Medication Management

Professional Education
The Need for Close Monitoring in Hyponatremia: Osmotic Demyelination Syndrome
In reviewing closed malpractice claims, The Doctors Company identified mismanagement of sodium levels during correction of severe hyponatremia as a serious problem that can result in catastrophic permanent neurological injury due to osmotic demyelination syndrome (also known as central pontine myelinolysis). This article highlights the importance of close monitoring of sodium levels during correction of severe hyponatremia, with a slow and controlled pace of sodium correction. Contributing factors discussed include clinical judgment with regard to rate of rise of sodium levels, patient monitoring, choice of practice setting, and communication between providers, especially at points of transition in care.
0.5 credit

Professional Education
Risky Practices: Hidden Liabilities Identified by Medical Office Assessments
Office practice assessments by The Doctors Company's patient safety risk managers uncover hidden liability risks, often exposing areas where patients can "fall through the cracks" and leave the practice vulnerable to a malpractice claim. Our Practice Risk INSIGHT, an assessment tool customized by specialty, zeros in on problematic areas. The assessments have been completed across a range of practice environments around the country—from small offices to practices that are part of large integrated delivery systems. In this course, we analyze the results of the Practice Risk INSIGHT assessments, highlight problem-prone areas and offer strategies to minimize liability.
1.3 credits

Professional Education
Telehealth: Review Your Service Components
Many practices implemented telehealth overnight in response to pandemic restrictions on elective care. Practices already using telehealth saw huge increases in volume. This program presents a roadmap for practices to evaluate their telehealth implementation using the best practice tips identified herein and their own lessons learned.
0.8 credit

May 14, 2021
Managing Healthcare Practice Operations during COVID-19
Debbie Kane Hill, MBA, RN, Senior Patient Safety Risk Manager
As COVID-19 cases continue to rise and fall across all regions of the United States, practices must adapt and adjust their operations according to regional mandates, which can transition overnight with the shifting environment. For areas where there is a resurgence of the virus or as new strains of the virus emerge, you will need to be attentive to newly imposed restrictions. If disease transmission slows further, authorities may lift additional restrictions.

Professional Education
Breast Cancer Claims – A Review in Gynecology
Breast cancer medical negligence claims are reviewed over a ten-year period to identify the major case types in which the gynecologist is the responsible party. The factors that contributed to those claims as identified by plaintiff and defense physician experts are discussed through case examples with learner questions. Risk mitigation strategies are identified to guide gynecologists in further providing the safest patient care and thereby improving their risk profile.
10.0 credits

Professional Education
Pain Management - A Closed Claim Analysis Looking at Risks and Lessons Learned
For the first time, The Doctors Company has published an analysis of lawsuits and claims filed against pain management physicians. This study completed in 2020 provides quantitative and qualitative information that a physician who practices pain management, including interventional approaches to treatment would find useful in mitigating the risks of unintended outcomes or harms. This study breaks down where most patient injuries occur, what those injuries are, and the lessons learned from those claims.
1.3 credits

Apr 14, 2021
Off-Label Use: Patient Safety Implications
Kim Hathaway, MSN, CPHRM, Patient Safety Healthcare Quality and Risk Management Consultant, and Richard Cahill, JD, Vice President and Associate General Counsel, The Doctors Company
The standard for appropriate off-label use of medications and other products is what other similarly trained physicians would do, not what the manufacturer of the medication or product recommends.

Professional Education
Interventional Radiology: Analysis of Closed Malpractice Claims
Studying interventional radiology malpractice claims provides an understanding of drivers of lawsuits and patient injuries that result. By analyzing these claims and identifying the contributing factors involved, risk mitigation strategies can be developed and implemented reducing adverse patient outcomes and increasing patient safety.
0.8 credit

Mar 23, 2021
Prescribing Opioids Safely: How to Have Difficult Patient Conversations
Roneet Lev, MD, Chief of Scripps Mercy Emergency Department, Chair of Prescription Drug Abuse Medical Task Force, and President of Independent Emergency Physicians Consortium
Drug overdose is the leading cause of accidental death in the U.S., and opioids account for over 60 percent of those deaths. Building a strong doctor-patient rapport can help facilitate tough conversations with patients about opioid prescriptions and reduce risks that could lead to malpractice suits.

Mar 17, 2021
Virtual Reality for Pain Management: An Alternative to Opioids
Miranda Felde, MHA, CPHRM, Vice President, Patient Safety and Risk Management, The Doctors Company
Many physicians are exploring virtual reality (VR) technologies as an alternative to opioid prescriptions. VR addresses both attention paid to pain and the patient’s emotional state: The immersive distraction of VR can help a patient mentally transport to another space, such as an underwater seascape, which may also positively affect the patient’s emotional state.

Professional Education
TeamSTEPPS® Teamwork Training in the Office Practice
This course provides an overview of the evidence-based TeamSTEPPS® concepts, tools, and strategies based on the four areas of 1) leadership, 2) mutual support, 3) situation monitoring, and 4) communication. TeamSTEPPS training provides teachable/learnable skills that improve communication and teamwork among healthcare professionals in both acute care and ambulatory care environments.
1.5 credits

Professional Education
HIPAA Fundamentals: 2021 Edition
This on-demand program provides an orientation to the basic requirements of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA gives patients many rights with respect to their health information.
1.0 credit

Professional Education
HIPAA for Managers: The High-Level View
The program explores and defines HIPAA policies and procedures, business associate agreements, security assessment and analysis, training requirements, HIPAA compliance requirements, breach events, and informed consent.
1.0 credit

Professional Education
Prevention of Diagnostic Error in Primary Care
Diagnostic errors occur often in primary care settings and can impact over 12 million outpatients annually. This is a top patient safety concern and a global burden. Significant patient harm can occur due to treatment delay, testing, or misdiagnosis. This course is an opportunity to promote awareness and visibility by identifying where these errors occur most often in the diagnostic process of care framework.
1.0 credit

Professional Education
It's the Little Things: An Introduction to Enhancing Patient Relations and Reducing Risks
It's the Little Things is designed to assist medical practices with improvements in patient interactions by looking at how incorporating hospitality as a focus makes a difference. It has been developed to improve multiple facets of patient interaction.
1.3 credits

Professional Education
Spotlight on Diagnosing PE/DVT
The overall incidence of venous thromboembolism (VTE) —including both deep vein thrombosis (DVT) and pulmonary embolism (PE) —is one case per 1000 patient years. Accurate and timely diagnosis of VTE can be improved with the use of diagnostic guidelines such as Wells criteria and scoring for both DVT and PE.
0.5 credit

Professional Education
Lessons Learned – Plastic Surgery Closed Claims Study: An Expert Analysis of Medical Malpractice Allegations
This course is based on the findings of a study conducted by The Doctors Company that analyzed 415 claims that closed against plastic surgeons (from July 2015–December 2018).
1.3 credits

Professional Education
Medical Error Prevention
The purpose of this monograph and continuing medical education activity is to provide physicians with the most current information regarding the prevention of common performance and diagnostic errors.
2.0 credits

Professional Education
Safe and Effective Opioid Prescribing – Florida Edition
The Doctors Company recognizes the opioid epidemic in this country. This course provides insights into the risks of opioid usage, as shown by malpractice claims, and how to reduce those risks both for your patient and for your practice. Approved by the Florida Board of Medicine—Controlled Substance Prescribing.
2.0 credits

Professional Education
Prevention of Medical Errors: CME Risk Management Course for Florida Practices
This activity is specific to Florida statutes and reflects regulations effective February 2020. Few medical errors are attributed to faulty medical judgment. More commonly, they are attributed to system failures inherent in healthcare delivery. By drawing on our professional liability closed claims data, we have identified common performance and diagnostic errors that reflect on the most common issues identified by Florida—wrong site surgery, surgery complications, cancer, Ob/Gyn related conditions, gastroenterology conditions, cardiology issues, neurological issues, and adverse drug events—that will serve as the focal point of this patient safety and risk management course.
2.0 credits

Professional Education
Cauda Equina Syndrome: A Failure to Diagnose
Failures of systems often prevent physicians from making timely diagnoses. Failures may result when patient assessments are incomplete, having a narrow diagnostic focus, or diagnostic test issues. Other factors that hinder timely diagnoses include failure to appreciate signs and symptoms, lack of consults, and failure to respond to repeated patient concerns/symptoms.
0.5 credit

Aug 28, 2020
Dispensing Sample Medications: Risk Management Strategies
Debbie Kane Hill, MBA, RN, Senior Patient Safety Risk Manager
If not carefully managed, sample medications can create issues that place patients and the practice at risk.

Professional Education
Making an Informed Consent an Informed Choice: Training for Healthcare Leaders
This activity is designed for healthcare professionals in leadership positions. It covers the principles of informed consent, crafting and disseminating an informed consent policy, and building systems to improve the informed consent process.
2.0 credits

Professional Education
Making an Informed Consent an Informed Choice: Training for Healthcare Professionals
This activity, designed for doctors, nurses, and other providers, examines problems with the process of healthcare informed consent. It describes the principles of informed consent and highlights the benefits gained from a good informed consent process.
2.3 credits

Mar 11, 2020
Analysis of Medical Oncology Claims
Darrell Ranum, JD, CPHRM, Vice President, Patient Safety and Risk Management
We analyzed 101 medical oncology claims to examine common injuries, identify strategies for mitigating risk, and learn what drives claims.
From The Doctor’s Advocate

Dec 20, 2019
Burnout Can Affect How Patients Communicate
By Robert D. Morton, BA, ARM, CPHRM, CPPS, Assistant Vice President, Patient Safety and Risk Management, The Doctors Company
If a physician appears burned out, patients may avoid asking questions for fear of adding to the stress.

Professional Education
Internal Medicine: When Personal Relationships Interfere with the Standard of Care
Physicians and dentists are often faced with the decision whether to treat friends and families without realizing the inherent risks in doing so. A review of one case will highlight some common circumstances and risks associated with the treatment of friends and family members.
0.8 credit

Video Dec 16, 2019
Artificial Intelligence in Healthcare: Benefits and Risks
A third of U.S. physicians are already using artificial intelligence (AI) in their practices, and many believe there is ample reason to think this advanced technology can help address diagnostic errors—the largest cause of malpractice claims. However, there are still unresolved questions about the risks.

Dec 12, 2019
Office of National Drug Control Strategy Promotes Building an Addiction Medicine Workforce
Roneet Lev, MD, Chief Medical Officer, Office of National Drug Control Policy
Dr. Lev recaps a White House event that focused on the field of addiction medicine.
From The Doctor’s Advocate

Professional Education
Spotlight on Anesthesia Claims: Moving the Needle
In this course we will show how comorbidities complicated the delivery of good anesthesia care. And we will share how important a thorough history and physical is to identifying potential problems that occur in the administration of anesthesia care.
1.0 credit

Professional Education
Safe and Effective Opioid Prescribing - Georgia Edition
This three-hour learning activity provides instruction on controlled substance prescribing guidelines, recognizing signs of abuse or misuse of controlled substances, and controlled substance prescribing for chronic pain management, as delineated in Georgia Rule 360-15-.01. It also provides tools and resources to assist in educating staff and informing patients.
3.0 credits

Professional Education
Safe and Effective Opioid Prescribing - Michigan Edition
This three-hour learning activity provides instruction on controlled substance prescribing guidelines, recognizing signs of abuse or misuse of controlled substances, and requirements delineated in Michigan’s law. It also provides tools and resources to assist in educating staff and informing patients.
3.0 credits

Dec 01, 2019
Dilaudid-Related Morbidity and Mortality from Respiratory Depression
Howard Marcus, MD, FACP, Chairman, Texas Alliance for Patient Access
Patient safety organizations and the FDA are focusing on ways to reduce patient harm from opioids.

Oct 31, 2019
The Algorithm Will See You Now: How AI’s Healthcare Potential Outweighs Its Risk
A third of U.S. physicians are already using artificial intelligence (AI) in their practices, and many believe there is ample reason to think this advanced technology can help address diagnostic errors—the largest cause of malpractice claims. However, there are still unresolved questions about the risks.

Professional Education
Interventional Radiology: Communications and Assessments
Ensuring patient safety for any procedure requires communication between the diagnosing physician and the proceduralist. This includes ensuring all physicians are aware of pre-procedural testing that the proceduralist would need to adequately care for the patient and manage complications.
0.5 credit

Professional Education
Advanced Practice Providers Closed Claims: What Can We Learn?
A recent study by the Association of American Medical Colleges predicts that the U.S. would need an additional 95,900 doctors, 22,700 NPs, and 12,800 PAs immediately if healthcare use patterns were equalized across race, insurance coverage, and geographic location. More understanding of the liability associated with APPs can help provide insight on the current situation and identify strategies that decrease risk, improve patient safety, and advance patient care.
1.0 credit

Professional Education
Dementia Q&A: What Physicians Ask About Diagnosis and Treatment
This course focuses on the common concerns and questions expressed by physicians about dementia and cognitive impairment. This course covers making the initial observation of cognitive decline and beginning a conversation with older adult patients; overcoming common barriers to making a definitive diagnosis of dementia; and managing the ongoing clinical needs of patients experiencing dementia.
1.5 credits

Professional Education
Alzheimer’s Disease and Related Dementias Evaluation and Diagnosis
The second course introduces The Alzheimer's Project Evaluation Algorithm and Evaluation Instruments, and focuses on differential diagnoses. The course includes ideas for how to prepare and engage in a sensitive dementia diagnosis disclosure with patients and caregivers.
1.5 credits

Professional Education
Dementia Screening Among Adults with Cognitive Decline
The first course introduces The Alzheimer’s Project and highlights the increasingly important role of primary care practitioners in dementia care. It presents The Alzheimer’s Project Cognitive Impairment Screening Algorithm and Screening Instruments, and it addresses reversible conditions that may present similar symptoms to cognitive impairment. The course incorporates four videos, each followed by a series of related questions.
1.3 credits

Professional Education
Physical Examination and Its Impact on Outcomes
Advancements in technology improve the timeliness and accuracy of many diagnoses but the technology does not replace a thorough physical examination. For some diseases, such as Parkinson’s disease, herpes zoster, cellulitis, and Bell’s palsy the PE is the only diagnostic tool available. This short course makes the case for reversing the downward trend for physical examinations.
0.8 credit

Professional Education
Ob/Gyn: Telephone Communications
The most frequent inconsistent practice found in the Practice Risk INSIGHT assessments was telephone communication (22 percent not met). When appropriate and adequate systems are in place, the physician is less at risk for having a suit filed. This case-based study provides insights and risk management techniques to lessen the frequency and severity of such a claim.
0.5 credit

Professional Education
Psychiatry: Preventing Adverse Outcomes
The Doctors Company study of closed claims reveals areas of higher risk in outpatient psychiatry practices. Using this as a foundation, the course provides information to evaluate your practice and make changes to improve decisions about treatment, operational processes, reporting, and documentation.
1.5 credits

Nov 16, 2018
Opioid Addiction in Pregnant Women and Moms: How to Make a Difference
Hannah Snyder, MD, and Christine Pecci, MD
Treating pregnant women and mothers with opioid addiction calls for a well-informed approach to patient safety.

Video Oct 31, 2018
Fighting the Opioid Epidemic: Progress Report from Surgeon General
Programs for combatting the opioid epidemic, reducing overdose rates, and addressing other addiction epidemic issues (including heroin and fentanyl) are explored by U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH. His comments were made to attendees at The Doctors Company's 2018 Executive Advisory Board meeting.

Video Oct 31, 2018
Surgeon General's Priority: Partnering for Public Health
Community health and economic prosperity are connected, and healthcare professionals can partner with the business community to improve public health. This priority for public health was shared by U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH, with attendees at The Doctors Company's 2018 Executive Advisory Board meeting.

Video Oct 31, 2018
Threat of Global Epidemics: Surgeon General Speaks
There is a growing threat of global epidemics, including Ebola and Zika, and U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH, is working to address this threat and promote health through better community partnerships. He made his comments to attendees at The Doctors Company's 2018 Executive Advisory Board meeting.

Video Oct 31, 2018
Naloxone to Fight the Opioid Epidemic: Surgeon General's Perspective
Co-prescribing naloxone can help turn around opioid overdose rates and is an important first step in fighting the opioid epidemic, says U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH. His comments were made to attendees at The Doctors Company's 2018 Executive Advisory Board meeting.

Video Oct 31, 2018
Surgeon General Addresses E-Cigarettes and Vaping
Vaping and e-cigarettes present a significant healthcare challenge for physicians today. U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH, addresses this issue and the fact that young people are susceptible to developmental delays and effects on the brain from vaping and e-cigarettes, which prime them for addiction up to age 26. His comments were made to attendees at The Doctors Company's 2018 Executive Advisory Board meeting.

Video Oct 31, 2018
Surgeon General's Strategies for the Opioid Epidemic
U.S. Surgeon General Vice Admiral Jerome M. Adams, MD, MPH, detailed some of the strategies, plans, and programs that can be effective in combating today's opioid epidemic when addressing attendees at The Doctors Company's 2018 Executive Advisory Board meeting. Topics include prescription drug monitoring programs, reasonable alternatives to opioids for acute and chronic pain management, medication-assisted treatment for those in recovery, and co-prescribing naloxone for those at risk of opioid overdose.

Oct 30, 2018
U.S. Surgeon General Discusses Public Health Issues
United States Surgeon General Vice Admiral Jerome Adams, MD, MPH, discusses how vaping and e-cigarettes present a significant healthcare challenge for physicians, as well as how changes in healthcare payment models are increasing the focus on public health.

Oct 30, 2018
U.S. Surgeon General Discusses the Opioid Epidemic
United States Surgeon General Vice Admiral Jerome Adams, MD, MPH, discusses the opioid epidemic’s huge impact and strategies to combat it, including prescription drug monitoring programs, medication-assisted treatment for those in recovery, and co-prescribing naloxone for those who are at risk of opioid overdose.

Video Jul 24, 2017
The Opioid Epidemic: A Closed Claims Analysis
Opioids play an important role in pain management—both in the acute and chronic settings. Unfortunately, the dramatic increase in opioid use over the past few decades has resulted in an opioid-related epidemic of addiction and death. To take a deeper look at the epidemic, The Doctors Company reviewed 272 malpractice claims in which patient harm involved opioids.

Jun 06, 2017
Prescribing Opioids Safely
Howard Marcus, MD, FACP
Dr. Howard Marcus discusses guidelines and recommendations for preventing opioid misuse and addiction in patients with acute or chronic pain.
From The Doctor’s Advocate

Mar 16, 2017
San Diego Death Diaries
Roneet Lev, MD
Dr. Roneet Lev provides insights into the prescription opioid abuse epidemic.
From The Doctor’s Advocate

Mar 16, 2017
Analysis of Medication-Related Claims from The Doctors Company
David B. Troxel, MD, Medical Director, Board of Governors
Dr. David Troxel reviews 1,770 closed by The Doctors Company in which patient harm involved medication factors.
From The Doctor’s Advocate

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