LeapFrog vs Consumer Reports

What hospital is the best in your area? Which hospital is the safest? Many times the public uses word-of-mouth from their friends and families to choose. A lot of times our own insurance policies determine which hospital we choose. Consumer Reports just rolled out their own version of safety rankings comparable to another version LeapFrog Group that was released last year.

In June, Leapfrog Group, a Washington D.C.-based hospital safety advocacy group, created its own safety rankings, but unlike Consumer Reports’ numerical scores, Leapfrog used A, B and C letter grades, similar to New York City’s restaurant grading system that only has three grades.

The director of the Consumer Reports Health Ratings Center, John Santa M.D., explained the report as a type of advocacy. “We’re doing this in part because 12 years ago the Institute of Medicine made the same suggestions that we’re making. This kind of information needs to be publicly reported, these problems need to be solved, but the hospitals still haven’t done it,” he said. There are differences in reporting between the two groups. “We each looked at some different measures,” said Leah Binder, CEO of the Leapfrog Group. “Particularly, they [Consumer Reports] looked at patient satisfaction measures and rates of CT scans. We didn’t look at those things. We looked at injuries, errors and accidents only. It’s kind of like having two different book reviews. Different reviewers have different interests.”

This is a good thing in that it helps educate the public about hospital safety. This is a bad thing is that the guidelines for determining safety is different from study to study. Where does your hospital rank?

Healthcare Reimbursement

If insurance companies are now tying reimbursement with patient satisfaction survey scores, then the same should apply to other areas of life. That Walgreens tech was rude to me, so my prescription is discounted. The cashier at McDonalds was terribly immature and the damn coffee machine was broken yet again. Free meal. How can this happen?

A doctor's personality should have nothing to do with his payment. But we all know a doctor with better bedside manner would influence the patient to rate them higher.

I hate the direction that healthcare is turning.

Are You Kidding Me?

My mouth just dropped open.  It's obvious to me that physicians do NOT read medication reconciliation forms for home meds at all.  The ones that do, kudos, but the ones that don't make my job more interesting and at times really get to me. Case-in-point:  50-something presenting to the hospital with lower GI bleed.

The doctor signed off to CONTINUE HER HOME MED OF PHENTERMINE FOR WEIGHT LOSS.  Are you kidding me?

I guess the nurse could have written "Purina Dog Chow - take one cup by mouth daily" and the physician would have signed off on it.

Way to go Joint Commission on putting in a requirement with no means of adhering to any sort of THINKING for anyone involved.

Except for the pharmacist of course to wade through the BS and find what is really needed.

I really like the one where the physician wanted to continue the patient's viagra while in the hospital.  THAT should keep the nurses on the floor on their toes running from a man who is looking for some fun.  Not good.

Medication reconciliation forms.  The bane of my existence.

Illegal alien...

I found it strange this morning to get an order for a drip that usually will run a fairly long amount of time.  In other words, we will compound a large volume to run, but I was told to just make a 250 mL bag of it.  Turns out the man in the hospital today is in his early 40's, an illegal alien, and they are keeping him from completely crashing to harvest his organs. So who shows up to sign the papers for that one?  Does the family receive American citizenship for his valor?

Magic Mouthwash (the vague term for a concoction of ANYTHING)

When I worked in retail pharmacy, a physician would write a prescription for "Magic Mouthwash" and the patient would hand over the prescription with this look of "magic."  This special blend of WHATEVER would be the cureall for their sore mouth and throat caused by thrush or radiation or any other mouth/throat pain condition.  The physician rarely would include what he/she "thought" to be their special recipe.  So, we would have to call and clarify. "What would Dr. Doe like in his magic mouthwash?"  I would ask simply.

"Magic Mouthwash?"  asks the nurse, "I don't know.  What do you normally put in it?"

Sigh.  "Well we could start with diphenhydramine, lidocaine, and nystatin all at a 1:1:1 ratio or we could do tetracycline and throw in some mylanta with the formerly mentioned ingredients at all different ratios.  There are probably a 100 different magic mouthwashes out there.  What is the doctor treating?"

And it would end up that I could pick whatever I wanted.  That made me think... hmmm  placebo effect.

So what exactly should you put in Magic Mouthwash?

The usual concoction contains equal amounts of viscous lidocaine and diphenhydramine for analgesia...and Maalox or a similar antacid to enhance coating of the ingredients in the mouth.  Some also include nystatin to prevent or treat fungal growth...a corticosteroid to reduce inflammation...or tetracycline to prevent secondary bacterial infections.

Who knows if this stuff even works and is worth the money since we pharmacists usually tack on a compounding fee.  I say get a prescription for lidocaine viscous and buy your own benadryl solution and mylanta and make your own... for less.