Mutual Matters

Opioids – The North Carolina STOP ACT

Posted by Blake Fagan, MD on Sep 14, 2017 12:30:00 PM

In the fight against the opioid epidemic, The North Carolina STOP Act (Strengthen Opioid Misuse Prevention) is a start.

As you may have heard, the STOP Act bill was signed into law on June 29, 2017. Here are some facts about how it will affect providers.

The following prescribing limits go into effect January 1, 2018:

  • If you are going to prescribe opioids for acute pain, you will be limited to a five-day supply or less with the initial prescription.
  • If you are going to prescribe opioids for post-operative pain, you are limited to a seven-day supply or less with the initial prescription.
  • Further opioid refills require a subsequent consultation. The provider may issue an appropriate refill with the consultation.
  • Providers should review a patient’s 12-month history in the NC Controlled Substance Reporting System (CSRS) prior to providing any opioid for pain and, if providing opioids on an ongoing basis, like for chronic pain, should review the patient’s history in the CSRS every three months thereafter. The review must be documented in the chart, or when applicable, document the technical reason that kept the provider from reviewing the CSRS.

The above rules are not required for hospice, palliative care, patients with cancer, patients in the hospital or in long-term care facilities.

So, now you know the summary of the law and how it affects us, but why did the government pass this law? Four people die every day in North Carolina from an opioid overdose. In 2015, patients in NC were dispensed 660 million opioid pills. We, as a medical community, were asked to prescribe less opioid pills. In 2016, patients in NC were dispensed 700 million opioid pills.  Furthermore, data shows that if an opioid naïve adult is prescribed a 30-day supply of an opioid prescription, he/she has a 35% chance of being on an opioid at one year and a 20% chance of being on an opioid at three years. The data shows that the increased risk of staying on an opioid starts to rise after five days of taking an opioid prescription.

To read the North Carolina Medical Board’s summary of the STOP Act, click here. To read the full text of the STOP Act, click here.

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Topics: Patient Safety

Updated Guidelines for Management of Pulmonary Nodules on CT

Posted by Marshaleen King, MD on Aug 24, 2017 1:00:00 PM

The Fleischner Society has published new guidelines for the management of incidental pulmonary nodules detected on CT images. The updated guidelines reflect new data in the field and are based on the consensus of a multidisciplinary group comprised of experienced thoracic radiologists, pulmonologists, surgeons, pathologists and other specialists. The guidelines apply to incidental nodules found in adults ≥ 35 years and should not be used in persons < 35, patients at risk for infection due to an immunocompromised state, individuals being screened for lung cancer or people with a known history of a primary cancer.

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Topics: Patient Safety

Coordination of Care: Keep Patient Info from Falling through Cracks

Posted by Bill Kanich, MD on Jun 8, 2017 1:00:00 PM

Accurate information about a patient’s past history is vital for decision making in every physician-patient interaction. In addition, proper documentation is essential for care that may be provided in the future by yourself or other physicians. Coordination of care is as much of a patient safety challenge as making an accurate diagnosis or ordering the appropriate treatment. The path of care from the initial complaint to completion of treatment is far from seamless. Sometimes it can be full of obstacles – such as the potential to misunderstand or not see important information, including details that could pose serious risks for the patient. Many medical liability cases involve poorly coordinated care that results in harm to a patient.

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Topics: Patient Safety, Healthcare Industry

Specialty Focus: Obstetrics and Gynecology

Posted by Bill Kanich, MD on Jun 2, 2017 4:16:59 PM

Case #1

A 28-year-old G1 P0 female presents in active labor after an uncomplicated pregnancy. She progressed adequately in labor, getting an epidural at 6cm dilatation. After delivery of the fetal head, the head partially withdraws back into the birth canal (turtle head) and this was immediately noted. A modified McRoberts’ maneuver was done with suprapubic pressure without success.

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Topics: Patient Safety

Hospital Advisory:  Should Hospital Security Officers Be Armed?

Posted by Chet Crockett on May 11, 2017 11:00:00 AM

In light of continued reports of violent incidents in healthcare facilities, healthcare professionals are debating whether arming their security officers will improve safety for patients.

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Topics: Hospital Management, Patient Safety, Healthcare Industry

Developing Resilience and Avoiding Physician Burnout, Part Four

Posted by Marshaleen King, MD on May 9, 2017 1:00:00 PM

The Road to Recovery Once Burnout Occurs

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Topics: Patient Safety, Healthcare Industry

Essential Medical Skill Can Change Physician Behavior and Improve Patient Outcomes

Posted by Bill Kanich, MD on Apr 27, 2017 1:49:32 PM

A recent Emergency Medical Journal article[1] examined the relationship between empathy and litigation. The authors enrolled two groups of patients into a randomized, double-blind controlled trial. The subjects watched simulated discharge discussions between physicians and standardized patients; half of the videos differed only by the inclusion of two brief empathy statements. These verbalizations included: 1) a reflection on the patients' concerns about their symptoms, and 2) a reflection on their health awareness.

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Topics: Patient Safety

Developing Resilience and Avoiding Physician Burnout, Part Three

Posted by Marshaleen King, MD on Apr 25, 2017 12:30:00 PM

Self-Care as a Path to Resilience

Resilient persons typically engage in positive thinking and are willing to face challenges. They seldom get frustrated when problems arise and they usually rebound from adversity. Although some people believe resilience is innate, this trait can be developed using a number of techniques. Self-care is a central component of

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Topics: Patient Safety, Healthcare Industry

FDA Boxed Warning Required for Fluoroquinolones

Posted by Bill Kanich, MD on Apr 14, 2017 1:30:00 PM

On May 12, 2016, the FDA released an announcement advising that the serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections who have other treatment options. For patients with these conditions, fluoroquinolones should be reserved for those who do not have alternative treatment options.

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Topics: Patient Safety

Physicians Prone to Medical Liability Claims

Posted by Bill Kanich, MD on Apr 6, 2017 1:00:00 PM

NEJM Study shows 1% of physicians accounted for one-third of all paid claims

A study in the January 2016 New England Journal of Medicine[1] analyzed paid medical liability claims, (an indemnity payment made to an injured party), and the physician’s name was reported to the National Practitioner Data Bank (NPDB) to determine if the characteristics of claim-prone physicians could be identified.

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Topics: Patient Safety, Healthcare Industry

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Here we share some basic insights on matters that are important to physicians, hospitals and healthcare professionals.

Topics include:

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