Sunday, December 31, 2017

Reflecting on Leadership, a New Year's reading recommendation list

key words:  resources, recommended reading, leadership, teamwork, reflection
Recommended Reading on Leadership
(some books also available in audio format)

Brene Brown's Rising Strong:  How the Ability to Reset Transforms the Way We Live, Love, Parent, and Lead

Primary Greatness: The 12 Levers of Success by Stephen Covey.
"The intrinsic rewards of primary greatness . . . integrity, responsibility, and meaningful contribution"
The book, First Things First by S. Covey, offers not a clock for how to do more in less time, but a compass.
"...provides you with a compass, because where you're headed is more important than how fast you're going"
See how small shifts and changes in behavior lay fertile ground for cultural change in the workplace in Margaret Heffernan's Beyond Measure, the big impact of small changes, a 2015 TED book.

The classic, The 7 Habits of Highly Effective People by S. Covey.

An Effective Life:  Inspiration about Effectiveness from Dr. Stephen R. Covey.  The basics of Covey's philosophy distilled into quotes and infographics.



Predictable Results in Unpredictable Times by Covey et al.

Arianna Huffington's Thrive:  The Third Metric to Redefining Success and Creating a Life of Well-being, Wisdom, and Wonder

No Greater Love—Mother Teresa



What are your favorite books on leadership and why?  Please write in the comments.


related blogposts


If you have found these recommendations helpful, please consider contributing toward the costs of supporting this blog resource and building related resources at our website.

Sunday, December 17, 2017

Gift Ideas for the Graduate Medical Student or Health Care Provider

The Graduate Medical Student, Resident, or Practitioner interested in Integrative Health
some gift ideas
list and links updated 11.30.2018

Bates’ Pocket Guide available in paperback and Kindle formats
Case Studies to Accompany Bates’ Guide available in paperback and Kindle formats
Vibrational Medicine by Richard Gerber, MD.  Paperback and Kindle formats.
Mindfulness for Beginners by Jon Kabat-Zinn
The Educated Heart, a practical guide to professional boundaries by Nina McIntosh
Griffin's Hospitals:  What They Are and How They Work

Deepak Chopra books

 Sebastian Junger
Tribe:  On Homecoming and Belonging, by Sebastian Junger, author of War and The Perfect Storm.   

Yeti Mug—keep your student hydrated and liquid stays hot or stays cold for the entire clinical shift or study session. 

68oz Thermos insulated (by Thermos)

RFID-blocking wallet--to protect your hospital ID card and other cards (credit cards)
RFID-blocking wallet, Trayvax company  Such as
Trayvax Ascent, Trayvax Element, Trayvax Axis, and Trayvax Contour and more at their website.

See the Gift Idea page for more inspiration and links to fair trade coffee and chocolate


The Integrative Medicine Researcher

"The Researcher" resource list was originally available as a perk in our spring fundraiser.

In the spirit of the "gift ideas" and resource recommendations, here is a list of items available through Amazon.  When you follow the links on this page to purchase an item, a few pennies goes toward the Hospital Handbook Project.  However, several of these resources are not available from Amazon, so we drafted a resource pdf of bibliographies, etc.  If you are interested in that pdf, please contact me through the contact page on the website.

Books available through Amazon—just follow these links:


The "Researcher's Resource List"--a pdf compilation of citations of recommended resources and
reading for the beginning or established researcher.  List has been compiled with feedback from the Hospital Practice Handbook community.  Pdf list contains favorite reads and resources to learn more about research in the field, clinical research design, and common research field issue discussions.
If you are interested in this pdf, send me a specific message through the contact page of our website.

Thank you for supporting this work!

You can follow us by subscribing to this blog, joining the contact list on the website, and following our Facebook page.

Related Information on Resources and/or Gift Ideas
the Gift Idea page
Integrative Medicine, the philanthropic movement into Mainstream Medicine--want to learn more?
Creating Resources to Grow and Connect the Integrative Medicine Community
Supporting our Hospital Administrators and Department Heads who are incorporating Integrative Medicine and Integrative Health professionals and paradigms into their programs

Saturday, December 9, 2017

Most Popular Posts of Autumn


Autumn Blogroll Review

For an update on the Hospital Practice Handbook Project work, please see In November, the Chum Salmon Run.

This Autumn, I did a series of posts related to the opioid epidemic as several major reference papers and recommendations for non-pharmacologic therapies from national organizations have come out over the past year.  Currently, the most popular of these posts is The Medication Review and Calculating the Morphine Equivalent Dose (MEQ) which, while reviewing how to recognize common opioid medications, also has links to several good resources on opioid safety training for both allied health and primary care providers.
Medication Review and Review of Systems:  Opioid Med side effects
The White Paper:  Acupuncture's Role in the Opioid Epidemic
Joint Commission Pain Management Standard update
37 Attorney Generals Push Incentives for Non-Pharm Pain Relief Therapy

The Lunchtime Listen series continues to be popular, particularly Duke University's Launching an Integrative Health ProgramCheck out the latest installment of the series with Opioid Epidemic.


Previous Blogroll Reviews
Most Popular Posts of the Spring Fundraiser

Monday, November 27, 2017

Lunchtime Listen: The Opioid Epidemic

key words:  medication review, opioid crisis, pain management, non-pharm options, the Surgeon General's Call to Action about the Opioid Epidemic, public health crisis, lunchtime listen audiovisual



Today's Lunchtime Listen recommendation, "Opioid Overdose Epidemic:  A Call to Action" is an audiovisual presentation, supported by the federal Joint Pain Education Project (JPEP), has several statistics about the opioid prescription increase, what the opioid epidemic is, side effects of opioids (pain sensitization, poor sleep) etc.  It mentions the 2016 U.S. Surgeon General's Call to Action about the Opioid Epidemic.    length of video:  about 26 minutes.

While the video is a module intended for prescribing practitioners, it has good information for non-prescribing practitioners to understand when talking with your prescribing colleagues about what you offer as non-pharm pain management therapy options for patients.

"1/4 of patients on long-term use opioids for chronic pain struggle with opioid use disorder"
"In 2014, accidental deaths from opioids exceeded accidental deaths from motor vehicle accidents"

After minute 25, the summary:
"#1.  DO NOT PRESCRIBE OPIOIDS as a FIRST LINE TREATMENT" 
Instead, it is recommended primary care providers consider which non-opioid and non-pharm therapies are appropriate.  
Here's a quick guide about what non-pharm therapies are commonly used in pain programs and how to refer created by several integrative medicine national organizations:  Moving Beyond Medications


Blogposts related to opioid medications and non-pharm options
Calculating Morphine Equivalent Dose
Medication Review and ROS:  Opioid Medication Side Effects
The Autumn 2017 White Paper:  Acupuncture's Role in Solving the Opioid Epidemic
Metrics and Pain Management:  Using the DVPRS as your Pain Scale



More Lunchtime Learning Recommendations
Launching an Integrative Health Program in a Medical Center 
Integrative Medicine Leadership:  Lori Knutson's "Leading Simply in a Complex System" 
The Complexity of Acupuncture Research in just 10 minutes
Samueli Institute's On Human Flourishing series
Research Review:  Key Studies to Understand when Discussing Pain Management with a Physician


If you have found this blog and its posts useful, contribute $5 or $25 today to support this resource (blog and website).  Thank you.  If you or your business/program want to sponsor or co-sponsor a specific project, like the Webinar Series, contact me.  


Do you want to follow our work at the Hospital Handbook Project?  Just join the contact list on the website, subscribe to the blog, and like our Facebook page.


Tuesday, November 21, 2017

In November, the Chum Salmon Run: Update on the HH Project Work

key words:  project update, fundraising, opioid crisis, online courses

Here in the Pacific Northwest, we have several "runs" of salmon.  Last week I chaperoned a school field trip for my daughter's class where we travelled to Twanoh State Park, where the Olympic mountains meet the southern portion of the Hood Canal. See quick video of it here.

Time for the monthly progress update.   I continue to learn more about the Teachable platform for hosting online courses as we finish up the beta-testing phase of the Workers’ Comp Documentation Toolkit:  (East Asian Medicine) Practitioner’s Perspective.  I designed this course for the WA L&I Acupuncture Pilot Participants to be successful in transitioning to this style of clinical work and the state workers’ comp system of documentation and reimbursement.

I have continued to post short clips of my Hospital Handbook Project work in the blog.  (The book manuscript has more comprehensive information.)   Recently have posted a series of posts related to the current opioid crisis.  The following posts are useful for the patient or patient advocate: 
And these posts are intended for the practitioner:
If you missed it, you can still listen (or watch, when there is video), a recommended Lunchtime Learning series from the related blogposts or from the YouTube playlist.

Our Facebook Page is growing.  Please “like” our page and rate it (if you like the information).  You can also send me messages/email through the Hospital Handbook Project Facebook page.
Book progress--I am going through edits of the manuscript and learning more about self-publishing process every month.



“Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow.” –Melody Beattie

Tuesday, November 14, 2017

The White Paper, Acupuncture's Role in Solving the Opioid Epidemic

key words:  research literacy, acupuncture for pain relief, acupuncture for pain management, non-pharm pain management options, opioid epidemic, cost-effectiveness of acupuncture, the acupuncture analgesic mechanism, acupuncture and neuroplasticity

"The United States is facing a national opioid epidemic, and medical systems are in need of non-pharmacological strategies that can be employed to decrease the public’s opioid dependence." 

"Acupuncture is an effective, safe, and cost-effective treatment for numerous types of acute and chronic pain. Acupuncture should be recommended as a first line treatment for pain before opiates are prescribed, and may reduce opioid use."

In September 2017, the white paper, Acupuncture's Role in Solving the Opioid Epidemic:  Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management, was published by The Joint Acupuncture Opioid Task Force, chaired by Bonnie Bolash, MAc.

This white paper is just 15 pages long and incredibly well-referenced (21 pages long when including references section).  You can look at a copy on Evidenced-based Acupuncture's website.

This work was a collaboration of the following national and international organizations:  The American Society of Acupuncturists (ASA), The American Alliance for Professional Acupuncture Safety (AAPAS), The Acupuncture Now Foundation (ANF), The American TCM Association (ATCMA), The American TCM Society (ATCMS), and the National Federation of TCM Organizations (NFTCMO).

All the topics in the paper are supported by research in the end notes/reference section.
I highlighted some topics with a related quote below.  Check out the full paper here.


For anyone asking, how does acupuncture work?  The paper states,
 "mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives." 

Is acupuncture cost-effective?
"...acupuncture’s cost-effectiveness could dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding the development of opioid addiction that requires costly care, destroys quality of life, and can lead to fatal overdose."

Who recommends it?
"Acupuncture has been recommended as a first line non-pharmacologic therapy by the FDA, as well as the National Academies of Sciences, Engineering, and Medicine in coping with the opioid crisis. The Joint Commission has also mandated that hospitals provide non-pharmacologic pain treatment modalities." [section 4]
"Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacological treatment options, and acupuncture stands as the most evidence-based, immediately available choice to fulfill these calls.  Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of pain seen commonly in hospitals." 

Acupuncture and neuroplasticity

"Acupuncture is effective for the treatment of chronic pain involving maladaptive neuroplasticity" and "acupuncture has the capacity to reverse adverse neuroplastic changes" [section 3]

Source:  The September 2017 white paper, Acupuncture's Role in Solving the Opioid Epidemic:  Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management
scientific journal citation:
Fan AY, Miller DW, Bolash B, Bauer M, Faggert S, He H, Li YM, Matecki A, Camardell L, Koppelman MH, Stone J, McDonald J, Meade L, Pang J.  Acupuncture's Role in Solving the Opioid Epidemic:  Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management --White Paper 2017. J Integr Med. 2017; 15(6): 411-425.  http://dx.doi.org/10.1016/S2095-4964(17)60378-9

Simultaneously published in Meridians:  Journal of Acupuncture and Oriental Medicine, winter 2018.  www.meridiansjaom.com

Related blogposts
Calculating Morphine Equivalent Dose
Medication Review:  Discerning Side Effects of Opioid Medications
37 Attorney Generals Push Incentive Programs for Non-Pharm Pain Management Therapies
Sept 2017 update on Joint Commission's Pain Management Standard
The Field of Acupuncture Research in 10 Minutes
FDA Pain Management Guideline Recommends Acupuncture
Lunchtime Listen:  the Opioid Epidemic
Metrics and Pain Management, using a Validated Pain Scale

Useful Infographic on Non-Pharm Pain Relief Options for a PCM
Moving Beyond Medications:  Non-Pharm Approaches to Pain Management and Well-Being, a one-page infographic for PCMs.  This is a collaborative work by several national integrative medicine groups.



Thursday, November 2, 2017

Professional Practice: Discerning Medication Side Effects from Symptoms and Signs


Medication Review and Review of Systems:  Side Effects of Opioid Medications
10.28.2017
Key words:  medication review, documentation standards, professional practice (OPPE), opioids, MEQ, medication side effects, workers’ comp, pain management

Why do you need to know?
It is important and useful for an EAMP to consider the side effects of a patient’s medications.  This helps, when going through the assessment, including the Review of Systems (ROS), to discern what is a side effect from a medication (branch or twig) vs. what is endemic to constitution or specific condition (root and/or earlier branch). 

What is the source of the following information?
The August 2017 CDC online training based on the January 2016 CDC Guidelines on Safe Opioid Prescribing, “Applying CDC’s Guideline for Prescribing Opioids” https://www.cdc.gov/drugoverdose/training/overview/index.html

Common side Effects of Opioid use
Constipation
Dry mouth
Drowsiness
Nausea
Confusion
Vomiting
Tolerance/loss of medication effectiveness
Physical dependence
Decreases ability to safely operate equipment
Sexual dysfunction

Red Flags—Be Wary of Opioid Medication + Nervous System Depressants
Benzodiazepines
Drinking alcohol
Why is this a red flag? 
These combinations [opioid + benzodiazepine or opioid + drinking alcohol] can quickly lead to respiratory depression (slowed and stopped breathing)

Serious Risks Associated with Opioid Use
Death
Opioid use disorder
Respiratory depression
Decreased ability to safely operate a vehicle
Unintentional ingestion by household members/others (children)
Overdose

What Conditions Make People at Extra High Risk for Adverse Events or Death d/t Overdose when taking Opioids, according to the 2016 CDC Guideline?
If they have a history of:
Overdose
Any sleep disorders
Renal or hepatic (liver) problem
Alcohol or substance use problem
Age:  65+
Pregnancy (pregnant women)
If they currently have one of the following:
Depression
Alcohol or substance use
Prescribed over 50 MME/day
Taking benzodiazepines
Treated with methadone

Reference for the above information:
Source:  The 2016 CDC Guidelines on Safe Opioid Prescribing.  For the related CEU training, go to the CDC course, Applying CDC’s Guideline for Prescribing Opioids  

Useful Infographic when Communicating with PCM Colleagues about Non-Pharm Pain Relief Options
Moving Beyond Medications: Non-Pharm Approaches to Pain Management and Well-Being, a one-page infographic for PCMs, a collaborative work by several national Integrative Medicine groups.

Related Blogposts
Calculating Morphine Equivalent Dose (MEQ)
Metrics and Pain Management, using a Validated Pain Scale

More about sleep disturbance as a side effect of opioid medications, see Sleep disturbance in patients taking opioid medication for chronic back pain, published 2016 in the journal Anaesthesia by Robertson and Purple et al.

If you found this information useful, please consider contributing to this resource at our website.  Thank you.

copyright Megan Kingsley Gale
Do not reproduce without the author's written permission

The author can be reached through the Hospital Practice Handbook's Facebook Page.  Just use the "message" feature on that Facebook Page.



Monday, October 23, 2017

The Medication Review and Calculating Morphine Equivalent Dose (MEQ)


Calculating Morphine Equivalent Dose (MEQ)
Last updated 2017.10.24

Key words:  documentation standards, pain medications, opioid medications, calculating morphine equivalent dose (MED), MEQ, medication review, metrics, pain management, opioids, workers's comp, return-to-work clinic model

Morphine Equivalent Dose Calculation (MEQ)
The morphine equivalent dose is a way of tracking how much opioid-type medication a patient is taking on daily basis. There are multiple medications that contain morphine, hence the calculation.


MEQ is a useful tool for determining red flags and for tracking (by individual patient or a general measure of all patients in specific outpatient clinic environment) how much opioid-type pain meds patients are taking before starting EAM treatment vs. when they finish treatment. MEQ data taken at initial and re-evaluations is a useful way to track that info. 

1.    First, do the medication review with the patient.
In a medication review, you take down patient-reported information on prescriptions, over-the-counter meds and supplements.
If patient is unclear about what they are taking, communicate with the referring provider to get this information. 
[The ACPA has a useful wallet card for patients to track their meds.]

2.    Second, recognize which prescriptions are opioid-based medications.
Names of commonly prescribed opioid medications
Codeine
Fentanyl transdermal
Hydrocodone
Hydromorphone
Methadone
Morphine
Oxycodone
Oxymorphone
Tapentadol
Tramadol

3.    Third, after you have finished the med review, plug the opioid-based prescriptions and daily mg dosages into the online Opioid Conversion calculator to determine the daily morphine equivalent dose (MEQ).  Report/track this number in the MEQ portion in the medication review section of your chart note template.

4.    Fourth, note Red Flags such as MEQs above 50 and medication panels that include opioids plus one or more of the following:  mood drugs, sleep drugs.  For specific medication names and drug classes that warrant red flags, review the WA State Opioid Safety free CEU training.  Know how and when to make appropriate referrals or communication with referring provider.

Quick double-check: did you remember to ask your patient (who is on an opioid medication), about their pain?  Did you track this on a validated pain scale?  Learn more about pain scales in this post.

Related Resources


Primary Care-Specific Resources (Physicians, Nurse Practitioners, PAs)
copyright Megan Kingsley Gale
Do not reproduce without the author's written permission

If you found this helpful, contribute $5 or $25 to the Hospital Handbook Project today to support this resource (website and blogposts).

Want to learn more?  Contact me about our related online, self-paced courses.

The author can be reached through the Hospital Practice Handbook's Facebook Page.  Just use the "message" feature on that Facebook Page.


Tuesday, October 17, 2017

Update on my Workers' Comp Supplement Resource, "Practitioner Perspective"

keywords:  projects, resources, workers' comp, return-to-work model, documentation standards

So, Indiegogo requires me to post monthly updates.  If you didn't follow the spring campaign you can check it and learn more about our project lists and related projected budgets (per project) here.

Today's update is about my more recent volunteer work with creating a supplemental resource for state (Washington) practitioners who have enrolled in the new WA State L&I Acupuncture Pilot.  It is a work-in-progress and I will link to the course when it is more refined.

However, there are some outgoing expenses for the worker's comp Practitioner resource.  If you are interested in supporting this specific project, you can donate to WEAMA, the nonprofit state professional organization that has been spearheading this work the last 5+ years.  To donate, please go to the WEAMA webpage and tag "for Megan's L&I Resource" in the comments section of your online donation.  Donations to WEAMA are tax-deductible.

Here is the update I posted:
Happy Autumn!  Our family is still here in the Pacific Northwest.  Military family life is about "making plans and then making plans again and then going back to plan A or C" someone probably once said.

We are enjoying the cool weather and the transition back to school for my oldest. 
In my last post, I mentioned my volunteer professional work with creating supportive materials for L&I Pilot Project participants was taking up a significant portion of my time.  The work has continued and hope to unveil the link to my first online course, "Practitioner Perspective" at the state professional association meeting (Washington East Asian Medicine Association) on Sunday, October 22nd, at Bastyr University in Kenmore, WA. 
The resource I created is a documentation toolkit to support Practitioners involved in the WA state Workers' Comp Pilot to be successful by reviewing professional documentation standards in our field, with introduction to the return-to-work/rehab model and how Acupuncturists fit into it, and resources, with examples, on how to collect a few specific functional measures. 
There are outgoing expenses associated with creating this Resource. If you know someone, a professional, or a business that would like to donate toward this specific project, donations are accepted through Washington East Asian Medicine Association (WEAMA) at the donation page.  Caveat:  for the money to go toward the project, you must tag "for L&I project" in the comments field of your donation.  
Thank you for sharing this post!
Megan

Monday, October 2, 2017

37 Attorney Generals Push Incentives for prescription of Non-Pharm Pain Management Therapies

key words:  models of care, non-drug pain management, working as a team, research studies, funding/incentives

This September, Dennis Hoey of the Press Herald reported that there are now 37 state attorney generals that are pushing incentives to increase the use of non-pharmaceutical pain relief therapy as imperative to addressing the U.S. Opioid Crisis.

"Mills and her peers said the health care industry needs to promote the use of alternatives such as physical therapy, acupuncture, massage, and chiropractic care to treat patients' chronic pain."

"Mills said health insurers need to reduce any financial incentives to prescribing addictive narcotics and begin to offer greater coverage for alternative therapies."

Update:
As of Jan 2018, there is now a more comprehensive review of this in the winter 2018 issue of Meridians: JAOM, "U.S. Attorneys General Promote Acupuncture Coverage" by Bill Reddy, Dipl.Ac (NCCAOM) of the Integrative Health Policy Consortium (IHPC).  Electronic copies of Meridians are available gratis through your state acupuncture association membership or you can subscribe for e-copy or print copy through the journal's website.  

citation:
Reddy B. U.S. Attorneys General Promote Acupuncture Coverage. MJAOM. 2018; 5(1): 39-40.


Related
The White Paper:  Acupuncture's Role in Solving the Opioid Epidemic
Joint Commission Pain Management Standard is updated
More about a pilot in Vermont looking at Medicaid and acupuncture for chronic pain management 
Research from the NIH, "Acupuncture is effective, safe, and cost-effective for treating several chronic pain conditions when performed by well-trained healthcare professionals."
How to use a Validated Pain Scale in Your Clinical Care

More great resources at The Collaborative.

Monday, September 25, 2017

Joint Commission Pain Management Standard update for Greater Clarity on Recommendations to Acupuncture and other Non-Pharmacological Pain Relief Therapies


key words:  pain management, acupuncture, nonpharm pain relief therapy, working as a team, joint commission, state and federal programs, research

The new Joint Commission Pain Management Standard will be officially implemented Jan.1st, 2018 for any accredited facility.  These new standards were developed through a multi-year vigorous review process.  According to this source, the new pain management guidelines include:

1.  Facility (hospital) has a pain management leadership team which monitors performance improvement activities and is "responsible for pain management and safe opioid prescribing".

2.  Facility provides non-pharmacological pain management therapies (such as acupuncture/East Asian medicine, chiropractic, yoga, physical therapy, health psychology/MBSR, massage therapy) by qualified, licensed practitioners

3.  Facility provides staff and licensed independent practitioners (LIPs) "with educational resources and programs to improve pain assessment, pain management, and the safe use of opioid medications based on the identified needs of its patient population."

Related Story, Field-forwarding Leadership (update from Jan 2018)
Arya Nielsen, PhD, is one of the leaders in this Pain Management Standard update.  Read her story of perseverance and success in updating the Joint Commission's Pain Management Standard in the Duke University Leadership Program in Integrative Medicine newsletter (Jan 2018).
"Dr. Arya Nielsen exemplifies this type of grassroots leader, and we owe her a great debt for leading us through this important change for the fields of integrative medicine and pain management."  
The Joint Commission is the most influential organization in setting hospital practice standards in the U.S.  Read Dr. Nielsen's inspiring story.

Related blogposts:



Duke University Integrative Leadership Program notes the following related references on management of Chronic Pain with Integrative Medicine:

  • The April 2017 issue of the British Medical Journal focused on the use of integrative medicine (acupuncture, mind-body systems, dietary/nutrition interventions, and herbal medicine therapy) for 3 chronic pain conditions:  neck pain, back pain, and rheumatoid arthritis.  The article discusses some mechanisms of action and efficacy studies.
  • Primary Care:  Clinics in Office Practice published a special issue on Integrative Medicine (IM) with review articles about IM use in primary care settings for chronic pain and other conditions in June 2017.