Expanding Latent Tuberculosis Infection Testing and Treatment in Massachusetts Primary Care Clinics via the ECHO Model.

INTRODUCTION/OBJECTIVES: In the US, reactivation of latent tuberculosis infection (LTBI) accounts for 80% of new cases. In 2016, the US Preventive Services Task Force provided a new recommendation that primary care providers (PCPs) should conduct LTBI screening, whereas in the past, LTBI cases were evaluated and treated by specialty providers. This shift in care revealed knowledge gaps surrounding LTBI treatment among PCPs. This study assessed changes in PCPs' confidence for performing key aspects of LTBI care before and after participation in an LTBI Extension for Community Healthcare Outcomes (ECHO) course. METHODS: The ECHO Model™ is an evidence-based telementoring intervention. Participants were primary care team members from clinics throughout Massachusetts who voluntarily enrolled in the ECHO course. In this mixed-methods evaluation, primary outcomes were PCP self-reported confidence changes by pre- and post-course surveys and post-course semi-structured interviews. RESULTS: Twenty PCPs (43% of registered PCPs) attended at least 3 of the 6 sessions and 24 PCPs (31% of registered PCPs) completed at least one survey. Confidence increased in selecting a test (P = .004), interpreting tuberculosis infection test results (P = .03), and selecting a treatment regimen (P = .004). Qualitative interviews with 3 PCPs revealed practice changes including switching to interferon gamma release assays for testing and using rifampin for treatment. CONCLUSIONS: Use of the ECHO model to train PCPs in LTBI management is feasible and efficacious. For continuing medical education, ECHO courses can be leveraged to reduce health disparities in settings where PCPs' lack of familiarity about a treatment topic contributes to poor health outcomes.

Legal Implications in the Care of Orthopedic Patients: Serious Complications.

To help reduce potentially devastating outcomes from spinal complications and venous thromboembolism, it is essential for the bedside nurse to have a comprehensive understanding of risk factors and assessments. The orthopedic nurse carries a responsibility for accurately assessing, documenting, and mobilizing the team when abnormal changes occur. Nurses act as patient advocates. The bedside nurse must communicate with the physician. If a patient or family sues the health care team, after a careful screening of the case for merit, the legal process begins. A health care provider should never give in to the temptation to alter medical records.

Liability in the care of the elderly.

The most common reasons nursing homes are sued are residents' fractures and pressure ulcers. The majority of cases in a sample of 118 nursing home lawsuits resulted in settlement or a plaintiff winning at trial. The most successful method of defending a lawsuit was to dispute the facts. Risk prevention strategies include working in a sufficiently staffed facility, attending to the needs of the residents and families, and complying with federal and state regulations.

Medication errors. A bitter pill.

According to the Agency for Healthcare Research and Quality, over 770,000 hospitalized Americans are injured or die each year from adverse drug events. The scope of the problem is now recognized by governmental and professional agencies. Traditionally, the legal and healthcare systems have focused on identifying incompetent and poorly performing healthcare providers as the cause of patient injury instead of systematically making the system safer. The solution to this problem lies in understanding how and why medication errors occur and identifying what can be done to prevent them. This article will identify the factors that contribute to adverse medication events in healthcare and discuss current initiatives to prevent errors. The role of nursing in improving medication administration and reducing adverse events will be detailed.