Tag Archives: Pharmacy

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2020 is the Year of the Nurse: Is your organization preparing?

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On Jan. 30, 2019, the Executive Board of the World Health Organization (WHO) declared 2020 “The Year of the Nurse and Midwife (YONM)” in commemoration of the 200th birth anniversary of Florence Nightingale. The WHO has shared the following in anticipation:

“Nurses and midwives play a vital role in providing health services. These are the people who devote their lives to caring for mothers and children; giving lifesaving immunizations and health advice; looking after older people and generally meeting everyday essential health needs. They are often, the first and only point of care in their communities. Quite simply, the world will only achieve universal health coverage by recognizing the critical role they play and by investing more in the nursing and midwifery workforce.”

“The year-long global focus on nurses and midwives is a unique opportunity to get involved! Campaign assets will be made available.”

In terms of healthcare organizations employing nurses, the opportunity exists for nurses to be rightfully honored for their place in the global health delivery system, and for their employers to create a new vision of what nurses can accomplish in the 21st century.

More than Cannon Fodder

If healthcare leaders were to question nurses regarding their working conditions, recognition, and how valued they feel, they would doubtless hear that nurses feel like so much cannon fodder crushed beneath undue stress, poor staffing, high injury rates, and the threat of aberrant behavior by both patients and staff.

In a study published in late 2018 by the Bureau of Labor Statistics (BLS), nurses were shown to experience high rates of work-related injuries. To wit:

“Many of the approximately 3 million RNs working across all industries face workplace hazards in performing their routine duties. RNs spend time walking, bending, stretching, and standing (exposing themselves to possible fatigue, as well as slips, trips, and falls); often lift and move patients (becoming vulnerable to back injuries); and come into contact with potentially harmful and hazardous substances, including drugs, diseases, radiation, accidental needlesticks, and chemicals used for cleaning (which can cause exposure-related injuries and illnesses). In 2016, workplace hazards for RNs resulted in 19,790 nonfatal injuries and illnesses that required at least 1 day away from work, at an incidence rate of 104.2 cases per 10,000 full-time workers (private industry).”

“Since the workplace injuries and illnesses of RNs bear monetary and societal costs, understanding those injuries and illnesses can help combat future hazards through improvements in policy and technology. RNs are the keystone of the healthcare system, and injury and illness prevention strengthens the system at its core and improves patient care.”

Regarding workplace violence, the BLS concluded:

“While violent events accounted for only 12.2 percent of all injuries to RNs in 2016, the incidence rate — 12.7 cases per 10,000 full-time workers — was approximately 3 times greater than the rate of violent events for all occupations (3.8 cases per 10,000 workers).”

These and other statistics help us recognize nurses being on the edge. According to the National Institutes of Health, “some nurses graduate and start working and then determine the profession is not what they thought it would be. Others may work a while and experience burnout and leave the profession. Turnover in nursing seems to be leveling off, but only after years of steady climbing in rates. Currently, the national average for turnover rates is 8.8% to 37.0%, depending on geographic location and nursing specialty.”

Recognize, Reward, and Improve Nurses’ Experience

If nurses are more than just cannon fodder who we throw to the wolves each day, how can leaders utilize YOTN in order to improve nurses’ experiences and decrease attrition from the profession? In the face of an increasingly older population, nurses must be valued and retained, not just worked to the bone and replaced by the next group also destined to burn out.

There are any number of strategies to employ, including but not limited to:

  • Improving staffing, especially in relation to nurse-patient ratios
  • Instituting anti-bullying initiatives to weed out nurse bullies who prey on colleagues
  • Improving nurse compensation and benefits
  • Increasing educational opportunities, including humane loan forgiveness programs
  • Succession planning funneling high-performing nurses into leadership
  • Leveraging available technologies to decrease nurses’ injuries that far outstrip injury rates of construction workers
  • Moving beyond Nurses’ Week platitudes like tote bags and monogrammed coffee mugs
  • Training nurses robustly in assertive communication, conflict resolution, leadership, and delegation
  • Increasing salaries for nursing professors in order to create nursing schools’ capacity; too many qualified candidates are turned away every year due to lack of instructors and space

An Opportunity Not to be Squandered

The Year of the Nurse could be a watershed moment for nurses around the world, or the opportunity could be squandered by legislators and healthcare leaders who fail to do what must be done. Nurse attrition is real, and if bullying, staffing, injury, violence, and unsafe practices remain the norm, we will continue to see massive attrition and worldwide nursing shortages.

As the largest segment of the healthcare workforce, nurses are the backbone and lifeblood of care delivery. Woe to us and the public we serve if we fail to improve the lot of nurses and provide for them the recognition, opportunities, compensation, education, and safety they deserve.

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Study: Robotic transplants safe for obese patients with kidney disease

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University of Illinois at Chicago research finds that robotic kidney transplants for obese patients result in survival outcomes comparable to those in nonobese patients.

Published in the American Journal of Transplantation, the study highlights 10 years’ worth of data from some 230 robotic-assisted kidney transplants in patients with obesity conducted at University of Illinois Health hospitals.

The study reports one- and three-year patient survival rates of 98% and 95%, respectively, among kidney transplant patients with obesity. Only 17 of 239 patients developed graft failures and returned to dialysis, resulting in a 93% three-year kidney graft survival rate.

Patients had a median age of 48 and a median body mass index of 41.

Wound complications occurred in nine patients and a surgical site infection occurred in only one patient. The study reports that 88 patients were readmitted to the hospital within 30 days, but only 10 readmissions were related to surgical complications.

When compared to nonobese patients, the results are strikingly similar. Nonobese patient results were gleaned from the United Network for Organ Sharing for the same time period, January 2009 to December 2018.

Patients who are obese aren’t good candidates for surgery, so they have traditionally been deemed ineligible for kidney transplants, says Dr. Mario Spaggiari, assistant professor of surgery at the University of Illinois at Chicago’s College of Medicine.

“Advances in surgical care, including increasing proficiency and acceptance of robotic surgery, are making kidney transplants a safe option for more people,” Spaggiari said.

Robotic surgery helps to lessen adverse surgical events associated with obesity in open transplants, Spaggiari said. Specifically, the number of post-surgical wound infections dramatically reduces when robotic surgery is used to perform the transplant. This is an important factor in the long-term viability of the transplanted organ.

Surgeons at University of Illinois Health were among the first to offer robotic kidney transplants to obese patients. Transplants using the technology have been performed at UI Health since 2009.

“Our surgical program is focused on advancing care for everyone, including members of vulnerable communities who experience increased rates of various comorbidities, including obesity,” said Dr. Enrico Benedetti, professor and Warren H. Cole Chair of Surgery.

“Ten years of transplant experience shows us that obesity does not have to be a disqualifying factor in kidney transplants. To our knowledge, this is the largest cohort to date of robotic kidney transplants and these findings tell us that kidney transplantation is a viable option for many people with obesity,” Benedetti said.

“The patients who received transplants spent more than three-and-a-half years on dialysis before undergoing surgery, and that is just the median number,” Spaggiari said. “Without surgery, these people would have had no choice but to remain on dialysis — which can itself be a barrier to achieving an ‘ideal’ weight for transplant — and accept the limitations it places on their quality of life. With surgery, they can get back to normal life, which is most important. They can also have increased chances of achieving other health-promoting behaviors, like exercise or weight loss.”

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The benefits of cognitive behavioral therapy in the palliative setting

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Advanced stages of diseases such as cancer, COPD, end-stage renal disease and heart failure can lead to a constellation of physical and psychosocial distress. Symptoms such as fatigue, poor sleep and appetite, dyspnea, nausea and pain impact quality of life and can cause significant suffering.

Often, these symptoms are intertwined with intense feelings of sadness, anxiety or depression. For those involved in the care of these individuals, the goal is to alleviate physical and emotional suffering as much as possible with the purpose of improving quality of life and optimizing well-being.

In recent years, a great deal of attention has been given to the value of cognitive behavioral therapy (CBT) in the palliative setting. Traditional CBT is a very effective form of psychotherapy centered around changing maladaptive thought patterns or perceptions that lead to mood disorders such as anxiety and depression.

Simply stated, changing maladaptive thoughts to more realistic, positive or adaptive ones leads to improvements in mood. But this approach does not always fit perfectly into the palliative or hospice setting wherein patients with serious disease have very real fears about suffering, uncontrolled pain, dyspnea and other noxious symptoms; these thoughts are not maladaptive nor are they unreasonable.

Fortunately, mental health and palliative clinicians have focused on modifying cognitive behavioral therapy to better address the unique needs of those living with life-limiting illness.

With CBT’s emphasis on the present rather than on what lies ahead, clinicians can address a patient’s symptom burden and its resulting psychosocial impact.

For an individual with metastatic pancreatic cancer and concomitant shortness of breath, for instance, incorporating CBT techniques can be very effective in terms of promoting relaxation, shifting the focus away from troubling symptoms and addressing intrusive thoughts that lead to anxiety.

The keys to easing suffering through cognitive behavioral interventions are to:

1. Acknowledge the very real fears, worries and concerns that patients have.

2. Educate them about the cyclical and bidirectional nature of physical symptoms and anxiety (e.g., dyspnea can make one feel anxious and the anxiety, in turn, may manifest itself physiologically as shortness of breath).

3. Create awareness of the automatic thoughts that get triggered when symptoms or side effects arise. Oftentimes patients mistake medication or treatment side effects for progression of disease (i.e., “My nausea must mean that the tumor is growing.”).

4. Utilize a variety of techniques to address intrusive thoughts, calm the acute stress response and manage depression or anxiety.

These techniques include, but are not limited to, cognitive restructuring (questioning and modifying potentially maladaptive thoughts); relaxation techniques, such as autogenic relaxation training and deep breathing exercises; promoting engagement in self-soothing and pleasurable activities; problem-solving around troublesome symptoms; and acceptance of disease progression through mindfulness and meditation.

It can be very beneficial to incorporate existential therapies and spiritual practices, particularly when the illness is deemed terminal and the clinician is called upon to support the individual and his/her family around acceptance.

For patients facing life-limiting disease, suffering can be physiological, emotional and existential. Burdensome symptoms not only impact quality of life, but they have a bidirectional relationship with anxiety and depression. Treating this set of symptoms through cognitive behavioral therapy may ease unnecessary suffering and lead to improved mood, more meaningful interactions with loved ones and overall improved quality of life.

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The successful healthcare career toolbox

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Like any career, forging a way forward in the world of healthcare takes diligence, planning, and nurturing of your goals.

Whether seeking a career in nursing, physical therapy, medicine, or interventional radiology, many tools and strategies for creating a successful career are ubiquitous. For those interested in achieving their career objectives, the contents of your career-building toolbox should not be overlooked.

The Nuts and Bolts

For the healthcare professional, some essential building blocks are the resume or CV, cover letter, business card, and complete LinkedIn profile. There are others, but most everyone will agree that these are absolutely necessary.

Your Resume or CV:

Your resume or CV is essential — even in the 21st-century job marketplace. While some employers no longer require a resume, this document is something that every healthcare professional must have in their toolbox; it also must be regularly updated (at least annually) in order to prevent last-minute editing for a quick turnaround.

If an individual says, “I’m perfectly happy in my job and plan to stay here until I retire,” that’s a nice sentiment, but healthcare is volatile and even the most loyal employee can be suddenly laid off due to reorganization, corporate acquisitions, or mergers. Therefore, an updated resume is essential.

The Cover Letter:

Cover letters can be written on the fly, but having a skeleton letter on hand is helpful, as well as a thank you letter for after interviews. There are plenty of online templates, and for those who find writing such letters difficult, having a template makes the last-minute job easier.

Cover and thank you letters must be well-written, structurally and grammatically flawless, and make a strong case on your behalf. They should not simply regurgitate your resume’s contents; rather, they should call attention to the resume elements that are most salient.

Writing cover letters isn’t rocket science, but a career coach or expert can be employed to help craft the most compelling letter possible, and this also applies to resumes.

LinkedIn’s Robust Platform:

LinkedIn is an essential networking tool, as well as a useful online platform for showcasing your experience, background, and accomplishments.

Building a robust professional network is crucial, and LinkedIn is your playground for such an endeavor. Using this platform, you can connect with current and former colleagues, industry experts, thought leaders, and recruiters. You can also join groups that include other professionals with whom you have something in common (e.g., operating room nurses, healthcare executives, medical entrepreneurs; etc.)

While your LinkedIn profile indeed used to serve as a simple online resume, it’s now more like a resume on steroids since it can include colleagues’ endorsements of your self-selected skills; written recommendations; uploaded documents, including your resume and various certificates; videos of your presentations; slideshows; etc.

LinkedIn also allows you to post updates and curated content to your newsfeed (similar to Facebook), and you can use LinkedIn’s native publishing platform to write articles that demonstrate your expertise and leadership. If a potential employer or colleague Googles you (a common practice) and reads your original articles, this may be key to your being asked for an interview.

Recruiters also spend time on LinkedIn searching for potential job candidates. In fact, for some positions, your LinkedIn profile may serve as the only way by which you can apply, thus not having a complete profile takes you out of the running for those opportunities. LinkedIn also contains a feature by which a job-seeker can flag their profile so that recruiters know they’re in the market for a new position.

There are additional features of LinkedIn, but these are the essentials that easily make the case for logging on and creating a powerful profile that will work for you and your career.

Your Business Card:

The majority of healthcare professionals who are not self-employed business owners have likely never thought of having their own business card. However, a business card is a small and important investment that every professional should make.

If you’re in a restaurant or grocery store and happen to meet the CEO of a healthcare facility where you’ve always dreamed of working, you likely won’t have a copy of your resume in your purse or back pocket.

And if you find yourself at a medical conference meeting valuable colleagues, exchanging contact information is essential. While you can program one another’s details into your phones, one or both of you may not remember who this individual is or why you wanted to get in touch in the first place.

Enter the simple business card, which serves as a mini resume that can jog the memory of a new contact so that they remember you and why they want to follow up.

A business card is a simple affair without frills or logos and contains just the facts. The front of the card will contain:

  • Your name and credentials
  • Phone
  • Email
  • City and state
  • Customized LinkedIn profile URL

The back of the card will display five or six bullet points outlining the essential skills or professional characteristics that make you stand out. For example:

  • Successful nurse executive
  • 20+ years CEO of large health system
  • MSN in Healthcare Administration
  • MBA-MPH
  • Expertise in staffing and onboarding

Don’t Skimp on the Toolbox

Your healthcare career toolbox is your passport to more success, satisfaction, and connection. Use these tools and strategies to your advantage and enjoy the fruits of your labors that can powerfully influence how other professionals and colleagues perceive your value and expertise.

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Study reveals the best time to take blood pressure medications

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The number of Americans at risk for heart attacks and strokes keeps increasing. In the United States, an estimated 103 million adults have high blood pressure, nearly half of all adults. Recently published guidelines have redefined hypertension as a reading of 130 systolic or 80 diastolic. The previous standard was 140 over 90.

The percentage of U.S. adults with high blood pressure jumped from 32% under the old definition to nearly 46% under the new definition. Overall, cardiovascular diseases remain the leading cause of death in the world, claiming nearly 18 million lives in 2015, and in the U.S., heart disease is the No. 1 cause of death and stroke.

In 2009, Americans visited their healthcare providers more than 55 million times to treat high blood pressure. About 7 in 10 adults with high blood pressure use medications to treat the condition. However, what time of day should patients take their blood pressure medications?

A new large study, the Hygia Chronotherapy Trial, investigated the effect of time of day when people take their blood pressure medications on their risk of cardiovascular problems.

The study, led by Professor Ramón C. Hermida, Director of the Bioengineering and Chronobiology Labs at the University of Vigo, Spain, found that patients who took their medications at bedtime had nearly half the risk (45% reduction) of dying from or suffering heart attacks, myocardial infarction, stroke, heart failure or requiring coronary revascularization compared to patients who took their medications in the morning.

The Hygia Project is composed of a network of 40 primary care centers within the Galician Social Security Health Service in northern Spain. A total of 292 doctors are involved in the project and have been trained in ambulatory blood pressure monitoring, which involves patients wearing a special cuff that records blood pressure at regular intervals throughout the day and night. The Hygia Chronotherapy Trial monitors blood pressure for 48 hours rather than the usual 24 hours.

In this multicenter, controlled, prospective endpoint trial, 19, 084 hypertensive patients (19,614 men, 8,470 women, average age, 60 years) were assigned to take the entire daily dose of 1 or more than 1 hypertension medications at bedtime (n=9552) or all of them on waking (n=9532).

At inclusion and every clinic visit (at least annually) throughout follow-up, ambulatory blood pressure monitoring was performed for 48 hours. The researchers adjusted their analyses to account for factors that could affect the results, such as age, sex, Type 2 diabetes, kidney disease, and smoking and cholesterol levels.

During the average 6.3 years follow-up, 1,752 patients died from heart or blood vessel problems or experienced myocardial infarction, stroke, heart failure, or coronary revascularization. Individual outcomes showed that the risk of death from heart or blood vessel problems was reduced by 66%, the risk of myocardial infarction was reduced by 44%, coronary revascularization by 40%, heart failure by 42%, and stroke by 49%.

Data from ambulatory blood pressure monitoring showed that patients who took their medications at bedtime had significantly lower average blood pressure both at night and during the day, and their blood pressure dipped more at night compared with those who took their medications on waking.

According to Hermida, the results of this study show that patients who routinely take their anti-hypertensive medication at bedtime, as opposed to when they wake up, have better-controlled blood pressure and a significantly decreased risk of death or illness from heart and blood vessel problems.

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Congress may give dental coverage to millions of Medicare recipients

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Did you know around 10,000 baby boomers turn 65 each day and can sign up for Medicare? While the program’s 60 million beneficiaries can access dental, vision and hearing through supplemental options such as Advantage plans or standalone insurance policies, original Medicare — Part A and Part B — excludes dental, vision and hearing coverage except in very limited circumstances.

But Medicare recipients might just see better coverage and more services in the new year. Several bills now before Congress would give Medicare participants access to dental, vision and even hearing coverage if passed.

Additionally, the federal government would have authority to negotiate prices with drug manufacturers and to create a cap for Medicare out-of-pocket spending on prescription drugs.

All these proposals have cleared the necessary committees over the last few weeks and are now waiting for full action on the floor of the House.

There have been proposals over the years that would do this, but in the past, they haven’t gone anywhere. “But it looks like this time something could get passed in at least one chamber of Congress,” said David Lipschutz, associate director at the Center for Medicare Advocacy.

However,the bills are generally supported by Democrats and opposed by Republicans. This means that even if the measures get approved in the Democratic-controlled House, they would face an uphill battle in the Republican-dominated Senate.

Details on the Bills

H.R. 3: Includes provisions to allow the Medicare program to negotiate with drugmakers, cap out-of-pocket spending by beneficiaries on prescriptions at $2,000 and expand the low-income subsidy program, which helps cover Part D premiums and out-of-pocket costs.

H.R. 4650: Would add preventive and screening dental services, including oral exams and cleanings under Part B. It would also cover procedures such as tooth restorations and extractions, bridges, crowns, root canal treatments and implants and dentures. Beneficiaries would chip in the standard 20% for basic treatments and 50% for major treatments.

H.R. 4665: Would add routine eye exams to coverage through Part B, with beneficiaries generally paying 20% of the cost. It also would provide some coverage — $100 — toward contact lenses or eyeglasses.

H.R. 4618: Would provide coverage under Part B for hearing exams and hearing aids, with beneficiaries contributing 20%.

The expanded coverage would, of course, come with a cost. “The majority of people on Medicare still choose to be in [original] Medicare, so having an expansion of benefits would accrue to everyone,” Lipschutz said. “It would be a significant improvement to the program and fill holes that have been there since its inception.”

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Survey: Patients who experience telehealth services are happy with them

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For those who use telehealth services, the results are quite good, a survey by J.D. Power shows. The satisfaction rate is about 85% — 851 on a 1,000-point scale — while almost half (46%) of all who participated in the survey gave telehealth services a score above 900.

The survey included almost 8,300 consumers. In addition to their being happy with the service, they reported that it usually addressed their clinical issues; almost 85% of telehealth users said they resolved their medical problems as a result of their remote teleconsultation. Seventy-three percent said they experienced no issues at all during their visit.

Health consultations typically went quickly, with an average of 17 minutes to complete enrollment into a telehealth program, nine minutes to wait for a provider (physician or nurse practitioner), and only 18 minutes for the actual consultation.

The biggest hurdle for telehealth is a lack of awareness by consumers. Among consumers who have not used telemedicine, 29% told J.D. Power the service isn’t available to them, and 37% say they do not know whether their provider even offers it.

According to the survey, 65% of those who used telehealth services did so because they received a positive recommendation from others, including friends, family members, their employer or doctor.

Common barriers to telehealth adoption include technological maturity by practices and convincing leadership that telemedicine is a substantial investment; compelling providers that telemedicine is an effective way to treat patients; getting staff to accept the idea and learning strategies; and teaching patients the technological skills required to access telemedicine. Technology barriers and lack of computer literacy prevailed as significant issues in successfully implementing telemedicine, the Journal of Telemedicine and Telecare suggests.

There are other limitations. According to Stat News, “traditional Medicare limits telehealth to services provided using real-time, interactive audio and video telecommunications systems. That means no store and forward technologies, such as prerecorded audio or video, email, or text messaging. Traditional Medicare also restricts the use of telehealth to rural settings, and may originate only from providers’ offices and other facilities like rural health clinics or hospitals.”

“We are looking at telehealth services [as] similar to mobile banking and its early adoption rates,” said Greg Truex, J.D. Power’s managing director of health intelligence, in a statement. “Early attempts at trying to convince consumers to bank via their phone failed, and initiatives were abruptly canceled.”

But then it caught on. Many hope the same is the case for telehealth.

Those companies providing telehealth services include Teladoc, which had the highest rating with 870 points, followed by Doctor on Demand with a score of 867. MDLive received a score of 847, and MeMD and American Well received scores of 843 and 820, respectively.

Among insurers, Humana was the highest-ranked, followed by Kaiser Permanente and Cigna. Anthem and Aetna had scored 850 and 840, respectively.

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Groupthink: A danger to healthcare innovation

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In the healthcare universe, we follow orders and policies and procedures because that is part and parcel of our clinical world’s rules.

However, doing what you’re told can come at a price if you violate your own moral code and personal values or the orders have potential to cause harm to a patient. It can also feel like the antithesis of evidence-based practice when you’re told to do something a certain way because “that’s the way we’ve always done it.”

“Groupthink” is a term apparently first used by George Orwell in his seminal novel “1984,” and it describes a group of people adhering to an idea as an abdication of personal responsibility or agency.

You could say that when many Germans accepted Adolf Hitler’s megalomaniacal views, they were participating in perhaps the most dangerous episode of groupthink of the 20th century, even if they simply turned a blind eye. There’s no comparison of healthcare in 2019 with the days of 1939, but we still need to guard against the lack of critical thinking in our midst.

Increasing Complexity

As healthcare becomes more complex and the 21st century offers the potential for powerful innovation, we need open-minded and intellectually curious individuals who can lead us into the future without groupthink holding us back.

From artificial intelligence (AI) and robotics to new treatment protocols and novel medical techniques, change is the only constant. Holding tight to the past can seem foolhardy and narrow-minded when we know that positive change is just around the corner.

With increasing complexity comes the need for creative solutions. “That’s the way we’ve always done it” is a dangerous precedent to follow, yet many healthcare workers readily accept this excuse as a reason to not explore alternative approaches to vexing problems.

Intrapreneurship: A Remedy for Groupthink

Intrapreneurs practice the opposite of groupthink. These individuals are employees who go above and beyond by taking ownership of their work and keeping an eye out for innovative ways to make even incremental improvements. When groupthink rears its ugly head, it is often intrapreneurs who come up with novel solutions that no one else may have considered.

Healthcare leaders can nurture intrapreneurship by listening to staff, encouraging out-of-the-box thinking, and otherwise creating a friendly, creative environment where all opinions matter. Common intrapreneur qualities include:

  • Open-mindedness
  • Creative thinking
  • The ability to think beyond the problem
  • Unwillingness to go along with the crowd just because it’s easier
  • Ability to work autonomously
  • Resourcefulness
  • Authenticity
  • Resilience
  • Confidence without arrogance

Using this list, one can easily extrapolate what the opposite of an intrapreneur would be.

Those more close-minded individuals on staff should not have the same influence and power as forward-thinking intrapreneurial team members, yet in some organizations the intrapreneurs struggle to be heard and the naysayers rule the day. The prudent healthcare leader is aware of such dynamics and actively seeks to change them.

Stamping Out Groupthink

The first step in stamping out groupthink is seeing it for what it is and acknowledging its presence. If you happen to be a healthcare leader, you can walk the talk of innovation and out-of-the-box thinking by embodying those characteristics yourself.

If you’re a staff member without a leadership position, you can increase your intrapreneurial influence within the organization by finding your allies at work and collaborating on developing solutions to ongoing problems.

If the person or people you report to are as guilty as groupthink as the rest, you may have an uphill battle; in fact, you may very well need to seek a position in an organization that will show appreciation for your innovative spirit.

Groupthink isn’t always easy to overcome, but it can be resisted when the will to change is strong. The abdication of one’s personal agency to a group can be dangerous, especially when that group focuses on the path of least resistance rather than the path to true innovation.

If you are an intrapreneur with a gift for diplomacy and bringing others to the table, use your influence to stamp out groupthink and instigate an innovation revolution. And if you’re a leader in the healthcare space, fighting against groupthink and advocating for innovation and forward thinking should be your true north star.

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Controlling hypertension: Do electronic pill bottles and text messaging work?

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Only half of the 77.9 million adults in the United States with high blood pressure have their condition under control. By 2030, it is estimated that the prevalence of hypertension will increase 7.2% from 2013 estimates. High blood pressure was listed as a primary or contributing cause of death in about 348,102 of the more than 2.4 million U.S. deaths in 2009.

The risks increase as blood pressure rises, whether you have high blood pressure or a normal blood pressure. Between the age of 40 and 70, for every rise of 20 mmHg systolic or every 10 mmHg diastolic, the risk of heart disease and stroke doubles.

As shown in the Framingham Heart Study, high blood pressure is more common with age. In that study, 5,300 participants were divided into three age groups: younger than 60, 60-79, and 80 or older. The blood pressure percentages for each age group were 27% in the younger than 60 group, 63% in the 50-79 group, and 74% in the 80 and older group.

A major factor in uncontrolled hypertension is patients’ failure to consistently take their medications.

Researchers from Penn Medicine tested new tactics, including text messaging and remote monitoring via an electronic pill bottle to test adherence. They found that although each method appeared to keep medication adherence high, neither method seemed to drive down blood pressure levels.

About 150 patients who took medication for their high blood pressure across four Philadelphia primary care practices participated in the study and were split into three groups: group 1 received standard of care; group 2 received electronic pill bottles that monitored their medication adherence, and group 3 received automated text messages asking about medication adherence. Groups 2 and 3 also received daily text messaging prompting them to take their medications.

The electronic pill bottles recorded every time they were opened and transmitted that data to the researchers using Penn Medicine’s Way to Health automated technology platform. Each day, participants received one of two text messages either congratulating them for taking their medication the previous day or acknowledging that they hadn’t taken their medication the previous day. Both messages featured a reminder to take the medication that day.

Participants using two-way text messaging were asked to respond “yes” or “no” to whether they had taken their medications. Automated messages also either congratulated them for taking their medication the day before or acknowledged that they hadn’t.

Adherence to medication was found to be high among participants, both near 80%. Despite the extra methods employed, the researchers found that both blood pressure levels and rates of adherence to blood pressure medications remained similar to patients in the control group.

Participants’ blood pressure levels might not have improved because of non-adherence, but it is also possible that the participants may have needed higher doses of their medications or new medications.

Shivan Mehta, MD, MBA, associate chief innovation officer at Penn Medicine, an assistant professor of medicine, and lead author of the study, is now testing the social support factor in a new trial that also offered blood pressure cuffs and remote monitoring to patients. This new study also nudges clinicians to consider dose escalation or additional medications.

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How to boost pain management satisfaction scores at your hospital

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As a hospital administrator, analyzing patient comments regarding pain management is something you probably have to do. Yet, it’s easy to overlook common issues that cause or increase pain for your patients. These could be issues your patients don’t even realize are causing them problems.

Root out these problematic areas and implement solutions to make your patients more comfortable by utilizing this advice:

Document pain measures taken in relation to procedures scrupulously.

Research from a team including Bonnie J. Stevens published in the Canadian

Medical Association Journal found that less than one-third of painful procedures pediatric patients underwent were documented with specific pain management intervention strategies.

Make sure that the pain management approach your teams use is adequate, can be adjusted based on patient needs during a procedure without difficulty, and is completely explained in notes.

Make sure your student doctors understand pain management protocol in detail.

Research from Boston College, led by study author Judith Shindul-Rothschild, found that teaching hospitals often have poor pain control satisfaction rates due to ineffective coordination between medical students and residents and hospitalists and nurses.

Make certain your doctors-in-training have the supervision and instruction they need to address patient pain sufficiently and correctly.

Revamp your needle know-how.

A study from Children’s Hospitals and Clinics of Minnesota Minneapolis found that shots hurt less for kids when the following four steps were stringently taken:

  • numbing with a topical anesthetic
  • sugar water or breast milk given during immunization, if desired
  • never restraining or holding down a child
  • distracting a child with a toy or video as the shot is given

Simple, humane steps can make a huge difference for your peds patients. Appropriate topical numbing and maybe a little distraction can’t hurt when it comes to immunizing adult patients, either.

Consider not using opioids for surgery on a case-by-case basis.

A study presented at the American College of Surgeons Clinical Congress in 2018found that patients who have colorectal surgery without opioids are hospitalized for shorter periods of time.

The keys to this approach’s success: patient education; preemptive pain management; non-opioid anesthesia; modified nerve blocks; and non-narcotic analgesics post-surgery. These are worth a look at your institution.

Address complaints immediately.

Nothing is more frustrating to a patient in need than not being given appropriate meds. Make sure your teams are using the pain scale frequently and properly.

Also, ensure that patients’ pain complaints are instantly dealt with, either by needed administration or in-depth explanation as to why meds are not appropriate so other comfort measures can be swiftly taken.

Your patients need this reassurance — make it your business to ensure they always have it.

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