Communication Issue Leads to Retained Foreign Body
This case study was put together by our partners at CRICO and was written by Kathy Dwyer, MSN, RN Description Following successful cranial surgery, a 54-year-old man experienced back and lower extremity pain which was ultimately diagnosed as being related to an intrathecal lumbar catheter left behind at the time of surgery eight months earlier. Key Lessons Consider options that limit over-reliance on memory. Implementing structured communication tools (i.e., SBAR, I-PASS) may help to mitigate risk and improve outcomes. Patients play an important role in their own care and recovery. Retained foreign body cases are difficult to defend. Clinical Sequence...
Update on Controlled Substances and Telehealth Prescribing
On June 14th the U.S. Drug Enforcement Agency (DEA) submitted their long-awaited final rule for telehealth prescribing of controlled substances to the White House Office of Management and Budget (OMB) for a final rule before publication. The rules are expected to be published sometime prior to December 2024. As previously reported, in May 2023 the DEA had temporarily extended the COVID-19 telemedicine flexibilities for prescribing controlled substances. By way of background, The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 requires prescribers to conduct an in-person examination to evaluate each new patient at least once before prescribing a controlled substance. After...
The Hawaii Legislature and Governor Josh Green, MD, have enacted significant legislation impacting Hawaii physicians. For a broad report on healthcare legislation enacted, see the Hawaii Medical Association 2024 Legislative Report. Provider Orders for Life Sustaining Treatment (POLST) Effective immediately, this measure (SB 2529) amends the definition of “patient’s provider” initiating POLST orders by removing language that requires the provider to “examine” the patient. Entities testifying in support of the amended law noted that this “examination” requirement often resulted in delays in completing and/or updating a patient’s POLST, particularly for patients in hospice care. The amended law recognizes that “POLST...
Incomplete Record Review Delays Endocarditis Diagnoses
This case study was put together by our partners at CRICO and was written by Margaret Janes, CRICO Description A diagnosis of endocarditis was made 18 days after the patient, who had a (known) congenital bicuspid aortic valve, initially presented with fever and fatigue. Key Lessons When patients return with repeated complaints, consider other causes for symptoms Communicating with patients in ways not captured in their health records may contribute to missed information and assessment opportunities Develop triggers for when to bring patients to the office when they call with unresolved complaints Clinical Sequence A 43-year-old female saw her new...
This case study was put together by our partners at CRICO and was written by Margaret Janes, CRICO Description A diabetic patient being treated for a foot contusion suffers necrosis and requires a partial amputation. Key Lessons Engage patients in their care plan; do not assume patients understand or will comply with recommendations. Documentation in the medical record supports care provided at the time of a patient encounter. Clinical Sequence A 62-year-old male with a history of diabetes, neuropathy, and peripheral vascular disease presents to the ED after suffering for three days with a contused foot after a heavy box...