Sinbad Provides a Pertinent Medical Lesson

We're taking a break from all things medical the last two weeks of December. Hopefully these videos will make you smile and as a bonus, each post will have a book/gift card winner drawn from the subscribers/followers list. So, sounds like a great time to start subscribing and following!

Check back frequently and often to see if you've won. Address must be e-mailed to jredwood1@gmail.com by 12/31/2011 to claim.

Today's winner is: Dianna Benson who subscribes via FeedBlitz!

Now enjoy the video! I love Sinbad and he provides a good medical lesson.

Holdman Christmas Lights

We're taking a break from all things medical the last two weeks of December. Hopefully these videos will make you smile and as a bonus, each post will have a book/gift card winner drawn from the subscribers/followers list. So, sounds like a great time to start subscribing and following!

Check back frequently and often to see if you've won. Address must be e-mailed to jredwood1@gmail.com by 12/31/2011 to claim.

Today's winner is: Nancy Lynn Jarvis who follows via Networked Blogs!

Now enjoy the video. This has been one of my holiday favorites.

Ever Had a Day Like This?

Hope everyone had a great Christmas! Any funny stories out there? Best gift?

I have one. My 9 y/o daughter came up to me, "Santa is so rude."

"Why?" I ask.

"He put my cookie back in the bin."

"Ummm..."

How about you?

We're taking a break from all things medical the last two weeks of December. Hopefully these videos will make you smile and as a bonus, each post will have a book/gift card winner drawn from the subscribers/followers list. So, sounds like a great time to start subscribing and following!

Check back frequently and often to see if you've won. Address must be e-mailed to jredwood1@gmail.com by 12/31/2011 to claim.

Today's winner is: Diane J!

Now enjoy the video!

Christmas Morning Disaster!

We've been enjoying some holiday fun. I certainly hope your Christmas morning does not go like this. I loved this video and I hope you enjoy it too.

But before we have Christmas fun, our next winner is: km.weiland@.... who subscribes via FeedBlitz! 

Remember, you must e-mail me your address by 12/31/2011 to jredwood1@gmail.com. 

Now, please remember to check those fish Christmas morning before the children come down to see them.



Hope you all have a Merry Christmas!

A Social Network Christmas

We're taking a break from all things medical the last two weeks of December. Hopefully these videos will make you smile and as a bonus, each post will have a book/gift card winner drawn from the subscribers/followers list. So, sounds like a great time to start subscribing and following!

Check back frequently and often to see if you've won. Address must be e-mailed to jredwood1@gmail.com by 12/31/2011 to claim.

Today's winner is: Leila Rose Foreman who follows via Networked Blogs.

Now enjoy the video!

Christmas Fun

We're taking a break from all things medical the last two weeks of December. Hopefully these videos will make you smile and as a bonus, each post will have a book/gift card winner drawn from the subscribers/followers list. So, sounds like a great time to start subscribing and following!

Check back frequently and often to see if you've won. Address must be e-mailed to jredwood1@gmail.com by 12/31/2011 to claim.

Today's winner is: twobellesandabook!

Now, enjoy the video. Love this because I'm a dog lover.

Up and Coming: Drawings Galore!!

Over the next two weeks, Redwood's Medical Edge is celebrating all those who subscribe and follow. On my regular post days (Mon, Wed, and Fri) I'll be drawing names from these lists for prizes. All you have to do is subscribe or follow!

I'm really humbled that so many of you are keeping track of things here and finding the information useful. I have great things planned for January that I know you'll enjoy but I think it's good to take a step back and just... well... be thankful for all that you've given me.

So, check back frequently and often to see if you've won!!

Many blessings to you this Christmas Season... Jordyn

Author Beware: The Law-- HIPAA (3/3)

Today, I'm concluding my three-part series on the HIPAA law. I'm going to focus on how I've seen it violated in published works of fiction.

Situation 1: A hard-nosed journalist makes entry into the hospital and begins asking the staff about a current patient. One nurse pulls him aside and gives him the information. This is a clear violation of HIPAA. All media requests will go through the public relations office. For any information to be released, the patient needs to give their permission.

Situation 2: A nurse on duty calls her friend and notifies her that another victim involved in a crime spree that her sister was a victim of is an inpatient at her hospital. Again, unless that person has provided direct care to the patient or the patient gives their consent for the information to be released, the nurse is in violation of HIPAA. However, the author of this particular ms handled it well. At least she had the character divulge that she could get in "big trouble" if upper management found out what she'd done. Think back to Brittney Spears in part one of this series.

Situation 3: Small town high school mascot falls ill on the field during a football game and is rushed to the hospital. A paramedic takes him to the ER. When the paramedic's wife arrives, she inquires about his condition. The paramedic/husband tells her what the doctors found. Again, the wife is not providing direct medical care to the patient. This paramedic has violated the patient's HIPAA rights by divulging this information to his spouse. Now, I understand, in small towns-- this information may "leak out". A better way for the author to have handled this would have been to have the wife of the fallen mascot tell this woman what his diagnosis was. HIPAA doesn't apply to family members and they can willingly share information with who they wish. That may not make the patient very happy--- ahh... another area of conflict!

Have you seen HIPAA violations in works of fiction that you've read?

Author Beware: The Law-- HIPAA (Part 2/3)

Situations involving minors can be an easy way to increase conflict in your manuscript. Here is an easy area to use.

Minors presenting to the ED for evaluation of a pregnancy or STD related complaint.

Here's a set-up. Mother brings her 14 y/o daughter in to "get checked for pregnancy". Okay, great. Already we have inherent conflict. After all, if the daughter was in agreement about allowing her mother to know this information, they could have done a home pregnancy test and matter solved.

At times, parents will bring their children to the ER thinking that, because they've signed them in as a patient and they're the parent, we'll have to do as they ask and they'll learn the information that way.

This isn't the case. Will we do the pregnancy test? Maybe. The patient has to be willing. Will we relay the pregnancy test results to the parent? If the 14 y/o patient says "no" then we will not.

Most states have laws surrounding minors that issues related to pregnancy or STD's is protected information and can only be released to the patient. Depending on the state, the cut-off is 13 or 14 years. This is different from us giving information about a follow-up culture for strep throat.

I've had parents call back for test results. I had a step-mother call for pregnancy test results on a patient. Nope, can't give you the information.

Another area is that minor patients can sign themselves into the ER without parental consent for these matters as well. Generally, for all other conditions, we have to make attempts to get the parent on the phone for verbal consent witnessed by two individuals.

What do we do?

As healthcare providers, we really do try and facilitate open dialogue between the parent and child. We'll sit with the 14 y/o daughter privately and go over why it would be best for her to share this information, regardless of the results, with an adult.

Can you think of other healthcare situations involving minors that could be high areas of conflict?

Author Beware: The Law-- HIPAA (Part 1/3)

Several months ago, I was watching a local TV news station when a nurse manager was being interviewed about the fact that you could look up ER wait times on the Internet before checking in. That's a whole other can of worms I won't get into today but the problem with her interview was that the camera shot included her standing next to their patient tracking board in which you could clearly see the last name of the patient, their age, and their medical complaint.

I almost fell out of my chair. This was a clear HIPAA violation and that ER manager should have known better than to be standing anywhere near that board.

Each time you visit the doctor's office or sign into the urgent care or emergency department for treatment, you should be given a paper that outlines your rights under HIPAA which stands for the Health Insurance Portability and Accountability Act. It basically outlines rules on how to deal with a patient's "protected health information" or PHI.

What this boils down to for the bedside clinical worker falls into a couple of areas and I'll give some examples below.

1. I should be providing direct care to a patient or should have provided recent care in order to look up their chart. Some of you may remember the healthcare workers that were fired for accessing Brittney Spears medical information. They were likely fired under this provision.

2. I can't share any specific information (name--never, age, and complaint) listed together in areas where other's could become aware of the patient's visit. This would include areas like social media (a big no-no). When cases are presented at medical conferences, generally all patient information is blacked out (say on x-rays). And the patient is only spoken of in general terms. Such as: 16y/o presented to the ER for evaluation of neck pain. Now, across the USA for one day, probably several patients presented with this complaint so how do you know which one it was?

3. I shouldn't be sharing patient information with my spouse unless he has provided direct care to the patient as well. Therefore, since my husband is an accountant, I can't say--- "Oh, by the way our neighbor's daughter was seen for a broken arm today in the ER." Unless I've asked the mother specifically if it's all right that I mention this to my husband, I have violated that patient's rights by sharing that information with my spouse. Working in pediatrics, I've been in the situation often and don't mention the visit at all when home.

4. Requests for information about a patient from the media generally go through the public relation's office. This tends to happen more off hours, a reporter will get through to the ER desk and begin to ask questions. Most, if not all hospitals, are very firm that all media inquiries go through public relations. This allows them to control the message.

5. Patient information cannot be given over the phone unless specified by permission. This is why, when you fill out those HIPAA forms at your doctor's office, they generally ask who they can talk to and what kind of information they can share. Perhaps you don't want your husband to know why you were at the OB's office. A caveat to this is giving information to your personal physician who is following up on your ER complaint. We will generally give specifics for this because they are providing your follow-up care.

Next post I'll talk specifically about HIPAA and minors.

Up and Coming: Author Beware--- The Law

This week at Redwood's Medical Edge I'm doing an Author Beware series on healthcare privacy laws. Boring? Hardly... everyone remember how several staff members got fired for looking into Britney Spears's medical records?

http://www.mtv.com/news/articles/1583480/medical-workers-fired-looking-at-britney-spears-records.jhtml

Exactly...

I'll be covering the most common authorly violations of the HIPAA act I see in manuscripts. You'll definitely want to avoid these or have your characters suffer some repercussions if they violate this law.

Looking forward to your thoughts and comments.

Jordyn

ED Issues: Cop versus Nurse

My brother works in the next county over as a deputy sheriff. I always say a writer is blessed if they have a law enforcement officer and a medical person in the family. That helps cover a lot of manuscript issues. My brother does patrol so, at times, he'll bring a person in custody to the ER for drug testing. After a frustrating interaction with the ED staff, I'll get an irate call from him, "Why did the ER do that!" Most often, it has to do with making him wait.

Personally, I have a great respect for the police and know their time is valuable as they would rather be on the road than stuck in the ER. Most areas of conflict come up when we don't understand the other's work. ER nurses get upset with the floors when they don't take an admission quickly because we can't stop what walks into the department even if we close to ambulances. The floors think the ED didn't do enough of an evaluation and left too much for them to do. Nearly every agency that receives and hands-off people to someone else has sources of conflict-- this is guaranteed.

When my brother called to complain about how long he'd had to wait for his prisoner to get his lab work, I immediately wanted to defend the ER workers.

These are the first things I thought.

1. The prisoner is a low priority. We're going to take care of sick patients first. The higher the acuity in the ER, the longer the wait time is likely to be. We have to save lives first.

2. Confusion on what needs to be done. I remember this from my adult ER days. We're not drawing blood or doing drug testing on prisoners every day. Since it's not something done often, there are likely questions on the proper procedure. We're going to want to make sure it's done correctly, particularly if it goes to court. The delay could be the staff actually researching how to handle the situation (what tubes to put the blood in and what paperwork to fill out).

3. The prisoner has a babysitter. I know that's a horrible term for a police officer. Generally, a police officer cannot leave someone who is in his custody. So, as the ER staff, we know there's an extra set of eyes on that person and we will worry less about something happening to them.

What other sources of conflict do you see? Have you written a scene with a mix of ER and law enforcement?

Medical Question: Flu and Pregnancy

Bonnie asks:

My question has to do with one of my characters who gets a deadly form of influenza (swine and avian flu combined) early in her pregnancy. She winds up in the ICU. She survives but then discovers she’s pregnant. She worried about the baby.

What are the possible dangers to the baby?

Heidi says:

The flu is actually more dangerous to the pregnant woman herself than to the fetus. Most women and healthcare providers delay preventative and treatment of the flu because they fear possible effects on the baby. More women in their third trimester of pregnancy die of the flu, than anything else including accidents and domestic violence.

Untreated flu symptoms that can and usually do send pregnant woman to the ICU include such things as high fevers, dehydration, and viral infections. The effects on the fetus include an increase in still births, brain damage, premature birth, and spontaneous abortion. Woman early in pregnancy are at greatest risk for spontaneous abortion. This would be the case for your patient. Treatment of the flu (antiviral's), is the best thing for this patient, the benefits greatly outweigh the risks.

I encourage all pregnant patients to get the flu shot and to call their health care provider immediately for flu like symptoms. Tamiflu and Relenza work best when given within the first 48 hours of flu symptoms. Always your best defense is a good offense, get your flu shot.

***********************************************************************

Adelheideh Creston lives in New York. She is former military and married military as well. Her grandmother was a WAVE and inspired her to become a nurse. Heidi spent some time as a certified nursing assistant, then an LPN, working in geriatrics, med surge, psych, telemetry and orthopedics. She’s been an RN several years with a specialty in labor and delivery and neonatology. Her experience has primarily been with military medicine, but she has also worked in the civilian sector.

Heidi is an avid reader. She loves Christian fiction mysteries and suspense. Though, don’t recommend the gory graphic stuff to her… please. She enjoys writing her own stories and is yet unpublished. 

Nurse Assisted Deliveries: Heidi Creston

Babies come when they want to, not necessarily when we want them to. Every labor and delivery nurse and OB provider are well aware of this fact. Nurse assisted deliveries happen daily.

The primary reasons for nurse assisted deliveries are:

1. Physicians are over extended.  They have more than one patient delivering at one time or are  covering OR and/or ER as well as OB.
2. They are not on site due to office hours.
3. Precipitous Deliveries (baby comes quickly).

Labor and delivery nurses are specially trained to monitor and keep close observation on a patient's status in order to notify the OB provider in a timely manner. Most patients are kept on continual electronic fetal monitoring. The pattern on the fetal strip provides information concerning both fetal and maternal status to include how soon delivery may be.

Sterile vaginal exams or cervical examinations to monitor dilation is another skill that L&D nurses are trained to perform. Nurses also educate their patients to report any signs of increased pressure.

It is always preferable for the OB provider to be present for the delivery, due to the increased risk to the patient (possible birth complications such shoulder dystocia), but in the event the provider does not make it, labor nurses are trained to deliver.

The L&D staff will make every effort to contact the provider, they will stop any measures taken to induce labor (turn off pitocin, instruct patient how to breathe thru contractions), provide support, and set up for delivery.

If the delivery is imminent, the nurse will guide the patient in her delivery, guiding the head, checking for nuchal cord. A nuchal cord is when the  umbilical cord is around the neck.  In some cases the cord can be untangled by hand.  Tight cords need to be reduced, clamped and cut.

Nurses also must be careful of other body parts being entangled by the cord as well. Delivery of the body is usually rapid once the head and shoulders are out.

If there are no complications with the infant, nurses will usually leave the baby on the mother’s chest with an uncut cord for 3-5 minutes. Nurses do not attempt to deliver the placenta, but if the placenta delivers spontaneously they place it in a container for the provider.

After delivery, if the provider remains unavailable, the nurse will clean the perineum and assess for tears and bleeding. Given the situation (excessive bleeding) the nurse may restart the pitocin, give a dose of methergine or hemabate, provide continuous fundal massage, and or perform a vaginal sweep. Upon arrival of the provider, the nurse will give them a full report.

Although most deliveries are uneventful, there are many things that could go fatally wrong with the delivery itself or during the post partum period. These include but are not limited to: malpresentation (ie: breech, compound limbs), cord prolapse/cord accidents/nuchal cords/body cords, placental abruption, and post partum hemorrhage.

******************************************************************************
Adelheideh Creston lives in New York. She is former military and married military as well. Her grandmother was a WAVE and inspired her to become a nurse. Heidi spent some time as a certified nursing assistant, then an LPN, working in geriatrics, med surge, psych, telemetry and orthopedics. She’s been an RN several years with a specialty in labor and delivery and neonatology. Her experience has primarily been with military medicine, but she has also worked in the civilian sector.

 

Heidi is an avid reader. She loves Christian fiction mysteries and suspense. Though, don’t recommend the gory graphic stuff to her… please. She enjoys writing her own stories and is yet unpublished.

Up and Coming

Hey all! Hope you have had a great week. Anyone holiday shopping? Finished yet?

Seemingly, I have survived my first week post shoulder dislocation. Last Sunday, I asked people to post in the comments section cause of said injury and I would pick a winner today. Well, congratulations, Sandra Ardoin, who said: If it was like my brother's dislocation, someone (who had no clue what they were doing) was trying to teach you judo.

That made me laugh out loud. So, Sandra is the happy winner of a $15.00 Visa gift card and a book of her choice. I'll give her a few options. Sandra, send your address to me at jredwood1@gmail.com and we'll figure out what book you'd like to read.

The real cause of my injury--- a cable machine push-up. First exercise on the second rep. My trainer dude was nearly as white as I was and though I do appreciate his offer to pop my shoulder back into place... unless you are in the ED with Fentanyl in your pocket... please stay away from my dangling arm.

This week:

Monday: Heidi Creston talks about nurse-assisted deliveries. She's a stellar OB RN. I know, because she's been a great eye for my character's OB issues.

Wednesday: Medical question concerning influenza and the possible complications for a pregnant woman. I'll also be over at Christian Mama's Guide discussing all things pediatrics.

Friday: Cop versus Nurse. Always a fun time in the ER when the police bring in a prisoner. Good way to add conflict to your ms.

Anyone else typing in a sling? Have a great week...

Jordyn

Pediatric Controversies: Immunizations 3/3

I'm concluding my three part series on one area of pediatrics that causes a lot of controversy. Immunizations.

Why don't people choose to immunize their children? I would say a large majority of these parents would claim a concern about Thimerisol (covered in Part One) and the much talked about but unsupported risk that there is a link between autism and the MMR vaccine (covered in Part Two). This link is not supported by the medical research.

Some people choose not to vaccinate because they're possibly suspicious of western medicine or in general prefer herbal or homeopathic remedies. 

Another reason? I think it's because we largely don't see children suffering or dying from these illnesses that we vaccinate against. People who lived during times when polio was a known affliction in the US probably had a different opinion about vaccinating against polio.




H1N1/Widipedia

 An interesting thing happened early in the fall of 2009. H1N1, otherwise known as the "swine flu" made an outbreak. It affected a large number of people but the pediatric population, particularly late elementary through early high school, had some very serious complications. Several children nationally required mechanical ventilation (a breathing machine) to save their life. Several children died.

There is a vaccine for H1N1. In fact, it's been included in the regular flu vaccine this year and last year. However, in 2009, distribution came a few months after the outbreak. The interesting part? It was scarce because so many people wanted it for themselves and their children. They didn't want them to die from the swine flu. Most people don't see children ill or dying of the diseases we routinely vaccinate against. The immediacy of the experience is lost.

If you have chosen not to immunize, I hope you've taken the time to research the diseases and their complications. Choosing not to immunize is a risk as well. How does this play out in fiction?

Let's say a 6 month old child presents to the ED with high fever and a rash and has never been immunized. Now, we as the ER staff have to worry about all those diseases the child is not protected against. This may set the child up for additional lab tests and procedures. Parents aren't generally happy when we explain why we have to add these other tests. This is an excellent way to add conflict.

What are your thoughts about immunizations? I'm happy to post any dissenting, well-articulated opinion in the comments section. No derogatory remarks please. I know this issue has a lot of passion on both sides.