Brillinta, Arixtra, Xarelto, Pradaxa, Effient… Say What?

Posted by on Jul 20, 2014 in Blog, Legal Nurse Consulting

By Neely Cotten, ACNP, MSN The Annals of Pharmacotherapy recently published a research study that raises concern for anyone involved in the review and analysis of medical claims. The study estimated that seven percent of all medication errors are made in the administration and monitoring of blood thinners. That makes this class of drug the second most likely to be associated with administration and monitoring error. While the last generation of anticoagulants have specific lab values to monitor their effects, scientists have not yet developed correlating tests for each new drug.  This is something that adds to the burden for anyone handling a claim. The back story In the not-so-distant past, practitioners prescribing anti-coagulants had just two choices — heparin or warfarin. The FDA approval of Lovenox, a new low-molecular weight heparin, revolutionized the medical world in the early 90’s. Patients receiving heparin and warfarin required inpatient administration or strict phlebotomy schedules and rigid dietary restrictions as outpatients to prevent bleeding complications. Lovenox made it possible for patients with clotting disorders to self-administer their medications at home with no outpatient blood work required. The safety, efficacy and low risk of complications associated with Lovenox changed how physicians treated their patients. Despite the progress made in this new generation of blood thinners, the side effects of unmonitored anticoagulants can be dangerous and potentially devastating.  The most common side effect is uncontrollable bleeding. Such episodes have spurred researchers to create new drugs that act on different portions of the body’s clotting cascade. Within the past ten years, new blood-thinning medications have flooded the market.  Aging Boomers, their doctors and others now face a daunting list of names, mechanisms of action, and monitoring parameters for these complex, life-or-death medications. The relative scarcity of data on this new generation of anticoagulants raises serious concerns for patients and providers alike.  That’s because the efficacy and side effects of the medications are potentially un-measureable. Why is this important? Today, the management of irregular heartbeat, stroke, and blood clots requires an unprecedented level of expertise.  It also ups what is required for anyone to review an insurance claim. Cases of medical malpractice can be won or lost by your understanding of the monitoring parameters for anticoagulants. For example, imagine that a patient experiences a cerebral hemorrhage, or brain bleed, after receiving the anticoagulant Xarelto. If I were reviewing a claim as a Legal Nurse Consultant, I would ask: Did the physician fail to adequately monitor the patient’s bleeding times in order to prevent this? Was this is an unforeseeable event? What would you do?  Would you ask these and other questions?  More important, what conclusions might you draw from the responses you got? Neely Cotten, ACNP, MSN...

Read More

Is the glass half empty or half full?

Posted by on Jul 1, 2014 in Blog, Legal Nurse Consulting

By Debra West, RN, BSN, CCM, LNC Medical records are often incomplete. Office notes, hospital records and even test results might be missing, leaving gaps in treatment. Yet, in order to have a clear picture of the claimant, the injury, medical treatment and diagnosis, we must have all of the  records. The problem With me and others trained to assess injury claims, red flags immediately go up when I discover the records are incomplete.  That’s because missing records may contain valuable information regarding the injury. They often hold the key to the relationship, if any, between the Mechanism of Injury and the alleged injuries. Records may be purposefully omitted which define preexisting illness/injuries or even date the injury to a much earlier or later time. When records are submitted, we assume they are complete.  However, this is rarely the case. Best practices When reviewing the records pay close attention to the page numbers.  This is frequently the first clue of missing documents. Next, look at the dates of service on the billing and compare the dates with the records received. Occasionally an office note will refer to an earlier appointment, which is another way to check for completeness. Bottom line The reviewer must have a complete set of records to accurately assess the reported injuries, the Mechanism of Injury, pre-existing pathology and if there is a relationship between the alleged injuries and the event.  Rendering an opinion without full assessment of the file can lead to costly acceptance of claims, which possibly could have been diverted if the records had been complete. Debra West, RN, BSN, CCM, LNC is a Legal Nurse Consultant with MKC Medical Management.  Contact Debra at 865-551-6800 or...

Read More