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| California Hospitals Fined for Safety Violations |
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California's Department of Public Health has fined 18 hospitals $25,000 per incident for failing to comply with state laws overseeing patient safety and quality of care.
The hospitals cited included:
Doctors Medical Center in San Pablo, where a patient's death was attributed to incompetent staff, poor training and the incorrect insertion of an intravenous catheter;
Palomar Pomerado Health System in Poway, where three patients experienced intraoperative awareness due to an improperly maintained anesthesia machine;
Scripps Green Hospital in San Diego, where a patient fell off an operating table during surgery; and
San Gorgonio Memorial Hospital in Banning, which failed to stock emergency medications in its ORs, PACU, radiology department and emergency ward. The hospital also lacked crash carts for emergency cardiac situations.
This is the state's fourth round of fines since a law requiring the discipline of non-compliant hospitals took effect last year. More than 40 hospitals have been fined. "We are working with California hospitals to ensure excellence in patient care, and these fines are one more way to ensure our goal," the health department's Suanne Buggy told a Redlands newspaper. The health department publishes investigative reports on each violation cited.
Kent Steinriede |
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| What Happens When Opioids Backfire? |
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It's a rare and challenging pain management paradox: opioid drugs, designed to relieve acute and chronic pain, can have the reverse effect in some patients and actually exacerbate it. A new study offers strategies for combating this complication.
Although most patients treated with opioids do not develop opioid-induced hyperalgesia (OIH), the condition was documented as early as the late 19th century. For a paper published in Pain Treatment Topics, Peggy Compton, RN, PhD, an associate professor of nursing at the University of California Los Angeles School of Nursing, examined decades of laboratory and clinical evidence of OIH, including research showing a higher incidence of post-operative OIH in patients who had received short-acting opioids during various abdominal surgeries.
Theories for why opioids reduce some patients' tolerance for pain range from genetic factors to the type and source of the pain. "What is clearly evident from the literature," writes Dr. Compton, "is that when OIH does arise, it can be challenging for the clinician to manage."
Noting that increasing the opioid dose worsens the pain associated with OIH rather than improving it, she recommends other strategies for preventing or minimizing the effects of OIH, including:
keeping the opioid dosage as low as possible without impeding its effectiveness;
using adjuvant medications such as dextromethorphan, propofol or COX-2 inhibitors;
using long-acting rather than short-acting opioids;
rotating different types of opioids; and
combining low-dose opioid antagonists, such as naltrexone, with opioid agonists.
Dr. Compton also stresses the importance of closely monitoring patients' responses to opioid therapy and differentiating between OIH and such opioid-related conditions, such as tolerance, withdrawal, addiction and pseudoaddiction.
Irene Tsikitas |
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| Safer, Synthetic Heparin Developed |
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Researchers at Rensselaer Polytechnic Institute in Troy, N.Y., have built the largest dose of synthetic heparin ever created in a lab. The development comes months after batches of contaminated heparin forced the FDA to recall the blood-thinning drug and sparked demand for a safer alternative.
Robert Linhardt, a senior professor of biocatalysis and metabolic engineering at RPI, led the development of the synthetic heparin. He was also one of the investigators who discovered the contaminant in the tainted heparin.
"When we found the contamination, it was another sign that the way we currently manufacture heparin is simply unsafe," he says in a statement. "Unlike the current heparin that is harvested from possibly disease-carrying animals in often very poor conditions, our fully synthetic heparin will be created in a pharmaceutical manufacturing environment from fermentation to packaging. This will give drug manufacturers extreme control over the safety and purity of the product."
Mr. Linhardt's research team based the synthetic heparin on the E. coli bacteria, which they say makes their version of the drug easier and faster to produce. The milligram heparin dose they built is a million times higher than any dose built to date, but will need to be expanded to kilogram doses before it's used in human trials, a development Mr. Linhardt believes could occur over the next five years.
"Ultimately, drug companies are going to need to produce tons of this drug to keep up with global demand," he says. "Such levels of productions are further down the road."
Daniel Cook |
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| Instapoll: Working Weekends? No Thanks |
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There are many reasons why outpatient surgical facilities might consider doing cases on weekends: To accommodate a surgeon who can't make it to your place during the week, to ease an overbooked schedule, or to postpone that renovation or expansion project chief among them. According to last week's online poll, however, most of you would rather not work Saturdays.
Out of 69 responses, only 12 percent reported that their facility is open for business over the weekend. Half of those said it's working out great. The other half said that doctors and nurses dread it. Another 7 percent said they're seriously considering scheduling weekends. But a whopping 81 percent said they hope they never see the (Satur)day when they're staffing a weekend OR.
Check out this week's poll - are you paid what you deserve? - located on the lower right side of our front page.
Dan O'Connor |
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| News & Notes |
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New ICD codes in 2011 The U.S. Department of Health and Human Services is proposing to update the ICD-9 code set now in use with an ICD-10 set, which would accommodate more diagnoses and new procedures, by Oct. 1, 2011. ICD-9 contains 17,000 codes and is expected to run out of codes next year, according to HHS. The ICD-10 set has more than 155,000 codes and allows for more detail on electronic health records and transactions between providers and payers. HHS is accepting public comments on the proposal until Oct. 21, 2008.
Compression stockings misused Research published in the September issue of the American Journal of Nursing shows that 29 percent of patients use compression stockings incorrectly and that 26 percent wear the wrong size. For their study, researchers examined 142 patients in recovery, 37 of whom wore thigh-length stockings and 105 with knee-length ones. They found use and size errors more common among those with the higher stockings and among overweight patients. They recommend making knee-length compression stockings a standard and improving nurse and patient education about their correct use.
Smokers' throat surgery risks Patients who smoke are at increased risk for bleeding after uvulopalatopharyngoplasty with tonsillectomy, according to a study published in the August issue of the Archives of Otolaryngology - Head & Neck Surgery. Researchers reviewed post-op bleeding rates in 1,010 tonsillectomy patients from 2000 to 2005. They discovered 10.2 percent of patients who smoked bled post-op as compared to 5.4 percent of non-smokers. The researchers attribute the large difference to "a marked increase in post-operative hemorrhage in the patients who underwent UPPP" and note "further investigation of this relationship is needed, with stratification of patients by the number of cigarettes smoked and attention to the length of time before and/or after surgery that patients refrain from smoking." |
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