GO TO HEALTH™© with Dr. Mike and www.ihealsolutions.com

Wednesday, December 12, 2012

The Daily Apple™© Volume 1, Number 3

The Daily Apple™© Volume 1, Number 3

From Dr. Mike & Infinity Health Solutions

www.ihealsolutions.com

December 12, 2012 PGY 40 Day #165

BLUEBERRIES ARE GOOD FOR YOU TOO!

What Can You Do To Optimize Your Acute Care?
Take Ownership for Self or Family Member in Conjunction with YOUR Trusted Physician

In The Daily Apple™© Volume 1, Number 1, I promised to “use The Stress Management Workbook, to help maintain order and perspective in what has become an extraordinarily complex and fragmented “business of medicine”. Recently, I have been contacted by Friends and Family who have required acute care for one reason or another. That leads me to fast forward to Acute and Hospital care for this edition. Specifically, let’s look at what you can do to optimize your care, or your family member’s care, if acute, or hospital care is necessary. For this purpose; to get family on the same page with Doctors, Nurses and other Caregivers, I have developed the Stompp™*IT** daily rounds checklist. This comprehensive checklist will help you to help yourself or your loved one get the best possible care from 3^rd parties. If you wish to use it, contact me via dr.mike@ihealsolutions.com so terms and conditions of use can be clarified. Without a condition of use agreement, you do NOT have permission to use the form for any reason. I will respond to email requests for use ASAP. If you have comments about the form, please feel free to contact me through this blog, or email.

STOMPPIT™© V122012: StepWisely®™© Infinity Health Solutions & MFM

MFM@IHS part of the StepWisely® System for Mission Adhesion & Team Development WWW.IHEALSOLUTIONS.COM

Stompp™*IT** daily rounds checklist PILOT #6 December 2012 Patient-Family V1: Patients & Families are Part of the Team!

STRATEGIC TARGETED OPERATIONS MANAGEMENT for patient protection*

daily rounds checklist: care coordination and integration tool**

goal: OPTIMAL PATIENT CARE through teamwork (“get everybody on the same page”)

Base data

patient name: sticker

admit date: today’s date:

admit service: consulting serviceS:

Primary Diagnosis/problem: reason for admission: reason in ICU:

Primary service: referring physician:

primary family contact: power of attorney:

CODE STATUS: ADVANCED DIRECTIVES ON THE CHART:

updated problem list to include:1. ____________ 2. __________ 3. __________

4. __________ 5. __________ 6. __________ 7. __________ 8. __________ 9. _______________

meets admission/discharge criteria for ICU

TARGETS: SEE SEPARATE GUIDELINES, PROTOCOLS, BUNDLES, INITIATIVES & PACKS** FOR DETAILS & use qi/pi data sheet to list need for new guidelines.

FAMILY INTEGRITY PROTECTION & PRESERVATION GUIDELINES

1. ARE WE DOING EVERYTHING POSSIBLE TO HELP THE FAMILY DEAL WITH THE PATIENT’S ILLNESS?

COMFORTABLE? PHYSICAL, EMOTIONAL, FINANCIAL, ISSUES, ETC., FAMILY LEADER, CONFERENCES? DISCHARGE PLANNING? LONG TERM CARE CONSIDERATIONS? OPTIMAL PATIENT SUPPORT NETWORK ESTABLISHED?

PATIENT INTEGRITY PROTECTION & PRESERVATION GUIDELINES

POPS™ (Patient + Organ Specific Preservation Strategies)

1. ARE WE DOING EVERYTHING POSSIBLE TO OPTIMIZE THE PATIENT’S OUTCOME?

2. ARE WE PROVIDING CARE ACCORDING TO PATIENT’S WISHES?

3. DO WE KNOW/HAVE PATIENT WISHES IN WRITING? (When in doubt err on the side of life!)

4. ADVANCED DIRECTIVES?

ALL GENERAL PATIENT PROPHYLAXIS GUIDELINES: NOSOCOMIAL COMPLICATION PROPHYLAXIS AND ENVIRONMENTAL CONTROL

1. ARE WE DOING EVERYTHING POSSIBLE TO PREVENT HOSPITAL, ILLNESS AND TREATMENT ASSOCIATED COMPLICATIONS?

ID: SEPSIS, LINES, HARDWARE, VAP, UTI, GEN IMMUNIZATION & IMMUNE BOOST. SPECIFIC: Line Holidays? Line Changes? Dental Care & Oral Hygeine? Abx & prophylaxis end points? Handwashing? Pro Biotics for CDAD prophylaxis?

NON INFECTIOUS: DVT-PE, ASHD. EYE, SKIN, DELERIUM, GLUCOSE, FALL, MALNUTRITION, DECUBITUS ULCER, GI BLEEDING, GENERAL DEBILITY

SPECIFIC: RESTRAINTS, INSULIN, KINETICS, ROOM (LIGHT, NOISE, TEMP CONTROL), ALCOHOL & WERNICKE- KORSAKOFF ENCEPHALOPATHY

SPECIFIC ORGAN PROTECTION & PRESERVATION AND TREATMENT OPTIMIZATION GUIDELINES: (GENERIC AND DISEASE SPECIFIC)

TOPS™ = Tartets for Specific Organ Preservation

1. ARE WE DOING EVERYTHING POSSIBLE TO OPTIMIZE PRIMARY, SECONDARY AND TERTIARY DISEASE PREVENTION?

(DETAILS ON NEXT PAGE)

SPECIFIC ORGAN PROTECTION & PRESERVATION AND TREATMENT OPTIMIZATION GUIDELINES: (GENERIC AND DISEASE SPECIFIC)

ARE WE DOING EVERYTHING POSSIBLE TO OPTIMIZE PRIMARY, SECONDARY AND TERTIARY DISEASE PREVENTION?

□ CNS (BRAIN & SPINAL CORD): PERFUSION & BP CONTROL? ^Na+?

^ Mg++? TEMP CONTROL? H/H = 10/30? EUGLYCEMIA? EUVOLEMIA?

□EYE PROTECTION

□ HEART: PERFUSION? BETA BLOCKER? HEART RATE CONTROL? ASPIRIN? OTHER ANTICOAGULATION? CATH? H/H = 10/30?

□ LUNG: PERFUSION? ASNJMB Guidelines? VENT: Smallest tidal volume and lowest pressures? Weaning vent? Minimize ABG draws? Sedation Holiday? VAP prophylaxis? TOF?

□ KIDNEY: PERFUSION? High Cardiac Filling Pressures? Euvolemia +?

□ GUT: PERFUSION? Abdominal hypertension?

□ LIVER: PERFUSION?

□ MUSCULOSKELETAL: PERFUSION? KINETICS?

□ SKIN: PERFUSION? KINETICS

□ ENDOCRINE:

DOCUMENTATION IN RECORD: Diagnoses and Problems listed in PRIORITY order? PROGRESS NOTES? Procedure notes include DX? Separate Procedure note for each procedure? ORDERS? BILLING: Proper documentation to reflect charges?

QUALITY AND PERFORMANCE IMPROVEMENT ISSUES: Q & PI Documentation on separate encounter form?

TODAY’S TARGETS & PLANS: today’s date:

NAMES/SIGNATURES:

SICU RESIDENT: _________________________ SICU ATTENDING: _________________

PATIENT, or FAMILY REPRESENTATIVE/MPOA: _________________________________

PRIMARY NURSE: __________________ CHARGE NURSE: ________________________

DIETICIAN: __________ OCCUPATIONAL, PHYSICAL AND SPEECH THERAPISTS:

TEAM PHARMACIST: ___________________________TEAM RT: ____________________

PRIMARY ATTENDING: _______________ CONSULTANT ATTENDING: ____________

NOTES:

STOMPPIT™© V122012: StepWisely®™© Infinity Health Solutions & MFM

MFM@IHS part of the StepWisely® System for Mission Adhesion & Team Development WWW.IHEALSOLUTIONS.COM

Sunday, December 2, 2012

The Daily Apple™© Volume 1, Number 2

The Daily Apple™© Volume 1, Number 2

From Dr. Mike & Infinity Health Solutions

www.ihealsolutions.com

December 2, 2012 PGY 40 Day #155

Yes, in Volume 1, Number 1, I promised to “use The Stress Management Workbook, to help maintain order and perspective in what has become an extraordinarily complex and fragmented “business of medicine”. So, let’s do it. Here you go … the first few pages of The “Original” Stress Management Workbook, with exception of format & tweaking to fit the blog, unchanged. If you want a copy, contact me directly by email at Dr.Mike@ihealsolutions.com.

To our families

Preface

The twentieth century has been marked by tremendous advances in

the theory and practice of medicine. Phenomenal scientific and technological

discoveries have found their way into medical practice. People have grown

to expect certain seemingly miraculous results from the institutions and providers

of medical care, and often, the expectation is that the "impossible" can be achieved.

There is, however, increasing popular awareness that modern medicine

cannot perform miracles despite the available science and technology. Professionals

and laymen alike are learning that advances in medicine, however dazzling, cannot

make up for life styles that breed pathology. Life ·style is now being recognized as

a major factor in the development of many of our modern medical problems. General

attitude and behavior are clearly linked to the individual's health status. Moreover,

most medical problems seem to occur more frequently with increasing stress, and

environmental exposure appears to be a factor in most illnesses. Expectations

appear to have an effect on health and well-being. Such varied problems as cancer,

cirrhosis of the liver, malnutrition, pancreatitis, ulcers, high blood pressure,

headache, food poisoning, voodoo deaths, and others appear to be influenced by both

internal and environmental factors, both emotional and physical.

Professionals and laymen are beginning to realize and teach that the

individual has a great responsibility in the promotion of his own health and the

prevention of his own disease. The concept of self-care is steadily gaining acceptance.

People are beginning to realize that they have control over certain factors that affect

their health and wellbeing. But although these concepts are being accepted more

readily, the methods for their application and general use have not been widely available.

THE STRESS MANAGEMENT WORKBOOK is designed for the

individual who takes the concept of self-care seriously and wants to do whatever

he* can to promote his own health and well-being, as well as take advantage of the

best that modern medicine has to offer. Although the book can be read rather quickly,

the material is designed to be implemented gradually and thoughtfully in conjunction

with advice from your personal physician. It is expected that your initial planned

changes may take up to two years or more to institute.

_________________________________________________________________________

*Throughout the book we have used such constructions as "the individual ... he" solely for the economy of language.

Our usage of personal pronouns is not, in any way, intended to imply any connotation of sexual role discrimination.

December 2, 2012 Addendum:

NB: Please read this book carefully and use in conjunction with your trusted Family Doctor. This book is not intended to treat any medical emergencies and is not a substitute for your doctor or any other healthcare provider. The Stress Management Workbook is designed to help you take The Best Possible Care™© of yourself, and to help you achieve optimal health & wellness. It takes time to reprogram; to bust a lifestyle that breeds pathology and to build a lifestyle that breeds health, wellbeing and wellness. Be patient. Be strong. You can do it. We are here to help.

Tuesday, October 23, 2012

October 23, 2012 PGY 40 Day #115

A is for Apple

The Daily Apple™© is a StepWisely® periodical brought to you by Michael F. Mascia, MD, MPH (aka Dr. Mike) & Infinity Health Solutions www.ihealsolutions.com

It has been said that “An apple a day keeps the doctor away.” Is this a fact? The short answer is, yes! You say, “I want scientific evidence”! OK, good, you will get it, but not today.

Preface & Introduction

Stay tuned to The Daily Apple™© for detailed StepWisely®™© answers to this and other questions that will help you Go to Health™©. In the meantime eat an apple a day, and let me introduce you to the Daily Apple™©. This periodical blog is an offshoot of The Stress Management Workbook: An Action Plan for Taking Control of Your Life and Health (© Aronson & Mascia 1979, 1981), a self help book published by Appleton Century Crofts as a guide for patients who wanted to “take charge” of their health and healthcare. Now, after 30 additional years of experience coaching patients, family, friends, other docs - after decades of preventing illness, caring for the sick and treating casualties it is time for the “Next Generation", “The NEW and Revised Stress Management Workbook”. Updated and interactive, the new book is starting to take shape and you can be a part of it. So, please join me in this blog, where we will explore the many ways you can learn to “Take the Best Possible Care™©” of yourself, those you love, those around you, and beyond. This blog will take you through the Original Stress Management Workbook and the new material that will become The New Stress Management Workbook.

Lots of material to cover, so let’s get started. This is how. We will StepWisely®™©, one small step at a time, to be slowly compiled into these pages, twitter and facebook. These pages will fit into the framework of The ORIGINAL Stress Management Workbook. The Daily Apple™© will provide regular Health Bits, Bytes and Bites on this blog, the Infinity Health Solutions website (www.ihealsolutions.com), on twitter (@ihealsolutions and @dr_mike_IHS) and Facebook (ihealsolutions) in the context of The Stress Management Workbook, OK?

We will use the Stress Management Workbook, to help maintain order and perspective in what has become an extraordinarily complex and fragmented “business of medicine”. We will help bring you back to the basics and the fundamentals of self care, so you can take full advantage of the opportunity you have to create “an action plan for taking control of your life and health”. Confused? Comments? Questions? Engage in the process & write to me (dr.mike@ihealsolutions.com) I will get back to you ASAP.

Ciao for now,
Dr. Mike

Wednesday, August 29, 2012

APSF: Patient Safety Leaders

PGY 40, Day 60

Attenzione!

ANESTHESIOLOGISTS and the Anesthesia Patient Safety Foundation (APSF): Encouraging Patient Safety for Decades

Anesthesiologists: Do the survey (link in the email below from R. Stoelting) and support APSF!

Patients: Encourage and support APSF!

Below is my recent email conversation with Robert K. Stoelting, MD, APSF President. It starts from the bottom and works up to the top.

Patients, Providers and Patient Safety Advocates will find it valuable. Anesthesiologists are your PATIENT SAFETY ADVOCATES on the front lines of operating rooms around the world. Don't let the Business of Medicine pressure them to cut corners on patient safety!!!

StepWisely®™© ... Join with me to Encourage Doctors and Patients ... we must work together to OPTIMIZE patient care.

Have a Safe and Love Filled Day!

Dr. Mike
Michael F. Mascia, MD, MPH

From: rstoel7145@aol.com
Date: August 8, 2012 21:53:31 EDT
To: masciam@aol.com
Subject: Re: Request from Anesthesia Patient Safety Foundation/Please Consider

Hi Mike:

Thanks for confirming continued support.

I appreciate your comments regarding the checklist initiative but did not realize you were expecting a response. I am pleased with any visibility you can give the survey including sharing the link with colleagues and encouraging participation. For the moment, APSF needs maximum input to create a template that is compatible with multiple practice models.

Regards,
Bob

rstoel7145@aol.com

-----Original Message-----
From: Michael F. Mascia MD, MPH <masciam@aol.com>
To: rstoel7145 <rstoel7145@aol.com>
Sent: Sat, Jul 21, 2012 9:35 pm
Subject: Re: Request from Anesthesia Patient Safety Foundation/Please Consider

Thanks, Bob, This is GREAT! I will do my best to work the survey ASAP.

As an advocate for check lists, I have been using them effectively for 30+ years with/to benefit both PATIENTS and RESIDENTS.

Sadly, today's production lines often PUSH Docs to ignore optimal practices, and encourage cutting corners. I started anesthesiology in 1989 (my second career) under Jane Matjasko, and safety was THE priority at that time. Since then, conditions on the front lines have deteriorated drastically and patients are often neglected for the sake of speed. This is unacceptable for many reasons, not the least of which is "cutting corners" is dangerous, a violation of the Hippocratic Oath, and disregards of the "first do no harm" principle. And, toward what end? We both know it is speed, which boils down to MONEY.

My M/O has always been, "Treat the patient as if you are the one going for surgery = you are the patient." & "If it is NOT RIGHT, PUT the BRAKES ON." When I started, these were workable operating principles. Now, there are morons in power who would consider my practices "disruptive behavior" and to be sure, they would (and do) complain about the way I work. Generally, I get away with it, because I ALWAYS put the PATIENT first!

So, the bottom line is this. I am happy to see the APSF take this on, and I will do what I can do ... on the front lines, in the larger community ... and with the APSF. Operating principles that allow the physician/anesthesiologist to STOP the production line with impunity would go a long way toward protecting the patients.

Thanks for doing what you do. APSF support is essential for Patients and FRONT LINE PROVIDERS.

Salute! Amore e buona fortuna!
Ciao for now,

Mike Mascia
Michael F. Mascia, MD, MPH
President
Infinity Health Solutions
MFM@IHS ip
On Jul 21, 2012, at 18:54, rstoel7145@aol.com wrote:

           Anesthesia Patient Safety Foundation
  Building One, Suite Two   8007 South Meridian Street Indianapolis, IN 46217-2922
                                Tel: 317,885,6610   Fax: 317.888.1482 E-mail: stoelting@apsf.org
Dear Colleague:

On behalf of the Anesthesia Patient Safety Foundation (APSF), I am writing to request your participation in helping the foundation create the content of a template for a “Pre-anesthetic Induction Patient Safety (PIPS) Checklist” that could be utilized by anesthesia professionals and anesthesia groups to create a safety checklist that best fits their practices.

Specifically, based on your experience and knowledge, but now as the patient (the passenger rather than the pilot), what would you want to be part of a safety checklist immediately before induction of your anesthetic?

Visit: https://www.surveymonkey.com/s/3VHDTJY to express your opinions and contribute to development of the content of the template described above.

The survey is 22 questions and the estimated time to complete is 4-6 minutes.

You are welcome to invite colleagues to also participate in this survey.

Thank you in advance for your participation and contributions to this APSF patient safety initiative.

Sincerely,
Bob
Robert K. Stoelting, MD
President

rstoel7145@aol.com