When was the last time you spent time in a hospital ward looking closely at the physical condition of the building?
Did you notice the chipping paint? The peeling wallpaper? The cracks in the floors? The stained ceiling tiles? The upholstery that was worn thin and so stained it can't be cleaned anymore? The blinds that are missing slats and won't open or close? The curtains that are worn and stained? The bed linens that are stained? The clutter of equipment in the hallways and rooms?
I notice these things every time I step into the hospital ward I work on. I do my best to make sure stained linen is changed before my patient ever goes near the bed. That stained curtains are taken down and replaced. But it is impossible to hide the deterioration of everything else.
The patients who are admitted to hospital are acutely ill or requiring some immediate intervention. Mothers are arriving to deliver their babies. The physical environment should be one of impeccable cleaniless and condition. Yet Canadian hospitals are often falling far short of this standard under the guise of fiscal restraint. Even if the money would be spent to restore the units, there isn't any place to physically put patients while the work is done.
Can a hospital defend its infection rate and care when it can't provide patients with an environment that promotes health and healing?
Sunday, June 28, 2009
Friday, June 19, 2009
Canadians give clear message on health care
As early as July 2008, Leger Marketing did a study which showed 70% of Canadians believe prescription medications are prescribed more often than necessary. The same study showed one third of Canadians do not believe the Canadian health care system meets their needs.
The lack of confidence in health care to meet their needs is a powerful commentary on the current state of healthcare in Canada. Recent changes to some provincial health care systems will result in even less ability for Canadians to access the care they need, when they need it.
Patients who enter a system when they are already doubting their care may be more likely to seek compensation for negligent care. Adding to this atompshere is the lack of trust simmering between front line staff and management. Internal strife directly impacts patient care-- and the patients know it.
A legal nurse consultant assists attorneys faced with these claims primarily through careful analysis of the choronology and the care records to determine if the facts translate into merit. This "weeding out" process helps reduce costs while also establishing a base for claims which move forward.
The lack of confidence in health care to meet their needs is a powerful commentary on the current state of healthcare in Canada. Recent changes to some provincial health care systems will result in even less ability for Canadians to access the care they need, when they need it.
Patients who enter a system when they are already doubting their care may be more likely to seek compensation for negligent care. Adding to this atompshere is the lack of trust simmering between front line staff and management. Internal strife directly impacts patient care-- and the patients know it.
A legal nurse consultant assists attorneys faced with these claims primarily through careful analysis of the choronology and the care records to determine if the facts translate into merit. This "weeding out" process helps reduce costs while also establishing a base for claims which move forward.
Thursday, June 18, 2009
Changes to Care for Moms with Breech Pregnancies
The standard of care in Canadian hospitals since 2000 has been to deliver all breech babies by caesarean section. This method of delivery was based on solid research which showed the risks for potential harmful outcomes to the baby were too high for vaginal delivery. The Society for Obstetricians and Gynegologists of Canada has recently announced that this standard care will be reversed.
It is a basic premise of mechanics. The largest part of a fetus is the head-- and breech babies have their heads delivered last. There is always a risk that the head will prove too large for the mother's pelvis which results in fetal death and dismemberment as well as major injury to the mother during attempts to save the baby.
The other harsh reality is that delivery with best outcomes for mom and baby requires genuine finesse and loads of experience-- neither of which is easily found in our latest generation of obstetricians. They haven't seen or done enough breech deliveries to be good at it.
As a labour and delivery nurse in her third decade of experience, I have seen the time where breech pregnancies were delivered without a c-section. I have also seen babies severely compromised in the process when the obstetrician is not skilled enough to do it.
Two issues present themselves in the world of medical liability:
1. Will mothers be completely informed and truly understand the risks their babies face? If a delivery goes very wrong during this period of attempting to reduce the c-section rate by any means possible, can the defence argue against years of evidence that planned c-section delivery is best for the baby's safety?
2. Thousands of women were not given the choice in the type of delivery. Does this mean they have grounds to question that lack of options should obstetricians return to vaginal delivery of term breech pregnancies?
Breech deliveries are high risk, even in the operating room babies can have a traumatic delivery, cases presenting themselves over the next few years will require specialized expertise to determine if every possible factor was considered before the method of delivery was determined.
It is a basic premise of mechanics. The largest part of a fetus is the head-- and breech babies have their heads delivered last. There is always a risk that the head will prove too large for the mother's pelvis which results in fetal death and dismemberment as well as major injury to the mother during attempts to save the baby.
The other harsh reality is that delivery with best outcomes for mom and baby requires genuine finesse and loads of experience-- neither of which is easily found in our latest generation of obstetricians. They haven't seen or done enough breech deliveries to be good at it.
As a labour and delivery nurse in her third decade of experience, I have seen the time where breech pregnancies were delivered without a c-section. I have also seen babies severely compromised in the process when the obstetrician is not skilled enough to do it.
Two issues present themselves in the world of medical liability:
1. Will mothers be completely informed and truly understand the risks their babies face? If a delivery goes very wrong during this period of attempting to reduce the c-section rate by any means possible, can the defence argue against years of evidence that planned c-section delivery is best for the baby's safety?
2. Thousands of women were not given the choice in the type of delivery. Does this mean they have grounds to question that lack of options should obstetricians return to vaginal delivery of term breech pregnancies?
Breech deliveries are high risk, even in the operating room babies can have a traumatic delivery, cases presenting themselves over the next few years will require specialized expertise to determine if every possible factor was considered before the method of delivery was determined.
Monday, June 15, 2009
Defective Implanted Defibrillator Leads
A common procedure for people with irregular or unusual heart rhythms often receive defibrillators implanted into their chest to provide a necessary shock to maintain a healthy heart rhythm whenever necessary. It was a big, and unwelcome, surprise when the manufacturer, Medtronic, announced last year that their Sprint Fidelis leads were malfunctioning at rates that were higher than other leads. These defective leads were pulled from the implant market but cannot be changed or removed without a real risk of harm to the patient. Numbers vary depending on the source, but in the range of 87.9% to 94.3% of the leads are still in place in patients.
In May of 2009, the Heart Rhythm Society, an American cardiac physicians’ group representing MDs who implant and extract defibrillators and their associated leads, issued policy statements calling for hospitals to better police the experience and training of the surgeons who extract defibrillator leads. This is especially important given the risk to the patient to remove or change these defective leads. HRS also issued a statement calling for companies that produce the leads to do be more accountable in the tracking the performance of their devices once they’re on the market.
A legal nurse consultant can provide information for a case where there may be a suspicion of a malfunctioning cardiac defibrillator, its leads or an injury that occurred while the leads were being removed. One of the questions that must be answered is the experience of the doctor who connected or extracted the leads. While the new guidelines have yet to be determined in Canada, the training and experience of the physician may be relevant to the injury. Legal nurse consultants for the defence may be able to raise the level of experience as an avenue of defence of the doctor. Legal nurse consultants for the plaintiff will question the lack of experience of the physician as evidence of negligence.
The incidence of medical device failure is a serious one. And is definitely the type of case requiring the expertise of a legal nurse consultant.
In May of 2009, the Heart Rhythm Society, an American cardiac physicians’ group representing MDs who implant and extract defibrillators and their associated leads, issued policy statements calling for hospitals to better police the experience and training of the surgeons who extract defibrillator leads. This is especially important given the risk to the patient to remove or change these defective leads. HRS also issued a statement calling for companies that produce the leads to do be more accountable in the tracking the performance of their devices once they’re on the market.
A legal nurse consultant can provide information for a case where there may be a suspicion of a malfunctioning cardiac defibrillator, its leads or an injury that occurred while the leads were being removed. One of the questions that must be answered is the experience of the doctor who connected or extracted the leads. While the new guidelines have yet to be determined in Canada, the training and experience of the physician may be relevant to the injury. Legal nurse consultants for the defence may be able to raise the level of experience as an avenue of defence of the doctor. Legal nurse consultants for the plaintiff will question the lack of experience of the physician as evidence of negligence.
The incidence of medical device failure is a serious one. And is definitely the type of case requiring the expertise of a legal nurse consultant.
Friday, June 5, 2009
Economy and healthcare changes bring business to lawyers
This week saw glimmers of recovery in the Canadian economy. Mortgage rates, always tied to the bond market, have started to rise and this is a sign that the slump is beginning to come to an end.
However, the healthcare industry is not going to follow that trend. Layoffs and budget cuts have begun in major hospitals at a time of increasing patient loads. Nursing shortages that were the focus of news articles as recently as two weeks ago are suddenly announced "over" by politicians seeking to justify radical changes to the voting public. Clinical educators are slated for layoffs as well which directly impacts the continuing education for nurses and other professionals.
This has been good news for nursing and other health professional recruitment firms from other countries; they have begun actively seeking to recruit our experienced, well-educated registered nurses and they are succeeding. Offers are for positions with great wages and benefits in prime locations.
How does all this bring business to lawyers?
Patient care is coming under direct duress in the current work environment and this leads to mistakes.
Management is being shifted so that managers are in charge of units in which they have no clinical experience. Management of units is being consolidated under the supervision of one manager.
Education and training programs are being cut so staff will not maintain their skill levels at current standards. New staff, already coming in without the background of a registered nurse, will not receive a consistent orientation program so their care may not reflect policies and procedures.
Hiring freezes mean no replacements for maternity leaves of up to one year, no replacements for the retiring nurses, no replacements for nurses injured on the job and no coverage for absent staff. Nurses already have the highest absentee rate in Canada and this will only increase as staff become more overworked and stressed.
Less staff on the floor means current standard nurse-patient ratios will come under pressure to change. Areas where levels of care now dictate 1:1 nursing for the optimum patient outcome may see nurses caring for 2 or 3 patients and important information on the patient's condition will be missed or delayed in being seen resulting in compromised outcomes. Even layoffs in the clerical sector impacts patient care when nobody is at the desk to answer calls from the rooms while the nurses are busy with patient care in other areas of the unit.
There are implications for the mental health of all hospital staff during this period. Rumours and awareness of the impact of these changes have created an environment of high stress, lack of concentration and decreasing commitment to an employer who cuts jobs. Stressed hospital staff simply cannot perform at optimum levels.
Legal nurse consultants have the experience of hospital nursing to know the implications for patients and families during times of high stress and staff cutbacks. They can tell the legal team what to look for to see if the employer is at fault for the care that was or was not received during a hospital stay. Legal nurse consultants can pick up the subtle wording of other nurses that provides clues about the unit activity that affected your client. They can also give advice on questions for interviews that will demonstrate the environment during the event and its impact on your client.
Legal cases involving hospitals in Canada will see an increase as acuity, activity and populations rise while staff and budget levels decrease. Are you ready with your full legal team that will best represent your client?
However, the healthcare industry is not going to follow that trend. Layoffs and budget cuts have begun in major hospitals at a time of increasing patient loads. Nursing shortages that were the focus of news articles as recently as two weeks ago are suddenly announced "over" by politicians seeking to justify radical changes to the voting public. Clinical educators are slated for layoffs as well which directly impacts the continuing education for nurses and other professionals.
This has been good news for nursing and other health professional recruitment firms from other countries; they have begun actively seeking to recruit our experienced, well-educated registered nurses and they are succeeding. Offers are for positions with great wages and benefits in prime locations.
How does all this bring business to lawyers?
Patient care is coming under direct duress in the current work environment and this leads to mistakes.
Management is being shifted so that managers are in charge of units in which they have no clinical experience. Management of units is being consolidated under the supervision of one manager.
Education and training programs are being cut so staff will not maintain their skill levels at current standards. New staff, already coming in without the background of a registered nurse, will not receive a consistent orientation program so their care may not reflect policies and procedures.
Hiring freezes mean no replacements for maternity leaves of up to one year, no replacements for the retiring nurses, no replacements for nurses injured on the job and no coverage for absent staff. Nurses already have the highest absentee rate in Canada and this will only increase as staff become more overworked and stressed.
Less staff on the floor means current standard nurse-patient ratios will come under pressure to change. Areas where levels of care now dictate 1:1 nursing for the optimum patient outcome may see nurses caring for 2 or 3 patients and important information on the patient's condition will be missed or delayed in being seen resulting in compromised outcomes. Even layoffs in the clerical sector impacts patient care when nobody is at the desk to answer calls from the rooms while the nurses are busy with patient care in other areas of the unit.
There are implications for the mental health of all hospital staff during this period. Rumours and awareness of the impact of these changes have created an environment of high stress, lack of concentration and decreasing commitment to an employer who cuts jobs. Stressed hospital staff simply cannot perform at optimum levels.
Legal nurse consultants have the experience of hospital nursing to know the implications for patients and families during times of high stress and staff cutbacks. They can tell the legal team what to look for to see if the employer is at fault for the care that was or was not received during a hospital stay. Legal nurse consultants can pick up the subtle wording of other nurses that provides clues about the unit activity that affected your client. They can also give advice on questions for interviews that will demonstrate the environment during the event and its impact on your client.
Legal cases involving hospitals in Canada will see an increase as acuity, activity and populations rise while staff and budget levels decrease. Are you ready with your full legal team that will best represent your client?
Subscribe to:
Posts (Atom)
