Wellness Week Recap
In January 2016, ACEP was the first national medical specialty to have a dedicated time to focus on the well-being of its members. EM Physicians having a burnout rate of 54%, one of the highest rate on the most recent Medscape survey. A 2014 Cochrane review reported that interventions including massage and meditation along with the practice of mindfulness appears to be a helpful approach in reducing burnout. The idea of promoting the well-being of physicians was appealing, and I wanted to extend this to the entire ED staff at Hilo Medical Center (HMC).
As part of our Wellness Week, we brought in several community businesses that promote the tenants of healthy living. We offered healthy alternative lunches to the ED staff, which included smoothies and fresh foods from a local organic cafe. By bringing in a blender and fresh fruit, we were able to offer our night shift staff home-made smoothies as well. Eating nutritiously can hep combat work fatigue.
A local yoga studio instructor offered to give yoga classes focusing on myofascial release and meditation. Exercise is a large component in combatting stress outside of work. We were also able to bring in a masseuse who offered complimentary 15 minute massages during shift hours. We had him set up in an empty room in our ED so the staff would be able to go in during a quick break to get some needed relaxation.
One of the main reasons that our Wellness Week at HMC was so successful was not only our ability to offer healthy foods, exercise and relaxation, but also that we were able to show our appreciation to our physicians and ED staff. Working in the front-lines of medicine is a daunting task, but everyday our physicians and nurses and techs go into work, knowing they will change lives. While we might not get a "thank you" or a pat on the back after every difficult shift, it does help when we and those we work with are shown gratitude.
What we do has an impact on our community and those around us. In addition to caring for our patients, we have to remember to pay attention to ourselves as well.
JABSOM Emergency Medicine Interest Group (EMIG)
Hawaii ACEP welcomes Jeremy Shin and Harry Wynn-Williams as the new JABSOM EMIG co-Presidents for the upcoming school year. They look forward to collaborating with HACEP members and continuing the close partnership that exists between our two groups.
EMIG encourages interested medical students to gain as much exposure and knowledge about Emergency Medicine as they can by offering workshops, physician shadowing, research opportunities, and volunteer activities. Hawaii ACEP members are encouraged to participate whenever possible to mentor what will be the next generation of emergency physicians. Visit the EMIG website at this address: https://sites.google.com/site/jabsomemergencymedicine/. Contact the EMIG group at firstname.lastname@example.org.
Pediatric Head Injuries
Click here to read an item on Pediatric Injury Guidelines referenced in our June newsletter.
NEJM Article On Boston Marathon Bombing
Here, a link to a May 1, 2013 New England Journal of Medicine article about the coordinated response of hospitals and first responders to the Boston Marathon bombing.
Pediatric Burn Injury Guidelines
Please click here to view pediatric burn injury guidelines from Kapiolani Medical Center for Women and Children in Honolulu.
Treating Distal Radial Fractures In Children
Please click here to view an article on closed treatment of distal radial fractures in children. One of the authors is Dr. Byron Izuka.
Opioid Guidelines And Best Practices
For your convenience, here are opioid guidelines and best practices that the Hawaii Chapter supports.
Hawaii State Prescription Monitoring Program
In February of 2012, the state of Hawaii initiated an online resource allowing registered health care providers to access state data regarding prescriptions for controlled substances. The website allows physicians to quickly look up any completed prescription for controlled substances filled by a pharmacy or dispensing provider in the state, including workman's compensation clinics and veterinarians.
Visit the above website to register. Use the link under "How to Register to Retrieve Patient Controlled Substance Usage Reports." The entire process takes less than 15 minutes, though days to weeks are needed to confirm your eligibility. We have seen registration difficulties in the past, but those appear to have been solved.
Once registered, login at the same website and enter the patient' first and last name along with their date of birth and hit the "View" button. Any prescription for a controlled substance filled in Hawaii within the designated time frame will be displayed. Patient consent is NOT required to access the information.
There are some potential hiccups. Military pharmacies are currently exempt - so a prescription filled on a military base will not be displayed. I have been told that efforts are being made to include military pharmacies in the near future. Second, there have been glitches in uploading data. You will find some prescriptions that you know have been filled are not displayed. Derek Nakamura, Chief Special Agent of the Department of Public Safety's Narcotic Enforcement Division tells me that episodes of missing data do occur, but they are rare.
I have been using the system daily in my practice for 6 months and find it invaluable. Almost every shift, I find data on the system that changes my approach to at least one patient. The system generally requires less than 2 minutes for me to access records and is easy enough that I am able to obtain a report before I write almost any narcotic prescription.
Narcotic diversion and abuse is a huge area of focus on both state and national levels. A bill presented in this year's legislature would have severely limited the ability of emergency physicians to prescribe narcotics. While it appears to have been tabled for now, physicians as a group will need to change our practice to address the problem or someone else will. For the good of your patients and colleagues, register and use the system.
Of note, it appears the state will be moving to a new vendor to operate the system. Mr. Nakamura indicates that he expects the transition to be seamless for providers and should only require using a different website. We will notify you when further information is available.
Will Scruggs, MD
President-Elect, Hawaii ACEP