Failure to Resume Anticoagulation after Procedure Causes Stroke
This case study was put together by our partners at CRICO and was written by Jennifer Clair MacCready, Senior Patient Safety Program Director, AMC PSO Description A failure to restart anticoagulation treatment after a stenting procedure led to a 70-year-old man having a stroke. Clinical Events A 70-year-old male presented to the emergency department with a gangrenous toe and was found to have an obstructed superficial femoral artery. The patient’s history included atrial fibrillation, stroke, hypertension, chronic kidney disease, coronary artery disease, diabetes mellitus type II, chronic obstructive pulmonary disease, and chronic heart failure. They were also being treated with...
This case study was put together by our partners at CRICO and was written by Debbie LaValley, BSN, RN Description A 30-year-old woman with history of childhood splenectomy suffered a life-threatening infection. Key Lessons Primary care physicians should be prompted to give booster vaccines to asplenic patients. An annual exam is an ideal time to review a patient’s history and any educational aspects of his or her care. Verify that your telephone triage and coverage service adequately handles patient calls. Clinical Sequence A 30-year-old female began care under a new primary care physician (PCP). At her first visit, the nurse...
Last week, following oral arguments in April, the U.S. Supreme Court dismissed the case United States v. Idaho and remanded the case back to the U.S. Court of Appeals. Importantly, the decision also reinstated the prior injunction against Idaho’s prohibition of abortion under the Emergency Medicine and Active Labor Act (EMTALA), meaning that hospitals can once again perform abortion as part of medically necessary stabilizing care for patients presenting with emergent complications of pregnancy. Since the Dobbs decision overturned federal protections on abortion, Idaho is currently one of 14 states with the most restrictive laws prohibiting abortion, except in cases...
Communication Issue Leads to Retained Foreign Body
This case study was put together by our partners at CRICO and was written by Kathy Dwyer, MSN, RN Description Following successful cranial surgery, a 54-year-old man experienced back and lower extremity pain which was ultimately diagnosed as being related to an intrathecal lumbar catheter left behind at the time of surgery eight months earlier. Key Lessons Consider options that limit over-reliance on memory. Implementing structured communication tools (i.e., SBAR, I-PASS) may help to mitigate risk and improve outcomes. Patients play an important role in their own care and recovery. Retained foreign body cases are difficult to defend. Clinical Sequence...
Update on Controlled Substances and Telehealth Prescribing
On June 14th the U.S. Drug Enforcement Agency (DEA) submitted their long-awaited final rule for telehealth prescribing of controlled substances to the White House Office of Management and Budget (OMB) for a final rule before publication. The rules are expected to be published sometime prior to December 2024. As previously reported, in May 2023 the DEA had temporarily extended the COVID-19 telemedicine flexibilities for prescribing controlled substances. By way of background, The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 requires prescribers to conduct an in-person examination to evaluate each new patient at least once before prescribing a controlled substance. After...