Wednesday, May 25, 2011

Throwing in the Towel "Time out Towel" to be exact

Ok, I understand the need to do a Time Out when starting a surgical case, but what happened today just blew me away. There in the room was a Registered Time Out Safety Towel! It is just an Orange towel that says time out. Of course it is trademarked and no doubt created and owned by someone who works with JACHO because these just showed up before our latest JACHO inspection. I had to ask how much these cost. Well, since they are in the OR they must be sterile and have a thread count that makes sure that they wont leave lint on the instruments. Of course, they are disposable. So, guess what. A box of 24 individually wrapped, sterile Time Out (r) safety towls is $112.00. So, instead of just having the time out, we know have to have the JACHO approved and probably wholly owned useless towel that just ads even more cost to the health care system. I hate to admit, I took the towel and wadded it up and threw it as hard as I could at the hamper only to be told that they couldn't be reused!

Saturday, May 21, 2011


I have been noticing that alot of the patients that we see who are on Medicare and Social Security Disability are rather young. Many are under 45 years old. Being rather a cynic personally, I asked the front desk to keep track this week if they could how many patients I saw who were on Social Security and Medicare/Caid who met the following criteria: under 45, able to drive, talk on the telephone, and walk. The last three I included because I figure that if you can do these, there is at least some job that you can do. The answer they gave was a bit shocking to me. It was 18! I dont know if this was a high weekly number or a low weekly number. But still, 18! I am not sure what the truw dollar amount of full Social Security Disability and Medicare/Medicaid is but I can imagine both combined might be about $20,000.00. This is probably a very low ball estimate as these folks are receiving care that normally would have been covered by private insurance. Anyway, 18 time 20K is $360,000! This was in one week! No wonder Medicare and Social Security are going broke! I shouldn't have gone back up to ask the our front office staff anymore questions but I couldnt help my self. When I asked them about the number of people who met the criteria, they said "oh, yeah the Gamers". I asked why they called them that. They explained, "oh, they know how to game the system, they all are on disabilty for fibro". I said, "no, way, all of them?". They answered, "not really, two were on it for chronic fatigue". I asked why and they looked at me like I was a moron. "they have fibro and chronic fatigue because it gets you free money!" Great, we are all screwed!

Saturday, May 7, 2011

Pine Box Warning

I had to give a pine box warning to one of our pharmacists last night. The patient had a deep rapidly spreading infection and was allergic to penicillin and all cephalosporins. The infection appeared to be gas forming and we needed to jump on it in a hurry. He had already failed Flagyl. I wrote to get him started on 900 mg of cleocin every 8 hours asap and made arrangements to go to the OR. When the patient got to pre-op, he still had not received his cleocin. I called the pharmacy to see what was up and immediately was told that it had to be appoved by the pharmacy supervisor on call because cleocin had a black box warning. After I told them that I didnt give a ***it and that I wanted it now, I asked them what was the "lack box warning" It turns out that it can lead to C. difficile diarhea. I told them that I hope they do get diahrhea, that means that they will still be alive! Right now there is a Pine Box Warning, without it, they will be dead!

I got the cleocin and the patient did ok. Anerobic infections are no fun. Anyway the head of the pharmacy called me and apoligized for the delay. She told me that from the administratosphere and edict came out that to decrease complications that may lead to extended stays in the hospital (CMS) unfunded and possible litigation issues, they had instituted this Black Box Warning policy!