Same Problems, Different Virus

October 20, 2014

Evelyn McKnight and Lauren Lollini

Lauren Lollini is a patient safety advocate who has been integral in changing laws to keep patients safe as well as a member of the Drug Diversion Prevention Committee.

Lauren Lollini is a patient safety advocate who has been integral in changing laws to keep patients safe as well as a member of the Drug Diversion Prevention Committee.

If you are like many Americans out there with access to electricity or cell reception, you have been bombarded by the media attention to this ebola situation. I phrase it as a situation because I do not quite know how else to categorize it, yet. Typically, I am not one to catastrophize. And like my fellow patient safety advocates across the country, we are not surprised by the same things which might mortify the rest of our fellow Americans.

Why not, you ask? Because we have seen this all before, over and over again.
read more »

Tom McKnight reflects on 33 years of family practice

October 13, 2014

Evelyn McKnight and Lauren Lollini

Tom McKnight recently was named the Nebraska Family Physician of the Year at the Nebraska State Capitol

Tom McKnight recently was named the Nebraska Family Physician of the Year at the Nebraska State Capitol

It is a pleasure to announce that Dr. Thomas A. McKnight—Tom—a founding member of HONOReform and our medical director, was honored by Governor Dave Heineman on October 8, 2014. In a special proclamation, Tom was named “2014 Family Physician of the Year” in Nebraska. We are grateful for Tom’s ongoing leadership and guidance.
He is pictured with Representative Jeff Fortenberry and Governor Dave Heineman. The text of his talk is included here.

Thank you Gov Heineman, Representative Heineman, and the NE Academy of Family Physicians. I am humbled and honored by this award. I know that there are many deserving family physicians in our state that provide outstanding, compassionate care on a daily basis to Nebraska families.

I chose to go into family medicine because it provides the opportunity to be involved in peoples’ lives from birth to death. I’ve enjoyed family medicine because of the broad range of challenges emotionally and intellectually that each patient encounter brings. In my daily routine I often celebrate with new parents when they bring their baby to the doctor for the first time and then go to the next exam room to break the news to a married couple that the husband has terminal lung cancer and has only a few months to live. I have to say family medicine is as challenging and exciting now as it was 33 years ago when I started my practice.

After finishing medical school at UNMC i did my residency in Cedar Rapids, IA. I took a temporary position in the ER while we were waiting the birth of Luke. This gave me a chance to see a different side of medicine. It taught me that i wanted to develop long term relationships with patients and that i would only be fulfilled in having my own practice.

We volunteered for 6 months in various Native American Health Centers in NM, MT and AK before we settled in our new home in Fremont. This time period also allowed me to get licensure and staffing in place to open my solo practice in July, 1981. I still remember how happy but anxious i was to see my very first patient with brand new staff. Evelyn and I wonder if it was bravery or foolishness to have a new baby, buy a house, start a brand new practice with no patient base, all with no other income. It worked out. Fremont has been very supportive of us and it has been a marvelous place to practice medicine and raise a family.

The loyalty of my staff is unmatched. In the 33 years of practice 2 employees have been with me from the beginning, 6 have been with me 25 years or more and 9 have been with me for more than 10 years. We have 5 families who have two generations that serve patients with me. With all the stresses and changes in medicine, I think this is remarkable. It shows their dedication to caring for their friends and neighbors in Fremont. Their dedication goes beyond the time they spend at the office. They attend patients’ weddings and funerals, give baby showers for needy patients and organize fundraisers to help with patient’s medical bills. Most importantly they hold patients’ hands when they need a compassionate listener, share in the joy of a new baby and shed tears in the loss of a loved one. Patients know their dedication and i think that often they would rather see their favorite staff member than me. The same devotion the staff shows to our patients they extend to me and my family. They do their best to make my day run as smoothly as possible and that is not easy, given how many emergencies come up in one day. In the years of illness within my own family, they sent supper home with me every day for a year. They took our kids to their activities and hugged me through the time of my mother’s death. We will never forget your kindness and compassion.

The most important part of this journey is my family. They were patient and understanding when i was called from family life to attend to others’ needs. I was privileged to mentor all three sons during their medical education. It was marvelous to see their compassion and care of patients during their family medicine rotations. It gave them an understanding of my career. I’m honored that they have chosen medicine for their own career paths. Its rewarding and sometimes humorous to talk to them about their own patients. I got a phone call from Curtis the psychiatrist recently, asking me how to treat constipation!

The most important person here is Evelyn. She has stood by my side, been the most trusted confidante and understanding partner that i could have. She was the mother, often the father when i wasn’t able to be part of family life. She waited patiently for me many late nights to share the joys and sorrows of my day. I know how difficult it is and she continues to offer her support and love. I am eternally grateful.

Being involved with medical students throughout my career has been extremely rewarding. It is a source of continued stimulation and keeping up with the advancements of medicine. Sharing the joy of their first delivery or the satisfaction of suturing their first laceration gives me a warm feeling. Its interesting to show them private practice medicine and what it is like to be involved in a community. I love following their educational and career advancement and then have them as specialty consultants.

The patient doctor relationship is special. I am privileged to care for 4 generations of families. I am so humbled that they have placed their trust in me, many for 3 decades. We’ve gotten to know each other well and i feel like a part of their lives. They are a part of mine as well; they ask about my family and send me gifts and articles that they know i would like. This is really what family practice is about – caring for families through generations. It is a blessed coincidence that the first baby I delivered in Fremont in 1981 was JoAnne’s baby girl named Christine. I delivered Christine’s baby girl Caitlyn in 2011, the last baby I delivered.

Many things have changed in medicine in the years of my career. Immunizations now prevent many diseases that were devastating to families when i first started practice. I remember many nights interrupted by trips to the ER where i did spinal taps on children, looking for meningitis, which is now very uncommon with meningococus vaccine. We now have genomics to assist with cancer care and cardiovascular disease. We used to have to get hard copy medical journals to research new developments but now i can consult Medscape on my smartphone. Computerized medical records are replacing cumbersome paper charts and will allow patients to have their medical records anywhere in the world. Patients have changed also, for the better. They are more involved and knowledgeable about treatment options. They are full partners in their healthcare, which is better for them and healthcare providers. Patients know their bodies better than anyone and bringing this knowledge to the partnership makes for better health. We need to embrace these changes in technology and patient partnership.

I’ve enjoyed opportunities to serve in ways other than office medicine. Service trips to third world countries, membership on nonprofit boards, medical staff offices and our own patient safety foundation HONOReform has promoted my own personal growth. We have met so many wonderful, committed people in these endeavors. Their dedication inspires me.

Our own experience with medical error and the work of HONOReform has made me a better doctor because i understand both the doctor and the patient side of the relationship. I’m less defensive, more compassionate, and more grateful than i used to be. I’ve learned how to accept responsibility and do the right thing, even when that is a very difficult thing to do. To say “I’m sorry, this is not what i wanted for you” when my care of a patient did not turn out as planned is the right thing to do.

HONOReform is a national organization, and we stay very active here in Nebraska. If I could wish one thing for our state, it would be the adoption of a bill that emphasizes safe injection practices. We have seen many lives here in Nebraska (and throughout the country) altered or ended because of lack of adherence to injection safety. HONOReform is willing to roll up our sleeves and work with Nebraska lawmakers to put an injection safety bill in place. We believe this legislation is overdue.

For all of this, I thank you from the bottom of my heart. Our work is not done, we are eager to see what the next 33 years will bring.

How my 6 year old found the CDC website

October 6, 2014

Evelyn McKnight and Lauren Lollini

Lauren Lollini and her 6 year old daughter Lucy

Lauren and her 6 year old daughter Lucy

When I was infected with Hepatitis C, my daughter had just turned one. The devastation of such a horrendous diagnosis coupled with the new person who was now in my life was almost stranger than fiction. Now more than five years later, after a wild ride and a journey still in process, I have started to open up to my daughter and talk a bit about the drug diversion which caused my disease.

I know, I know, Lucy is only six and the idea of drug diversion seems a pretty intense subject for a first grader. But every so often she asks me to tell the story and I know which one she means. And as it is a very long story with many twists and turns, I always ask, which part?
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It Takes Courage to Speak the Truth

September 29, 2014

Evelyn McKnight and Lauren Lollini

Lauren is the survivor of the 2009 Hepatitis C Outbreak in Colorado who chose to take a first step to passing legislation to make patients safer.

Lauren is the survivor of the 2009 Hepatitis C Outbreak in Colorado who chose to take a first step to passing legislation to make patients safer.

As a therapist, I often find myself congratulating clients for taking the first step as that is usually the most difficult. That first step might be making a phone call and asking about what resources are available for help or quite literally taking that first step into my office. So, too, do I congratulate the past contributors to our blog who have gone above and beyond to take that first step to share their stories. By speaking their truth, they have risked much, but were still undeterred.

You simply need to scroll back through the last few months and you will find many heroes who could no longer stay silent. Most recently, Anita Betrand shared her journey from addiction as a CRNA to that of an advocate speaking out so others can learn from her. Her struggle in and of itself was an arduous one, yet Anita chose to take that one next step to help educate so other healthcare workers finding themselves in a similar circumstance know there is a light at the end of the tunnel.
read more »

Sharing stories, transforming ourselves

September 22, 2014

Evelyn McKnight and Lauren Lollini

Evelyn McKnight, president of HONOReform

Evelyn McKnight, president of HONOReform

In my work as a patient safety advocate, I have had the great good fortune of meeting many people who share with others their tragic story of how they were affected by unsafe healthcare. Like my family, their families were hit with a Mack truck on the road of life when they went to the doctor seeking better health, but came away with a worse medical condition because of unsafe healthcare. Telling the story may be gut-wrenching – it can be like living a nightmare all over. But through sharing their stories, these brave men and women are able to transform their experience into something useful, rather than simply a horrible personal trauma. read more »

Sharing stories, transforming healthcare

September 15, 2014

Evelyn McKnight and Lauren Lollini

“If I look at the mass I will never act. If I look at the one, I will.”
- Mother Theresa

Evelyn McKnight, president of HONOReform

Evelyn McKnight, president of HONOReform

Tomorrow marks the one year anniversary of “Survivor’s Stories” blog. We thank you for your loyal readership, and we ask you to share with all your associates.

Today we want to thank the many people who have so graciously shared their personal stories with us. Thank you Barbara, Johnny, Mary, Amanda, Ron, Tom, Kim, Tom, Chuck, Melisa, Patty, Tam, Jan, Sharon, Joe, Karen, Rich and Anita for sharing your own story of how your life has been affected by unsafe injections. We know how difficult it can be to share such deeply personal stories with others, especially total strangers. We also know how vitally important it is.

The number of Americans that have been affected by unsafe injections in the past decade is staggering, reaching into the hundreds of thousands. Yet these numbers, although alarming, do not bring about change as readily as the story of the one. These numbers are dry statistics, “human beings with the tears dried off,” and fail to spark emotion or feeling and thus fail to motivate action. Social psychologists argue that this reflects the way our consciences and ethical systems are based on individual stories and are distinct from the parts of our brains concerned with logic and rationality. See “Psychic Numbing and Genocide” for more fascinating information on the numbing effect of impersonal data.

It is the personal stories that change hearts. And when hearts are changed, behaviors are changed. Healthcare becomes safer for all Americans.

I will never forget my first visit to Capitol Hill to visit my congressional delegation’s offices. Congressmen are busy people, and the staff that supports them is equally busy. When I first sat down with staffers, I could read distraction and disinterest in their faces. But as I told my story, they became transformed. They peered at me closely. They asked questions. They took notes. And by the end of the interview, they asked me what their boss could do to help and even made offers of what he would do that day.

Personal stories are powerful. When there is a face on an issue, it becomes real. It moves people to action.

I was very nervous the first time I told my story publicly, which was to a nursing class at Johns Hopkins School of Nursing. After the class, the professor said to me, “Today you have spoken to a hundred new nurses. After hearing you speak, they will never compromise patient safety. Through your story, you have made healthcare safer for all the patients that they will serve, which will be thousands upon thousands over the course of their careers.” The butterflies in my stomach flew away immediately, and after looking at it in this way, I have never been reluctant to share my story ever since.

Do you have a story to tell?
How would hearing your story motivate providers, policymakers and manufacturers to commit to safe injections?

Again, we thank all the many people who have shared with others how their lives have been affected by unsafe injections. And we ask those of you who have a story, but have not shared it, to let us help you tell your story. Contact me anytime at evelyn@honoreform.org. Thank you.

Next week we will discuss how sharing stories help the people who have been affected by unsafe injections.

The Importance of “Safety by Engineering”

September 8, 2014

Evelyn McKnight and Lauren Lollini

Evelyn McKnight, president of HONOReform

Evelyn McKnight, president of HONOReform

From the beginning, Safety by Engineering has been an important ongoing stance position of HONOReform. Recognizing the valuable work of industry, urging industry to go the extra mile to ensure patient safety, and working in tandem with industry, when our goals are shared ones—these are some of the many aspects of our work.

We are especially pleased with our current collaboration with BD (Becton, Dickinson and Co.). We admire their work and culture. Putting patient safety first—and having patient advocates beside them, as they do—is an ongoing aim of BD. Adopting more and better safety engineered devices, here in the United States and throughout the world, only makes good sense.

In this blog, below, titled “Collaborating for Patient Safety,” my story and the mission of HONOReform are described. It appeared on the BD Worldwide site on September 2, 2014.
In the near future, we will update you on our collaboration with BD. And we will continue to update you on the importance of “safety by engineering.”

http://www.bd.com/showcase/honoreform/index.aspx?WT.ac=honoreform

HONOReform Extends Thanks and Congratulations to New Hampshire

August 25, 2014

Evelyn McKnight and Lauren Lollini

In this blog, HONOReform executive director Steve Langan, included in the photo with Governor Hassan, thanks colleagues in New Hampshire for two new important laws–and he includes a recent AP story.

Steve Langa shakes Governor Hassan's hand at New Hampshire bill-signing ceremony

Steve Langan shakes Governor Hassan’s hand at New Hampshire bill-signing ceremony

Congratulations and many thanks to our colleagues in New Hampshire, many of whom are included in the August 6 AP article by Rik Stevens, which is appended below, for their determination to create and pass legislation in New Hampshire that will help protect patients there.

“We believe these two new measures will be of great benefit in insuring the safety of the patients who are receiving care in our hospitals and also in insuring the integrity of the healthcare delivery system,” said Steve Ahnen, president of the New Hampshire Hospital Association. “These laws are an important step forward in preventing these horrific acts from occurring again in New Hampshire and, potentially serving as a model for the rest of the nation.” read more »

Making Lemonade: One CRNA’s Story of Addiction and Recovery – Part 2

August 19, 2014

Evelyn McKnight and Lauren Lollini

Anita Bertrand, CRNA, will be presenting at the upcoming AANA annual meeting

Anita Bertrand, CRNA, will be presenting at the upcoming AANA annual meeting

Anita Bertrand is a certified nurse anesthetist. She will be giving the 11th Annual Jan Stewart Memorial Lecture at the AANA 2014 Nurse Anesthesia Annual Congress. Her story of addiction and recovery is continued from last week. We are grateful to her for sharing her story of addiction and recovery today and next week.

Prevention
During that time of active addiction, it never occurred to me I’d be asked to drug test, as random drug screening was not practiced in any of the healthcare setting I have been employed. But, how often could we identify a HCW with a developing addiction problem or one that is already out of control by instituting random drug screens? Some HCWs could be helped before harm is caused to patients, or before being discovered in a fatal event, as what happens in specific HCW professions such as anesthesia or ICU nursing. The “survivalist” behavior demonstrated as the brain becomes hijacked by the disease of addiction shows us how little control the addicted HCW has over the outcome of the disease. It WILL be fatal to the HCW left untreated, and in the process may contribute to harm to patients as well.

How many physicians, nurses, technicians, and aides working across the country are struggling with this disease and have no resources available due to fear, shame, stigma, isolation? In my state alone there are hundreds of nurses who are being monitored in the alternative to discipline program sanctioned by the state and the Board of Nursing. These are nurses who are getting help and treating their disease while being monitored in their work environment. This does not count the number of nurses who do not fit the profile to be accepted into the program and are under state board monitoring. This does not include the physicians, dentists, technicians, and other HCWs in the state. This does not include the number of HCWs who have not been discovered or who will succumb to the disease in the future.

Since no profession is immune to this disease, 10% of the number of all HCWs would amount to how many across the country? What needs to happen to not only bring more awareness and education to the problem, but to change the mindset of the industry so that HCW can get the help they need and be able to return to their professions as healthy, recovering providers without the stigma and discrimination? I am extremely grateful for the individuals who intervened for me so that I could get the help I needed before harming a patient or causing further harm to myself.

There is no doubt that we are lacking in understanding of the diseases of addiction and alcoholism. When education is provided, it focuses on the patient with the diseases, and seldom includes the HCW as a patient, and as our career choice being a setup for the triggering of the disease. Individuals who gravitate toward a career as a HCW may have a predisposition toward the disease; access and availability become the trigger. This access and availability may complete the gamut of things that fall into place when the HCW is experiencing trials and tribulations of life events…those HCWs who would not otherwise fall prey to the disease.

When we take action to prevent and treat the disease early, we eliminate the need for law enforcement and criminal actions.

Treatment and Returning to the workplace
We know that approximately 10% of society as a whole has problems with addiction/alcoholism, and unfortunately the majority of these people end up in jails, prisons, and institutions that do very little in the treatment of the disease. The disease is the culprit for the criminal behavior and the treatment is focused on treating the behavior rather than the disease.
Some states have alternative-to-discipline programs for HCWs so that they may obtain treatment while maintaining their licenses “National Association of Alternative Programs” .
There are many states that do not have such programs in place. In some cases the HCW chooses not to, or is unable to enroll in these programs due to legal consequences of the disease. For the states that do not have any kind of alternative to discipline program, the HCW’s ability to obtain employment in the future is essentially ripped away as the licensing board suspends or revokes the license.
Returning to practice in the healthcare setting after treatment for the disease of addiction and alcoholism is extremely difficult. Few hospital settings will employ nurses who have had a history of addiction treatment and are under a monitoring contract with their respective board of nursing or alternative to discipline programs. Again, there is a lack of knowledge and support for both the employer and employee. This realization and understanding on the part of the addicted HCW produces another roadblock for the addicted HCW to willingly seek help for this chronic, progressive, fatal disease.

Gratitude
Personally, I am grateful for the program in place that directed and monitored me before and during my return to work as a healthcare provider. I am extremely grateful for individuals who supported and employed me, giving me a chance to demonstrate that this disease is treatable, and that with treatment, it is possible to continue my career as a HCW and provide safe patient care.

At the end, this is my wish. In the effort to continue to provide safe patient care I encourage HONOReform and all of its great colleagues to continue to do all they can—at the state and federal levels—to prevent drug diversion and help addicted healthcare workers. I pledge my support to my HCW colleagues. As my friend Evelyn McKnight says, “Lives depend on it.”