Medical Cannabis

Medical cannabis remains a controversial topic throughout the United States as many states are repealing associated restrictions. Both recreational and medicinal cannabis is now available in a handful of states.  Despite the growing research supporting cannabis as a pain management and rehabilitation tool, the federal government continues to classify cannabis as a Schedule 1 drug. This makes cannabis federally illegal, as well as limits medical studies that would better explore the benefits. 

Cannabis and cannabis derivatives are used to treat the symptoms of many ailments and illnesses, such as cancer, PTSD, AIDS, epilepsy, and more.  According to a 2017 study published in Cancer Chemotherapy and Pharmacology, pharmaceutical cannabis can decrease nausea caused by chemotherapy and almost eliminate vomiting. Cannabis has also been found to relieve the spasticity of the muscles that is sometimes associated with multiple sclerosis and can help treat appetite loss and “wasting” associated with conditions such as HIV/AIDS and certain types of cancers. One chemical compound of the cannabis plant, Cannabidiol (CBD), has been used to treat and reduce seizures in people with epilepsy (specifically Lennox-Gastaut syndrome and Dravet syndrome). Cannabis is used to treat chronic pain, and in some cases may be used instead of opioids for pain management. (Opioids are highly addictive and are typically not recommended for long-term use in treating chronic pain.)  Cannabis may also be beneficial in symptom management of some mental health conditions, such as PTSD.

While there are many benefits to using cannabis, there is still much we do not know about this plant and its long-term usage. For example, studies have shown that frequent use may seriously affect short-term memory, as well as impair cognitive ability. While there are many ways to ingest cannabis, smoking anything can seriously damage your lung tissue. Immediate side effects of cannabis use may include paranoia, elevated heart rate, anxiety, and impaired motor function.  Long-term effects may include mood swings, lung infections, panic attacks, and memory loss.  Signs of impairment may include red eyes, delayed reaction time, poor hand-eye coordination, lack of concentration, and decreased perception of time and distance.

Cannabis has been implicated in a high percentage of automobile crashes and workplace accidents. A review of the medical record and summary of care often provides insight into the extent and timing of cannabis use in relation to a mishap.  R&G is here to help with reviews of cases involving cannabis.  Please call 623-566-3333 or 1-888-486-2245 for more information about case reviews. 

The month of May is Celiac Awareness Month

There are over 200 symptoms that people with Celiac Disease may experience. You could be feeling fatigued, have a stuffy nose, get regular abdominal bloating, stomach pain, or even have an itchy skin rash.  These symptoms can be misdiagnosed for years as allergies or stomach issues, creating missed or delayed diagnosis.  Celiac Disease is an autoimmune disorder, not an allergy.  It can be treated with a gluten-free diet, but it can lead to colon cancer and other very serious medical conditions if not addressed.

The only way to be officially diagnosed with Celiac Disease is by a tissue sample taken endoscopically from your small intestine.  When someone with Celiac Disease ingests gluten (the protein found in wheat, barley, and rye) an autoimmune response is triggered in the small intestine. This response damages the villi that are responsible for absorbing nutrients. Many people are gluten intolerant, but please do not confuse this with someone who has Celiac Disease.  If you have a medical diagnosis, all food you consume must have less than 20 ppm (parts per million) of gluten.  To give you an example of this, a crumb of regular gluten bread is much higher than 20 ppm.  Cross-contamination of gluten products is the number one issue for people with this diagnosis.  Potatoes, as a rule, do not contain gluten- but slice them on a wooden cutting board that someone previously cut bread on makes this an unsafe food option.  Or frying potatoes in oil that gluten products like chicken tenders have fried make the food unsafe for someone with Celiac Disease.

All stages of life are affected once diagnosed. It is not easy to navigate at any age.  Soy and teriyaki sauce, spice blends, canned soup, some medications and supplements, imitation crab, licorice, and oats would appear gluten free, but they all contain hidden gluten products.  When you have a child, it will affect the formula you give them, the foods you introduce to them as toddlers, the preschool birthday parties you attend, and the lunches served at your elementary school.  A teenager will be limited to fast food stops after high school games and college parties you attend.  Once an adult, the potlucks at work and the dinner parties you get invited to will present other challenges as well.  People with Celiac develop a new social norm which is to always to be prepared, which means lots of planning ahead and preparing your own food for social gatherings. You always err on the side of caution because consuming gluten can affect you physically for days or weeks.

Hope is on the horizon.  Many trials have started to find a solution to the Celiac problem.  There is a biotech company that focuses on eradicating food allergies.  They are developing a safe substitute for gluten products so people at home can make bread, pasta, and pizza without the harmful gluten effects.  Time will tell if this is an option, but the trial stage has proved very promising.  Another company is currently in trials for a medication you take before eating your meals that eliminated cross contamination issues. This drug does not enable people to eat a regular gluten diet, but it would be used in conjunction with a gluten free diet to protect against unintended gluten consumption.  It would be a massive breakthrough for a Celiac diagnosis.  Eating French fries at a restaurant could be in your future!  For the most current information, please visit the Celiac Disease Foundation at Celiac.org. 

Historical Perspective for a Successful Legal Nurse Consulting Firm

R&G Staff 
January 2021 

R&G Medical Consultants, now R&G Medical Legal Solutions, was founded in February 1992 by Rosie Oldham, BS, RN, LNCC. Her background in nursing administration, risk management and quality improvement were extremely valuable in the startup of the firm. 

R&G’s first cases were personal injury and in December 1992, the firm began working on product liability cases (resulting in completion of over 750 cases). This led to staff expansion and rapid company growth. During this project R&G   implemented total quality management procedures. Peer review of work products led to a successful 100% deficiency free submission of claims. From 1994 to 1996, R&G processed over 450 toxic tort cases (water contamination) for the defendants.  In 1997, R&G began focusing on complex medical malpractice and personal injury cases.  

Fast forward to 2021. Use of and incorporation of technology is the foundation of R&G’s continued success to managing large scale projects.  Incorporation of nurse project directors and non-nurse project managers free clients from the administrative burden of coordinating many logistical areas of mass tort. Record retrieval combined with customizable nurse work products allow for one stop shopping for clients.  

Foundational services such as nurse work products that range from in-depth, pertinent verbatim to summaries of care remain a staple.  Hybrid products, such as a combination of pertinent verbatim of key events, combined with summaries of general that capture events in an efficient, cost effective manner are now offered.    

A new service related to radiology films, will be launched in the near future.  Clients will be able to view, manage, and share radiology data online in lieu of tracking and managing CDs.  Key features of the service include cinematographic (CINE) views, digital measuring tools and panning.  

All services at R&G are customizable to fit the needs of each client.  No project is too big or small.  If interested in R&G services please call Catherine Beasley, MS, BSN, LNCC at 623-566-3333 or email cbeasley@rngmedical.com .   

HIPAA Certification, To Do or Not To Do

Catherine Beasley, MS, BSN, LNCC 
Dec 2020 

Breaches of protected health information are becoming commonplace.  The US Department of Health and Human Services, Office for Civil rights now publishes a Breach Report Results which can be accessed at https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf.   

Hospitals and health care organizations must report breaches affecting more than 500 people to the Department of Health and Human Recourses as required by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.  A breach of more than 500 patients’ information may result in the organization’s name on the Department of Health and Human Resources website.  Simply stated, breaches of protected health information are bad for the business of health care organizations.  Patients are left to wonder about the ability of the organization to provide safe, effective care.  After all, if an organization can’t manage paper, how can they manage safe care?   
 
The Health Insurance Portability and Accountability Act (HIPAA) training is now available online by third party vendors.  Training can be done at the convenience of the trainee and both individual and corporate rates are provided.  Seminars ranging from one or two days are also offered nationwide and pricing varies by vendor.   

The Department of Health and Human Services is very clear in that breaches of protected health care information are unacceptable regardless of the number of victims impacted.  However, does having a HIPAA certification mean an organization is better able to secure the personal data of those they serve?  There are two schools of thought to consider.  First, the training and knowledge will support safe practice and thus decrease risk of any potential breaches.  Training will also increase the confidence level of staff in managing protected health information and recurring training allows the trainee access to up to date information regarding HIPAA.   

An opposing view is that the Department of Health and Human Services does not endorse or recognize HIPAA certifications regarding security rules and warns against misleading marketing claims.   

“We have received reports that some consultants and education providers have claimed that they or their materials or systems are endorsed or required by HHS or, specifically, by OCR. In fact, HHS and OCR do not endorse any private consultants’ or education providers’ seminars, materials or systems, and do not certify any persons or products as HIPAA compliant.” 

The HHS website goes on to reflect:  

“There is no standard or implementation specification that requires a covered entity to “certify” compliance. The evaluation standard § 164.308(a)(8) requires covered entities to perform a periodic technical and non-technical evaluation that establishes the extent to which an entity’s security policies and procedures meet the security requirements. The evaluation can be performed internally by the covered entity or by an external organization that provides evaluations or “certification” services. A covered entity may make the business decision to have an external organization perform these types of services. It is important to note that HHS does not endorse or otherwise recognize private organizations’ “certifications” regarding the Security Rule, and such certifications do not absolve covered entities of their legal obligations under the Security Rule. Moreover, performance of a “certification” by an external organization does not preclude HHS from subsequently finding a security violation. 

Given certification is not mandatory it is up to an organization to ensure compliance is achieved.  Investment in training, while not required, is an organization decision based on the level of comfort and ability to meet requirements.   

Breach Portal, (n.d.).  Retrieved 23 Nov 2020  from https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf 

HHS.gov. (n.d.).  Are we required to “certify” our organization’s compliance with the standard security rule?  Retrieved 23 Nov 2020 from https://www.hhs.gov/hipaa/for-professionals/faq/2003/are-we-required-to-certify-our-organizations-compliance-with-the-standards/index.html 

HHS.gov. (n.d.) What you should know about OCR HIPAA privacy rule guidance materials.  Retrieved 23 Nov 2020 from https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/be-aware-misleading-marketing-claims/index.html 

The Future of TELEHEALTH is NOW!

Doctor with stethoscope Reaches out of computer screen.

The idea that a health care provider could diagnose and treat a patient via teleconferencing technology was a concept more at home in the Star Trek™ realm than what is now an increasingly commonplace event.

Patient consultations currently take place via video conference, e-health including patient portals, remote monitoring of vital signs, sleep studies at home and cardiac monitoring during the patients’ work day are common.  While there are many other applications,  (ATA, 2015) “all are considered part of telemedicine and telehealth”.

There are a great many questions regarding reimbursement, regulations, infrastructure and access as well as provider and patient adoption and whether these will fall into a viable alternative to face-to-face health care.  There are a great number of barriers that need to be overcome for telehealth to enjoy parity with inpatient visits.

With the shortage of health care providers, particularly in primary care, congressional and media attention over the past year has increased dramatically.  According to a Georgia Public Policy Foundation study, without telehealth, patient access might be delayed, denied or otherwise not available.  (Bachman 2015) reflects patient savings in time and money and reduction of stress from delayed or denied face-to-face medical care.

Patient and Doctor Consult via TabletThe Affordable Care Act has brought millions of people into the healthcare system, and currently 44 states have telehealth legislation pending.  Bills are being debated in committees for eventual introduction in Congress. There is also greater media attention highlighted on network TV and radio news shows to include blogs within the online community of health care providers and patients.

There are concerns regarding whether or not patients will readily accept telehealth alternatives, but these are essentially unfounded.  Most of the population has grown along with online technology, which includes user friendly programs that assist with reliable practice.

Elderly senior citizens may face some challenges using digital tools, a Pew Research Study (Smith, 2013) found that, “Six in ten seniors – 59%- report using the Internet.”  This percentage has been increasing by 6% over a similar point annually.  In fact, the rate of adoption of social media among those age 60 and over is the fastest growing segment of the marketplace.

Concerns about reliability of data to inform the provider is mitigated by ongoing advances in the industry making telehealth technology the cutting edge of innovation.   Higher video and image resolution, efficient use of bandwidth has made connectivity more reliable with electronic health record systems facilitating the increased data exchange (iHealthBeat, 2013).  Real time IT-enabled transfer of patient monitoring has evolved sufficiently to support telemedicine platforms. (Darves, 2014)

Scientific studies in the area of telemedicine and quality of care “indicate that the use of telemedicine for such applications as monitoring of chronic care patients or allowing specialists to provide care to patients over a large region have resulted in significantly improved care.  For most telemedicine applications, studies have shown that there is no difference in the ability of the provider to obtain clinical information, make an accurate diagnosis, and develop a treatment plan that produces the same desired clinical outcomes as compared to in-person care when used appropriately”.  (2013 American Telemedicine Report, Telemedicine’s Impact on Healthcare Cost and Quality)

Doctor Consults Specialist and Discuss Readiology Image via ComputerThe same report found that the vast majority of the peer-reviewed research studies about the cost effectiveness of telemedicine (based on large sample sizes and following sound scientific rigor) are relatively new but are consistently concluding that telemedicine saves the patients, providers and payers money when compared with more traditional approaches to providing care.  An August 2014 study by global professional services company Towers Watson estimated telemedicine could potentially deliver more than $6 billion a year in health care savings to U. S. companies (Towers Watson, 2014).

Reimbursement has been a thorny issue in telehealth.  There is a wide discrepancy between how to pay in comparison to traditional in-office visits.  (U.S. Department of Health and Human Services Health Information Technology, 2014).

Health care provider regulatory bodies are just getting started in the process of interstate practice, NCSBN’s Nurse Licensure Compact (LNC) has been ahead of the curve since implementation in 2000.  The NLC allows RNs and LPNs/LVNs to have multistate licenses with ability to practice in their home state and other NLC states.  Currently there are 24 states in the NLC.  BONs (Boards of Nursing) have been actively involved in revising the NLC to ensure it reflects best practices and provides public protection and continued high standards.  Several organizations are actively involved in compiling state by state telehealth nursing licensure requirements similar to what is available for physician requirements.

Telehealth is a concept waiting for all of the factors influencing its acceptance as part of the health care delivery system to align.

References

American Telemedicine Association.  “What is Telemedicine?”

American Telemedicine Association. (2013) “Telemedicine’s impact on healthcare cost and quality.”

Bachman, R.E. (2015).  Telehealth & Patient-Centered Care. Georgia Puclic Policy Foundaiton, Atlanta

Darves, B. (2014). “Technology advances boosting Telehealth, but changes to widespread use remain.”

iHealthBeat (2013). “Health care providers leveraging advances in Telehealth technology.”

Smith, A. (2013). “Older adults and technology use: Attitudes, impacts, and barriers to adoption.”

Towers Watson. (2-14). “Current Telemedicine Technology Could Mean Big Savings. [News Release]

U.S. Department of Health and Human Services Health Information Technology. “What are the reimbursement issues for telehealth?”

Arizona State Board of Nursing Regulatory Journal, (2015), In Focus, Spring.

National CPR and AED Awareness Week

The Beat Goes On!

In December of 2007, Congress declared the first week of June each year as National CPR/AED Awareness Week in an effort to increase the number of people certified in cardiopulmonary resuscitation (CPR) and trained to use an Automatic External Defibrillator (AED). In today’s advanced technological world, the American Heart Association (AHA) has determined that in order to increase the survival rates for victims of sudden cardiac arrest, we need to go back to the basics of  CPR. This is not limited to healthcare workers but includes lay people as well. According to the AHA there is a 95 percent mortality rate for over 300,000 Americans who are victims of sudden cardiac arrest each year. It is also estimated that on average it takes 8 to 10 minutes for 9-1-1 to reach a victim. Survival rates for individuals with ventricular fibrillation treated by AEDs have been reported between 0% and 31%. Comparatively, the survival rates for performing CPR alone are reported between 0% and 6%.  More lives could be saved if members of the general public have training in the use of AEDs and CPR. .

Why is this important?

The reason that this is so important is after four minutes without oxygen going to the brain it will begin to die. After eight minutes it becomes the point of no return, irreversible brain death begins to occur. So even if the heart is restarted, the damage after eight minutes can never come back. This is why we need people to do CPR. In cases where CPR is performed immediately, this risk is cut in half. Victims’ chances of survival decrease by 7 to 10 percent each minute that they go untreated after their heart stops, so bystanders’ knowledge of CPR is a matter of life or death.

Why did they change CPR?

New CPR Rules: Pump First, and Save the Breaths for Later If you have ever been trained in CPR, we were all trained  A-B-C,  for “airway, breathing, compressions”. But the American Heart Association (AHA) recommends a different approach. The new mnemonic is C-A-B; we’re now supposed to start chest compressions right after calling 911; adjust the airway and leave the rescue breaths for last. The AHA wants to encourage people to be willing to administer CPR; so making the mouth-to-mouth breathing a less prominent part may make the procedure more palatable.  In recent years, the results of study after study have supported the fact that the victims who receive compressions alone from bystanders survive as well as those who received traditional CPR.  The guidelines apply to adults, children, and infants but exclude newborns.

[vc_accordion collapsible=”yes” disable_keyboard=”” active_tab=”false”][vc_accordion_tab title=”How to Do the New CPR, A Step by Step Guide” icon=”hb-moon-plus-circle”][vc_column_text]

  • Establish responsiveness, if victim is not responsive, roll the person onto their back. Check for a pulse for no more than 10 seconds.
  • Call 911 or ask someone else to do so.
  • Start chest compressions. Place the heel of your hand on the center of the victim’s chest. Put your other hand on top of the first with your fingers interlaced.
  • Press down so you compress the chest at least 2 inches in adults and children and 1.5 inches in infants. “One hundred times a minute or even a little faster is optimal,” Sayre says. (That’s about the same rhythm as the beat of the Bee Gee’s song “Stayin’ Alive.”) Allow for a complete recoil of the chest after each compression. Give at least 30 compressions before you proceed to rescue breathing.
  • If you’re been trained in CPR, you can now open the airway with a head tilt and chin lift.
  • Pinch closed the nose of the victim. Take a normal breath, cover the victim’s mouth with yours to create an airtight seal, and then give two, one-second breaths as you watch for the chest to rise.
  • Continue compressions and breaths – 30 compressions, two breaths – until help arrives.

These guidelines apply to children and adults alike, since AHA officials did not want separate and potentially confusing advise for different groups of people. The change in CPR is part of a larger revision of its emergency heart care recommendations.

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”How To Use an Automated External Defibrillator” icon=”hb-moon-plus-circle”][vc_column_text]
AEDs are user-friendly devices that untrained bystanders can use to save the life of someone in cardiac arrest.

  • Before using an AED, check for puddles or water near the person who is unconscious. Move him or her to a dry area, and stay away from wetness when delivering shocks (water conducts electricity).
  • Turn on the AED’s power. The device will give you step-by-step instructions. You’ll hear voice prompts and see prompts on a screen.
  • Expose the person’s chest. If the person’s chest is wet, dry it. AEDs have sticky pads with sensors called electrodes.
    • Apply the pads to the person’s chest as pictured on the AED’s instructions.
    • Place one pad on the right center of the person’s chest above the nipple.
    • Place the other pad slightly below the other nipple and to the left of the ribcage.
  • Make sure the sticky pads have good connection with the skin. If the connection isn’t good, the machine may repeat the phrase “check electrodes.”
  • If the person has a lot of chest hair, you may have to trim it. (AEDs usually come with a kit that includes scissors and/or a razor.) If the person is wearing a medication patch that’s in the way, remove it and clean the medicine from the skin before applying the sticky pads.
  • Remove metal necklaces and underwire bras. The metal may conduct electricity and cause burns. You can cut the center of the bra and pull it away from the skin.
  • Check the person for implanted medical devices, such as a pacemaker or implantable cardioverter defibrillator. (The outline of these devices is visible under the skin on the chest or abdomen, and the person may be wearing a medical alert bracelet.) Also check for body piercings.
  • Move the defibrillator pads at least 1 inch away from implanted devices or piercings so the electric current can flow freely between the pads.
  • Check that the wires from the electrodes are connected to the AED. Make sure no one is touching the person, and then press the AED’s “analyze” button. Stay clear while the machine checks the person’s heart rhythm.
  • If a shock is needed, the AED will let you know when to deliver it. Stand clear of the person and make sure others are clear before you push the AED’s “shock” button.
  • Start or resume CPR until emergency medical help arrives or until the person begins to move. Stay with the person until medical help arrives, and report all of the information you know about what has happened.
    [/vc_column_text][/vc_accordion_tab][/vc_accordion][vc_separator color=”grey” align=”align_center”][vc_column_text]
AED
AED Setup and Use

 

RESOURCES: American Heart Association. 2010 Guidelines for CPR and Emergency Cardiovascular Care, October 2010
http://www.cardiacscience.com/marking-national-cpr-and-aed-awareness-week/
http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/What-is-CPR_UCM_001120_SubHomePage.jsp
http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/CPR-Statistics_UCM_307542_Article.jsp
http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf
http://mycprcoach.com/hands-only-cpr/ Weisfeldt ML, Sitlani CM, Ornato JP, Rea T, Aufderheide TP, Davis D, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol. Apr 20 2010;55(16):1713-20.
Automatic External Defibrillation Author: Joseph J Bocka, MD; Chief Editor: David FM Brown, MD http://emedicine.medscape.com/article/780533-overview
AED use: National Institute of Health – AED proceedures
Graphic and CPR Data: American Heart Association CPR Awareness Page