Displaying items by tag: medical

Resources for Your Medical Director!

Our Medical Directors are a vital part of our Medical Clinics, and provide critical services for us often at their own expense and time. Here are some resources you can pass on to them to let them know how much we all appreciate them and their service to the clinics.

Physicians need 30-50 hours of AMA Category 1 CME to meet the AIUM requirements. Is your Medical Director looking for opportunities to sharpen his/her skills in reading Limited OB Ultrasounds?

American Institute for Ultrasound Medicine: www.aium.org

"Not to be missed is the 38th Annual Advanced Ultrasound Ob/GYN Seminar" http://www.aium.org/soundWaves/article.aspx?aId=865&iId=20150107
Learn From the Experts at the 38th Annual Advanced Ultrasound Seminar: Ob/Gyn
Come to Lake Buena Vista, Florida, this February if you want to expand your obstetric and gynecologic ultrasound knowledge with renowned experts in the field. View the program and register. Join Codirectors Lennard D. Greenbaum, MD, and Frederick W. Kremkau, PhD, along with ultrasound luminaries Alfred Z. Abuhamad, MD, Beryl R. Benacerraf, MD, Joshua A. Copel, MD, Steven R. Goldstein, MD, John C. Hobbins, MD, and Lawrence D. Platt, MD.
This seminar, hosted by the AIUM in collaboration with Orlando Health and the Wake Forest School of Medicine, will be held February 19-21, 2015, at Disney's Yacht and Beach Club Resorts in Lake Buena Vista, Florida. The seminar is filling quickly! Register today and earn up to 13.5 AMA PRA Category 1 Credits.

Do you have a physician who would like to serve your center as a Medical Director but is not trained to read OB scans? Please read through all the options available for them and pass the information along to them.

Below are some great options you can offer to them as resources for both initial training and refresher courses. While Heartbeat does not have any direct knowledge of the courses, these resources were recommended by an RDMS ultrasound trainer who serves in the pregnancy center ministry, and we are passing on the information for the physician to investigate and choose the course best suited for their needs.

Gulfcoast Ultrasound Institute: www.gcus.com 

Thomas Jefferson University: http://www.jefferson.edu/university/jmc/departments/radiology/education/cme/ultrasound_courses.html 

Wake Forest: http://www.wakeultrasoundeducation.com/courses-and-seminars/obstetrical-ultrasound/ 

IAME: https://iame.com/conferences/obgyn_ultrasound/

Another Great Resource From the AIUM:

Everything You Want to Know About First-Trimester Obstetric Ultrasound is a great learning tool for which physicians can earn up to 6.0 CME credits.

"After viewing this program, participants should be able to describe the sonographic signs of normal and abnormal gestations and define the role of ultrasound in the early diagnosis of fetal anomalies. The learner attributes are patient care, medical knowledge, and practice-based learning and improvement."

This DVD comes with 5 CME test and evaluation forms that allow you and up to 4 colleagues to earn credits at no extra charge. Need more than 5 tests? Purchase additional sets of 5 tests/evaluations for only $160.00.

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New FDA Consumer Update Urges Women to Obtain Medical Sonograms with Trained Operators

By Susan Dammann RN

The FDA has issued a warning. While the FDA's main focus in the warning is to advise pregnant women to avoid commercial sonogram services for nonmedical purposes that could pose a danger to the developing fetus, emphasizing that these are prescription medical devices, are to be used only by trained health care professional and only with a prescription, included within the warning are guidelines/recommendations which we in the pregnancy help medical clinics should be aware of.

Below are three excerpts from the 12/16/14 FDA Consumer Update which may pertain to the use of ultrasound imaging in the PMC, and a question for you to consider.

"Fetal ultrasound imaging provides real-time images of the fetus. Doppler fetal ultrasound heartbeat monitors are hand-held ultrasound devices that let you listen to the heartbeat of the fetus. Both are prescription devices designed to be used by trained health care professionals. They are not intended for over-the-counter (OTC) sale or use, and the FDA strongly discourages their use for creating fetal keepsake images and videos."

Question: Are the sonograms in your center being performed by trained health care professionals?

"The long-term effects of tissue heating and cavitation are not known. Therefore, ultrasound scans should be done only when there is a medical need, based on a prescription, and performed by appropriately-trained operators."

Question: Are the sonograms performed in your center based on a prescription for a medical need?

"Similar concerns surround the OTC sale and use of Doppler ultrasound heartbeat monitors. These devices, which are used for listening to the heartbeat of a fetus, are legally marketed as "prescription devices," and should only be used by, or under the supervision of, a health care professional."

Question: If your center uses Doppler, is it being used under the supervision of a health care professional?

As you consider the above FDA recommendations in relation to the ultrasound services performed in your PMC keep in mind also that one of the points in the Commitment of Care and Competence to which all Heartbeat Affiliates sign in agreement is:

Medical services are provided in accordance with all applicable laws, and in accordance with pertinent medical standards, under the supervision and direction of a licensed physician.

To read the full FDA Consumer Update click here.

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Ultrasound Safety – Revisited

by Kevin T. Rooker, RT(R), RDMS, RVT, Sonography Consultantsultrasound1

Is ultrasound safe? Will it hurt my baby? These are questions we sometimes hear from our clients. We need to be able to answer those questions with confidence for several reasons. First, because our patients deserve an honest answer, and second because we never know who is listening. We know that there are some that think you should not be performing limited OB ultrasound and will always be looking for reasons to justify their position. Let's not give them that opportunity on the issue of ultrasound safety. Unfortunately, we, the medical community, have not done as well as we can at educating ourselves on the safety of ultrasound1.

Ultrasound is a wave of mechanical energy that penetrates human tissue as an oscillating (alternating) wave of high and low pressure. As it does so, there are two potential types of biological effects; Mechanical and Thermal. In 1993, the FDA allowed ultrasound manufacturers to significantly increase the amount of ultrasound energy created in diagnostic ultrasound systems, as long as they displayed the MI (Mechanical Index) and TI (Thermal Index) on the screen for the operator (and our clients) to see. The premise being that if we know what the MI and TI are, what their limits are, and most importantly how to lower them, then we are being as safe as we possibly can.

The Mechanical Index is a safety metric which lets the operator know how much energy is being transmitted into the patient during a sonography examination. Remember that sound is created by pressure waves, so mechanical energy is transmitted into any object which receives sound. Sound waves can be quite powerful. For example, think of the thump on your chest when sitting next to a teenager's car with the high dollar stereo system. It is defined as the peak negative pressure (PNP) of the ultrasound wave (point of maximal rarefaction). In easier terms; think pressure change divided by time. Lots of pressure change over short periods of time can be damaging. The FDA has established a maximum MI of 1.9 for diagnostic imaging. Any machine capable of generating MI greater than 1.0 must display the MI onscreen. The FDA MI limit for obstetric sonography is 1.0.

The Thermal Index is another safety metric which lets the operator know the potential of creating heat (hyperthermia) with the ultrasound beam. Many assumptions are made in this calculation, and it is often thought that the heating potential is underestimated. So keep in mind that the TI formulation was not intended to, and cannot provide an accurate measure of temperature rise within a specific patient. Instead it was designed to provide the operator with a relative measure of risk for a particular imaging mode. A Thermal Index of one (TI 1) indicates conditions under which the rise in temperature would be likely to be 1°C. The thermal index is different for different types of tissue, and can be displayed on your system accordingly: soft tissue (TIs), bone (TIb) and cranium (TIc). In the first trimester, when using Doppler to hear and demonstrate the fetal heart, the TIs setting us used. The limit for TI varies with time, please reference the chart below from the British Medical Ultrasound Society, the entire document may be found here.

Ultrasound Safety

Enough about what the MI and TI are, how do we as operators keep them at safe levels? There are two basic concerns to remember.

First is the AIUM ALARA policy2; which is an acronym for As Low As Reasonably Achievable. Simply translated, it means to keep the output power settings as low as possible, that still allows for adequate images. Most ultrasound systems can operate with output power settings at about 50% and still produce quite satisfactory OB images. Have your system presets adjusted so that when you are performing OB sonography both (abdominally and transvaginally), the output power settings are set low. You can always increase them if clinically necessary. And keep in mind that you can increase the gain to make your image brighter, as gain is just how well the system is "listening", it has no effect on the TI.

The second concern is time. Keep the overall examination as short as is reasonable. If using Doppler to allow Mom to hear her baby's heartbeat, depending upon your ceter's policy, keep the Doppler exposure to about 5-10 seconds. Know where to find the MI and TI displays on your system. If you don't know, consult your operator's manual or contact the manufacturer of your ultrasound system for more information.

Diagnostic ultrasound in obstetrics has been around for the better part of 40 years. To date, no one has been able to prove (and many have tried) that diagnostic ultrasound, when used prudently (MI,<1.0 and TI<0.7), has had any adverse effects developing fetuses; and this includes the limited use of Doppler in the first trimester "Thus far, there have been no significant thermal effects documented in humans and at this time the possibility of having all the factors present to is highly unlikely 3." However, it has been shown that aborting a living fetus is fatal, every time.

References

1. Ultrasound Is Safe . . . Right? Resident and Maternal-Fetal Medicine Fellow Knowledge
Regarding Obstetric Ultrasound Safety. J Ultrasound Med 2011; 30:21–27
Sheiner E, Abramowicz JS. Clinical end users worldwide show poor knowledge regarding safety issues of ultrasound during pregnancy. J Ultrasound Med. 2008;27(4):499-501

2. As Low As Reasonably Achievable (ALARA) Principle Approved 4/2/2014 aium.org/officialStatements/39

3. FDA Recommendations for the Safe Use of Ultrasound in Obstetrics CNE article authored by Sherri A. Longo, M.D. Assistant Professor in the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Tulane University School of Medicine in New Orleans, Louisiana; e-edcredits.com/nursingcredits/article.asp?testID=29

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Fuss about Practice Fusion?

By Jor-El Godsey, Vice PresidentFree1

If you don't know the difference between EHR and EMR and PHR, HIPAA and HI-TECH, EPM and PMS , PRC and PMC, then stop reading.

If you do, or think you do, you're probably knee-deep in medical clinic regulations and/or clinic practices.

Pregnancy help medical clinics have been growing in number and complexity for the last twenty years. Originally focused on ultrasound services, many life-affirming, medically savvy centers are expanding medical services to include STI testing/treatment, pre-natal care, and more.

Good business systems, important for all pregnancy help organizations, has been a dynamic question for medically focused affiliates with the changing nature of health care regulations.

Life-affirming friends like eKyros and WayCool that specialize in database solutions for pregnancy help organizations have been answering that question with increased security, encrypted records and other HIPAA-necessary implementations. However, some in our community have either opted for, or promoted other software.

One of those is Practice Fusion. And, yes, there has been a fuss about Practice Fusion.

Practice Fusion is presented as being "free" (always attractive to non-profits) and, despite its relative newness (launched in 2007), has been quickly accepted by doctors office across the U.S. There are, however, some troubling findings that ought to give life-affirming pregnancy help organizations pause.

First, is anything really "free"? The article, "What Makes Free EHRs Expensive in the Long Run?" rightly notes, "...hidden expenses, heightened risk and unforeseen liabilities can cost you just as much as any web-based EHR..." So always beware of any Open Source product being offered for FREE.

Second, venture capitalists have invested nearly $200 million in this product. How will they realize their return on investment? It's always good to look a little closer to understand how a free product is able to remain current, supported and adaptable for future innovation. An article from Business Week notes the following:

The company makes money by charging more than 70,000 pharmacies, 300 diagnostics labs, and 21 imaging centers for access to its captive community of medical pros. For example, labs pay for the convenience of transmitting test results rather than faxing them, while drugmakers pay to deliver targeted ads to doctors. For an additional fee, companies can use a Practice Fusion tool to sift through its trove of more than 80 million patient records to identify patterns, such why doctors might be choosing one drug over another. The data is stripped of any information that would reveal the identity of the patients. The company is also working with insurer Aetna (AET) to identify at-risk patients to head off costly trips to the emergency room.

A pregnancy help organization using Practice Fusion apparently becomes part of the "captive community" targeted by those profiting from offering this "free" product.

Third, Practice Fusion's own practices have created significant compliance and confidentiality questions. Some industry watchers have noted, that "[a]ccording to experts, it may have violated the grand poobah of medical privacy laws — HIPAA — potentially getting both the doctors and Practice Fusion — as a "business associate" — into trouble. Additionally, the Federal Trade Commission may see what the start-up did as a deceptive business practice."

Along with these three specific points about Practice Fusion (or free EHRs in general), there comes a much more basic question:

Is there value in working within our specialized world of life-affirming pregnancy help to sharpen a good tool for all of us to use?

We think so, and we encourage you to think carefully when considering such important business tools.

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24 Hour Turn-Around on Ultrasound Scans?

Making Sense of AIUM Guidelines24hour1

Connie Ambrecht RDMS, Executive Director Equip Leaders Now/Sonography Now 
Beverly Anderson, J.D., CEO Dove Medical
Susan Dammann RN LASm Medical Specialist

The Issue

In April 2014, the American Institute of Ultrasound in Medicine (AIUM) sent an email to its members stating it had "Updated Guidelines and Official Statements." Included in the list was the guideline titled "Documentation of an Ultrasound Examination."

First, it is valuable to revisit who AIUM is, as well as its role in ultrasound imaging. In its own words, "the AIUM is an association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation."

In the first section of the guidelines, AIUM outlines what it considers high-quality patient care. The guidelines state a permanent record should always be kept of the images, and an interpretation should be provided for patient records. All medical professionals involved should be able to communicate well and work as a team to provide what is expected: quality patient care.

The next section lists what should be included in the official report. In some clinical settings, the interpretation of the images is transcribed and a separate report page is generated for the patients chart. In the PMC setting it is common that a signature is obtained on the ultrasound report page and serves as the final report.

Section three discusses the final report from the interpreting physician or medical director of the clinic. According to this April 2014 update, the final report should be generated in 24 hours. I know you are thinking or asking... "How can we do that?!"

We restate the following from the AIUM guideline: Practice guidelines of the AIUM are intended to provide the medical ultrasound community with guidelines for the performance and recording of high-quality ultrasound examinations. The guidelines reflect what the AIUM considers the minimum criteria for a complete examination in each area but are not intended to establish a legal standard of care.

This AIUM Guideline is NOT a legal requirement. It is a national practice standard.

We at Sonography Now live in the service trenches with you as we train on-site. We understand that getting interpretations in a timely fashion versus every 24 hours can seem unnecessary. Taking one step at a time can ease such a transition. If you want to make changes to accommodate a faster interpretation time, it doesn't need to change immediately.

Building a plan of action can remedy the feeling of urgency. Some clinics we work with have images interpreted daily so that the final report can be given to the patient. You have the freedom to choose your course of action based on your mission and vision.

Concerning our routine ultrasound report procedure, we need to answer the questions:

  • Do they jeopardize patient safety?
  • Are they legally defensible?
  • Would they put our reputation at risk if widely known?

Our patients feel an urgency to have definitive information about their pregnancy. They need their confirmed diagnosis, not the nurse's preliminary findings.

My nightmare concerning delays in the physician reading Dove Medical's ultrasound exams is that our nurse will miss an ectopic pregnancy the physician would have caught, the patient will not have received the appropriate instructions and/or referral for immediate care, and the patient will suffer injury as a result. I strive to insure both the skill level of our nurses and also the prompt reading of all exams.

Should We or Shouldn't We?

While some Medical Directors feel it would be consistent with the highest level of care which we strive for, that these standards should be recommended/set and then the center should work toward them, other Medical Directors who have discussed the issue feel strongly that we do not need to comply with the 24 hour mandate and that it would be impossible for most centers to do so.

Where the Rubber Meets the Road

We must remember that our Medical Directors are volunteering their services. If pressure is put upon them to comply with this standard, are we risking losing them as a Medical Director? If that scenario is a high probability, we must ask "How is this patient best served?" What do we tell the patient?

We can't do the sonogram because we can't turn the report around in 24 hours? Is a longer turn around period better for the patient than having no service at all? Also it is critical that we not alienate our Medical Directors who are sacrificing their time and skills to serve the patients in our clinic. Without them, we cannot offer ultrasound services at all.

If we set this as policy because it meets national standards but we cannot comply, what are the consequences? Is it better to adopt a policy set on the highest excellence we are feasibly able to provide so that we can continue serving our patients, rather than potentially losing our medical director or other consequences which would impede serving the patient? Then as we can, going forward, do what is possible to shorten the turn-around time.

Practical Considerations

Centers should make efforts to have ultrasound reports read, signed and returned within the shortest time frame that is reasonably feasible. Any scans with questionable findings of concern or emergency problems should be referred promptly to a physician or hospital emergency room. This policy should be made known to the patient on the intake form.

You may want to consider the following options, among others, as means to improve your turn-around time. This is only a sampling of options and not a recommendation of any specific option.

  • Use Doc-U-Sign as a mechanism to transmit scans via internet with appropriate safeguards for patient identity.
  • Both E-Kyros (www.ekyros.com) and WayCool (www.waycoolsw.com) have options available for uploading and securing the physicians signature.You may contact these businesses for more information.
  • Some centers are using an encrypted cloud-based means of submitting their ultrasound reports to their physician or radiologist for review and signature.
  • E-mailing the reports to the Medical Director using only a client number.
  • Some ultrasound machines have a software program already installed that is capable of electronic transfer.
  • Logmein is being used by some centers. This allows the Medical Director or Radiologist to log in to your computer via remote access from anywhere to sign reports. This requires transferring the images from your machine to your computer and either typing the report or scanning it in.
  • Some centers upload scans to a memory stick, transfer them to the computer and use High Tail to send the ultrasound and reports to the Medical Director.

Consideration for Your Center

Inform your Medical Director of the recommendation by the AIUM and have a conversation with them. Let him/her know that it is a practice standard, not law. Discuss the best and most feasible policy for your center. Examine your current policy and practice – how well is that working? Does it meet the goal for the best service your clinic can provide for the patient? Look at and discuss some of the options for improving the turn-around time. Are there any steps you feel you should take at this time? Set a time to re-examine and evaluate.

General Ultrasound Checkup

The AIUM Official Statement concerning Limited Obstetric Ultrasound (LOU), reaffirmed on 4/2/2014, makes some clear statements about the services we provide. I am reminded again that we must see ourselves as competent medical professionals and our services as medical diagnosis. Points of emphasis in the AIUM Official Statement include:

  • "A limited obstetric ultrasound examination is performed to answer a specific, acute clinical question." In our clinical setting a standard sonogram is unnecessary. Our clinical question is "Is there a viable pregnancy?"
  • "Clinical judgment should be used to determine the proper type of ultrasound examination to perform." This is why we don't perform a LOU if the patient is bleeding or cramping. It is no longer clinically appropriate. We need to be absolutely clear in our messaging and in the statements made by staff that an ultrasound exam is performed only when clinically indicated. At Dove Medical, we no longer allow patients to schedule an appointment for an ultrasound. Our nurse offers an ultrasound when indicated and will schedule the exam for a later date if necessary. The patient can refuse an ultrasound, but she cannot demand one.
  • "Lack of qualification or inexperience of the sonographer/sonologist does not justify performance of a limited ultrasound examination when a standard examination is indicated." Our nurses must tell the patient we obtain only three pieces of information because that is how we answer the specific clinical question before us. This means our RNs don't tell patients that they aren't trained to do [fill in the blank – patient questions we've gotten include "Is everything all right?" "Is it a boy or girl?" etc.]
  • "Obstetric ultrasound examinations are not performed for entertainment or for sex determination in the absence of an accepted clinical indication." At PMCs, we perform the LOU to make a pregnancy diagnosis and for no other purpose.
  • "When a patient undergoes a limited ultrasound examination, it is important that she understands why a limited scan is being done and that she has appropriate expectations regarding the information sought." Again, we must clearly understand the clinical reason we scan, so that our messaging to our patients emphasizes our scope of practice. Our consent form must have a statement about the limited exam to determine only three pieces of information (location of pregnancy, heartbeat, gestational age) for the purpose of diagnosing pregnancy because that is our limited scope of clinical practice and the patient must sign that she understands this.

As an education organization Equip Leaders Now and Sonography Now have responsibility to keep ourselves informed of changes that may impact your specialized clinical setting. Our role is to pass information along and let you decide how it fits in your clinic. At Sonography Now, our mission is to provide education related to imaging, at Equip Leaders Now, our mission is to build leaders by providing the tools needed to make informed decisions to build strong communities. In doing this we have an obligation to give you information so you can be empowered with the information to form your own talking points and messaging so you can be represented well in your community and to the patients you serve.


Contact Connie Ambrecht or Beverly Anderson at 702-925-8737 with any questions or for a private webinar for your team on this topic.

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NAPN: A Voice for Pro-Life Nurses

by Lynn Smith RN, National Association of Pro-Life Nurses Member,
and Marianne Linane RN, MS, MA, National Association of Pro-Life Nurses Executive DirectorNAPN1

In 1995, during the U.S. Senate debate on the Partial-Birth Abortion Ban Act, Sen. Barbara Boxer (D. California) read into the record a letter from Geri Marrullo, then-executive director of the American Nurses Association, in opposition to the proposed ban on Partial-Birth Abortion.

The ANA claimed to be "the only full-time professional organization representing the nation's 2.2 million registered nurses."

While investigating the ANA's exclusive claim to represent the nation's RNs to the U.S. Senate, it was discovered that though there were 2.2 million RNs at the time, and the ANA is exclusively RNs, only 190,000 nurses were actually members; only 9% of U.S. nurses.

In 2011, there were 3.1 million nurses, and only 180,000 nurses were members, or about 6%.

RN Magazine, the mainstream nursing journal, did a survey in 1999, showing that nearly 2/3 of nurses surveyed thought that partial-birth abortion should be prohibited by law. [Marissa Ventura RN, Aug. 16, 2002, "Ethics on the Job: Where Nurses Stand on Abortion."]

In response to the ANA's position against a ban, a unique and separate professional nurses organization, the National Association of Pro-Life Nurses stepped forward and, in 2000, submitted a Friend of the Court brief in Stenberg v. Carhart, supporting a ban on partial birth abortion. In 2003, NAPN nurses gathered nurses' signatures on a national petition, which was submitted to the U.S. Congress, also to ban the procedure.

All nurses can appreciate the gains that the ANA has accomplished in making nursing more professional and patient care more effective. This is what we want and expect from a full-time professional association.

If the ANA was only neutral on bioethical issues, we would have cause for concern, but the clearly aggressive anti-life political lobbying by the ANA, is a disservice to nurses of conscience, and a misrepresentation to the public, to our courts, to our elected officials, and even to other nurses.

NAPN

The National Association of Pro-Life Nurses offers nurses of conscience a choice for affiliation with a professional organization that is a voice affirming the gift of life.

Chartered since 1978, The National Association of Pro-Life Nurses is a not-for-profit organization uniting nurses who are "dedicated to promoting respect for every human life from conception to natural death, and to affirming that the destruction of that life, for whatever reason and by whatever means, does not constitute good nursing practice."

It's a community of like-minded nurses who can offer advice and encouragement on problems that nurses encounter.

As a professional organization, NAPN works to:

  • establish and protect the ethical values of the nursing profession.
  • secure protection of the rights of nurses and paramedical personnel, who refuse to participate in procedures that are counter to the beliefs held in the NAPN mission statement.
  • maintain a legal defense fund for use in representing nurses in such disputes.
  • participate in the legislative process to promote life-affirming legislation.

The NAPN legal defense fund also provides the resources needed to submit Friend of the Court briefs in cases such as those heard by the United States Supreme Court. Several of these briefs have been filed, some which are on the opposite side of the argument from the American Nurses Association's briefs, such as Stenberg v. Carhart and the more recent decision, Hobby Lobby v. Sebelius.

Education

NAPN provides education for those facing difficult choices involving life-taking decisions and promotion of positive alternative choices.

Members are kept informed on current issues through Pulse Line, the quarterly newsletter, and links to relevant medical journal articles at the website: NursesForLife.org.

A $1,000 scholarship is awarded annually to a nursing student whose application best meets the criteria established. It is decided by the scholarship committee.

Continuing education is provided at its general meetings, in conjunction with the annual National Right to Life Committee Convention and speakers are provided for local nursing events on life topics.

NAPN has a strong position statement supporting informed consent for human research subjects.

Two outstanding pro-life nurses who have been members are Brenda Pratt Shafer, the nurse who exposed the practices at Martin Haskell's abortion clinic, because she was an eyewitness to partial-birth abortions, and Jill Stanek, who exposed the practice of abandoning babies surviving late-term abortions, left to die, alone and uncomforted, in the dirty utility room of the hospital where she worked.

Both Brenda and Jill have testified before the U.S. Congress and both were instrumental in having those practices outlawed, to the extent that Congress could act.

For more information visit NursesForLife.org Consider becoming a member of the National Association of Pro-Life Nurses, and joining your voice with the professional organization that can best represent your life affirming values to other nurses, to the public, to our courts and to our elected representatives.

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Ebola 101

ebola1

by Susan Dammann RN, Medical Specialist

With the recent presentation of Ebola cases in the United States, many in the health care field, including pregnancy center staff, are seeking to learn more about the virus and even more so, if prevention measures should be put into place. This article is intended as a resource to help you achieve those goals.

Part 1 will familiarize you with information about the Ebola virus, risks of transmission, symptoms of Ebola infection, and the diagnosis and treatment of Ebola victims, not inclusive of hospital protocol. Part 2 will offer recommendations and tools from various sources your center may wish to use to develop guidelines and procedures to screen for and deal with possible Ebola carriers.

Part 1: Information

Ebola, also known as Ebola hemorrhagic fever, is a severe viral illness that is rare and can be deadly. It is caused by an infection with one of the Ebola virus strains. To date, there have been nearly 9,000 reported cases of infection with Ebola in Africa in the recent outbreak, with more than 4,000 of those cases resulting in death.

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  • "One of the difficulties in identifying potential cases of Ebola infection is the nonspecific presentation of most patients. Fever/chills and malaise are usually the initial symptoms, so all medical personnel should maintain a high index of suspicion in these cases.
  • Patients who survive infection with Ebola generally begin to improve around day 6 of the infection.
  • There is no cure for Ebola infection; treatment is largely supportive. Therefore, prevention of the spread of Ebola in healthcare facilities is particularly important.
  • Patients with fever, even subjective fever, or other symptoms associated with Ebola infection along with a history of travel to an Ebola-affected area within the past 21 days need to be identified in triage.
  • If such a patient is identified, she/he needs to be isolated immediately in a single room with access to a bathroom. The door to the room should remain closed." (quoted from MedScape.org)

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Transmission

"When an infection does occur in humans, the virus can be spread in several ways to others. Ebola is spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with

  • blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola
  • objects (like needles and syringes) that have been contaminated with the virus
  • infected fruit bats or primates (apes and monkeys)

Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months. Abstinence from sex (including oral sex) is recommended for at least 3 months. If abstinence is not possible, condoms may help prevent the spread of disease."

(quoted from cdc.gov)

"Persons who have direct contact with infected individuals or their blood and body fluids, such as healthcare personnel without access to appropriate personal protective equipment or other caregivers in hospitals or homes, and persons handling bodies of deceased EVD patients are at high risk for Ebola virus exposure and infection.

Airborne transmission of Ebola virus has been hypothesized but not demonstrated in humans. While Ebola virus can be spread through airborne particles under experimental conditions in animals, this type of spread has not been documented during human EVD outbreaks in settings such as hospitals or households.

CDC infection control recommendations for U.S. hospitals, including recommendations for standard, contact, and droplet precautions for general care, reflect the established routes for human-to-human transmission of EVD and are based on data collected from previous EVD outbreaks in Africa in addition to experimental data."

(quoted from cdc.gov)

Can Ebola Be Transmitted Through a Sneeze?

"The only time that Ebola is in the lungs in sufficient quantities to produce virus in fluid that would be expelled during a sneeze is during extraordinarily advanced disease. A typical Ebola patient doesn't have a lot of virus in the lungs, but a person with advanced disease who is close to death could have a lot of virus in the lungs. During intubation, or when a very sick, infected person coughs or sneezes, an improperly protected healthcare worker could be at risk for being infected.

It would be a stretch to say that someone who is infected but well enough to walk around among other people would have enough Ebola in his or her lungs to be able to spread it by sneezing."

(quoted from MedScape.org)

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Part 2: Recommendations and Tools

Pregnancy Center Considerations

If your center is currently serving clients from West African countries where the Ebola Virus has been reported, then you may wish to consider proactively creating a screening policy.

Should Ebola become a serious concern in our nation, the following are recommendations from various sources.  Your board of directors in conjunction with your Medical Director or Medical Advisor may then need to develop the best strategy for your center in screening for Ebola carriers and what protocol your center will follow should such a person be identified.

Medscape interviewed Arjun Srinivasan, MD (CAPT, USPHS), Associate Director of CDC's Division of Healthcare Quality Promotion, asking some key questions about the Ebola crisis. They began with the upcoming influenza season and the worries that primary care clinicians may have about symptomatic patients who also have concerns about Ebola.

"Medscape: How should clinicians handle patients who present with symptoms of fever, nausea, and vomiting, in light of current Ebola recommendations?

Arjun Srinivasan, MD (CAPT, USPHS): It's important to remember that the telephone can be one of the tools that can help keep us safe from Ebola. When people call for appointments, it's an opportunity to ask them the screening questions about whether they might have risks for Ebola. Important in that is a travel history or potential exposure to a patient with Ebola. A checklist for patients being evaluated for Ebola is available on the CDC website.

Medscape: If there is no positive travel or exposure history in the past 21 days, can a clinician rule out Ebola?

Dr Srinivasan: Yes. The exposure or travel history is a key to identifying patients who might be infected with Ebola. There is an algorithm you can use to help you determine who might be at risk for Ebola, available at cdc.gov."

(quoted from MedScape.com)

The CDC Checklist for Patients Being Evaluated for Ebola Virus Disease (EVD) in the United States (linked to above) may offer some initial steps upon arrival of a possible carrier and initial assessment.

Below are three protocols and a questionnaire from the Franklin County, Ohio Health Department website. (Heartbeat International is located in Franklin County, Ohio) You may also want to look on the health department websites in your county for their recommendations.

Protocol for Assessing Possible Ebola Exposure in Healthcare Settings

Protocols for Dispatch and First Responders to Limit Exposure to Ebola

Protocol for Assessing Possible Ebola Exposure in Work Settings

Travel History and Exposure Screening Questionnaire

From the following document by the American Hospital Association the following may be of importance:

  • Implement triage protocols to identify potential patients and institute precautions
  • Designate site managers overseeing implementation of safety precautions

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The following statements from the CDC may be helpful as you consider what steps to take.

"When a patient possibly infected with the Ebola virus appears in a hospital emergency department (ED), clinicians need not necessarily cover themselves from head to toe with personal protective equipment (PPE), according to new guidelines from the Centers for Disease Control and Prevention (CDC).

The CDC also emphasizes that ED patients with an unconfirmed Ebola infection are not contagious unless they are vomiting, bleeding, having diarrhea, or otherwise producing body fluids associated with an advanced stage of the disease and a healthcare worker comes in direct contact with them.

"If you're not at risk of being exposed to blood or body fluids, then you're not at risk of transmission," said Arjun Srinivasan, MD, associate director of the healthcare-associated infection prevention programs of the CDC's National Center for Emerging and Zoonotic Infectious Diseases. "When that risk exists — the patient is throwing up, for example — then you choose PPE that provides full-scale protection."

The first step in the CDC's algorithm for ED clinicians is determining the patient's exposure history: Has he or she lived in or traveled to a country with widespread Ebola disease or had contact with an infected person in the previous 21 days? If so, then the identification of Ebola signs or symptoms comes next. One sign is fever, either subjective or 100.4°F and higher. Other signs include headache, weakness, and muscle pain, as well as the red-alert symptoms of vomiting, diarrhea, abdominal pain, and hemorrhage, as in bleeding gums or nose bleeds.

A patient with these signs and symptoms along with a definite exposure history should be isolated immediately, either in a private room or a separate enclosed area with a private bathroom or a covered bedside commode. The CDC guidance states that only essential healthcare workers with designated roles should care for the patient and should log in and out of the room.

More information on the new Ebola guidance from the CDC is available on the agency's website.

(quoted from MedScape.com)

For additional or ongoing information, the CDC has a wealth of information available here.

Above all, we must look in faith to God Almighty for His wisdom and protection. Psalm 91 is a magnificent promise of protection and there is no better time for daily meditation in this Psalm, as we rest in faith in the One who is able to keep us safe in times of trouble.

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How Your Center Can Help Prevent Ebola's Spread

MSnurse

As the Ebola outbreak has spread from West Africa to isolated cases in parts of Europe and now the United States, there has been no shortage of panic and paranoia among Westerners—even those working in the health care fields.

Still, it is an established and repeated fact that Ebola's spread can be prevented simply by following proper safety procedures in a medical setting. An informational page on Ebola published at the World Health Organization's (WHO) website points to the sad reality of Ebola's largely preventable spread:

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD [Ebola Virus Disease]. This has occurred through close contact with patients when infection control precautions are not strictly practiced.1

As those involved in the life-saving work of pregnancy help in the medical setting, how can you protect yourself, your clinic, and your clients from this deadly virus?

The answer starts with educating yourself, your staff and volunteers, and your clients as to how Ebola spreads, which, again according to WHO, involves the following:

Ebola... spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.2

Consider the functions of your Pregnancy Help Medical Center or Clinic.

  • Could you come into contact with any bodily fluid when handling a urine pregnancy test?
  • What about collecting a specimen for STD/STI testing?
  • Broken skin that can be exposed and contacted while conducting an ultrasound?

With these points of contact posing risks in light of the Ebola virus—in addition to several diseases that are much more likely to spread—make sure your center is paying special attention to policies such as Universal Precautions as defined by the Centers for Disease Control (CDC) and OSHA Regulations.

Under Universal Precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, (Hepatitis B), and other blood-borne pathogens. Universal Precautions involve the routine wearing of gloves, other protective clothing, hand washing, and such infection control measures that are designed to place a barrier between potentially infectious blood or body fluids and employees.3

For more information on how you can keep your center protected from the spread of viral infection, check out Heartbeat International's Medical Essentials for Pregnancy Help Organizations©.

 


1. "Ebola virus disease," World Health Organization, http://www.who.int/mediacentre/factsheets/fs103/en/ (accessed Oct. 17, 2014).

2. Ibid.

3. Medical Essentials for Pregnancy Help Organizations©Heartbeat International, 2014, Part IV, page 4.

 

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The Buzz from the Medical Tracks

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We love hearing from you in the pregnancy help medical community.

Here's a sampling of what attendees said about the 2014 Heartbeat International Conference in Charleston, South Carolina. The Conference featured 78 workshops, including six each in the Medical Matters and Ultrasound Advancement tracks, in addition to two medically focused in-depth all-day workshop sessions and a special keynote from John Bruchalski, M.D., founder of Tepeyac Family Center & Divine Mercy Center.

1. "I feel much more confident after these workshops and webinars. Thank you!"
Jo-Ellen O'Keefe, Pregnancy Help and Information Center (Ectopic Pregnancy, Audrey Stout RDMS)

2. "Very interesting and groundbreaking information – this will change things!"
Reagan Nielson, Vitae Foundation (Update on Abortion Pill Reversal, Dr. Delgado)

3. "Dr. Delgado's presentation was so very exciting! It was interest peaking, informative and empowering. I'm grateful for his work and research regarding the APR. (Abortion Pill Reversal)"
Jamie Koser, Heartline Pregnancy Center (Update on Abortion Pill Reversal, Dr. Delgado)

4. "Very creative teaching! Lots of light bulbs went off!"
Cheryl Didrekson, Kimberly Home, Inc. (Flipping Uterus, Roxanne Ertel RDMS)

5. Amazing presentation! I have been scanning for 12 years and finally understood the anatomy of the uterus on U/S! Thank you!"
Jennifer Snowden, New Beginnings Women's Center (Flipping Uterus, Roxanne Ertel RDMS)

6. "Super excellent."
Katherine Niemiec, Family Life Services Clinic and Pregnancy Center (Flipping Uterus, Roxanne Ertel RDMS)

7. "Thank you! This was the most enlightening session of the week and worth the entire trip to learn these nuggets."
Patti White, New Beginnings (Flipping Uterus, Roxanne Ertel RDMS)

 

When am I Due? Why Should I be Concerned?

Healthy Pregnancy/Healthy Baby Series: Part 1

By Helen Risse RN MSN

baby-bumpIf you work with pregnant women, you have a great opportunity to improve birth outcomes. When a new client visits your pregnancy help organization, this may be the only contact you have with her.

What should she be sure to know before she leaves you? Does she know her due date? Will you be telling her based on the first day of her last menstrual period?

It is important to define due date and term pregnancy. Remind your new mother that her due date is really a due time that looks at two weeks before to two weeks after that date as being "term". Many people still think of pregnancy in terms of nine months. Explain that pregnancy is defined as 40 weeks or 10 lunar months.

At the end of 2013, the American College of Obstetrics and Gynecology (ACOG) redefined the meaning of "term".

  • Early term: Between 37 weeks, 0 days and 38 weeks, 6 days.
  • Full term: Between 39 weeks, 0 days and 40 weeks, 6 days.
  • Later term: Between 41 weeks, 0 days and 41 weeks, 6 days.
  • Post term: Between 42 weeks, 0 days and beyond.

Research has noted that the brain of a baby at 35 weeks, 0 days grows in size by two-thirds in the following four weeks.

Research has noted that although the weight of a baby may look normal, babies born before 39 weeks are sleepier babies. These babies do not latch and suckle as well as babies born at 39 weeks 0 days. They have more problems with higher bilirubin levels. These concerns can lead to serious consequences. The choice of an elective delivery date must factor in these findings.

Women should also be taught the signs of preterm labor. Teach women about contractions. Explain what they may feel and describe those symptoms that should put them on alert.

Describe contractions as feeling like:

  • Menstrual cramps
  • Low, dull backache
  • Pelvic pressure—feeling that the baby is pushing down
  • Heavy feeling in your pelvis (pelvic congestion)
  • Stomach cramps—with or without diarrhea
  • The abdomen may tighten or get firm then relax or soften

Describe vaginal discharge or bleeding:

  • An increase or change in your normal vaginal discharge
  • Red, brown or pink discharge or spotting

Describe water breaks:

  • Gush of fluid from vagina
  • Slow trickle of fluid from vagina-(panties feel wet and you don't know why)

General feeling that something is not right.

What should she do if she thinks she may be having preterm labor? Below are some guidelines you may discuss with your Medical Director to develop a policy/procedure for your center.

  • Empty bladder
  • Drink 1-2 glasses of water or juice (no caffeine, sugar, or sports drinks)
  • Lie down on your side and time the contractions from the beginning of one to the beginning of the next. Write down when the contractions start.

If the contractions are coming more than every 15 minutes or 4-6 in an hour, call your doctor.

It is important to stay well hydrated. Dehydration can often cause a woman to experience contractions.
Women should know the risks that increase concerns for preterm labor. Women who are at greatest risk for preterm labor are those who have had a previous preterm birth, as well as those who are pregnant with multiples, and those with certain abnormalities of their uterus or cervix.

Other risk factors include smoking, drinking alcohol, using illegal drugs, domestic violence, including physical, sexual or emotional abuse, or lack of support.

Additional risks factors related to her health include infections, including urinary tract infections, sexually transmitted infections, diabetes, high blood pressure, second trimester bleeding from the vagina, being underweight before pregnancy, obesity, and a short time period between pregnancies.

When asked if there is anything that can be done to prevent preterm labor, tell a woman to:

  • See her doctor early and regularly during pregnancy,
  • Eat nutritious meals and snacks,
  • Drink at least 8 glasses of water, juice or milk every day, and
  • Avoid cigarettes, alcohol, drugs and medications not prescribed by her doctor.

If you have one visit from a pregnant woman and pass on this information, you may contribute to an improved outcome. Every extra day her baby is in a healthy intrauterine environment is positive for the development of her baby, which in turn can be a big help to a new mother.


References

Spong CY. Defining "Term" Pregnancy: Recommendations From the Defining "Term" Pregnancy Workgroup. JAMA. 2013;309(23):2445-2446. doi:10.1001/jama.2013.62

ACOG Clinical Guidelines: Definition of term pregnancy. Committee Opinion No. 579. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;122:1139–40.35
Go the Full 40 Campaign tool Kit :http://www.health4mom.org/pregnancy/healthy_pregnancyo

The last weeks of pregnancy count: July 5th, 2012l Kit: http://newsmomsneed.marchofdimes.com/?tag=brain-development

 

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