Reflection on FDA Guidance on Filliing of Medication Vials

July 27, 2015

Evelyn McKnight and Lauren Lollini

Steve Langan, director of HONOReform, shares recent FDA guidance on medication vials

Steve Langan, director of HONOReform, shares recent FDA guidance on medication vials

Thank you to Dr. Tom McKnight for sharing his experience last week in the blog post titled “Summertime and Safe Injections.” From what we have learned from nurses, techs, office administration and nursing students, some providers and others insist, subtly or directly, on not “wasting” any medication. Sadly, regrettably, using medication from single-dose vials more than one time is a widespread practice, and so is the misuse of the multi-dose vial.

We are grateful to FDA for this clear response on overfilling vials. It’s a helpful document to include in HONOReform’s ongoing advocacy work. As they say, it takes a village to raise a child; we are finding that it takes a village to raise a body of knowledge regarding safe injections. FDA and CDC and others have taken a clear stand on virtually all aspects of injection safety.

We encourage all health care workers to join us. We invite all patients to always ask for a safe injection. And we thank Tom McKnight for demonstrating that patient safety must be, in all settings, the uppermost concern.

Summertime and Safe Injections

July 20, 2015

Evelyn McKnight and Lauren Lollini

Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE

Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE

Everyone agrees that summer is meant for fun, especially fun in the great outdoors. But sometimes injuries happen in the pursuit of fun, resulting in a trip to the Emergency Department.

I practice medicine in a town that is near a state park. Thousands of people flock there in the summertime, boating and swimming in the pretty blue lakes. When I first began my family medicine practice 30+ years ago, our hospital did not have Emergency Room physicians. The primary care physicians on staff were called in to care for patients who needed to be seen. I wish I would have kept track of how many times I trekked to the ER to stitch up a camper from the state lakes, who cut himself on a piece of glass or during a fall while waterskiing. I think it would be interesting to know.

Sometimes the nurse who was helping me would bring out a vial of lidocaine that had been used for the previous patient. I wouldn’t know if the previous healthcare provider had used safe injection practices or if they had reused needles and syringes to access the vial, thus contaminating it. The vial was usually not labeled, either. I would direct the nurse to throw out the previously used vial, and use a new vial. Some of the nurses thought this was unnecessary and it took some time and thoughtful discussion before we all agreed on designating a vial for each patient.

With so many people at the lakes, we might have many emergencies at once. It was not unusual to have 10 people waiting to be seen when an ambulance would roar in and all the doctors and nurses would drop what they were doing and rush to participate in the code. The pace was stressful and fast – a combination that can lead to error. We all had to be on our toes at all times to make sure that every action was safe for the patients as well as the staff. During a code, many injections are given very quickly. With several healthcare providers standing close together around the patient, working rapid-fire, there was the possibility of accidental needlesticks and improper disposal of sharps.

Not long ago I myself was a patient at the ER. I was stung many times while harvesting honey from our beehives – the bees were not going to give up the result of their hard work without a fight! I swelled up like a balloon, and felt my throat closing. We rushed to the ER where I was given IV’s to reduce the swelling. I was so glad that the staff had had had the thoughtful discussions about injection safety. They saved my life that day, and protected me from any disease that could have been transmitted through unsafe injections.

Our hospital now has emergency room physicians on staff. I am grateful, and not just because it frees me from being called in at any time of the day or night. I am grateful for their knowledge of and committment to injection safety, because we are all patients at some time. Although I have given up beekeeping, I haven’t given up waterskiing; I just might need to be stitched up after a fall!

Methodist Monday: “You need to speak up when you see someting unsafe”

July 13, 2015

Evelyn McKnight and Lauren Lollini

Scott J. Greenwood is a Junior Level Nursing Student at Nebraska Methodist College

Scott J. Greenwood is a Junior Level Nursing Student at Nebraska Methodist College

Unsafe injection practices aren’t something I thought about until I read Dr. Evelyn McKnight’s book. I was under the impression that these sorts of things didn’t happen in the U. S. in this day and age. Now that I know how easily these things do happen, I will always pay extra attention when giving an injection to keep my patient safe.

Hearing her experience also made it clear that as a nurse, you need to speak up when you see something unsafe. It doesn’t matter who the person is. If I were doing something unsafe, even unintentionally, I would expect somebody to step in and to correct me.

I’m glad I was given the opportunity to hear Evelyn speak. It drove home the point as to why safe injection practices are so important.

In Gratitude for a Simple Gesture of Respect

June 29, 2015

Evelyn McKnight and Lauren Lollini

Newsweek ran a feature article on drug diversion in hospital settings

Newsweek ran a feature article on drug diversion in hospital settings

The cover story of Newsweek June 18, 2015 edition is When Drug Addicts Work in Hospitals, No One is Safe.

The lengthy article was written by Kurt Eichenwald and was the result of an interview and correspondence with David Kwiatkowski, the radiologic technician who was sentenced to 39 years in prison after infecting patients with hepatitis C through unsafe injection practices. Kwiatkowski, who was infected with hepatitis C, stole injectable pain medications from the hospital where he was working and injected himself. He changed the needle, rinsed the syringe with water, refilled the syringe with saline and put these syringes back on the medication cart for use with patients. In this way, at least 45 patients in seven states were infected with hepatitis C. One patient has died from the infection.

Regrettably, this scenario is not unusual in the United States. The CDC estimates that 30,000 people may have been exposed to hepatitis C over the past decade by infected hospital employees who have used narcotics intended for patients. Federal researchers estimate that 100,000 healthcare workers in the United States are addicts and their theft of narcotics from patients is believed to be widespread. As many as 379,000 health care workers in the United States are addicted to drugs or alcohol, according to New Jersey pharmacist Mitch Sobel, who delivered this information at a recent New Jersey Department of Health meeting.

Getting back to the excellent Eichenwald article, what is unusual is that Kwiatkowski apologized…and desribed how he diverted drugs so that we can correct the healthcare delivery system to prevent harm to the public.

Since he is not eligible for parole, Kwiatkowski has nothing to gain from his disclosures. In fact, he and prison officials fear the article might anger other inmates and place him in danger.

As one who contracted hepatitis C through unsafe injection practices, i want to commend Mr Kwiatkowski for apologizing and sharing his story. It is so meaningful to victims when there is an apology; I still yearn for the gift of this simple, but profound gesture of respect. It is very difficult to fully heal from harm of this magnitude without an apology–it is as if something is missing, and closure is impossible.

Kwiatkowski not only apologized, but gave us a clear picture of how diversion takes place in hospitals. This important “insider” knowledge–not unlike when casinos ask cheaters to help them catch other cheaters–will help us make the changes that are long overdue. As we reported in a previous blog, HONOReform is helping to head efforts at a national level to help prevent drug diversion. We encourage all stakeholders to join us.

In the Newsweek article, Kwiatkoski said he is “haunted by the knowledge that he hurt so many people and believes he needs to make amends by revealing the scope and methods of this medical crime that endangers un unknowing public. “

Somebody has to tell how it’s done, how easy it is and how the structure of the hospitals isn’t any good to stop it,’ he says of drug diversion.”

Examining all ways to prevent drug diversion has never been more important. Patients throughout the country are harmed, and there is no national system in place to stop diverters. From just one patient affected by unsafe injection practices, thank you, David Kwiatkowski, for your candor. We need you and others continue to tell us how to fix the system that is so easy to violate.

 

What Does It Mean for Patients?

June 22, 2015

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.

I am grateful HONOReform had the opportunity to respond in the June 12 Concord Monitor to the horrible but all too common report of provider drug diversion by a healthcare worker.

As Steve Langan, HONOReform executive director, said, “Drug diversion may likely be the most enormous elephant in the room, in healthcare.” Anyone who has tried to pay attention to the many conversations on healthcare in the United States knows that there are many gaps and there have been many breakdowns.

If we continue to look the other way and deny and ignore the fact of widespread drug abuse and drug diversion among healthcare workers, more and more systematic challenges will develop.

According to recent statistics, there are as many as 379,000 addicted healthcare workers right now in the United States.

What does this mean for patients? They may not be receiving the medication they have been prescribed, in the recovery room or in other hospital settings. And, worse yet, they may receive an infection of bloodborne pathogens, such as hepatitis C or HIV.

At HONOReform, we believe a first priority in American healthcare is protocol and regulations that prevent drug diversion. This is a problem that can and must be fixed.

Robust materials developed by partners at the Safe Injection Practices Coalition the One and Only Campaign will soon be in place. We welcome the opportunity to help distribute these materials to leadership at healthcare facilities throughout the country.

Messaging and education are essential, important; but, in this case, we need government leaders at all levels to take a stand. Patients have been placed over and over in a vulnerable position, and addicted healthcare workers continue to practice with very little oversight and not nearly enough intervention.

In the near future, we will make an announcement of an upcoming meeting on drug diversion prevention.

Nebraska Methodist College Junior Level Nursing Student by Brittney L Commins

June 15, 2015

Evelyn McKnight and Lauren Lollini

Comminspic
Listening to Dr. McKnight was inspiring. Listening to her heart-breaking struggles and what she has overcome has motivated me to commit to safe injection practices. I want to make that if I were ever in a situation where I had witnessed an incident similar to Dr. McKnight’s that I would take action to prevent injury to the patient. Patients need to be comfortable and be able to trust their health care providers; delivering positive and safe patient care will empower and establish an excellent patient to provider relationship. I will strive to be aware of my surroundings and the cares being done by fellow nurses and physicians, making sure to advocate for the safety of the patient. read more »

Preparing Future Healthcare Providers

June 8, 2015

Evelyn McKnight and Lauren Lollini

" A Never Event" is being used in the curriculum of numerous healthcare training programs.

” A Never Event” is being used in the curriculum in numerous healthcare training programs.

Over time, some colleges and universities have incorporated “A Never Event: Exposing the Largest Outbreak of Hepatitis C in American Healthcare History” by McKnight and Bennington into their training of healthcare providers. This is a wonderful way to educate young providers about injection safety and patient safety in general. We always enjoy interacting with the students when we are invited to join class. It is very rewarding to us, because in the words of a nursing professor at Johns Hopkins School of Nursing, “Today you have spoken to a hundred new nurses. But they will never forget your story, and through their hands you have made healthcare safer for thousands.”

We have gathered together some thoughts of the students and professors from the past months and have used them to compose this six minute video for your enjoyment.

We know of some of the training programs that use A Never Event, but we suspect that there are others that we are unaware of. If you know of any that are not mentionned in the video, please let us know by emailing evelyn@HONOReform.org. Thank you!

Hepatitis C and preventive measures by Dr Mudasir Firdosi

June 1, 2015

Evelyn McKnight and Lauren Lollini

We would like to thank Dr. Mudasir Firdosi for helping to highlight Hepatitis C as a truly global issue. This is re-printed from a post which appeared in mid-May.

Kashmir valley is witnessing another disaster in the form of Hepatitis C epidemic. In some villages in Kokernag area, the number of cases is around 40% of the total population. In spite of media pressure, and demand from local population, authorities are still contemplating curbing the further spread of this infection. Similar scenario exists in other districts of the valley like Shopian, Kupwara, and Srinagar.

Hepatitis C is not transmitted by routine personal contact and there needs to be an actual transfer of the virus via blood, blood products and body fluids, from one person to another. From the sociodemographic profile of the rural population, one can easily exclude intravenous drug abuse or sexual contact as the cause of the current epidemic in majority of cases.
read more »

National Hepatitis Testing Day is May 19th

May 18, 2015

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.


May is National Hepatitis Awareness month and this year the CDC is designating May 19th as National Hepatitis testing day. This is an excellent reminder for the healthcare community and others to get tested.

Not me, you say? Let me tell you why ignoring this might be a deadly mistake. According to the CDC over 4 million people in the US have chronic hepatitis C and most have no idea. Many of our baby boomers are infected and because they show no symptoms, they are clueless to the infection and the damage it is doing to their bodies. http://www.cdc.gov/hepatitis/TestingDay/index.htm
read more »

HIV Outbreak in Southeastern Indiana; What’s Next?

May 11, 2015

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.

On March 26th, Mike Pence, the governor of Indiana, declared a public health emergency. It appeared, as of that date, 81 people had tested positive for HIV. All appeared to be linked to injection drug use. Without the executive order issued, the additional resources and services to curb the outbreak would not have been possible.

It is a growing issue in rural communities, drug abuse. Often due to the unemployment and underemployment rates, the socio-economic make up of a rural community and the lack of drug abuse counseling and other resources, the problem breeds like a bad infection. In this case, that infection is HIV.
read more »