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Melissa Mills BSN

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  1. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in Medical Marijuana: Understanding the Six Principles of Essential Knowledge   
    You enter the exam room to get Jane checked in before she sees the Cardiologist for her annual visit. As you’re reviewing her meds, Jane pulls out a medical marijuana card. She tells you that she takes it for chronic pain caused by Fibromyalgia, but that it hasn’t been working quite as well lately. Jane starts asking you questions about dosages and if you think she can increase what she is currently taking. She also tells you that she is getting ready to go on a trip to Kansas to visit a childhood friend and asks if she can take her marijuana with her there. Jane has lots of general questions about how the drug works. You silently think to yourself that you’re not prepared to answer her questions.
    Medical Marijuana Overview
    If you’re not sure what you need to know about medical marijuana and your patients, you’re not alone. As several states continue to develop and pass legislation and others change laws, it can be challenging to stay up-to-date. The National Council of State Boards of Nursing published the National Guidelines for Medical Marijuana. Here are the essentials you need to know when caring for a patient using cannabis or other medical marijuana drugs.
    Current State of Legalization
    Marijuana is currently classified as a Schedule I Controlled Substance by the Drug Enforcement Agency (DEA) which prohibits physicians from prescribing cannabis, pharmacies from dispensing it, and limits the amount of research that can be done about the long term effects and benefits. While the federal government doesn’t provide guidelines for use, many state medical marijuana laws do.
    Currently, thirty-three states and the District of Columbia, Puerto Rico and Guam have comprehensive medical marijuana laws. Another thirteen states allow for the use of low tetrahydrocannabinol (THC), high cannabidiol (CBD) products for medical use. The federal government under the Obama administration discouraged prosecution of people who distribute or use cannabis for medicinal purposes. However, this was rescinded in January of 2018, and federal prosecutors are now encouraged to decide which cases to prosecute.
    Principles of a Medical Marijuana Program (MMP)
    States create their own MMP rules for their jurisdiction. These rules vary from one state to the next. However, there are a few general concepts that exist regardless of the state:
    Health providers do not prescribe the drug
    Physicians certify that the patient has a qualifying condition under state law
    Qualifying conditions and the certifying process are described in each MMP, including the type of healthcare provider that can certify a qualifying condition
    Pharmacies do not dispense medical marijuana products
    Each state gives provisions for dispensaries that can sell the drug to those with a medical marijuana card
    Once a patient has a physician who will certify a qualifying condition, they can register with the MMP and then obtain cannabis from an authorized cannabis dispensary. Administration is generally limited to the patient or their designated caregiver. Some states allow employees of a hospice provider, nurse, or home health aide to act as a designated caregiver.
    Endocannabinoid System Overview
    Did you know that you have a body system named after cannabis? The endocannabinoid system is made up of a series of cannabinoid receptors that lie deep in cell membranes. You have naturally occurring endocannabinoids in your body that trigger this system. Plant substances like marijuana can trigger it as well. Endocannabinoids stimulate your system, promoting balance or homeostasis. The most well-known cannabinoids are tetrahydrocannabinol (THC), cannabidiol, (CBD), and cannabinol (CBN).
    Pharmacology of Cannabis
    Because marijuana remains illegal under federal law, there is a limited amount of research available to help you better understand the use, indication, and dosage of the drug. Placebo-controlled trials that have been done have determined a few conditions that medical marijuana can help. A current list of qualifying conditions include:
    Nausea and vomiting caused by chemotherapy Body wasting related to some severe chronic illnesses Pain caused by cancer or rheumatoid arthritis Chronic pain associated with fibromyalgia Neuropathies resulting from HIV/AIDS, diabetes, or multiple sclerosis (MS) Muscle spasticity from MS or spinal cord injuries As with all drugs, medical marijuana can cause some side effects. However, it’s important to note that a few of the side effects are desired for some patients. For example, if you have a patient who is experiencing weight loss and body wasting, medical marijuana might be prescribed for its ability to increase the appetite. Potential side effects include:
    Sleepiness Rapid heart rate Decreased blood pressure Dry mouth and eyes Increased appetite Hallucinations Paranoia Anxiety Decreased urination Safety Considerations for the Patient
    It’s essential you fully understand your facility policy for patients taking medical marijuana. The only people with the authority to administer the medicine is either the patient or their designated caregiver, so you should not give the drug.
    As with any other medications, medical marijuana must be kept in a locked area out of reach of children and others in the patient's room. Drug disposal should be done following the DEA Disposal Act.
    Approaching the Patient
    Social acceptance of the use of these products is still evolving, and scientific evidence continues to be obtained. Nurses are expected to provide care without personal judgment. Consider your own biases about the use of medical marijuana for pain and other conditions. However, regardless of your personal opinions, you must remain non-judgemental and understanding of the patient’s decision and right to use the drug.
    Have you had any personal experience caring for those with a medical marijuana card? Share your experiences below to get the conversation started.

     
  2. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in Medical Marijuana: Understanding the Six Principles of Essential Knowledge   
    You enter the exam room to get Jane checked in before she sees the Cardiologist for her annual visit. As you’re reviewing her meds, Jane pulls out a medical marijuana card. She tells you that she takes it for chronic pain caused by Fibromyalgia, but that it hasn’t been working quite as well lately. Jane starts asking you questions about dosages and if you think she can increase what she is currently taking. She also tells you that she is getting ready to go on a trip to Kansas to visit a childhood friend and asks if she can take her marijuana with her there. Jane has lots of general questions about how the drug works. You silently think to yourself that you’re not prepared to answer her questions.
    Medical Marijuana Overview
    If you’re not sure what you need to know about medical marijuana and your patients, you’re not alone. As several states continue to develop and pass legislation and others change laws, it can be challenging to stay up-to-date. The National Council of State Boards of Nursing published the National Guidelines for Medical Marijuana. Here are the essentials you need to know when caring for a patient using cannabis or other medical marijuana drugs.
    Current State of Legalization
    Marijuana is currently classified as a Schedule I Controlled Substance by the Drug Enforcement Agency (DEA) which prohibits physicians from prescribing cannabis, pharmacies from dispensing it, and limits the amount of research that can be done about the long term effects and benefits. While the federal government doesn’t provide guidelines for use, many state medical marijuana laws do.
    Currently, thirty-three states and the District of Columbia, Puerto Rico and Guam have comprehensive medical marijuana laws. Another thirteen states allow for the use of low tetrahydrocannabinol (THC), high cannabidiol (CBD) products for medical use. The federal government under the Obama administration discouraged prosecution of people who distribute or use cannabis for medicinal purposes. However, this was rescinded in January of 2018, and federal prosecutors are now encouraged to decide which cases to prosecute.
    Principles of a Medical Marijuana Program (MMP)
    States create their own MMP rules for their jurisdiction. These rules vary from one state to the next. However, there are a few general concepts that exist regardless of the state:
    Health providers do not prescribe the drug
    Physicians certify that the patient has a qualifying condition under state law
    Qualifying conditions and the certifying process are described in each MMP, including the type of healthcare provider that can certify a qualifying condition
    Pharmacies do not dispense medical marijuana products
    Each state gives provisions for dispensaries that can sell the drug to those with a medical marijuana card
    Once a patient has a physician who will certify a qualifying condition, they can register with the MMP and then obtain cannabis from an authorized cannabis dispensary. Administration is generally limited to the patient or their designated caregiver. Some states allow employees of a hospice provider, nurse, or home health aide to act as a designated caregiver.
    Endocannabinoid System Overview
    Did you know that you have a body system named after cannabis? The endocannabinoid system is made up of a series of cannabinoid receptors that lie deep in cell membranes. You have naturally occurring endocannabinoids in your body that trigger this system. Plant substances like marijuana can trigger it as well. Endocannabinoids stimulate your system, promoting balance or homeostasis. The most well-known cannabinoids are tetrahydrocannabinol (THC), cannabidiol, (CBD), and cannabinol (CBN).
    Pharmacology of Cannabis
    Because marijuana remains illegal under federal law, there is a limited amount of research available to help you better understand the use, indication, and dosage of the drug. Placebo-controlled trials that have been done have determined a few conditions that medical marijuana can help. A current list of qualifying conditions include:
    Nausea and vomiting caused by chemotherapy Body wasting related to some severe chronic illnesses Pain caused by cancer or rheumatoid arthritis Chronic pain associated with fibromyalgia Neuropathies resulting from HIV/AIDS, diabetes, or multiple sclerosis (MS) Muscle spasticity from MS or spinal cord injuries As with all drugs, medical marijuana can cause some side effects. However, it’s important to note that a few of the side effects are desired for some patients. For example, if you have a patient who is experiencing weight loss and body wasting, medical marijuana might be prescribed for its ability to increase the appetite. Potential side effects include:
    Sleepiness Rapid heart rate Decreased blood pressure Dry mouth and eyes Increased appetite Hallucinations Paranoia Anxiety Decreased urination Safety Considerations for the Patient
    It’s essential you fully understand your facility policy for patients taking medical marijuana. The only people with the authority to administer the medicine is either the patient or their designated caregiver, so you should not give the drug.
    As with any other medications, medical marijuana must be kept in a locked area out of reach of children and others in the patient's room. Drug disposal should be done following the DEA Disposal Act.
    Approaching the Patient
    Social acceptance of the use of these products is still evolving, and scientific evidence continues to be obtained. Nurses are expected to provide care without personal judgment. Consider your own biases about the use of medical marijuana for pain and other conditions. However, regardless of your personal opinions, you must remain non-judgemental and understanding of the patient’s decision and right to use the drug.
    Have you had any personal experience caring for those with a medical marijuana card? Share your experiences below to get the conversation started.

     
  3. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in Medical Marijuana: Understanding the Six Principles of Essential Knowledge   
    You enter the exam room to get Jane checked in before she sees the Cardiologist for her annual visit. As you’re reviewing her meds, Jane pulls out a medical marijuana card. She tells you that she takes it for chronic pain caused by Fibromyalgia, but that it hasn’t been working quite as well lately. Jane starts asking you questions about dosages and if you think she can increase what she is currently taking. She also tells you that she is getting ready to go on a trip to Kansas to visit a childhood friend and asks if she can take her marijuana with her there. Jane has lots of general questions about how the drug works. You silently think to yourself that you’re not prepared to answer her questions.
    Medical Marijuana Overview
    If you’re not sure what you need to know about medical marijuana and your patients, you’re not alone. As several states continue to develop and pass legislation and others change laws, it can be challenging to stay up-to-date. The National Council of State Boards of Nursing published the National Guidelines for Medical Marijuana. Here are the essentials you need to know when caring for a patient using cannabis or other medical marijuana drugs.
    Current State of Legalization
    Marijuana is currently classified as a Schedule I Controlled Substance by the Drug Enforcement Agency (DEA) which prohibits physicians from prescribing cannabis, pharmacies from dispensing it, and limits the amount of research that can be done about the long term effects and benefits. While the federal government doesn’t provide guidelines for use, many state medical marijuana laws do.
    Currently, thirty-three states and the District of Columbia, Puerto Rico and Guam have comprehensive medical marijuana laws. Another thirteen states allow for the use of low tetrahydrocannabinol (THC), high cannabidiol (CBD) products for medical use. The federal government under the Obama administration discouraged prosecution of people who distribute or use cannabis for medicinal purposes. However, this was rescinded in January of 2018, and federal prosecutors are now encouraged to decide which cases to prosecute.
    Principles of a Medical Marijuana Program (MMP)
    States create their own MMP rules for their jurisdiction. These rules vary from one state to the next. However, there are a few general concepts that exist regardless of the state:
    Health providers do not prescribe the drug
    Physicians certify that the patient has a qualifying condition under state law
    Qualifying conditions and the certifying process are described in each MMP, including the type of healthcare provider that can certify a qualifying condition
    Pharmacies do not dispense medical marijuana products
    Each state gives provisions for dispensaries that can sell the drug to those with a medical marijuana card
    Once a patient has a physician who will certify a qualifying condition, they can register with the MMP and then obtain cannabis from an authorized cannabis dispensary. Administration is generally limited to the patient or their designated caregiver. Some states allow employees of a hospice provider, nurse, or home health aide to act as a designated caregiver.
    Endocannabinoid System Overview
    Did you know that you have a body system named after cannabis? The endocannabinoid system is made up of a series of cannabinoid receptors that lie deep in cell membranes. You have naturally occurring endocannabinoids in your body that trigger this system. Plant substances like marijuana can trigger it as well. Endocannabinoids stimulate your system, promoting balance or homeostasis. The most well-known cannabinoids are tetrahydrocannabinol (THC), cannabidiol, (CBD), and cannabinol (CBN).
    Pharmacology of Cannabis
    Because marijuana remains illegal under federal law, there is a limited amount of research available to help you better understand the use, indication, and dosage of the drug. Placebo-controlled trials that have been done have determined a few conditions that medical marijuana can help. A current list of qualifying conditions include:
    Nausea and vomiting caused by chemotherapy Body wasting related to some severe chronic illnesses Pain caused by cancer or rheumatoid arthritis Chronic pain associated with fibromyalgia Neuropathies resulting from HIV/AIDS, diabetes, or multiple sclerosis (MS) Muscle spasticity from MS or spinal cord injuries As with all drugs, medical marijuana can cause some side effects. However, it’s important to note that a few of the side effects are desired for some patients. For example, if you have a patient who is experiencing weight loss and body wasting, medical marijuana might be prescribed for its ability to increase the appetite. Potential side effects include:
    Sleepiness Rapid heart rate Decreased blood pressure Dry mouth and eyes Increased appetite Hallucinations Paranoia Anxiety Decreased urination Safety Considerations for the Patient
    It’s essential you fully understand your facility policy for patients taking medical marijuana. The only people with the authority to administer the medicine is either the patient or their designated caregiver, so you should not give the drug.
    As with any other medications, medical marijuana must be kept in a locked area out of reach of children and others in the patient's room. Drug disposal should be done following the DEA Disposal Act.
    Approaching the Patient
    Social acceptance of the use of these products is still evolving, and scientific evidence continues to be obtained. Nurses are expected to provide care without personal judgment. Consider your own biases about the use of medical marijuana for pain and other conditions. However, regardless of your personal opinions, you must remain non-judgemental and understanding of the patient’s decision and right to use the drug.
    Have you had any personal experience caring for those with a medical marijuana card? Share your experiences below to get the conversation started.

     
  4. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in Medical Marijuana: Understanding the Six Principles of Essential Knowledge   
    You enter the exam room to get Jane checked in before she sees the Cardiologist for her annual visit. As you’re reviewing her meds, Jane pulls out a medical marijuana card. She tells you that she takes it for chronic pain caused by Fibromyalgia, but that it hasn’t been working quite as well lately. Jane starts asking you questions about dosages and if you think she can increase what she is currently taking. She also tells you that she is getting ready to go on a trip to Kansas to visit a childhood friend and asks if she can take her marijuana with her there. Jane has lots of general questions about how the drug works. You silently think to yourself that you’re not prepared to answer her questions.
    Medical Marijuana Overview
    If you’re not sure what you need to know about medical marijuana and your patients, you’re not alone. As several states continue to develop and pass legislation and others change laws, it can be challenging to stay up-to-date. The National Council of State Boards of Nursing published the National Guidelines for Medical Marijuana. Here are the essentials you need to know when caring for a patient using cannabis or other medical marijuana drugs.
    Current State of Legalization
    Marijuana is currently classified as a Schedule I Controlled Substance by the Drug Enforcement Agency (DEA) which prohibits physicians from prescribing cannabis, pharmacies from dispensing it, and limits the amount of research that can be done about the long term effects and benefits. While the federal government doesn’t provide guidelines for use, many state medical marijuana laws do.
    Currently, thirty-three states and the District of Columbia, Puerto Rico and Guam have comprehensive medical marijuana laws. Another thirteen states allow for the use of low tetrahydrocannabinol (THC), high cannabidiol (CBD) products for medical use. The federal government under the Obama administration discouraged prosecution of people who distribute or use cannabis for medicinal purposes. However, this was rescinded in January of 2018, and federal prosecutors are now encouraged to decide which cases to prosecute.
    Principles of a Medical Marijuana Program (MMP)
    States create their own MMP rules for their jurisdiction. These rules vary from one state to the next. However, there are a few general concepts that exist regardless of the state:
    Health providers do not prescribe the drug
    Physicians certify that the patient has a qualifying condition under state law
    Qualifying conditions and the certifying process are described in each MMP, including the type of healthcare provider that can certify a qualifying condition
    Pharmacies do not dispense medical marijuana products
    Each state gives provisions for dispensaries that can sell the drug to those with a medical marijuana card
    Once a patient has a physician who will certify a qualifying condition, they can register with the MMP and then obtain cannabis from an authorized cannabis dispensary. Administration is generally limited to the patient or their designated caregiver. Some states allow employees of a hospice provider, nurse, or home health aide to act as a designated caregiver.
    Endocannabinoid System Overview
    Did you know that you have a body system named after cannabis? The endocannabinoid system is made up of a series of cannabinoid receptors that lie deep in cell membranes. You have naturally occurring endocannabinoids in your body that trigger this system. Plant substances like marijuana can trigger it as well. Endocannabinoids stimulate your system, promoting balance or homeostasis. The most well-known cannabinoids are tetrahydrocannabinol (THC), cannabidiol, (CBD), and cannabinol (CBN).
    Pharmacology of Cannabis
    Because marijuana remains illegal under federal law, there is a limited amount of research available to help you better understand the use, indication, and dosage of the drug. Placebo-controlled trials that have been done have determined a few conditions that medical marijuana can help. A current list of qualifying conditions include:
    Nausea and vomiting caused by chemotherapy Body wasting related to some severe chronic illnesses Pain caused by cancer or rheumatoid arthritis Chronic pain associated with fibromyalgia Neuropathies resulting from HIV/AIDS, diabetes, or multiple sclerosis (MS) Muscle spasticity from MS or spinal cord injuries As with all drugs, medical marijuana can cause some side effects. However, it’s important to note that a few of the side effects are desired for some patients. For example, if you have a patient who is experiencing weight loss and body wasting, medical marijuana might be prescribed for its ability to increase the appetite. Potential side effects include:
    Sleepiness Rapid heart rate Decreased blood pressure Dry mouth and eyes Increased appetite Hallucinations Paranoia Anxiety Decreased urination Safety Considerations for the Patient
    It’s essential you fully understand your facility policy for patients taking medical marijuana. The only people with the authority to administer the medicine is either the patient or their designated caregiver, so you should not give the drug.
    As with any other medications, medical marijuana must be kept in a locked area out of reach of children and others in the patient's room. Drug disposal should be done following the DEA Disposal Act.
    Approaching the Patient
    Social acceptance of the use of these products is still evolving, and scientific evidence continues to be obtained. Nurses are expected to provide care without personal judgment. Consider your own biases about the use of medical marijuana for pain and other conditions. However, regardless of your personal opinions, you must remain non-judgemental and understanding of the patient’s decision and right to use the drug.
    Have you had any personal experience caring for those with a medical marijuana card? Share your experiences below to get the conversation started.

     
  5. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in Medical Marijuana: Understanding the Six Principles of Essential Knowledge   
    You enter the exam room to get Jane checked in before she sees the Cardiologist for her annual visit. As you’re reviewing her meds, Jane pulls out a medical marijuana card. She tells you that she takes it for chronic pain caused by Fibromyalgia, but that it hasn’t been working quite as well lately. Jane starts asking you questions about dosages and if you think she can increase what she is currently taking. She also tells you that she is getting ready to go on a trip to Kansas to visit a childhood friend and asks if she can take her marijuana with her there. Jane has lots of general questions about how the drug works. You silently think to yourself that you’re not prepared to answer her questions.
    Medical Marijuana Overview
    If you’re not sure what you need to know about medical marijuana and your patients, you’re not alone. As several states continue to develop and pass legislation and others change laws, it can be challenging to stay up-to-date. The National Council of State Boards of Nursing published the National Guidelines for Medical Marijuana. Here are the essentials you need to know when caring for a patient using cannabis or other medical marijuana drugs.
    Current State of Legalization
    Marijuana is currently classified as a Schedule I Controlled Substance by the Drug Enforcement Agency (DEA) which prohibits physicians from prescribing cannabis, pharmacies from dispensing it, and limits the amount of research that can be done about the long term effects and benefits. While the federal government doesn’t provide guidelines for use, many state medical marijuana laws do.
    Currently, thirty-three states and the District of Columbia, Puerto Rico and Guam have comprehensive medical marijuana laws. Another thirteen states allow for the use of low tetrahydrocannabinol (THC), high cannabidiol (CBD) products for medical use. The federal government under the Obama administration discouraged prosecution of people who distribute or use cannabis for medicinal purposes. However, this was rescinded in January of 2018, and federal prosecutors are now encouraged to decide which cases to prosecute.
    Principles of a Medical Marijuana Program (MMP)
    States create their own MMP rules for their jurisdiction. These rules vary from one state to the next. However, there are a few general concepts that exist regardless of the state:
    Health providers do not prescribe the drug
    Physicians certify that the patient has a qualifying condition under state law
    Qualifying conditions and the certifying process are described in each MMP, including the type of healthcare provider that can certify a qualifying condition
    Pharmacies do not dispense medical marijuana products
    Each state gives provisions for dispensaries that can sell the drug to those with a medical marijuana card
    Once a patient has a physician who will certify a qualifying condition, they can register with the MMP and then obtain cannabis from an authorized cannabis dispensary. Administration is generally limited to the patient or their designated caregiver. Some states allow employees of a hospice provider, nurse, or home health aide to act as a designated caregiver.
    Endocannabinoid System Overview
    Did you know that you have a body system named after cannabis? The endocannabinoid system is made up of a series of cannabinoid receptors that lie deep in cell membranes. You have naturally occurring endocannabinoids in your body that trigger this system. Plant substances like marijuana can trigger it as well. Endocannabinoids stimulate your system, promoting balance or homeostasis. The most well-known cannabinoids are tetrahydrocannabinol (THC), cannabidiol, (CBD), and cannabinol (CBN).
    Pharmacology of Cannabis
    Because marijuana remains illegal under federal law, there is a limited amount of research available to help you better understand the use, indication, and dosage of the drug. Placebo-controlled trials that have been done have determined a few conditions that medical marijuana can help. A current list of qualifying conditions include:
    Nausea and vomiting caused by chemotherapy Body wasting related to some severe chronic illnesses Pain caused by cancer or rheumatoid arthritis Chronic pain associated with fibromyalgia Neuropathies resulting from HIV/AIDS, diabetes, or multiple sclerosis (MS) Muscle spasticity from MS or spinal cord injuries As with all drugs, medical marijuana can cause some side effects. However, it’s important to note that a few of the side effects are desired for some patients. For example, if you have a patient who is experiencing weight loss and body wasting, medical marijuana might be prescribed for its ability to increase the appetite. Potential side effects include:
    Sleepiness Rapid heart rate Decreased blood pressure Dry mouth and eyes Increased appetite Hallucinations Paranoia Anxiety Decreased urination Safety Considerations for the Patient
    It’s essential you fully understand your facility policy for patients taking medical marijuana. The only people with the authority to administer the medicine is either the patient or their designated caregiver, so you should not give the drug.
    As with any other medications, medical marijuana must be kept in a locked area out of reach of children and others in the patient's room. Drug disposal should be done following the DEA Disposal Act.
    Approaching the Patient
    Social acceptance of the use of these products is still evolving, and scientific evidence continues to be obtained. Nurses are expected to provide care without personal judgment. Consider your own biases about the use of medical marijuana for pain and other conditions. However, regardless of your personal opinions, you must remain non-judgemental and understanding of the patient’s decision and right to use the drug.
    Have you had any personal experience caring for those with a medical marijuana card? Share your experiences below to get the conversation started.

     
  6. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in Medical Marijuana: Understanding the Six Principles of Essential Knowledge   
    You enter the exam room to get Jane checked in before she sees the Cardiologist for her annual visit. As you’re reviewing her meds, Jane pulls out a medical marijuana card. She tells you that she takes it for chronic pain caused by Fibromyalgia, but that it hasn’t been working quite as well lately. Jane starts asking you questions about dosages and if you think she can increase what she is currently taking. She also tells you that she is getting ready to go on a trip to Kansas to visit a childhood friend and asks if she can take her marijuana with her there. Jane has lots of general questions about how the drug works. You silently think to yourself that you’re not prepared to answer her questions.
    Medical Marijuana Overview
    If you’re not sure what you need to know about medical marijuana and your patients, you’re not alone. As several states continue to develop and pass legislation and others change laws, it can be challenging to stay up-to-date. The National Council of State Boards of Nursing published the National Guidelines for Medical Marijuana. Here are the essentials you need to know when caring for a patient using cannabis or other medical marijuana drugs.
    Current State of Legalization
    Marijuana is currently classified as a Schedule I Controlled Substance by the Drug Enforcement Agency (DEA) which prohibits physicians from prescribing cannabis, pharmacies from dispensing it, and limits the amount of research that can be done about the long term effects and benefits. While the federal government doesn’t provide guidelines for use, many state medical marijuana laws do.
    Currently, thirty-three states and the District of Columbia, Puerto Rico and Guam have comprehensive medical marijuana laws. Another thirteen states allow for the use of low tetrahydrocannabinol (THC), high cannabidiol (CBD) products for medical use. The federal government under the Obama administration discouraged prosecution of people who distribute or use cannabis for medicinal purposes. However, this was rescinded in January of 2018, and federal prosecutors are now encouraged to decide which cases to prosecute.
    Principles of a Medical Marijuana Program (MMP)
    States create their own MMP rules for their jurisdiction. These rules vary from one state to the next. However, there are a few general concepts that exist regardless of the state:
    Health providers do not prescribe the drug
    Physicians certify that the patient has a qualifying condition under state law
    Qualifying conditions and the certifying process are described in each MMP, including the type of healthcare provider that can certify a qualifying condition
    Pharmacies do not dispense medical marijuana products
    Each state gives provisions for dispensaries that can sell the drug to those with a medical marijuana card
    Once a patient has a physician who will certify a qualifying condition, they can register with the MMP and then obtain cannabis from an authorized cannabis dispensary. Administration is generally limited to the patient or their designated caregiver. Some states allow employees of a hospice provider, nurse, or home health aide to act as a designated caregiver.
    Endocannabinoid System Overview
    Did you know that you have a body system named after cannabis? The endocannabinoid system is made up of a series of cannabinoid receptors that lie deep in cell membranes. You have naturally occurring endocannabinoids in your body that trigger this system. Plant substances like marijuana can trigger it as well. Endocannabinoids stimulate your system, promoting balance or homeostasis. The most well-known cannabinoids are tetrahydrocannabinol (THC), cannabidiol, (CBD), and cannabinol (CBN).
    Pharmacology of Cannabis
    Because marijuana remains illegal under federal law, there is a limited amount of research available to help you better understand the use, indication, and dosage of the drug. Placebo-controlled trials that have been done have determined a few conditions that medical marijuana can help. A current list of qualifying conditions include:
    Nausea and vomiting caused by chemotherapy Body wasting related to some severe chronic illnesses Pain caused by cancer or rheumatoid arthritis Chronic pain associated with fibromyalgia Neuropathies resulting from HIV/AIDS, diabetes, or multiple sclerosis (MS) Muscle spasticity from MS or spinal cord injuries As with all drugs, medical marijuana can cause some side effects. However, it’s important to note that a few of the side effects are desired for some patients. For example, if you have a patient who is experiencing weight loss and body wasting, medical marijuana might be prescribed for its ability to increase the appetite. Potential side effects include:
    Sleepiness Rapid heart rate Decreased blood pressure Dry mouth and eyes Increased appetite Hallucinations Paranoia Anxiety Decreased urination Safety Considerations for the Patient
    It’s essential you fully understand your facility policy for patients taking medical marijuana. The only people with the authority to administer the medicine is either the patient or their designated caregiver, so you should not give the drug.
    As with any other medications, medical marijuana must be kept in a locked area out of reach of children and others in the patient's room. Drug disposal should be done following the DEA Disposal Act.
    Approaching the Patient
    Social acceptance of the use of these products is still evolving, and scientific evidence continues to be obtained. Nurses are expected to provide care without personal judgment. Consider your own biases about the use of medical marijuana for pain and other conditions. However, regardless of your personal opinions, you must remain non-judgemental and understanding of the patient’s decision and right to use the drug.
    Have you had any personal experience caring for those with a medical marijuana card? Share your experiences below to get the conversation started.

     
  7. Like
    Melissa Mills, BSN reacted to Libby1987 in The Essentials of Medication Reconciliation in Home Care   
    Thank you for discussing such an important topic.
    Perhaps it’s implied but it seems some steps are missing.  This is how I reconcile medications:
    Gather all meds in home. 
    Verify which meds patient has been taking since last medical encounter. (ie since home from hosptial)
    Compare these meds against most recent MD ordered list of medications. (ie discharge instructions)
    Note any discrepancies, notify MD and correct with changing, adding and/or omitting as indicated  
    Have patient/CG teach back reconciled list and identify container and how to take.  
    Request/suggest how to safely set up/organization/storage of meds if needed (ie remove discontinued meds and store elsewhere, correct mediplanner)
    Leave legible med schedule written in layman terms with patient. 
    Follow up for understanding and compliance next visit. 
  8. Like
    Melissa Mills, BSN got a reaction from Kaisu in The Essentials of Medication Reconciliation in Home Care   
    I agree with you completely, Kaisu. I think where we often run into problems as a nurse is having the time to dedicate the time to reconciliation that it needs truly.  When you do have that patient who shows up with meds in a bag that should have been tossed years ago - it can take a significant amount of time in the home and then you still need to call each prescriber and clarify what the patient should be taking. But, when you know, you have five more patients to see and 50 miles of ground to cover - this process can get pushed to the side. 
     
    Thanks for sharing your thoughts!!
  9. Like
    Melissa Mills, BSN reacted to Lane Therrell FNP, MSN, RN in What I Wish I’d Known About Continuing Education: Know Your Requirements [Part 1 of 3]   
    I recently renewed my family nurse practitioner credential (FNP-BC) for the first time since successfully sitting for the American Nurses Credentialing Center (ANCC) national board certification exam 5 years ago. I’ve always loved the idea of lifelong learning, and while I have benefited from leveraging continuing education to enhance my professional development, I’ll admit I’ve been frustrated with the level of detail and complexity involved in maintaining my professional credentials.
    While reflecting on what I can do, moving forward, to streamline my own overall license and credential renewal process, I came up with a list of things I wish someone had told me about continuing education and maintaining my professional licenses and credentials.
    Maintaining those hard-earned professional licenses and credentials requires a bit more than just taking a bunch of continuing education courses (CEs)—you’ll need to develop strategies and tactics for yourself in three categories: 1) knowing your renewal requirements; 2) managing your time and money; and 3) maintaining accurate records.
    In this first article of a 3-part series, I’ll share my view on why knowing your continuing education requirements is more complex than it seems on the surface. Requirements can change, certain CEs may not be recognized at all or in full, and not all types of CE credits convert to the number of hours you may expect. The complexity intensifies when you hold multiple licenses and credentials.
    Requirements Change
    You already know that continuing education and license renewal requirements vary by state, type of license, and credential. But did you know that your continuing education and certification renewal requirements are likely to change over time? Yes, credentialing bodies are constantly reviewing and revising their renewal criteria.
    It’s up to you to stay on top of these changes. First, be sure to get your information straight from the credentialing agency instead of relying on world-of-mouth information. Don’t depend on what your professors told you, what your classmates said, or what your colleagues discussed in the break room. Use what you’ve heard as a launching pad to conduct your own research: Go to the source and see it for yourself in writing.
    Second, build an ongoing plan for staying aware of changes. This means checking in with your licensing or credentialing organization periodically. Professional organizations can provide a gateway to finding out about these changes. Another way is to bookmark your credentialing bodies’ renewal criteria pages and check them routinely. Of course, this doesn’t work unless you actually remember to go and check the sites. I was amazed at how many of the criteria for my FNP board certification changed significantly during my 5-year renewal period.
    Know What Counts
    Not every continuing education activity you do will count for every license or credential renewal requirement you need to fulfill. (I know, right?!) Ideally, any continuing education credit you earn would be applicable cross the board, but that’s not always the case.
    Some CEs may not be recognized in full or at all by every credentialing agency. For example, the ANCC only recognizes 50 percent of the credit earned from providers not approved by the ANCC, and the California Board of Registered Nursing (CA BRN) only recognizes CE earned through CA BRN-approved providers. So, if I earn CE credits from a provider that is not recognized by the ANCC or the CA BRN, only half of those hours will count toward renewal of my FNP-BC, and none those hours will not count toward renewal of my state licenses.
    Conclusion? Before I enroll in a CE opportunity, I check to see if the provider is honored by the ANCC and the CA BRN. Being aware of this ahead of time helps me make savvy CE choices, and keeps me from being disappointed, frustrated, or panicked at renewal time.
    Some credentialing bodies allow professional activities other than CE courses to count toward license and/or credential renewal. For example, hours spent in clinical practice, precepting students, volunteering, making presentations, earning an advanced degree, or doing research can all count toward renewing my FNP-BC board certification if documented correctly. But, unfortunately, none of those things except taking academic nursing courses would count toward renewing my CA RN license.
    Knowing your requirements also means paying attention to the specific subject matter covered in the CE opportunity. For example, I need 75 continuing education hours every 5 years to renew my FNP board certification through ANCC and 25 of those must be specific for pharmacology. With this kind of specificity, the key is to make sure I earn enough pharmacology-specific hours to meet the pharmacology requirement. This can be tricky to track because some CE courses offer only a portion of the total hours as pharmacology-specific. For example, a CE course may offer 2 hours of total credit, but only 0.5 hours of that time counts as pharm-specific.
    Do The Math
    Closely related to the idea that not every CE credit you earn will count toward the renewal of every license or credential you hold, is the idea that the credits themselves are counted differently depending on who’s providing and who’s counting. The takeaway is: Know how ahead of time how each of your particular credentialing bodies recognizes, calculates, and converts CE hours.
    Admittedly, counting CE hours can be confusing. Descriptive words are a tip-off to how the calculations may vary. Various providers offer “contact hours,” “continuing education units (CEUs),” or “continuing medical education (CME).”  Words matter because they are not all calculated or recognized the same way. The ANCC offers a conversion formula: 1 contact hour = 1 CME or 0.1 CEU or 60 minutes; 1 CEU = 10 contact hours. Make sure you know the conversion formula that is being used by your credentialing body.
    Be aware that any algorithms embedded in online renewal or CE tracking applications should include consistent conversion calculations, but they may not always be accurate. The bottom line: Do your own math and double-check it. Being aware of this and knowing how to count your credits will help you decide which CE opportunities are right for you and prevent the worst-case scenarios of coming up short at renewal time or during an audit.
    Ultimately, continuing education benefits both you and the patients you serve. However, I wish someone had told me, back in the day, that “knowing your requirements” involves in-depth proactive thought and planning, especially when you hold multiple licenses and credentials. My intention in sharing this is to help you streamline your own personal continuing education strategy.
    In Part 2, I’ll share my thoughts managing your time and money to keep continuing education from breaking the bank.
    Meanwhile, here’s a question: What do you wish you’d known about continuing education before you embarked on the adventure yourself?
    Sources and Resources
    5 Reasons to Invest in Continuing Education
    ANCC 2017 Certification Renewal Requirements
    Continuing Education for License Renewal
    Lifelong Learning
  10. Like
    Melissa Mills, BSN reacted to Lane Therrell FNP, MSN, RN in 5 Reasons to Invest in Your Continuing Education   
    Continuing education allowed me to acquire a specialty certification while simultaneously meeting the requirements of maintaining my state licensure. I've always loved the idea of lifelong learning. 
  11. Like
    Melissa Mills, BSN reacted to Susie2310 in 5 Reasons to Invest in Your Continuing Education   
    I agree with this completely; changes in medicine and nursing happen frequently and it is important for nurses to keep up with changes in medicine and nursing that affect their practice. One example that comes to mind is revisions to ACLS guidelines and treatment of patients with ACS.
  12. Like
    Melissa Mills, BSN reacted to traumaRUs, MSN, APRN in 5 Reasons to Invest in Your Continuing Education   
    Cont ed is so very important. Medicine and nursing change so quickly - what was once standard practice only 2-3 years ago is now obsolete. 
    As a provider with two certs, I have to have 150 hours of CME to re-certify and they must all be related to my practice. This is important to keep my practice current. 
    Great article - thanks. 
  13. Like
    Melissa Mills, BSN reacted to Nightshade1972 in The Essentials of Medication Reconciliation in Home Care   
    I'm reminded of one of my MIL's hospital visits.  My inlaws lived alone, confident they could take care of themselves.  My wife would visit every weekend, usually Saturday.  Sometimes I'd come, sometimes not. 
    Anyway, MIL reached a point where she was sleeping more than she was awake, and "awake" consisted of her being very groggy and not with-it mentally.  Despite our urging, that didn't get addressed until she had to be hospitalized.  She usually went to Hospital A, closest to their house.  That hospital was full, so they sent her to Hospital B, closest to our house.  The staff at B looked at her meds list and were dumbfounded.  Multiple instances of Dr. A prescribing coumadin, Dr. B prescribing warfarin, and my MIL took both because my inlaws didn't have the medical sophistication to recognize a problem, and apparently their pharmacist never caught it.  Hospital B, as I said, were horrified when they realized what was happening.  They immediately eliminated half her meds, and severely cut the dosage on the other half.  They sent her home a few days later, with very strict instructions to follow the new dosing regimen.
    The very first thing she said when we got her home, after looking at the new dosing regimen, was, "I wonder if I should go back to taking all my old meds? The new doctors at Hospital B wanted me to change everything, I don't want the doctors at Hospital A to be mad!" It took all three of us a great deal of effort to convince her to follow the new medication regimen prescribed by Hospital B.
  14. Like
    Melissa Mills, BSN reacted to Kaisu in The Essentials of Medication Reconciliation in Home Care   
    Critical part of the admission process.  I believe medication issues are a major reason for hospital readmission and/or patient harm and a prime teaching opportunity.  I have taken out literally bucket fulls of medications from some homes.  It is one of the best ways to do good and potentially save a life.  
  15. Like
    Melissa Mills, BSN reacted to TAKOO01 in The Essentials of Medication Reconciliation in Home Care   
    Nice article. Med reconciliation was one of the best parts of home care. As you say, there are annoying parts, like multiple calls to providers and convincing people to keep meds in labelled containers. But its a great feeling to have everything straightened out. There is nothing better than going back for the revisit and seeing the patient doind much batter after interactions, duplicates, expireds and mislabels have been addressed.
  16. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in The Essentials of Medication Reconciliation in Home Care   
    You enter the home of Mrs. Jones to do her start-of-care OASIS assessment. You chit-chat with her before diving into your nursing care. She tells you that she was just released from the local hospital yesterday. She was admitted three days prior for a respiratory infection and exacerbation of her COPD. While in the hospital they started her on steroids, which increased her blood sugar. She tells you that she’s not even sure what medications she is supposed to be taking any more.
    As you get out your stethoscope and other necessary equipment, you ask Mrs. Jones to gather the pill bottles of all of her medications -prescription and nonprescription -  that she is currently taking. She shuffles off to the next room and comes back holding a box of pills that date back to the Obama administration. You silently ask yourself where you even start.
    You pull up the discharge papers to see what medications the hospital instructed Mrs. Jones to take. However, when you compare this to what she hands you in the box - it’s almost an entirely different list.
    Every home health nurse has experienced some version of this scenario. Transitions of care provide many opportunities for medication discrepancies. In fact, a 2014 study published in the Lippincott Nursing Center reports that up to 94% of patients transitioning from the hospital to home care experience at least one medication discrepancy. To combat these issues, all patients being admitted to home care services must have a thorough drug regimen review and medication reconciliation.
    What is Medication Reconciliation and Why is it Important?
    Medication reconciliation is the act of identifying the most accurate list of all medications a patient is taking. The list should include the name of the drug, current dose, frequency, and the route of administration. This list of medications must be shared with the primary physician to ensure that the patient is taking the correct medications per physicians orders.
    Patients are living at home longer than ever before and managing multiple chronic illnesses. Many times, this means they are on several medications and require frequent titrations or drug regimen changes. Without proper medication administration patients are at risk of exacerbations of their health conditions, admissions to the hospital, and even death.
    According to the Centers for Disease Control and Prevention (CDC), 3.8 billion prescriptions are written each year in the United States. One of every five new prescriptions are never filled, and of the ones filled, only about 50% are taken correctly. Non-adherence to medication regimens results in approximately 125,000 deaths due to cardiovascular disease each year. It’s also estimated that about 23% of nursing home admissions and 10% of hospital admissions could be avoided if patients took their medicines as directed.
    Because many home care admissions happen directly after discharge from a hospital or other inpatient facility, the risk of medication non-adherence is high. Home care nurses are in an ideal position to help patients get on the right track with their medications following discharge. Assisting patients with their medications starts with reconciliation.  
    Reconciliation: A Three-step Process
    To complete a thorough medication reconciliation process, you need to follow this three-step process. While it might seem simplistic, in home care many times, this process can take a few days and several phone calls to get straight. The diligence of home care nursing staff is essential when rectifying medications with one or more providers.
    Verify the List of Medications
    In the story above, you took the first step to verifying Mrs. Jones medications. By asking the patient to bring you the bottles of all prescription and non-prescription medicines they take, you’re initiating the process of obtaining the most accurate list.
    Be sure to specifically ask for non-prescription medications like headache relief pills, vitamins, and other supplements as some of these drugs can interact with other medications they might be taking. Elderly patients might not consider vitamins or herbs as part of their “medications,” so be specific that you want to see everything they take.
    Clarify the List
    Once you’ve created a comprehensive list of all medications the patient is taking, you need to check for any possible drug issues. Pay particular attention to:
    Duplicate Drug Therapies - Some patients require multiple prescriptions for the same condition. This can place them at an increased risk of experiencing severe side effects. It’s critical that you note examples of duplicate drug therapies and how it might be affecting the patient during your assessment.
    For example, if you’re performing medication reconciliation and notice that a patient is on three pills for high blood pressure, you want to dig a bit deeper. Some patients need this type of duplication in therapies to get a combination effect. However, if your patient tells you that they were put on the medication three years ago and since then have lost 60 pounds and that they experience dizziness with position changes - you’re going to want to communicate this with the care provider right away.  
    Potential for Interactions - Most electronic medical records have a built-in medication interaction checker. If you don’t have an electronic documentation system, you can use an online drug interaction checker like those found on Drugs.com or Rxlist.com.
    Enter all of the medications and check for adverse, major, moderate, and minor drug interactions. Educate the patient on the signs of a drug interaction and what to do if they think they are having one. You need to communicate any potential serious interactions with the prescribing and primary physicians, too.
    Reconcile the Medications
    Once you have a comprehensive list, it’s time to reconcile. If there are no duplications or potential drug interactions, the list can be sent to the physician usually via fax. However, if you identify any potential issues you need to notify the physician within 24 hours of finding the problem and have it resolved. This means that the doctor needs to respond to you so that you have an accurate list of medications for the patient.
    If you fax or email this communication to the provider, be sure to communicate clearly and concisely what you need from the physician. For example, instead of sending a list of meds and expecting the physician to find the potential issues, send the list and then add in a few bulleted items that clearly state what the problem is and what you need from the doctor or their staff.
    Fulfilling Your Essential Role
    The role of the home health nurse is crucial for the health and wellness of their patients. You might be the only person who is taking the time to review medications and answer questions for your patient about their medication regimen. Take the time to do a thorough medication reconciliation with every OASIS visit to keep your patients on the path to health.
  17. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in 5 Reasons to Invest in Your Continuing Education   
    Continuing education - these two words either excite you or send you into a state of boredom-induced slumber unmatched by pretty much anything else in life. Nurses are required to complete continuing education to maintain their licensure. However, experts tell us that there are more significant benefits to continuing education than just keeping our ability to practice the craft of nursing.
    Here are a few reasons you should spend your time and money investing in your future.
    Maintaining Licensure
    Every state in the U.S. has a different set of expectations for nurse continuing education requirements. Some states mandate a certain number of continuing education. Others have specific courses or topics they require to address issues that happen in the state, such as child abuse, domestic violence, or laws governing your practice.
    Providers of continuing education courses must meet specific rules to ensure that information is current and meets laws and nursing practice as it changes. This safeguards you from completing materials today that was outdated years ago. Be sure your up to date on what you need to know about nursing licensure.
    Improving Safety
    Your patients expect to be safe when in your care. No one wants to be responsible for adverse drug events, falls, or other unsafe patient situations. While it is impossible to eliminate errors altogether, it should still be your goal.
    When nurses participate in continuing education that focuses on best-practices, patient-centered care, and safety prevention - errors lessen and patient satisfaction increases.
    Fostering a culture of lifelong learning in nursing is one of the pivotal practices that keep patients safe. In fact, when the 1999 To Err is Human: Building a Safer Healthcare System was published by the Institute of Medicine (IOM), it showcased some scary numbers about patient safety:
    Up to 98,000 patients die each year due to preventable medical errors Medical errors cost up to $29 billion each year nationwide You might think that the IOM would have been looking for high-tech ways to rectify these numbers. The Robert Wood Johnson Foundation and the IOM joined forces to establish eight recommendations with goals for the next 20 years. Half of the strategies created to fix the issues found were based solidly in education. The four learning strategies included implementing nurse residency programs, increasing the percentage of nurses with a baccalaureate degree, doubling the number of nurses with a doctorate, and engaging nurses in lifelong learning.
    I believe that this study illustrates the strength of continuing education in nursing. When nurses are empowered to increase their own understanding of the profession, patients are safer and more satisfied with their care.
    Meeting Certification Requirements
    Have you considered becoming certified in a nursing specialty? Accrediting bodies often have their own requirements you must meet to maintain your certification. You might need to complete courses on specific topics or areas to achieve the necessary requirements.
    For example, if you’re like me and have a certification in Case Management, you’ll need to show that you’ve completed 80 hours of approved continuing education specific to being a case manager. Many courses will meet the requirements you need for your certification while also keeping you compliant with your state board of nursing.
    Gaining New Skills and Meeting Changes
    Healthcare is becoming more innovative every day. From new drugs and treatments to the use of artificial intelligence and virtual reality, there’s so much to learn. Instead of waiting for hands-on training opportunities to come to you on the job, consider enrolling in a CE course that provides an overview of skills you know you’re going to need.
    It’s essential to remember that not all new skills are technical. While learning how to use equipment or how to assess for specific diseases is necessary, sometimes the skills you need most are interpersonal. If you’re struggling at work with communication, time management, or you’re considering moving up the career ladder, there are courses to help you gain the knowledge you need.
    Advancing Your Career
    Whether you’re considering certification, returning to school, or just want to stay up on the latest research - all of this learning will help to advance your career. Continuing education is an excellent place to start if you’re considering changing your specialty. You can choose a few courses to take to learn the basics of just about any nursing niche out there so that you can find out if it might be right for you.
    Continuing education might be mandated. However, if you can flip the script on how you approach continuing education requirements you might find that there are many reasons to invest in your professional development.
    How you do feel about mandated continuing education? Do you enjoy it or do you just complete it because it’s required to maintain your certification?
  18. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in The Essentials of Medication Reconciliation in Home Care   
    You enter the home of Mrs. Jones to do her start-of-care OASIS assessment. You chit-chat with her before diving into your nursing care. She tells you that she was just released from the local hospital yesterday. She was admitted three days prior for a respiratory infection and exacerbation of her COPD. While in the hospital they started her on steroids, which increased her blood sugar. She tells you that she’s not even sure what medications she is supposed to be taking any more.
    As you get out your stethoscope and other necessary equipment, you ask Mrs. Jones to gather the pill bottles of all of her medications -prescription and nonprescription -  that she is currently taking. She shuffles off to the next room and comes back holding a box of pills that date back to the Obama administration. You silently ask yourself where you even start.
    You pull up the discharge papers to see what medications the hospital instructed Mrs. Jones to take. However, when you compare this to what she hands you in the box - it’s almost an entirely different list.
    Every home health nurse has experienced some version of this scenario. Transitions of care provide many opportunities for medication discrepancies. In fact, a 2014 study published in the Lippincott Nursing Center reports that up to 94% of patients transitioning from the hospital to home care experience at least one medication discrepancy. To combat these issues, all patients being admitted to home care services must have a thorough drug regimen review and medication reconciliation.
    What is Medication Reconciliation and Why is it Important?
    Medication reconciliation is the act of identifying the most accurate list of all medications a patient is taking. The list should include the name of the drug, current dose, frequency, and the route of administration. This list of medications must be shared with the primary physician to ensure that the patient is taking the correct medications per physicians orders.
    Patients are living at home longer than ever before and managing multiple chronic illnesses. Many times, this means they are on several medications and require frequent titrations or drug regimen changes. Without proper medication administration patients are at risk of exacerbations of their health conditions, admissions to the hospital, and even death.
    According to the Centers for Disease Control and Prevention (CDC), 3.8 billion prescriptions are written each year in the United States. One of every five new prescriptions are never filled, and of the ones filled, only about 50% are taken correctly. Non-adherence to medication regimens results in approximately 125,000 deaths due to cardiovascular disease each year. It’s also estimated that about 23% of nursing home admissions and 10% of hospital admissions could be avoided if patients took their medicines as directed.
    Because many home care admissions happen directly after discharge from a hospital or other inpatient facility, the risk of medication non-adherence is high. Home care nurses are in an ideal position to help patients get on the right track with their medications following discharge. Assisting patients with their medications starts with reconciliation.  
    Reconciliation: A Three-step Process
    To complete a thorough medication reconciliation process, you need to follow this three-step process. While it might seem simplistic, in home care many times, this process can take a few days and several phone calls to get straight. The diligence of home care nursing staff is essential when rectifying medications with one or more providers.
    Verify the List of Medications
    In the story above, you took the first step to verifying Mrs. Jones medications. By asking the patient to bring you the bottles of all prescription and non-prescription medicines they take, you’re initiating the process of obtaining the most accurate list.
    Be sure to specifically ask for non-prescription medications like headache relief pills, vitamins, and other supplements as some of these drugs can interact with other medications they might be taking. Elderly patients might not consider vitamins or herbs as part of their “medications,” so be specific that you want to see everything they take.
    Clarify the List
    Once you’ve created a comprehensive list of all medications the patient is taking, you need to check for any possible drug issues. Pay particular attention to:
    Duplicate Drug Therapies - Some patients require multiple prescriptions for the same condition. This can place them at an increased risk of experiencing severe side effects. It’s critical that you note examples of duplicate drug therapies and how it might be affecting the patient during your assessment.
    For example, if you’re performing medication reconciliation and notice that a patient is on three pills for high blood pressure, you want to dig a bit deeper. Some patients need this type of duplication in therapies to get a combination effect. However, if your patient tells you that they were put on the medication three years ago and since then have lost 60 pounds and that they experience dizziness with position changes - you’re going to want to communicate this with the care provider right away.  
    Potential for Interactions - Most electronic medical records have a built-in medication interaction checker. If you don’t have an electronic documentation system, you can use an online drug interaction checker like those found on Drugs.com or Rxlist.com.
    Enter all of the medications and check for adverse, major, moderate, and minor drug interactions. Educate the patient on the signs of a drug interaction and what to do if they think they are having one. You need to communicate any potential serious interactions with the prescribing and primary physicians, too.
    Reconcile the Medications
    Once you have a comprehensive list, it’s time to reconcile. If there are no duplications or potential drug interactions, the list can be sent to the physician usually via fax. However, if you identify any potential issues you need to notify the physician within 24 hours of finding the problem and have it resolved. This means that the doctor needs to respond to you so that you have an accurate list of medications for the patient.
    If you fax or email this communication to the provider, be sure to communicate clearly and concisely what you need from the physician. For example, instead of sending a list of meds and expecting the physician to find the potential issues, send the list and then add in a few bulleted items that clearly state what the problem is and what you need from the doctor or their staff.
    Fulfilling Your Essential Role
    The role of the home health nurse is crucial for the health and wellness of their patients. You might be the only person who is taking the time to review medications and answer questions for your patient about their medication regimen. Take the time to do a thorough medication reconciliation with every OASIS visit to keep your patients on the path to health.
  19. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in The Essentials of Medication Reconciliation in Home Care   
    You enter the home of Mrs. Jones to do her start-of-care OASIS assessment. You chit-chat with her before diving into your nursing care. She tells you that she was just released from the local hospital yesterday. She was admitted three days prior for a respiratory infection and exacerbation of her COPD. While in the hospital they started her on steroids, which increased her blood sugar. She tells you that she’s not even sure what medications she is supposed to be taking any more.
    As you get out your stethoscope and other necessary equipment, you ask Mrs. Jones to gather the pill bottles of all of her medications -prescription and nonprescription -  that she is currently taking. She shuffles off to the next room and comes back holding a box of pills that date back to the Obama administration. You silently ask yourself where you even start.
    You pull up the discharge papers to see what medications the hospital instructed Mrs. Jones to take. However, when you compare this to what she hands you in the box - it’s almost an entirely different list.
    Every home health nurse has experienced some version of this scenario. Transitions of care provide many opportunities for medication discrepancies. In fact, a 2014 study published in the Lippincott Nursing Center reports that up to 94% of patients transitioning from the hospital to home care experience at least one medication discrepancy. To combat these issues, all patients being admitted to home care services must have a thorough drug regimen review and medication reconciliation.
    What is Medication Reconciliation and Why is it Important?
    Medication reconciliation is the act of identifying the most accurate list of all medications a patient is taking. The list should include the name of the drug, current dose, frequency, and the route of administration. This list of medications must be shared with the primary physician to ensure that the patient is taking the correct medications per physicians orders.
    Patients are living at home longer than ever before and managing multiple chronic illnesses. Many times, this means they are on several medications and require frequent titrations or drug regimen changes. Without proper medication administration patients are at risk of exacerbations of their health conditions, admissions to the hospital, and even death.
    According to the Centers for Disease Control and Prevention (CDC), 3.8 billion prescriptions are written each year in the United States. One of every five new prescriptions are never filled, and of the ones filled, only about 50% are taken correctly. Non-adherence to medication regimens results in approximately 125,000 deaths due to cardiovascular disease each year. It’s also estimated that about 23% of nursing home admissions and 10% of hospital admissions could be avoided if patients took their medicines as directed.
    Because many home care admissions happen directly after discharge from a hospital or other inpatient facility, the risk of medication non-adherence is high. Home care nurses are in an ideal position to help patients get on the right track with their medications following discharge. Assisting patients with their medications starts with reconciliation.  
    Reconciliation: A Three-step Process
    To complete a thorough medication reconciliation process, you need to follow this three-step process. While it might seem simplistic, in home care many times, this process can take a few days and several phone calls to get straight. The diligence of home care nursing staff is essential when rectifying medications with one or more providers.
    Verify the List of Medications
    In the story above, you took the first step to verifying Mrs. Jones medications. By asking the patient to bring you the bottles of all prescription and non-prescription medicines they take, you’re initiating the process of obtaining the most accurate list.
    Be sure to specifically ask for non-prescription medications like headache relief pills, vitamins, and other supplements as some of these drugs can interact with other medications they might be taking. Elderly patients might not consider vitamins or herbs as part of their “medications,” so be specific that you want to see everything they take.
    Clarify the List
    Once you’ve created a comprehensive list of all medications the patient is taking, you need to check for any possible drug issues. Pay particular attention to:
    Duplicate Drug Therapies - Some patients require multiple prescriptions for the same condition. This can place them at an increased risk of experiencing severe side effects. It’s critical that you note examples of duplicate drug therapies and how it might be affecting the patient during your assessment.
    For example, if you’re performing medication reconciliation and notice that a patient is on three pills for high blood pressure, you want to dig a bit deeper. Some patients need this type of duplication in therapies to get a combination effect. However, if your patient tells you that they were put on the medication three years ago and since then have lost 60 pounds and that they experience dizziness with position changes - you’re going to want to communicate this with the care provider right away.  
    Potential for Interactions - Most electronic medical records have a built-in medication interaction checker. If you don’t have an electronic documentation system, you can use an online drug interaction checker like those found on Drugs.com or Rxlist.com.
    Enter all of the medications and check for adverse, major, moderate, and minor drug interactions. Educate the patient on the signs of a drug interaction and what to do if they think they are having one. You need to communicate any potential serious interactions with the prescribing and primary physicians, too.
    Reconcile the Medications
    Once you have a comprehensive list, it’s time to reconcile. If there are no duplications or potential drug interactions, the list can be sent to the physician usually via fax. However, if you identify any potential issues you need to notify the physician within 24 hours of finding the problem and have it resolved. This means that the doctor needs to respond to you so that you have an accurate list of medications for the patient.
    If you fax or email this communication to the provider, be sure to communicate clearly and concisely what you need from the physician. For example, instead of sending a list of meds and expecting the physician to find the potential issues, send the list and then add in a few bulleted items that clearly state what the problem is and what you need from the doctor or their staff.
    Fulfilling Your Essential Role
    The role of the home health nurse is crucial for the health and wellness of their patients. You might be the only person who is taking the time to review medications and answer questions for your patient about their medication regimen. Take the time to do a thorough medication reconciliation with every OASIS visit to keep your patients on the path to health.
  20. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in The Essentials of Medication Reconciliation in Home Care   
    You enter the home of Mrs. Jones to do her start-of-care OASIS assessment. You chit-chat with her before diving into your nursing care. She tells you that she was just released from the local hospital yesterday. She was admitted three days prior for a respiratory infection and exacerbation of her COPD. While in the hospital they started her on steroids, which increased her blood sugar. She tells you that she’s not even sure what medications she is supposed to be taking any more.
    As you get out your stethoscope and other necessary equipment, you ask Mrs. Jones to gather the pill bottles of all of her medications -prescription and nonprescription -  that she is currently taking. She shuffles off to the next room and comes back holding a box of pills that date back to the Obama administration. You silently ask yourself where you even start.
    You pull up the discharge papers to see what medications the hospital instructed Mrs. Jones to take. However, when you compare this to what she hands you in the box - it’s almost an entirely different list.
    Every home health nurse has experienced some version of this scenario. Transitions of care provide many opportunities for medication discrepancies. In fact, a 2014 study published in the Lippincott Nursing Center reports that up to 94% of patients transitioning from the hospital to home care experience at least one medication discrepancy. To combat these issues, all patients being admitted to home care services must have a thorough drug regimen review and medication reconciliation.
    What is Medication Reconciliation and Why is it Important?
    Medication reconciliation is the act of identifying the most accurate list of all medications a patient is taking. The list should include the name of the drug, current dose, frequency, and the route of administration. This list of medications must be shared with the primary physician to ensure that the patient is taking the correct medications per physicians orders.
    Patients are living at home longer than ever before and managing multiple chronic illnesses. Many times, this means they are on several medications and require frequent titrations or drug regimen changes. Without proper medication administration patients are at risk of exacerbations of their health conditions, admissions to the hospital, and even death.
    According to the Centers for Disease Control and Prevention (CDC), 3.8 billion prescriptions are written each year in the United States. One of every five new prescriptions are never filled, and of the ones filled, only about 50% are taken correctly. Non-adherence to medication regimens results in approximately 125,000 deaths due to cardiovascular disease each year. It’s also estimated that about 23% of nursing home admissions and 10% of hospital admissions could be avoided if patients took their medicines as directed.
    Because many home care admissions happen directly after discharge from a hospital or other inpatient facility, the risk of medication non-adherence is high. Home care nurses are in an ideal position to help patients get on the right track with their medications following discharge. Assisting patients with their medications starts with reconciliation.  
    Reconciliation: A Three-step Process
    To complete a thorough medication reconciliation process, you need to follow this three-step process. While it might seem simplistic, in home care many times, this process can take a few days and several phone calls to get straight. The diligence of home care nursing staff is essential when rectifying medications with one or more providers.
    Verify the List of Medications
    In the story above, you took the first step to verifying Mrs. Jones medications. By asking the patient to bring you the bottles of all prescription and non-prescription medicines they take, you’re initiating the process of obtaining the most accurate list.
    Be sure to specifically ask for non-prescription medications like headache relief pills, vitamins, and other supplements as some of these drugs can interact with other medications they might be taking. Elderly patients might not consider vitamins or herbs as part of their “medications,” so be specific that you want to see everything they take.
    Clarify the List
    Once you’ve created a comprehensive list of all medications the patient is taking, you need to check for any possible drug issues. Pay particular attention to:
    Duplicate Drug Therapies - Some patients require multiple prescriptions for the same condition. This can place them at an increased risk of experiencing severe side effects. It’s critical that you note examples of duplicate drug therapies and how it might be affecting the patient during your assessment.
    For example, if you’re performing medication reconciliation and notice that a patient is on three pills for high blood pressure, you want to dig a bit deeper. Some patients need this type of duplication in therapies to get a combination effect. However, if your patient tells you that they were put on the medication three years ago and since then have lost 60 pounds and that they experience dizziness with position changes - you’re going to want to communicate this with the care provider right away.  
    Potential for Interactions - Most electronic medical records have a built-in medication interaction checker. If you don’t have an electronic documentation system, you can use an online drug interaction checker like those found on Drugs.com or Rxlist.com.
    Enter all of the medications and check for adverse, major, moderate, and minor drug interactions. Educate the patient on the signs of a drug interaction and what to do if they think they are having one. You need to communicate any potential serious interactions with the prescribing and primary physicians, too.
    Reconcile the Medications
    Once you have a comprehensive list, it’s time to reconcile. If there are no duplications or potential drug interactions, the list can be sent to the physician usually via fax. However, if you identify any potential issues you need to notify the physician within 24 hours of finding the problem and have it resolved. This means that the doctor needs to respond to you so that you have an accurate list of medications for the patient.
    If you fax or email this communication to the provider, be sure to communicate clearly and concisely what you need from the physician. For example, instead of sending a list of meds and expecting the physician to find the potential issues, send the list and then add in a few bulleted items that clearly state what the problem is and what you need from the doctor or their staff.
    Fulfilling Your Essential Role
    The role of the home health nurse is crucial for the health and wellness of their patients. You might be the only person who is taking the time to review medications and answer questions for your patient about their medication regimen. Take the time to do a thorough medication reconciliation with every OASIS visit to keep your patients on the path to health.
  21. Like
    Melissa Mills, BSN got a reaction from traumaRUs, MSN, APRN in 5 Reasons to Invest in Your Continuing Education   
    Continuing education - these two words either excite you or send you into a state of boredom-induced slumber unmatched by pretty much anything else in life. Nurses are required to complete continuing education to maintain their licensure. However, experts tell us that there are more significant benefits to continuing education than just keeping our ability to practice the craft of nursing.
    Here are a few reasons you should spend your time and money investing in your future.
    Maintaining Licensure
    Every state in the U.S. has a different set of expectations for nurse continuing education requirements. Some states mandate a certain number of continuing education. Others have specific courses or topics they require to address issues that happen in the state, such as child abuse, domestic violence, or laws governing your practice.
    Providers of continuing education courses must meet specific rules to ensure that information is current and meets laws and nursing practice as it changes. This safeguards you from completing materials today that was outdated years ago. Be sure your up to date on what you need to know about nursing licensure.
    Improving Safety
    Your patients expect to be safe when in your care. No one wants to be responsible for adverse drug events, falls, or other unsafe patient situations. While it is impossible to eliminate errors altogether, it should still be your goal.
    When nurses participate in continuing education that focuses on best-practices, patient-centered care, and safety prevention - errors lessen and patient satisfaction increases.
    Fostering a culture of lifelong learning in nursing is one of the pivotal practices that keep patients safe. In fact, when the 1999 To Err is Human: Building a Safer Healthcare System was published by the Institute of Medicine (IOM), it showcased some scary numbers about patient safety:
    Up to 98,000 patients die each year due to preventable medical errors Medical errors cost up to $29 billion each year nationwide You might think that the IOM would have been looking for high-tech ways to rectify these numbers. The Robert Wood Johnson Foundation and the IOM joined forces to establish eight recommendations with goals for the next 20 years. Half of the strategies created to fix the issues found were based solidly in education. The four learning strategies included implementing nurse residency programs, increasing the percentage of nurses with a baccalaureate degree, doubling the number of nurses with a doctorate, and engaging nurses in lifelong learning.
    I believe that this study illustrates the strength of continuing education in nursing. When nurses are empowered to increase their own understanding of the profession, patients are safer and more satisfied with their care.
    Meeting Certification Requirements
    Have you considered becoming certified in a nursing specialty? Accrediting bodies often have their own requirements you must meet to maintain your certification. You might need to complete courses on specific topics or areas to achieve the necessary requirements.
    For example, if you’re like me and have a certification in Case Management, you’ll need to show that you’ve completed 80 hours of approved continuing education specific to being a case manager. Many courses will meet the requirements you need for your certification while also keeping you compliant with your state board of nursing.
    Gaining New Skills and Meeting Changes
    Healthcare is becoming more innovative every day. From new drugs and treatments to the use of artificial intelligence and virtual reality, there’s so much to learn. Instead of waiting for hands-on training opportunities to come to you on the job, consider enrolling in a CE course that provides an overview of skills you know you’re going to need.
    It’s essential to remember that not all new skills are technical. While learning how to use equipment or how to assess for specific diseases is necessary, sometimes the skills you need most are interpersonal. If you’re struggling at work with communication, time management, or you’re considering moving up the career ladder, there are courses to help you gain the knowledge you need.
    Advancing Your Career
    Whether you’re considering certification, returning to school, or just want to stay up on the latest research - all of this learning will help to advance your career. Continuing education is an excellent place to start if you’re considering changing your specialty. You can choose a few courses to take to learn the basics of just about any nursing niche out there so that you can find out if it might be right for you.
    Continuing education might be mandated. However, if you can flip the script on how you approach continuing education requirements you might find that there are many reasons to invest in your professional development.
    How you do feel about mandated continuing education? Do you enjoy it or do you just complete it because it’s required to maintain your certification?
  22. Like
    Melissa Mills, BSN got a reaction from JackChase1212, BSN, RN in Protecting the Vulnerable: How Nurses Must Place Patient Safety at the Forefront of Practice   
    Hi, Juan de la Cruz - I completely agree with you that all patients receiving care have a certain level of vulnerability. Even when my mother who is 100% capable of making her own decisions is in the hospital - a family member is always there to offer an extra level of protection. However, I do believe with experts who consider specific patient populations more vulnerable to harm. Those who can't make their own decisions regardless of age are left at our mercy and when in the wrong hands can be injured not just by a mistake, but by intentional acts. This is when the level of vulnerability is placed on a different plane than those who are cognitively capable of making decisions. 
    Thanks for your thoughts and engagement. 
    Melissa
  23. Like
    Melissa Mills, BSN reacted to Jesuah in Nursing Uniforms: From Skirts to Scrubs and Beyond   
    I am from Wisconsin and belong to an organization that does have capes. It is "The Wisconsin Nurses Honor Guard". We attend funeral services of deceased (newly or graveside for previously) nurses at the family's or funeral director request. This is similar to honor guard services for fire or police. It is only about 10 minutes for our part of the service. We wear white uniforms, not scrubs, can be pants and tops(we do have a couple guys in the organization) or a dress and we wear white hats. For those wearing a dress and white nylons, the cape can be used. The hats are usually used but are optional, particularly if it is a younger nurse that never had a hat. If anyone is interested in seeing pictures, there is a public website(as well as a member website)   winurseshonor guard.com
  24. Like
    Melissa Mills, BSN reacted to Jesuah in Nursing Uniforms: From Skirts to Scrubs and Beyond   
    I work as a travel nurse in L&D. Most of the places have their own scrubs and launder them too. Some of the scrubs that we are required to wear look horrible, extremely wrinkled, looks like they were *picked up off the floor or out of the laundry basket* but due to the possible need to go to the OR, we usually are not allowed to wear our own scrubs.
  25. Like
    Melissa Mills, BSN reacted to Ruby Vee, BSN in Nursing Uniforms: From Skirts to Scrubs and Beyond   
    It's amazing how many people favor "color coded" scrubs for different disciplines, when it never seems to help the patients figure out who is who.  Not even with a chart in their hand.  
    I disagree that color coded scrubs look "more professional."  Someone who picks their scrubs up off the floor or out of the laundry basket to wear to work is going to looked just as disheveled in the management favored color of choice as they would in a color they actually picked out.  Maybe more so, since management's color is not flattering on them, and they may have chosen a flattering color.  
    If the problem is that "it isn't evident at a glance who to turn to for help," then housekeeping, biomed, engineering, pharmacy, dietary and others can stop wearing scrubs.  
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