> Sedgwick Connection - >
>
  • 5 factors for fifteen - A solid grasp of past and present industry trends can help you prepare for challenges ahead. Sedgwick’s thought leaders are helping clients by forecasting five primary factors that will impact our industry this year. Learn more.
  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

WCI-The-Center-for-Excellence-graphicI think by now most would agree that “big data” is more of a catch phrase that encapsulates all things data, including interconnectivity of data repositories, trend analysis, benchmarking, predictive analytics and claim level interventions. Big data is a critical component of risk management and cost mitigation and many believe it is still in its infancy. This is why, as part of The Center for Excellence – The Study of Medical Cost Drivers in Workers’ Compensation track at the 2015 Workers’ Compensation and Education Conference in Orlando, I am moderating an all-star panel on big data.

“Thinking big data” is about ensuring your organization utilizes all information available to make meaningful business-related decisions and implement appropriate corrective interventions. While it doesn’t matter if the data is used for dashboarding, trending, benchmarking or predictive modeling, it does matter that the claim professional and nurse case managers understand the data and analysis behind the solutions being implemented and the intended consequence of their actions. Simply put, big data’s purpose is to link data – a lot of data – with action.

Health costs continue to rise and the proportion of claim costs associated with medical benefits continues to grow and outpace indemnity costs. The question that you must ask, and  what our panelists will share insight into, is how you can go from strategic to tactical, high to low, with data to translate corporate-level initiatives to drive desk-level solutions. Aligning trends with meaningful claims interventions can be one of the most vexing challenges faced by an organization.

I encourage you to watch the video below as I talk more in-depth about big data and analytics. Then leave your questions and comments or send them to me via Twitter @SPRogers68; I can share them with our panelists and provide the most insightful dialogue possible.

Most importantly, Sedgwick is pleased to sponsor The Center for Excellence – The Study of Medical Cost Drivers in Workers’ Compensation track and I encourage you to join us in person. If you have not registered please do so at wci360.com.

Scott Rogers, EVP of Casualty Operations

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

According to the Centers for Disease Control and Prevention (CDC), 46 people in the U.S. die from an overdose of prescription painkillers every day.[1] Deaths from prescription painkiller overdoses have increased more than 400% among women and 265% among men since 1999.[2] These kinds of statistics have been published across media channels over the past year and have prompted legislative action or dialogue across the U.S.

Now the CDC has published a new study indicating kinship between overuse of drugs such as opioids and marijuana to an alarming increase in heroin use, particularly among demographic groups not linked to heroin use in the past. According to the study, posted in a CDC Vital Signs release on July 10, 2015, heroin use in the U.S. increased 63% from 2002 through 2013. One remarkable finding of the study is that heroin use, historically considered a fringe society drug, has increased among a broad range of demographics, including men and women, most age groups and all income levels – as is the case with opioid drug abuse.

CDC-graph-heroin-use-and-opioids

The report indicates that abusers of opioid pain killers are 40 times more likely to be heroin abusers, compared to cocaine abusers who were 15 times more likely to be heroin abusers. Also, 59% of the heroin-related overdose deaths in the U.S. involved at least one other drug. One of the primary conclusions of the study is that there is a very strong correlation between use and abuse of heroin and opioid pain relievers.

Dr. Teresa Bartlett, Senior Vice President, Medical Quality at Sedgwick, said that clinical programs must consistently identify cases in which drugs are not being taken as prescribed. Injured employees receiving opioid medications must be consistently monitored for compliance. Diversion of medications creates dangerous situations in which opioid pain relievers are provided to family members or individuals in the community for non-medical use.

Risk managers and safety managers should consider these trends and make sure their claims administrators are implementing the safeguards necessary to close this potential gateway by preventing prescription drug abuse. Prevention measures include:

  • Prescription drug point-of-sale intervention by a trained clinician, pharmacist or peer physician when a prescription drug does not correlate with the injury diagnosis or if it is a chronic pain stage drug being prescribed for an acute injury. Referrals and diagnosis-based formularies with the pharmacy benefit management network are necessary for consistent intervention.
  • Peer intervention for prescriber education and alternative treatment negotiation for claims in which drugs have been provided for long-term chronic pain.
  • Identification of cases where potential diversions are occurring through systematic and strategic deployment of drug compliance testing to ensure that injured employees are taking medications as prescribed. We strongly recommend you have a written best practices policy for urine drug screening.
  • Assistance for long-term chronic users of opioid pain relievers through transfer of care or referral to abuse treatment when necessary.
  • Involvement of a behavioral health specialist, who can engage with injured workers being weaned from long-term opioid use for chronic pain. The specialist can identify risk factors for turning to illicit drugs in addition to providing behavioral management tactics.
  • Use of a Prescription Drug Monitoring Program by healthcare providers to evaluate their patients’ prescription drug use.
  • Use of an Opioid Agreement with injured employees and their prescribers as a standard part of claims management and case management.

According to Eddy Canavan, VP, Workers’ Compensation Practice and Compliance for Sedgwick, it is unlikely that a heroin addiction could become a compensable extension of a workers’ compensation injury. However, this is an untested area and employers should review their claims administrator’s and pharmacy benefit management networks’ clinical drug intervention programs to mitigate risk and to protect the health and safety of their injured employees.

Some opioids and heroin share another common risk: exposure to HIV infection.  An HIV outbreak was recently documented in rural Indiana and linked to injectable Opana, an opioid made more potent when crushed, dissolved in water and injected. According to a New York Times update, nearly 150 cases of HIV were documented in rural Indiana as a result of users sharing needles to inject Opana.[3] Insurers and employers must be vigilant to know where the drugs they are buying for injured workers are going.

Safety and risk leaders should act now to make sure drug prevention and health safety practices in claims and case management are aligned to safeguard their injured employees from this alarming trend.

James Harvey, SVP, Managed Care Products & Product Development

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

social-media-investigationsPerhaps you’ve heard…what happens in Vegas, stays on Facebook!

Does anyone remember what the internet was like before Facebook arrived in 2004? The creators of Facebook have stated that their goal was to create a richer, faster way for people to share information about the daily activities of their lives and what was happening around them. It didn’t take long for the concept to catch on because by December that first year, one million people had created their Facebook page. In just five years, Facebook users climbed to 200 million (1) and today its population would make it the world’s largest country, well ahead of the United States in 8th place (2). It’s no surprise that Facebook remains #1 among the top 15 most popular social networking sites (3), with an average 936 million daily active users (4).

While it can be argued that Facebook has been leading the social media revolution, there is no shortage of other social networking sites, social messaging platforms and video-sharing sites with staggering user statistics. Consider just these examples:

Twitter – 500 million tweets per day (5)
Instagram – 300 million monthly active users (6)
LinkedIn – 2 new members every second (2)
YouTube – 1 billion users each month and 300 hours of video uploaded every minute, now the 2nd largest search engine in the world (7)

We just can’t help but publish ourselves and socialize online.

When we post something online, it’s all too natural to feel as though our audience is just our friends. It’s easy to forget that, in reality, the whole world could be taking a look into our actions. This is part of the reason why today’s rich social media environment, along with unprecedented access to personal information, is optimal for obtaining useful information for investigating claims and combating fraud through social media investigations.

As some have found out the hard way, setting a Facebook profile to “private” does not entitle a person to a greater expectation of privacy or act as a shield to discovery, a ruling which is increasing by the numbers in courts across the country. Consider a recent Florida case involving a large Sedgwick client. The Plaintiff in this case made a personal injury claim from an alleged slip and fall. Counsel sought to compel the production of photographs posted to the Plaintiff’s Facebook account and provided the trial court with evidence from video surveillance showing the Plaintiff participating in activities which called into question the true extent of the Plaintiff’s injuries. The Plaintiff objected, claiming that her Facebook settings were set to private and therefore the court’s order unconstitutionally invaded her right to privacy and violated the Federal Stored Communications Act (SCA), 18 U.S.C. §§ 2701-271

However, the court overruled the Plaintiff’s objections stating that “before the right to privacy attaches, there must exist a legitimate expectation of privacy” and “…the photographs posted on a social networking site are neither privileged nor protected by any right of privacy, regardless of any privacy settings that the user may have established.”

As for the Stored Communications Act (SCA), 18 U.S.C. §§ 2701-271, the Court further stated: “The act does not apply to individuals who use the communications services provided” and “does not preclude civil discovery of a party’s electronically stored communications which remain within the party’s control even if they are maintained by a non-party service provider.” (8)

The fact is this: we understand each injured employee or claimant is a real person with some level of crisis in his or her life. Our colleagues’ goal is first and foremost to help make things right for these individuals; however, we also are required to follow applicable laws and protect our clients from fraud. When fraud is suspected, a social media investigation can be effective in identifying activities or behaviors that shed light on the extent of injuries and provide leads for further investigation. The internet is a real place (mostly), and while there’s no “magic bullet” to finding what’s out there, engaging professional services operating within legal guidelines is beneficial to finding, securing and verifying the facts, images and metadata shared across the internet.

What are your thoughts regarding the use of social media investigations for identifying and preventing fraud?  Is there a line that should not be crossed?

Linda Wisneski, VP, SIU Operations

Sedgwick SIU adheres to all copyright, privacy and pretexting laws when conducting social media investigations and securing social media content.

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

SupremeCourt-ACA-workerscomp-blLast week the Supreme Court ruled 6-3 to uphold the Affordable Care Act’s (ACA) health exchange subsidy. What does the ruling mean for workers’ compensation going forward?

The ACA’s subsidy ruling has been a roller coaster ride for most of the major players in the healthcare industry. There were a lot of predictions and contingency talks to avert any impact, mostly negative, should the Supreme Court shut down the premium subsidy that supports millions of Americans. Based on projections by the Congressional Budget Office, the healthcare industry was bracing for a big shockwave potentially affecting close to 19 million insured Americans and adding more than $100 billion to the country’s deficit over a 10-year period. Sedgwick was in the front row watching how the subsidy ruling unfolded and anticipating how the market would react. With the ruling behind us, we anticipate that things will continue to move forward as they were for employers and the healthcare industry in general.

One notable sign that the healthcare industry is back on track is the sudden uptick in the healthcare mergers and acquisitions (M&A) scene. Over the last two years, the ACA has been the catalyst for much of the provider consolidations in the healthcare industry and the subsidy lawsuit put a halt on this trend. Coincidentally and immediately following the subsidy ruling, news of mergers involving big insurers – including UnitedHealth Group, Anthem, Humana and Cigna – made headlines in the marketplace. Soon, the rest of the market will follow, including a projected surge in private exchanges and the continuous growth of accountable care alliances between providers. Further consolidation is anticipated in the healthcare sector to align with the new value-based healthcare model. Employers should examine how new relationships will affect continuity of care, including any potential cost implications. Nevertheless, the healthcare industry and workers’ comp will continue to work with the challenges of the aging workforce, shrinking access to care, cost-shifting and containing the rising healthcare cost now that the ACA provision continues.

The subsidy ruling came as a big relief to all parties involved, interestingly, including those who challenged the law. Unfortunately, however, the ACA’s road to maturity will continue to face tough political challenges down the road as the country’s leadership continues to shift. For now, a sense of normalcy and progressive movement is back in the healthcare industry. Overall, this new development should have a positive impact in workers’ comp; increased stability in the healthcare industry has a direct positive impact on the managed care services we provide our clients. We can now refocus all our energy toward keeping our workforce healthy and ready to return to work – until the next challenger to the law comes along…

Kimberly George, SVP, Corporate Development, M&A, Healthcare

Click here for more Sedgwick Connection posts on the Affordable Care Act

For ongoing discussion on ACA, workers’ compensation and healthcare reform, join our LinkedIn group Transforming Healthcare for Tomorrow

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

same-sex-marriageThe United States Supreme Court has ruled in a 5-4 decision that same-sex couples have the right to marry anywhere in the United States. This decision just made life easier for employers and TPAs who are responsible for administering leaves. We can now uniformly apply the Family and Medical Leave Act’s (FMLA) definition of spouse (reflected below) regardless of where same-sex couples were married or reside, including in the states of Texas, Louisiana, Arkansas and Nebraska where a federal judge in Texas had previously placed an injunction on adopting the Department of Labor’s definition of spouse since these states did not recognize same-sex marriage.

Spouse, as defined in the statute, means a husband or wife. For purposes of this definition, husband or wife refers to the other person with whom an individual entered into marriage as defined or recognized under state law for purposes of marriage in the State in which the marriage was entered into or, in the case of a marriage entered into outside of any State, if the marriage is valid in the place where entered into and could have been entered into in at least one State. This definition includes an individual in a same-sex or common law marriage that either:

(1) Was entered into in a State that recognizes such marriages; or

(2) If entered into outside of any State, is valid in the place where entered into and could have been entered into in at least one State.”

Reminders for employers:

  • Update FMLA policies if they currently include a detailed definition of spouse
  • Use caution in requiring proof of same-sex marriage if you do not require proof of marriage for opposite-sex spouses for purposes of taking leave
  • Train supervisors or anyone involved in the FMLA process of the change in definition as some employees will be entitled to FMLA protection where they were not in the past
  • Remember this change does not impact state leave laws that provide leave for Domestic Partners or Civil Union partners; while the employee would not be eligible to take leave under the FMLA (only applies to legal same-sex marriages), they still may be allowed leave under state law

Sharon Andrus, Director National Technical Compliance, Disability Administration

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

nurse-staffingDuring hospital and healthcare facility risk assessments around the country, we often hear nurses’ feedback about staffing challenges and heavy workloads. Is this perception or is it a reality that nurse staffing levels are impacting safety?

News reports and lawsuits related to nurse staffing issues suggest the problem is more than perception. It is important for risk and safety managers to be aware of staffing concerns in order to support nurses and help hospital management develop solutions. Identifying and maintaining an appropriate number and mix of nursing staff is critical to the delivery of safe patient care. At the same time, reductions in nursing budgets have resulted in fewer nurses working longer hours caring for sicker patients – and the problem may continue to increase as hospitals face challenges in recruiting and retaining adequate numbers of qualified nursing and other staff into the next decade and possibly longer.

Research suggests that improved nurse staffing has a beneficial effect on patient outcomes. Conversely, research shows that the likelihood of patient mortality in the hospital following a complication associated with failure to rescue increases by 7% for each additional patient added to the average registered nurse workload. A similar study focused on in-hospital cardiac arrest found a 4% decrease in the odds of survival for patients on hospital medical-surgical units with each additional patient per nurse.

Legislation requiring adequate nurse staffing at state and federal levels has been introduced in both the House and the Senate. The Registered Nurse Safe Staffing Act of 2014 (S. 2353) was introduced in the U.S. Senate on May 15, 2014 and was referred to the Committee on Finance. The bill requires unit-by-unit staffing plans and public reporting of the plans, but does not impose nurse-patient ratios. It also provides whistleblower protections for nurses and others who file a complaint for inadequate staffing. Additionally, some state boards of nursing have adopted rules of practice to protect nurses who believe they have been given an unsafe assignment. Currently, fifteen states and the District of Columbia have enacted legislation and/or adopted regulation to address nurse staffing.

How can hospitals and healthcare professional organizations address concerns about staffing shortages?  In its report Workforce 2015: Strategy Trumps Shortage, the American Hospital Association (AHA) Long-Range Policy Committee developed recommendations and strategies that include:

  • Hospital work redesign to maximize efficiency, effectiveness and staff satisfaction
  • Retention of existing workers, some of whom are near retirement
  • Attracting a new generation of workers to replace a large group of retiring workers

Redesigned work models are most successful when developed by nursing staff at the bedside in collaboration with leadership and consider patient care needs, staff skills competencies and hospital characteristics. In 2003, the Institute for Healthcare Improvement and the American Organization of Nurse Executives launched the Transforming Care at the Bedside Project (TCAB), funded by The Robert Wood Johnson Foundation, in an effort to improve hospital patient care and work environment by empowering front-line nurses to implement innovative practices on their units. Since that time, hospitals across the country and internationally are now applying TCAB principles and processes in their work. A toolkit containing best practice policies to involve staff, generate ideas and set goals to increase excellence of care and efficiency was created by 10 hospitals that participated in TCAB.

The Workforce 2015: Strategy Trumps Shortage report also encourages adoption of tools such as TeamSTEPPS to improve communication and support redesigned healthcare teams to accomplish work in a more effective and efficient way. Sedgwick’s Healthcare Risk Management team provides TeamSTEPPS training and coaching for teams in hospitals, long-term care and outpatient facilities and physician practices.

Whether perception or reality, hospital staffing concerns must be heard and resolved. Research demonstrates the strong correlation between lower nurse-to-patient ratios and improved patient and nurse satisfaction, better care outcomes and error reduction. Risk and safety leaders have an opportunity to collaborate with nurses at the bedside to create innovative strategies and develop solutions to build a safer environment for patients and nurses.

Ann Gaffey, RN, MSN, CPHRM, DFASHRM, SVP, Healthcare Risk Management and Patient Safety and Cynthia Hartsfield, BSN, RN, MA, CPHRM, contributor and former Sedgwick Healthcare Risk Management Consultant

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

marijuana-rxOver the last several years, I’ve been talking about how medical marijuana will ultimately become an issue in workers’ compensation and, with several cases we’ve seen across the country, this has become a reality. In each of my pieces, there is always a note that, even though states are moving to legalization (currently 23 states, the District of Columbia and Guam), the possession of medical marijuana remains a federal crime as it is a schedule I substance under the Controlled Substances Act (CSA). However, over the last couple of years, things have been changing very quickly relative to the federal government’s position on medical marijuana. It’s not just the President’s comments or revised Department of Justice policies that have raised the possibility the federal government is going down a path that could ultimately legalize medical marijuana; other areas of government are taking action too.

The two primary ways to change the scheduling of marijuana are congressional action or administrative action; there have been moves on both fronts that bear watching.

The Compassionate Access, Research Expansion and Respect States Act (CARERS), Senate Bill 683, was introduced in the U.S. Senate on March 10, 2015 by Rand Paul (R-KY), Corey Booker (D- NJ) and Kirsten Gillibrand (D-NY). Barbara Boxer (D-CA) joined as a co-sponsor on March 17, 2015. The major aim of the six-part legislation is to reclassify marijuana under the CSA from schedule I to schedule II in recognition that the substance has some medical uses. In addition, this bill would permit interstate commerce in cannabidiol (CBD) oils, allow banks to provide checking accounts and other financial services to marijuana dispensaries, allow Veterans Administration physicians to recommend medical marijuana to veterans and eliminate barriers to medical marijuana research. The bill is currently pending in the Committee on the Judiciary.

The 1,603-page $1.1 trillion federal omnibus spending bill signed into law by President Obama on December 16, 2014, provides in Section 538 that none of the funds made available to the Department of Justice could be used to prevent states listed from implementing their own state laws that authorize the use, distribution, possession or cultivation of medical marijuana. To block implementation of the recreational marijuana initiative voters in the District of Columbia approved during the November 2014 election, Section 809 of the bill prohibits the use of federal or any other funds contained in the bill to legalize or otherwise reduce penalties associated with the possession, use or distribution of marijuana.

The process for administrative rescheduling is specified by 21 USC 811. The Attorney General on his or her own or through the Drug Enforcement Administration (DEA) requests a scientific and medical evaluation and recommendation to determine whether a drug should be scheduled, rescheduled or removed from control entirely. Bloomberg Business reported June 2014 that the Food and Drug Administration (FDA) is studying, at DEA request, whether the classification of marijuana should be changed. A presentation prepared March 2015 by the FDA on its work on medical products containing marijuana describes the FDA’s role in scheduling and indicates that scientific review of public data and an 8-factor analysis is ongoing.

Previous requests to reschedule marijuana were denied due to a lack of existing scientific and clinical evidence to warrant the change. The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, grows marijuana for approved research in partnership with the University of Mississippi. Last year the DEA increased NIDA’s production quota from 46.3 pounds to 1,433 pounds, citing urgent need for research. Reportedly of the 100 grants for marijuana research, at least 28 studies are of the plant’s potential therapeutic uses in treatment of pain, inflammation, seizures, autoimmune disease and addiction.

Federal action on marijuana is at a crossroads. Not only do we have a new Attorney General with the swearing in of Loretta Lynch on April 27, 2015, a new DEA Chief will be named to replace Michele Leonhart who resigned on April 21, 2015. During confirmation hearings, Ms. Lynch testified that she is opposed to the legalization of marijuana. It remains to be seen what changes in policy will occur during her tenure.

In the meantime, employers contending with this complex and rapidly changing issue can refer to the guidance published in the April 2015 issue of the Journal of Occupational and Environmental Medicine. The report jointly prepared by the American College of Occupational and Environmental Medicine (ACOEM) and the American Association of Occupational Health Nurses (AAOHN) addresses temporary impairment as it relates to the workplace, discusses prevention of injuries related to impairment and suggests various strategies available to employers for monitoring workers for marijuana use.

Darrell Brown, Chief Claims Officer

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

fall-prevention-button-bed-alarmFall prevention has been one of the most challenging issues facing providers of healthcare for as long as, well, for as long as there have been providers of healthcare.

Not only do falls have serious impacts on patients, but healthcare facilities themselves are impacted negatively by falls. A Centers for Medicare & Medicaid Services (CMS) Final Rule in 2007 meant hospitals no longer receive payments for treating injuries resulting from in-hospital falls.

Not only are Americans living longer, but their list of co-morbidities is growing longer and the potential for falls is increasing as well. Those most vulnerable among us are receiving care by facilities experiencing intense regulatory, financial and ethical pressure to prevent falls. Thought leaders, experts on falls and healthcare providers are analyzing data and outcomes in attempt to identify effective and ineffective means of fall prevention.

One device which has recently come under scrutiny is the personal alarm. Personal alarms have been in widespread use for approximately 25 years, since the federal mandate by Congress in the Omnibus Reconciliation Act of 1987 went into effect in October of 1990 mandating the restriction of restraints in nursing facilities.

Personal alarms can come in several forms:

  • A magnet or pull-pin clipped to an item of clothing, which is activated when the person moves forward or otherwise pulls on the cord
  • Pressure-sensitive pads placed in the seat of the patient’s chair or on the mattress, which are activated when the patient lifts off the pad
  • Pressure-sensitive mats placed on the floor, which become activated when a person steps on the mat
  • Light beams directed on the bed or across a doorway which activate when the beam is crossed

Personal alarm use presents several challenges requiring vigilant monitoring by caregivers. Patient compliance is a very common issue. It doesn’t take very much initiative to learn how to turn off the alarms, and many do. The alarms depend on batteries in order to function and sometimes the batteries are not replaced in a timely manner. Caregivers turn the alarms off while providing care and sometimes forget to turn them back on. Let’s not forget that the costs of the devices can be quite high as well.

One major criticism for the use of alarms is this: once the alarm has been activated, the patient is already on the move. Therefore, to intervene in a potential fall, the caregiver must be close enough in proximity to the patient to enable him/her to reach them in time to prevent the fall. Even if close in proximity when an alarm sounds, a caregiver may likely be in the midst of providing care to another patient and unable to respond immediately.

In addition to the questionable effectiveness of personal alarms, some facilities have identified another motivation for eliminating their use: to reduce a culture of “institutionalization” in favor of a culture more conducive to a “living center.” High-pitched piercing alarms are not very fitting for an environment such as a living center.

Some facilities are reporting successful programs wherein they successfully eliminated alarms with no increase in falls or serious injury. The Hebrew SeniorLife Center in Roslindale, MA has done so for its facility of 600 residents by implementing “purposeful rounding.” Purposeful rounding entails more than simply poking one’s head in the room of a patient/resident for a visual check. It involves posing a series of questions related to the individual’s bathroom, hunger, thirst and pain needs and responding accordingly.

Medina Memorial Hospital, a hospital-based skilled nursing facility in Medina, New York, is another facility reporting successful alarm elimination by focusing on each specific resident’s daily life pattern and initiating care plans to address that individualized pattern.

Resources for assistance/tips/guidelines to reduce falls and alarms are growing as well. The Pioneer Network is a nonprofit advocacy group committed to promoting a move “away from institutional provider-driven models to more humane consumer-driven models” in a long-term care culture change movement. Their Starter Toolkit is worth checking out for practical advice in engaging all staff members when implementing practice changes.

Action Pact, another organization committed to culture change in long-term care, is offering a workshop, Eliminating Alarms and Preventing Falls by Engaging with Life. The workshop will take place in San Antonio, TX on June 16, 2015.

The evidence to support “no” as the answer to the use of alarms is increasing. The stakes have never been higher than they are today, as evidenced by increasing regulatory, financial and ethical motivational factors to reduce or eliminate the use. Is your facility/organization considering an answer to the question of alarm use?

Deborah McElhannon, RN, LNCC, RN Consultant Lead – PL

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print
UIS-Truck-1

Although fires only represent a small fraction of trucking accidents, they can be deadly and costly.

In the fire investigation industry, the cause of a truck fire often relates to preventative maintenance or lack thereof. In fact, the most common causes for truck fires that I have investigated can be broken down into two categories:

  • Wheel, brake or tire failures
  • Hose or wiring insulation failure

In both categories, many of these failures are preventable with proper preventative maintenance. Rigid preventative maintenance inspections that ensure proper lubrication in the wheel bearings and identify any leaks can reduce the risk of a frozen or locked bearing. The National Transportation Safety Board states that “daily inspection of hub oil levels and wheel seals is vital to prevent wheel bearing failure and that bypassing this requirement is a dangerous practice that can lead to a wheel fire or other serious consequences.” Tires in poor condition or severely underinflated also pose a fire risk as does a faulty brake system. Dragging brakes, for example, can produce significant heat and may not be readily identifiable to the operator, who continues to drive the truck unaware of a problem with the brakes. A carefully inspected brake system can significantly reduce the risk of fire incidents.

Likewise, taking the time to check fluid hoses or wiring insulation for cracking and general degradation is an important procedure. However, emphasis should be placed on identifying areas where hoses or electrical cables are in direct contact with another object. Hidden damage at the point of contact, caused by vibration and abrasion, may be identifiable on a hose or cable that otherwise looks to be in excellent condition. Figure 1 depicts an electrical failure of the positive battery. In this matter, the positive battery cable was routed adjacent to a battery ground cable. The point where the battery cables intersected resulted in long-term abrasion of the insulation. Once the insulation for both cables was compromised, the electrical fault occurred and caused this fire.

Figure 1: An electrical failure of the positive battery. In inspection, identify areas where hoses or electrical cables are in direct contact with another object.

Figure 1: An electrical failure of the positive battery. In inspection, identify areas where hoses or electrical cables are in direct contact with another object.

The trucking company in this case asked me to inspect other trucks at their facility. In nearly every case, the visible inspection of the cable insulation would have passed a routine preventative maintenance inspection, as the visible insulation was in good condition. However, closer inspection at the contact point between the positive cable and ground cable identified several instances of severely damaged insulation.

In addition to a closer inspection of potential contact points, the mechanic should also pay particular attention to hoses, wiring insulation, harnesses and wiring looms located in close proximity to hot surfaces, such as at or near the turbocharger or downstream as the exhaust piping exits the engine compartment. It is important to not only inspect these items, but also any heat shields installed by the manufacturer to protect combustible materials from these hot surfaces. Were heat shields properly re-installed after a recent service, damaged or not re-installed at all?

Although fires only represent a small fraction of trucking accidents, they can be deadly and costly. To avoid this situation, a thorough preventative maintenance program that addresses these primary fire hazards may further reduce your risk of a catastrophic fire loss. Are you protecting your fleet from these potential hidden dangers? If you have additional questions please feel free to leave your comments or contact us for more information.

Michael Hoffman, IAAI-CFI, District Manager
Unified Investigations & Sciences | a Sedgwick company

  • LinkedIn
  • Twitter
  • Facebook
  • Google Plus
  • Digg
  • RSS
  • Email
  • Print

Managing-drug-samples-physician-officeManaging drug samples in a physician’s office or ambulatory care clinic requires a system of checks and balances to help prevent medication errors and adverse drug events, establish a tracking system for alerts and recalls to comply with federal laws and regulations, and to protect from loss of inventory/pilferage. Also, medication dispensing should be held to equivalent standards of care whether done by a provider office or a pharmacy. Some organizations have stopped distributing sample medications in their provider offices to eliminate the need to manage them or to avoid any legal and ethical issues that can arise when free samples are provided by pharmaceutical company representatives. Others have deemed that the economic benefits to patients and the convenience of starting drug therapy at the time of the visit outweigh the time and effort needed to manage the samples and put sample control systems in place.

The patient safety and liability risks of drug samples include:

  • Improper labeling
  • Medication errors
  • Incomplete patient monitoring
  • Lack of appropriate tracking
  • Inattention to expiration dates
  • Theft

While handling of pharmaceutical samples by physician offices is largely unregulated, state medical practice acts generally allow physicians and certain other providers with prescribing authority to dispense drugs from their offices. However, from a risk management and patient safety perspective, physician offices that dispense samples need to be sure that patient education is provided and that samples are kept secure from patients and staff who are not authorized to prescribe and dispense them. This is an often-neglected function that Sedgwick consultants find when assessing office practices. Frequently, safeguards are not in place and there is a lack of understanding of safe drug sample management.

Sedgwick’s Drug Sample Management Guidance Toolkit offers recommended practices and action steps; see excerpt below.

Sedgwick_PL_Drug-Sample-Management-Guidance-Toolkit

Sample medications can be important to many patients when managing their health. Whether due to financial issues, limited access to a medication while waiting for a prescription renewal or for the purpose of evaluating the effectiveness of a newly prescribed medication, many physicians feel strongly about providing sample medications to their patients. When managed as outlined above, the handling and distribution of sample medications can be a win-win for patients and providers.

For more information about the Drug Sample Management Guidance Toolkit, contact HealthcareRM@sedgwick.com.

Kathy Shostek, RN, ARM, FASHRM, CPHRM, CPPS, Vice President, Health Care Risk Management