J. M. Febre and Associates

J. M. Febre and Associates Certified Legal Nurse Consultant, Experienced in Medical Research, Legal Case Management, Medical Malpractice, Legal and Medical Terminology, and more.

Certified Legal Nurse Consultant (CLNC) offering an extensive career in the medical field, combining experience as an RN, Charge Nurse, Flight Nurse and Legal Nurse Consultant. Noted ability to bridge the gap between the medical and legal industries by utilizing expertise in medical terminology and regulations and legal terminology and administration, as well as expertise in medical-related legal

Certified Legal Nurse Consultant (CLNC) offering an extensive career in the medical field, combining experience as an RN, Charge Nurse, Flight Nurse and Legal Nurse Consultant. Noted ability to bridge the gap between the medical and legal industries by utilizing expertise in medical terminology and regulations and legal terminology and administration, as well as expertise in medical-related legal

Nearly 1000 Healthcare Workers Killed Since 2014, WHO Says
06/04/2016
Nearly 1000 Healthcare Workers Killed Since 2014, WHO Says

Nearly 1000 Healthcare Workers Killed Since 2014, WHO Says

Over the last 2 years, nearly 960 people have been killed in attacks on healthcare in countries dealing with conflicts, and most were intentionally targeted, WHO says in a new report.

Handling In-Flight Medical Emergencies
06/01/2016
Handling In-Flight Medical Emergencies

Handling In-Flight Medical Emergencies

You're seated in an aircraft, flying at 30,000 feet across the country to attend an EMS conference. Unexpectedly, you hear a chime, and the flight attendant makes the announcement made popular by episodes of "Rescue 911" and other medical drama shows: "Is there a medical professional on board this a...

Don't get burn by your expert witness: Tips to keep your expert be a perfect expert.Get your free copy and share it with...
05/31/2016

Don't get burn by your expert witness: Tips to keep your expert be a perfect expert.

Get your free copy and share it with your experts, request through my website or PM me, I will send it to you for free, SAVE TIME AND MONEY !!!!!

Don't get burn by your expert witness: Tips to keep your expert be a perfect expert.

Get your free copy and share it with your experts, request through my website or PM me, I will send it to you for free, SAVE TIME AND MONEY !!!!!

MD versus NP. Who will benefit?
05/28/2016
VA Plan for Independent Advanced RNs Riles Physicians

MD versus NP. Who will benefit?

Proposed regulations would let advanced practice nurses work without physician oversight at VA facilities regardless of state law. Anesthesiologists in particular are steamed.

Boards Often Overlook Physician Sexual Misconduct, Study Says
05/19/2016
Boards Often Overlook Physician Sexual Misconduct, Study Says

Boards Often Overlook Physician Sexual Misconduct, Study Says

When hospitals, medical societies, and malpractice insurers report sexual misconduct to the National Practitioner Data Bank, the information usually doesn't register with state medical boards.

Nursing Home Falls. Short Term effects of balancing blood pressure medications.
05/16/2016
Falling, Serious Injury in Elderly Tied to Changes in BP Meds

Nursing Home Falls. Short Term effects of balancing blood pressure medications.

Now there are data showing that after starting antihypertensive meds or raising their dosages, physicians should keep a closer eye on older patients to make sure they tolerate the changes, say researchers.

Medical Error is Third leading cause of death in the United States.
05/16/2016
Medical Error in Public Eye at Geriatrics Meeting

Medical Error is Third leading cause of death in the United States.

Studies exploring medical error, the coordination of care, and dementia will be in the spotlight at the American Geriatrics Society Annual Scientific Meeting.

Safe? Secure? Legal? …….. Really?…….. What do you think?
05/14/2016
Joint Commission Approves Order Texting

Safe? Secure? Legal? …….. Really?…….. What do you think?

The Joint Commission says new text messaging platforms address its concerns about security and authentication; nonorder texting is also approved if secure.

05/14/2016

Skilled Nursing Facility: Traumatic Falls

According to Dr. Bijan Najafi, from Baylor College of Medicine, Houston, Texas, " The fact that a simple 20 second arm test could provide similar results as a time-consuming and complex process to identify frailty was behind our expectation."

The UEF (Upper Extremity Frailty) tests should be done routinely "in older adults and trauma settings as well as emergency departments," Dr. Najafi said. "An older fit patient who goes through a traumatic accident or an emergency accident can benefit from routine emergency care, while a frail older individual with higher vulnerability to stressors requires more complex care by a multidisciplinary team of clinicians to avoid adverse outcomes."

This could be "a quick and practical tool to improve identification of the vulnerable frail population and tailor decision making based on their vulnerabilities," he said. "This could be decision making about admission to hospital, elective surgery, length of stay, and post discharge care."

ICD Implant With Same-Day Discharge Gets an Evidence Base
05/09/2016
ICD Implant With Same-Day Discharge Gets an Evidence Base

ICD Implant With Same-Day Discharge Gets an Evidence Base

"It would be great to have guidelines," about the practice routine in Canada and done more than ever in the US. But now patients can hear "there are data out there now that show you can safely go home."

PREVENT: Protocol Lowers Pump Thrombosis in HeartMate II
05/09/2016
PREVENT: Protocol Lowers Pump Thrombosis in HeartMate II

PREVENT: Protocol Lowers Pump Thrombosis in HeartMate II

"My sense is that as long as the HeartMate II is still out there being used clinically, any new guidelines would use these data," said an author of the ISHLT's last LVAD guidelines.

Timeline photos
05/07/2016

Timeline photos

Nurses: Is This Standing Order Legal?
05/07/2016
Nurses: Is This Standing Order Legal?

Nurses: Is This Standing Order Legal?

A hospital establishes a complicated set of criteria for nurses to use in discontinuing telemetry, calling it a 'standing order.' Is this legal?

New Practice Guidelines on Antipsychotic Use in Dementia
05/07/2016
New Practice Guidelines on Antipsychotic Use in Dementia

New Practice Guidelines on Antipsychotic Use in Dementia

Judicious use of antipsychotics to treat agitation or psychosis in patients with dementia is the focus of new practice guidelines from the American Psychiatric Association.

05/03/2016
www.ena.org

Violence Against Nurses: Not 'Part of the Job'
By: Kathleen E. Carlson, MSN, RN, CEN, FAEN

I'm sorry, I was tired of waiting," the teenage patient told Rita Anderson, BSN, RN, CEN, FAEN, the emergency nurse she struck a few hours earlier. Anderson approached the girl in the emergency department (ED) when, out of frustration, the teen hit Anderson so hard the blow to her face dislocated her jaw. Police were surprised Anderson pressed charges against a patient.

Unfortunately, this incident isn't out of the norm in today's ED. More than 70% of emergency nurses have been physically or verbally assaulted by patients or visitors while they provided patient care in the emergency setting.1,2 The 24/7 accessibility of EDs, overcrowding, long wait times, and patients under the influence are just some of the factors contributing to the epidemic of violence in healthcare.

Legal Progress is Not Enough
Emergency Nurses Association (ENA) members have been hard at work advocating for stricter penalties for violence against emergency care professionals. And progress is slowly being made. Anderson pioneered efforts in New York to make it a felony to assault a nurse, and said resistance is often strong - among both nurses and law enforcement officials.

In March, Utah Gov. Gary Herbert signed a bill increasing the penalty for assault against healthcare providers or emergency medical workers when the assault causes substantial bodily injury.

Shortly thereafter, Georgia Gov. Nathan Deal signed legislation increasing punishments for aggravated assault and aggravated battery when committed against hospital emergency department personnel and emergency medical services personnel. But stricter laws are just part of the solution. Twenty-six states still need to increase penalties for this type of violence.

Violence in EDs has become so widespread that in 2012 ENA set out to study the stories of nurses assaulted in emergency departments. Existing survey data provided the startling incidence and prevalence of violence in emergency departments.

SEE ALSO: Weighing Employment Options in Healthcare

Scary Statistics
ENA further explored the personal experiences of assaulted nurses, which informed the study "Nothing Changes, Nobody Cares: Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted
While Providing Care," published in the Journal of Emergency Nursing in 2014. 3

Three common areas of concern emerged from the study's data:

The physical environment of the ED and the institutional culture of the ED
The impact the event had on the nurse regarding job performance, coping, and feelings regarding the interaction with the legal and judicial systems, law enforcement, or institutional culture
The precursors to the violent event either related to the perpetrator or the environment in which the event took place
In light of the study's data, researchers recommended training staff nurses and managers in cue recognition to identify high-risk patients and situations. Interventions on both personal and institutional levels needed to be developed to address high-risk situations to recognize and mitigate violence, rather than manage the reaction after the violent event, researchers said.

De-Escalating Potential Crises
So ENA upped the ante on the search for solutions. The association, representing more than 41,000 emergency nurses worldwide, wanted to help emergency healthcare providers understand when situations are escalating, and provide tools to help mitigate what could quickly become a violent situation. ENA sought to provide nurses with an objective tool they could bring to administration and say, "This is a high-risk environment," or "This is a high-risk person."

Thanks to a grant from the Occupational Safety and Health Administration, ENA developed "Workplace Violence: Know Your Way Out,"4 a free, two-hour online course designed to teach nurses, managers, and staff who work in emergency care settings how to:

Recognize workplace violence risk factors
Apply prompt and appropriate responses
Implement organizational prevention strategies, and
Report and analyze patterns of violence
The course encourages clinical staff and hospital leadership to assess workplace violence challenges and create a proactive plan. And, just as important, remove the culture of acceptance around violence.

Identify Problems and Suggest Solutions

The course shows we need to take a critical look at both our patient population and the physical layout of our departments. If there's one thing we can do today, it's to identify the things that make our EDs high-risk, and proactively develop solutions. You may not be able to affect problem areas such as staffing and throughput, but you can consistently identify and report threats of violence. Monitor and record what is happening. The days of sweeping these incidents of violence under the rug are over.

Addressing violence in the ED requires a multidisciplinary team approach. A successful workplace violence prevention program requires a fundamental change in approach among hospital administrators, managers, the general public and emergency care providers.

Now's the time to work together to stimulate change. What steps is your healthcare facility taking to recognize, mitigate and prevent violence?

"Workplace Violence Prevention: Know Your Way Out" was produced under grant number SH-23534-12-60-F-17 from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

References

1. Gacki-Smith J, Juarez AM, Boyett L, Homeyer C, Robinson L, MacLean SL. Violence against nurses working in US emergency departments. J Nurs Adm. 2009;39(7-8):340-9.

2. Emergency Nurses Association, Institute for Emergency Nursing Research. Emergency Department Violence Surveillance Study. Des Plaines, IL: Emergency Nurses Association; 2011. Available at: http://www.ena.org/IENR/Documents/ENAEDVSReportNovember2011.pdf. Accessed July 12, 2013.

3. Wolf L, Delao A, Perharts C. Nothing Changes, Nobody Cares: Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted While Providing Care. Journal of Emergency Nursing. 2014; (4): 305-310,

4. Emergency Nurses Association. Workplace Violence: Know Your Way Out. Available: https://www.ena.org/education/onlinelearning/wvp/Pages/default.aspx.

Kathleen Carlson is president of the Emergency Nurses Association.

05/02/2016

April 28, 2016
WHAT'S NEW!
Seeking Acute Ischemic Stroke Case Studies For New! AIS Toolkit
The American Stroke Association is developing an Acute Ischemic Stroke Toolkit to expand awareness of the 2015 AHA/ASA Focused Update to the 2013 Guidelines for the Early Management of Patients With AIS and to increase knowledge of screening tools/protocols for large vessel occlusions (LVO's). As part of the toolkit, we are seeking case studies that meet the following criteria:
Case Study that identifies assessment and /or clinical functional outcomes- including evaluation of LVO, from the EMS Physician's or Neurologist's perspective.
Hospital Approach and Community Case Model - opportunity to highlight differences between Acute Stroke Ready Hospitals/ PSCs and CSCs and the Physician / Stroke Coordinator process. More detailed, speaks to systems of care and opportunities within hospitals. How a Facility Might approach triage and stroke care, use of Assessment tools and role of EMS.
Please send any relevant cases you may have to [email protected].

New Stroke Journal Report - Better patient outcomes linked to Get With The Guidelines®-Stroke
Stroke patients at hospitals participating in a nationwide quality-improvement program were more likely to be discharged and less likely to die after discharge than patients in non-participating hospitals, according to new research in the American Heart Association's journal, Stroke.
To learn more, access the full report here.

04/30/2016

Seven types of emergency general surgeries (EGSs) account for the vast majority of all EGSs (80.0%), deaths (80.3%), complications (78.9%), and inpatient costs (80.2%), according to a retrospective review of 421,476 procedures performed in the United States.

The surgical procedures include partial colectomy, small bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy.

"This is a particularly high-risk population of surgery patients — those who undergo an EGS operation are up to 8 times more likely to die postoperatively than are patients undergoing the same procedures electively. In addition, approximately half of all patients undergoing EGS will develop a postoperative complication, and up to 15% will be readmitted to the hospital within 30 days of their surgery," the researchers write.

John W. Scott, MD, MPH, from the Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts, and colleagues report their findings in an article published online April 27 in JAMA Surgery.

The investigators analyzed data on 421,476 patient emergency general surgeries from the 2008 to 2011 Hospital Cost and Utilization Project's National Inpatient Sample that were weighted to represent 2.1 million patient encounters. They included a racially and ethnically diverse group of adults aged 18 to 105 years with a diverse mix of payer status and income levels. Large hospitals made up 61.2% and urban teaching hospitals 11.8% of the hospitals in the study.

In the overall sample, the mean mortality was 1.23% (95% confidence interval [CI], 1.18% - 1.28%), and 15.0% (95% CI, 14.6% - 15.3%) of the patients had at least one complication. The average cost per hospital admission was $13,241.

The researchers included 35 distinct three-digit procedure group codes in the final analytic sample and identified 138,992 partial colectomies, 78,478 small bowel resections, 619,197 cholecystectomies, 31,571 cases of operative management of peptic ulcer disease, 102,856 surgeries for lysis of peritoneal adhesions, 682,043 appendectomies, and 9418 laparotomies.

Complications included pneumonia, deep vein thrombosis and/or pulmonary embolism, acute renal injury, stroke, myocardial infarction, cardiac arrest, acute respiratory distress syndrome, sepsis, septic shock, mechanical wound failure, wound infection, postoperative gastrointestinal tract complications, and other postoperative complications including retained foreign body and postoperative hemorrhage.

The complication rates were 42.80% for partial colectomy, 46.94% for small bowel resection, 8.06% for cholecystectomy, 42.00% for operative management of peptic ulcer disease, 28.09% for lysis of peritoneal adhesions, 7.27% for appendectomy, and 40.15% for laparotomy.

The mortality rates were 5.33% for partial colectomy, 6.47% for small bowel resection, 0.22% for cholecystectomy, 6.83% for operative management of peptic ulcer disease, 1.59% for lysis of peritoneal adhesions, 0.08% for appendectomy, and 23.76% for laparotomy.

The inpatient costs were $27,558.77 for partial colectomy, $28 450.72 for small bowel resection, $10,579.35 for cholecystectomy, $27,095.60 for operative management of peptic ulcer disease, $17,387.27 for lysis of peritoneal adhesions, $9664.30 for appendectomy, and $21,962.55 for laparotomy.

"Although cost was not used to rank the procedures, it is notable that the same 7 procedures ranked by clinical burden also accounted for 80% of all EGS-related inpatient costs," the authors write. "This finding further emphasizes the usefulness of these 7 procedures to serve as the basis for understanding ways to improve quality and reduce cost among patients undergoing EGS."

In an invited commentary, Martin G. Paul, MD, from Sibley Memorial Hospital, Johns Hopkins Medicine, Washington, DC, writes, "While this study has the limitations associated with using claims-derived data, the next step would be to monitor the outcomes of these 7 operative EGS procedures in prospective, clinically derived databases, particularly those procedures that Scott et al have defined as being associated with the highest rates of complications, such as emergency bowel resection and surgery for the acute complications of ulcer disease."

The study contributes important information to the literature aimed at improving outcomes and reducing costs in caring for patients with intra-abdominal emergencies, and expands on the efforts of the American Association for the Surgery of Trauma that initially standardized definitions and diagnosis codes for EGS, Dr Paul adds.

"Continued studies along these lines should provide direction for high-impact quality initiatives, emphasizing not just a reduction in complications but an earlier recognition of these particularly morbid adverse events. Also necessary are improved metrics for measuring the quality of the acute surgical care that is delivered, so that this can be better standardized across our health care system. Finally, national health policy needs to address the fact that we have a decreasing number of general surgeons facing a growing burden, and appropriate resources and strategic planning need to be directed toward correcting this," Dr Paul explains.

One coauthor reports being the principal investigator of a contract with the Patient-Centered Outcomes Research Institute and a Harvard Surgery Affinity Research Collaborative Program grant; he also reports being the cofounder and an equity holder in Patient Doctor Technologies Inc. The remaining authors and commentator have disclosed no relevant financial relationships.

JAMA Surg. Published online April 27, 2016. Article full text, Commentary extract

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30 SERVICES

1. Scree or investigate cases for merit.
2. Define the applicable standards of care.
3. Define deviations from, and adherences to, the applicable standards of care.
4. Assess the alleged damages and/or injuries.
5. Identify factors that caused or contributed to the alleged damages and/or injuries.
6. Organize, tab and paginate medical records.
7. Summarize, translate and interpret medical records.
8. Identify and recommend potential defendants.
9. Conduct literature searches and integrate the literature and standards/guidelines into the case analysis.
10. Research and analyze the validity and reliability of research studies relied on by all parties.
11. Identify and review relevant medical records, hospital policies and procedures, other essential documents and other tangible items.
12. Expand the attorney's medical library.
13. Interview clients, key witnesses and experts.
14. Consult with healthcare providers.
15. Identify types of testifying experts needed.
16. Locate and interface with expert witnesses.
17. Communicate with potential testifying experts.
18. Analyze and compare expert witness reports and other work products.
19. Serve as liaison between the attorney and healthcare providers, testifying experts, parties, witnesses and other consultants.
20. Prepare interrogatories.
21. Review and drafty responses to various legal document and correspondence for the attorney's signature.
22. Assist in exhibit preparation.
23. Prepare deposition and trial ( cross or direct) questions.
24. Review , analyze and summarize depositions, including past testimony.
25. Attend depositions, trials, review panels and arbitration and mediation hearings.
26. Help prepare witnesses and experts for deposition and trial.
27. Develop written reports for use as study tools by the attorney.
28. Coordinate and attend independent medical examinations (IMEs).
29. Develop life care plans.
30. Coordinate and assist in facilitating focus groups and mock trials.

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