We offer this publication as a member service of the West Virginia Primary Care Association (WVPCA).

Some practices try to combine KM 14 (Medication Reconciliation) and KM 15 (Medication Lists). Let's look first at how they differ, and why, and then we can consider the further opportunity to improve patient safety by coordinating medication reconciliation in the medical neighborhood.

Medication lists should be updated at least annually and are intended to include both prescription and nonprescription medications, over-the-counter medications and all those touted supplements-both evidenced-based and otherwise-that a patient has deemed useful to their nutrition and health (does a practice know how many of its patients use CBD oil?) or that were suggested by their clinician. The reason for these lists is therefore to be able to alert a patient if something is recalled, a recommended dose is revised or a study has discovered a new interaction. These need to be in a practice's system in such a way that the practice can search for all patients who are currently on a specific medication and so it can determine how often it should update lists.

The denominator should be all active patients in the practice; the nume rator should be all patients whose medication list was updated within the past year. For patients without any medications, a dated inquiry showing "none" can count in the numerator-but remember that "medication" in KM 15 is broadly defined and would includ e vitamins for a pediatric patient.

One difference between KM 14 and KM 15 is that medication reconciliation is a more defined process. While meeting the criterion does not require demonstrating the reconciliation process, an evaluator may need to delve into the practice's process to determine that it is doing more than merely updating the medication list. Certainly, updating the list is a starting point, but KM 14 focuses on prescribed medications, with an actual review of dosage, frequency and interactions. This criterion also focuses on the need for a review following a care transition: The patient's list may have been updated recently, but a transition from another source of care initiates anew need. 

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January 16, 2020 | 12:15 PM - 1:15 PM

 

Please join the West Virginia Primary Care Association and Dr. Judith Feinberg, Professor of Behavioral Medicine & Psychiatry, WVU Medicine to learn more about Pre-Exposure Prophylaxis (PrEP) to prevent HIV in your communities. Given the current state of the rapid increase in HIV cases in West Virginia, now is the time to improve HIV screening as well as assessing patients for risk of HIV. Let's all work together to prescribe prevention of HIV.  Registration for this one-hour webinar is available  here.

Learning Objectives:

Target Audience:  Doctors, Nurse Practitioners, Physician Assistants, Certified Nurse Midwifes

January 21, 2020 | 12:00 PM - 1:00 PM

 

Please join the West Virginia Primary Care Association (WVPCA), along with Julie Jackson from the WV Dept. of Oral Health to learn more about the seriousness of vaping and it's impact on our adolescents. Vaping is becoming an increasing epidemic among teens. In 2018, e-cigarette use nearly doubled in high school students. 

 

Vaping is the act of inhaling and exhaling the aerosol, often referred to as vapor, which is produced by an e-cigarette or similar device. The term is used because e-cigarettes do not produce tobacco smoke, but rather an aerosol, often mistaken for water vapor, that actually consists of fine particles. Many of these particles contain varying amounts of toxic chemicals, which have been linked to heart and respiratory diseases and cancer.  Many teens have dangerous misconceptions that lead them to believe that vaping is harmless.

 

Join us for an hour long webinar that will provide a clear understanding of the challenges, dangers and information needed for support our students in making good choices.  Registration for this webinar can be found  here.

 

CEUs available for nursing, social work and dental.

 

After this webinar, participants will:

 

Target Audience: Medical providers, Nurses, Behavioral Health providers, Dental Hygienists

Dr. Max Self grabs a sanitary wipe and cleans off the small flashlight in his hands. More than 20 years as a family doctor in rural Fort Scott, Kan., has taught him a few tricks for dealing with little kids: "I've got my flashlight. See? Look, you want to hold it?"

Two-year-old Taelyn's brown eyes grow round, and her tiny hand reaches out. But, first, Self makes sure the little girl opens her mouth wide, and he peers down. Behind him sits another staff member - a medical scribe. The scribe gives the doctor the ability to "focus on people," rather than toggling between a computer screen and the patient. It's a new perk Self didn't have when he worked at Mercy Hospital.

With the arrival of the New Year, employers should consider reviewing and updating their employee handbooks. Many non-union employers are surprised to learn that their efforts to regulate employee conduct often implicate federal labor law. Section 7 of the National Labor Relations Act ("NLRA") guarantees employees the 

right to "engage in ... concerted activities for ... mutual aid or protection." The National Labor Relations Board ("NLRB") has held that employees are protected from discipline or discharge for engaging in social media activity that constitutes "concerted, protected activity." This statutory protection applies to both union and non-union workplaces.

 

Most employers have adopted rules and policies that discourage or prohibit their employees from engaging in certain types of conduct, but as you can see above, these policies need to be narrowly tailored so that they do not interfere with an employee's Section 7 rights.

 

Fortunately, the Office of General Counsel at the NLRB has issued some helpful guidance as to which policies are more apt to run afoul of the NLRA. The General Counsel has identified three categories of workplace rules. Category 1 includes workplace rules that are generally lawful to maintain. Category 2 consists of workplace rules that warrant "individualized" scrutiny. Category 3 covers rules that are simply unlawful to maintain.

 

Working in reverse order, Category 3 is clear and unequivocal. Employers may not adopt or enforce rules that require confidentiality regarding wages, benefits or workplace conditions. Likewise, employers may not prohibit employees from joining unions. These activities are expressly protected under the NLRA.

 

Category 2 rules are not obviously lawful or unlawful and must be evaluated on a case-by-case basis to determine whether they interfere with rights guaranteed by the NLRA. The General Counsel has identified several examples: broad conflicts-of-interest rules that do not specifically address fraud or self-dealing; confidentiality rules involving "employer business" or "employee information" (rather than patient information or proprietary information); rules prohibiting disparagement or criticisms of the employer; rules prohibiting false or inaccurate statements (rather than rules prohibiting defamatory statements).

 

Category 1 is perhaps the most helpful to employers in terms of providing practical guidance. The General Counsel has identified several examples of workplace rules that fall under this category: (a) civility rules; (b) no-photography and no-recording rules; (c) rules prohibiting insubordination; (d) disruptive behavior rules; (e) rules protecting confidential, proprietary and patient information; (f) rules prohibiting defamation or misrepresentation; (g) rules prohibiting use of intellectual property (e.g., employer logos); (h) rules requiring permission to speak on behalf of the employer; and (i) rules prohibiting competition, nepotism and self-enrichment.

 

The NLRB's approach to these issues typically seesaws based upon presidential appointments. Unless a new president is elected in 2020, employers will be well-served to follow the General Counsel's guidance when reviewing and updating their handbooks.

                                              ________________________________

Justin M. Harrison is a labor & employment lawyer at Jackson Kelly PLLC. He is available for consultation through a special retainer relationship with the WVPCA. Justin can be reached at (304) 340-1358.

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