@ Medication Use

The economic downturn has placed tremendous pressure on employees over their long-term job security. Employees are responding by seeking out employers that offer a better work-life balance, and research shows they work harder for those that do.

In the current economic environment, work-life balance now ranks as one of the most important workplace attributes—second only to compensation, according to research conducted by the Corporate Executive Board among more than 50,000 global workers. And employees who feel they have a better work-life balance tend to work 21% harder than those that don't.

The critical need to ensure an adequate work-life balance for employees in the downturn is largely being neglected by employers as more and more pressure is put onto employees. In 2006, 53% of employees felt they had a good work-life balance; that number fell to 30% in the first quarter of 2009.

FDA Warns Consumers to Stop Using Hydroxycut Products
Dietary Supplements Linked to One Death; Pose Risk of Liver Injury

The U.S. Food and Drug Administration is warning consumers to immediately stop using Hydroxycut products by Iovate Health Sciences Inc., of Oakville, Ontario and distributed by Iovate Health Sciences USA Inc. of Blasdell, N.Y. Some Hydroxycut products are associated with a number of serious liver injuries. Iovate has agreed to recall Hydroxycut products from the market.

The FDA has received 23 reports of serious health problems ranging from jaundice and elevated liver enzymes, an indicator of potential liver injury, to liver damage requiring liver transplant. One death due to liver failure has been reported to the FDA. Other health problems reported include seizures; cardiovascular disorders; and rhabdomyolysis, a type of muscle damage that can lead to other serious health problems such as kidney failure.

Liver injury, although rare, was reported by patients at the doses of Hydroxycut recommended on the bottle. Symptoms of liver injury include jaundice (yellowing of the skin or whites of the eyes) and brown urine. Other symptoms include nausea, vomiting, light-colored stools, excessive fatigue, weakness, stomach or abdominal pain, itching, and loss of appetite.
 
“The FDA urges consumers to discontinue use of Hydroxycut products in order to avoid any undue risk. Adverse events are rare, but exist. Consumers should consult a physician or other health care professional if they are experiencing symptoms possibly associated with these products,” said Linda Katz, M.D., interim chief medical officer of the FDA’s Center for Food Safety and Applied Nutrition.

After weeks of collaboration with a diverse group of organizations, today Google endorsed the Markle Foundation's framework on Meaningful Use and Certification. The framework outlines criteria for hospitals and physicians wishing to qualify for the health IT-related federal stimulus funds in the American Recovery and Reinvestment Act (ARRA). Among other things, the ARRA allows providers to qualify for health IT funding if they demonstrate that they are making a "meaningful use" of information technology. We think it's critically important that the U.S. Department of Health and Human Services (HHS) considers patient access to their digitized medical records via electronic health records (EHRs) when considering how to define "meaningful use."

Medicine is a profession practiced by note, not rote.

A note to the lab, for tests. To the nurse, to start an IV. To the pharmacist, for pills. To self: Call patient and ask whether those pills are working.

Whether the patient gets better (or, at least, feels better) requires fleet skills, deep knowledge and, often, the ordinary act of the right person seeing the right note at the right time -- and acting on it.

Electronic medical records are supposed to cyber-stack all those notes to streamline sharing, retrieving, reading and analyzing -- all to reduce errors, improve patient care and cut costs. Hence, the $19 billion the feds set aside earlier this year to get smaller medical practices to use electronic medical records, which they might otherwise avoid doing because of the investment of time and money.

But working with electronic medical records is not easy, even for people smart enough to make it through medical or nursing school. Many doctors call the technology frustrating and difficult to use, according to a 2009 survey by the American College of Physician Executives.

"There's a general fear that you put something new like this in an exam room with me and it's going to ruin my interaction with the patient," says Dr. Michael McNamara, a Kaiser Permanente pediatrician and a liaison for doctors on health-records issues, "It's a super-powerful tool, and if you let it, it can become the focus of the conversation."

How so? Well, some doctors aren't exactly known for their people skills. Stick a computer between one of these doctors and a patient during an exam, and without the proper training, it can impede eye contact and stilt the conversation, making patients feel less like human beings and more like points of data.

Fixing glitches
Many hospitals and large health management organizations such as Kaiser adopted these systems years ago and have had time to work through the glitches.

"When we first went live, nurses thought, there's no way we can document this in the room, there's no way we can document this in front of the patient," says Lori Becker, a registered nurse at Providence St. Vincent and specialist in informatics. "But you can pull the computer away from the wall so you're not standing with your back to the patient."

At Kaiser, providers are trained to turn the computer screen toward the patient, unless someone else is in the room, and explain what information is being recorded and why, says Dr. Terry Williams, a family practice physician. Those who work well with the systems during exams tend to treat the patient and the computer as two conversational partners, interpreting between the two when necessary.

"If I see you start to cry or something, I stop, look away from the thing and look at you," Williams says. "If you're just ordering things and you're not engaged with the patient, it can be just like some guy is talking on his cell phone with you in the room."

Still, among Williams' patients, "20 percent just hate computers. If you're even near that thing, they get upset."

When Kaiser first put computers in exam rooms early this decade, it designed a study to measure whether entering data into the electronic system took doctors' attention away from patients. Kaiser found just the opposite: Doctors spent more time in the exam room, and patient satisfaction scores were higher.

"From the patient point of view, I'm now spending more time with them, and if there's one thing they want, it's more time," McNamara says. "We were very worried people would say, 'This is impersonal, you're not paying attention to me.' But they actually felt they were getting more attention when the computer was in the room."

Studying videotapes
Kaiser, with patients' permission, went so far as to videotape and study exam-room interactions between clinicians and patients.

"People who were skilled at communication before introducing a computer were better, and people who were not skilled at communication before a computer were worse," McNamara says.

Kaiser, which helped Virginia Garcia's Hillsboro clinic go live with electronic health records Monday, wrote curriculum to train providers to maintain a soothing bedside manner even while typing away at the computer.

"One of the things patients want to know is what you're doing on the screen," McNamara says. If doctors don't explain otherwise, "you could be checking your stocks. Who knows what you're doing. That lack of knowing allows patients to fill in the blanks. They may think you're seeing something of concern and you don't want to share it with them."

Interesting - not sure why OHSU wasn't interviewed as we have an integrated (ambulatory and inpatient) EHR.

The Institute of Medicine recommended Tuesday that doctors, medical schools, professional groups and drug makers make far-reaching changes to prevent industry gifts and payments from influencing patient care and research.

The IOM, part of the National Academy of Sciences, proposed the elimination of many now-common practices. It said doctors, for example, shouldn't accept meals, trips or other gifts from companies. Nor should physicians participate in clinical trials if they have a financial interest in the outcome, or sign on to ghost-written articles.

The IOM also said professional societies shouldn't accept direct industry funding for the development of guidelines on treating patients. And it recommended that companies disclose payments publicly, and in a central place.

WASHINGTON – According to first quarter federal reports, Google participated in lobbying efforts aimed at allowing the sale of electronic medical records in the economic stimulus legislation.

This contradicts the Internet giant's earlier response to Consumer Watchdog, a California-based, non-profit consumer education and advocacy organization, that their claims against Google were "100 percent false."

Consumer Watchdog reported the "rumored" lobbying in January and charged that Google was pushing for the provisions so it could sell patient medical information to its advertising clients on the new "Google Health" database. Google responded by contacting the Rose Foundation, a charitable foundation in California, about withdrawing Consumer Watchdog's funding.

FDA announced the final ruling on new, more stringent packaging and warning label requirements for OTC pain relievers and fever reducers containing acetaminophen and NSAIDs at a briefing today. Internal analgesics, antipyretics and antirheumatic drug products are all affected by this ruling. Matthew Holman, PhD, Deputy Director, Division of Nonprescription Regulation Development, Office of Nonprescription Products, Office of New Drugs, Center for Drug Evaluation and Research (CDER), FDA; and Charles Ganley, MD, Director, Office of Nonprescription Products, Office of New Drugs, CDER, FDA, addressed press questions and spelled out the requirements, which were originally stated in December 2006. Manufacturers must comply with these requirements within a year of today’s date.

The new labeling would clearly identify products containing acetaminophen or NSAIDs on both the package and on the bottle and would warn consumers about the risk of stomach bleeding with NSAIDs and liver damage with acetaminophen, particularly when consumed with alcohol. The requirements would make consumers aware of acetaminophen and/or NSAID presence in OTC products such as Tylenol, Tylenol Children's, Excedrin PM, Alka-Seltzer Plus Cold & Sinus, Sudafed Sinus & Cold.

“Acetaminophen will be prominently displayed in highlighted text on all products containing acetaminophen,” Ganley said. He added that the drug facts panel on the outside of packaging, manufacturers will have to include a bolded warning about potential liver damage.

MONDAY, April 27 (HealthDay News) -- Medication errors and adverse drug reactions cost lives and dollars each year in the United States, but two new reports suggest ways hospitals and pharmacists can work to reduce these mistakes.

Medication errors are one of the most common medical errors, affecting at least 1.5 million people every year and costing the health-care system between $77 billion and $177 billion annually, researchers point out in the April 27 issue of the Archives of Internal Medicine.

In the first report, researchers led by Dr. Jeffrey L. Schnipper, of Brigham and Women's Hospital and Harvard Medical School, used a computer system to keep track of the medications patients were taking when they were admitted to the hospital and the medications they were taking when they were discharged.

"It turns out that we commit about 1.5 errors per patient either for the admissions orders in the hospital or, much more commonly, in the discharge orders, which is kind of appalling," Schnipper said. "These are errors with potential for patient harm. There are about three times as many errors without potential for patient harm."

For the study, Schnipper's team randomly assigned 322 patients from two hospitals to have their medications entered into a computer program at admission that was designed to reconcile those medications with the ones they were taking when they left the hospital. In addition, the researchers tried having different people take the patient's medication history and keep track of all the medications they were taking. These included doctors, nurses and pharmacists.

Among the 162 patients in the program, there were 1.05 medication errors per patient compared with 1.44 errors among patients receiving usual care -- a 28 percent reduction in errors.

Of the errors, 43 among patients in the program had the potential to cause serious harm compared with 55 among patients in the usual-care group.

The problem of medication error starts when patients are asked what drug they are taking when they come into the hospital, Schnipper said. "Patients don't know what they are taking. You have got to carry your current accurate medication list in your wallet," he advised.

Since the initial study, error rates have continued to drop as people got used to the system and the "culture" in each hospital changed to accommodate the program, Schnipper said. "Preliminarily, it looks like we are down to half an error per patient," he said.

The Joint Commission on Accreditation of Healthcare Organizations has made medication reconciliation a national priority. Medication reconciliation is identifying the most accurate list of all medications a patient is taking, and using this list to give correct medications for patients anywhere within the health-care system.

Matthew Grissinger, a medication safety analyst at the Institute for Safe Medication Practices, believes the study is a good model for hospitals to follow to help reduce medication errors.

The most important feature of the system was developing a method for taking patient's medication history on admission. "Standardizing the process of who is going to do what in regard to medication reconciliation in hospital admission and discharge is really the biggest challenge organizations have," he said.

I think one of the understated benefits of EHRs (+ CPOE) is the streamlining of the medication reconciliation process.

CHICAGO, April 27 (Reuters) - Pharmacists who spend extra time talking to heart patients about their drugs and looking for medication errors make a significant difference at reducing mistakes, U.S. researchers said on Monday.

A study suggests pharmacists could play a significant role at reducing medication errors, which cost the United States as much as $177 billion a year. Many commonplace errors go unnoticed, causing adverse health reactions, it said.

Dr. Michael Murray of the University of North Carolina at Chapel Hill and colleagues studied the effect of a program that trained pharmacists to prevent drug-related errors.

They studied 800 people with heart failure or high blood pressure who took part in one of two clinical trials.

One group worked with pharmacists who had been trained to instruct patients on the proper use of their medications, to monitor the patients, and to communicate with their doctors to spot errors.

The other group got medication from pharmacists with no special training.

Murray and colleagues, writing in the Archives of Internal Medicine, said they found 210 medication errors or harmful side effects among the patients in the study.

Not sure who "pharmacists with no special training" are, but good press, nevertheless