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  • Opioids: CDC clarifies prescribing guidelines

    In a letter released April 10, the CDC clarified its Guideline for Prescribing Opioids for Chronic Pain, stating that they weren’t meant to be unduly restrictive for chronic pain patients. The letter came in response to repeated concerns from healthcare societies, providers, and experts.

    The clarification says that physicians are encouraged to use their best judgment when prescribing opioids. In addition, the guideline is not meant to deny appropriate opioid therapy to anyone suffering from conditions such as cancer and sickle cell disease.

    “The Guideline is not intended to deny any patients who suffer with chronic pain from opioid therapy as an option for pain management,” wrote CDC Chief Medical Officer Deborah Dowell, MD, MPH. “Rather, the Guideline is intended to ensure that clinicians and patients consider all safe and effective treatment options for patients.”

    She also said that they’ll revisit the guideline as new evidence and prescription recommendations become available.

  • Ebola, Zika, and the flu: CMS and CDC want action on emerging infections

    Between antibiotics losing their effectiveness, people refusing to vaccinate, and constant lapses in infection control, the threat of disease should be on the top of every physician’s and nurse’s mind. And not just because CMS and the CDC are taking notice—although they are.

    The CDC issued a bulletin urging hospitals and other healthcare facilities to remain prepared for infectious disease outbreaks.

    “The ongoing outbreak of Ebola virus disease (EVD) in the Democratic Republic of Congo (DRC) serves as a reminder for U.S. healthcare facilities to review their infection prevention and control processes to safely identify and manage patients with communicable infections,” states the CDC.

    Meanwhile, CMS has issued a new memo highlighting concerns over potential outbreaks of infections like Ebola, the Zika virus, or influenza.


  • Many patients using anticoagulants are taking aspirin the same day

    Physicians who’ve prescribed anticoagulants to their patients should double-check to make sure those patients aren’t using aspirin too, a new study out of Michigan Medicine suggests.

    The study, published this month in JAMA Internal Medicine, found that 37.5% of the 6,539 patients reviewed were receiving the anticoagulant warfarin and aspirin without a clear indication, and that these patients were at a significant increase in adverse outcomes. 

    “Nearly 2,500 patients who were prescribed warfarin were taking aspirin without any clear reason over a seven-year period,” says senior author Geoffrey Barnes, MD, a vascular cardiologist and an assistant professor of internal medicine at U-M Medical School. “No doctors really own the prescribing of aspirin, so it’s possible it got overlooked.”

    The study cohort included 6,539 patients who were enrolled at six anticoagulation clinics in Michigan between 2010 and 2017.

  • High hospital C-section rates will be published online in 2020

    Next year, patients and potential parents will have one more metric by which to judge your hospital. Starting July 2020, The Joint Commission (TJC) will publicly report hospitals that have consistently high C-section rates on its Quality Check website.
    Hospital rankings will be based on TJC’s perinatal care (PC) Cesarean Birth measure PC-02. Hospitals accredited by TJC are already required to report that data to the accreditor, but this will be the first time it’ll be visible to the public.
    TJC will only track the number of C-sections done on nulliparous, term, singleton, vertex (NTSV) births—procedures performed on first-time mothers carrying a single baby that has its head facing down at the onset of labor.

  • Q&A: Legal marijuana use in hospitals

    While still illegal federally, there are currently 33 states that have legalized marijuana for medical use. At the moment, the laws on this topic are very dependent on where your facility is located, and you should take the time to look up your state laws.

    This Q&A is meant to clear up some of the broader questions around medical cannabis in healthcare—for patients as well as healthcare employees.

    This Q&A has been lightly edited for clarity.

    Benjamin Caplan, MD,
    is the founder of the CED Clinic and a spokesman for Doctors for Cannabis Regulation, the only national physicians’ association dedicated to the effective regulation of cannabis in the United States. 

    Q: If a patient has a valid medical marijuana recommendation, is he or she allowed to bring it to the hospital? Say if they’re going to be there for an extended period of time or overnight?
    That’s a policy question for hospitals. There are places in the United States where it’s legal to bring [medical cannabis] to a hospital, although they would not be administering it. But it’s different region to region.
    I think there’s a legal question and an ethical question. State laws are telling medical patients that they are allowed to have a choice to use this particular medicine. Hospital policies are quite different, and for good reason. In order for doctors to best manage illnesses carefully, and to the best of our abilities, we must know as much as we can [about] what a patient is taking. But it’s very common for patients to sneak cannabis in back rooms or under the radar, which is really unfortunate for everyone. I think the hospital perspective should be embracing what patients find helpful.
    To have cases where patients are having seizures in a hospital and they can’t get the medicine that they want (and find helpful) as an outpatient is a real cultural disconnect for the medical establishment. I think the solution is for people to not sneak around; the solution is for hospitals to open their arms to patients who find a medication helpful. 

  • Talk down: Joint Commission on de-escalation

    At 10 p.m. on May 20, 2018, a patient was transported by the fire department to Loretto Hospital in Chicago and put into a wheelchair in the emergency department. It was a Friday night, and the patient had been brought in for alcohol abuse.

    About an hour later, the patient and a patient care technician (PCT) got into a heated verbal altercation. The patient then got up from his wheelchair and walked toward the PCT. Another staffer tried to stand between the two, but the PCT pushed the patient “very hard.” The patient fell and hit his head on the front of his hospital bed, “causing a deep laceration to the head.”

    CMS later cited the facility for violating the patient’s right to be free from abuse and harassment.

    This case study is one of many similar incidents that can be found on HospitalInspections.org. Put yourself in the shoes of the participants: If you were the PCT in this situation, what would you have done? What if you were the staffer who tried to stop the fight—what would you have done to get the other two to calm down? If your employees had been involved, what do you think they would have done?

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