrieved 2 June 2005 at http://www.nchc.org/facts/cost.shtml
National Coalition on Health Care. (2004) "Health Insurance Coverage." Retrieved 2 June 2005 at http://www.nchc.org/facts/coverage.shtml
Patient portals, electronic medical records, and personal monitoring devices are three of the most revolutionary technologies in the healthcare sector. Each of these technologies presents patients with the potential to empower themselves, taking control of their own healthcare outcomes, and taking part in their overall healthcare goals. These technologies also streamline healthcare administration and minimize medication and billing errors. However, each of these technologies is also constrained by a range of issues related to accessibility, with potent socioeconomic class disparities evident. Security and standardization of healthcare technologies are also proving problematic. Patient portals, electronic medical records, and personal monitoring devices are all technologies that have the potential to radically improve the quality of healthcare and patient outcomes, as well as improve overall patient experiences. Because of their abundant benefits, these technologies need to be embraced and promoted through effective public health policies. Otherwise, disparities will continue to threaten to exacerbate…