Thursday, April 24, 2014

Skills test notes

Testing Procedure:

Need to be on time, wear scrubs, have hair pulled back, have a wrist watch and have I.D. and voucher.

What are students tested on?
·         Vital Signs:
Temp:                     How to correctly obtain a tympanic temperature: many forget to pull back on the ear gently.
Pulse:                     How to locate a radial pulse.  Please teach them how to obtain an apical pulse.


B/P:                        Don't re-inflate cuff.  Do NOT tighten B/P valve too tight, just turn until it stops.

Make sure students know how to time for 30 seconds or 1 minute and do any math involved. Students are allowed to use a calculator for the skill and written tests.

·         Beginning/Ending Procedure:
Many are forgetting to verbalize/demonstrate-WEARING GLOVES, providing privacy, raising bed to working height, return bed to lowest position & report and document.

·         Critical Criteria:
Critical criteria include behaviors that are part of EVERY skill tested.
1. Infection control and universal precautions:  (Following all rules of medical asepsis)
2. Safety: (Protecting resident and self from physical harm)
3. Residents’ rights:  (Taking action to prevent or minimize emotional stress to resident)
4. Communication:  (Explaining procedure to resident prior to initiating it)
5. Recognizing and reporting changes: (Observing and reporting abnormalities)

·         Hand WashingDemonstrating hand washing is necessary and is evaluated as part of the critical criteria. Approximately 40% of students are doing this WRONG!!!

Hand washing Procedure
1. Don’t touch the sink with your uniform
2. Turn water to warm
3. Wet and soap hands
4. Wash hands with fingers down for 15-30 seconds, including wrist, nails and between fingers
5. Rinse with fingertips down
6. Use dry paper towel to dry hands
7. Use same paper towel to turn off faucets
8. Discard paper towels appropriately (Do not use it to finish drying your hands)

Prompts: Each student will be given 2 prompts (helpful hints during the test, if needed).  What is a prompt?
 What skills do I think most people struggle on?
Right vs. Left:  (Right vs. left side of resident, this will count as a prompt.  I give at least one prompt a day for this), hand washing, placing Nasal Cannula, obtaining accurate height, log roll with hip fracture precautions, dressing/undressing, PROM and ambulating (placing cane and wheelchair on strong side).

Overview of Skills:

Each student will be given a scenario with 5 skills from the list below.
 Students are expected to demonstrate skills. 
Students need to physically practice each skill, not just watch.

Most students do this skill very good!!!
Some students forget to place tubing over leg and attach to bed frame (not over or on side rail) always-below level of bladder.
MANY students have never placed a nasal cannula before.
Many students forget to raise the side rail when turning patient. Some students do not know what the draw sheet is.
Most students do fine with this skill, they will need to verbalize how often to check/remove compress.
They need to calculate intake by subtracting what is remaining in container from the amount they are told was originally in the container.
Some students forget the conversion rate.
Many students do fine with this skill.
Some students forget what order to put on/remove PPE.
Due to the length of time it would take to perform all of the steps we have students verbalize the bathing and oral care.
SKILL 11: ABDOMINAL THRUST (Conscious Patient only)
They need to remember to ask “Are you choking”.  Many students do not know correct placement.
Most students do fine measuring the weight.  Many students do not know how to measure height.
Some students do not know how to place the heel in the correct location.
Most students do not do this properly.  They need to know the terms flexion, extension, adduction, abduction or rotation- how to take the joint through all ranges of motion.
Most students do well at positioning.  Many students forget to raise side rail while turning patient.
Many students forget cane should be placed on residents’ strong side.
Many students are forgetting to lock the wheelchair brakes. MANY DO NOT KNOW WHERE TO PLACE THE WHEELCHAIR WHEN THEY TRANSFER.  They do not know what a “Pivot Transfer” is.
Some students forget how to tie a quick-release knot.
  Some students forget to line the sink.
This is a very difficult skill for MOST students.  They are forgetting to use at least 2 persons and the draw sheet. Resident should not be rolled onto injured side and they also forget to place abduction splint or pillows between legs to support hip.
Most students do fine with skill.  A few students do not know they should not use toothpaste and a toothbrush for this skill.
Most students do fine with this skill.
Most students do fine with this skill.
Many students forget to dress weak side first and undress weak side last.
Most students do fine with this skill.
Most students are doing fine with this.
Some students do not know how to properly place fracture pan.
Most students do not know to place the label on the specimen container and not just in the bag.

Sunday, April 6, 2014

On Food And Food For Thought

 On Food And Food For Thought

An expert offers a clear-eyed assessment of conventional, organic, genetically modified, And genetically engineered foods.

An 86-year-old woman enthused to her daughter, “I don’t mind being in the rehab center—the food here is great!” This comment might serve as the standard to which long term and post-acute care facilities aspire: to create delicious, nutritious meals that ensure living there is a highly palatable experience. 
Nutrition is the bedrock of both health recovery and continued well-being, especially among elders and those with compromised immunity. Yet health care providers can face significant challenges designing menus to meet patient needs. Some of the factors providers must address include the following:
■ Emotional factors. Loneliness and depression can affect appetite. For some, feeling depressed leads to not eating; in others it may trigger overeating.
■ Metabolism. For every year over the age of 40, metabolism slows down. This means if someone continues to eat the same amount and kinds of food as when they were younger, they are likely to gain weight because they are burning fewer calories. In addition, seniors in assisted living or post-acute care settings are generally less physically active than previously.
■ Taste and appetite. Taste and smell diminish with age, and salt must often be restricted or omitted due to health conditions. Medications can also negatively influence appetite.
 Digestion. Due to changes in the digestive system, older adults generate less saliva and stomach acid, making it more difficult for their bodies to process certain vitamins and minerals, such as B12, B6, and folic acid, which are necessary to maintain mental alertness, memory, and good circulation. 

Conventional Vs. Organic

One of the biggest ongoing food debates concerns conventional versus organic foods. For older people, especially those with chronic health conditions, organic (or unsprayed) is far better and may not cost more when purchased in large quantities, or directly from the organic farmers.

What’s the distinction? The terms “conventional” and “organic” refer to the ways in which food is grown, handled, and processed. Conventional farmers use synthetic or chemical means to fertilize soil, control weeds and insects, and prevent livestock disease. Organic farmers opt for less-invasive methods such as manure or compost fertilizer, crop rotation, and giving animals room to roam; hence, the term “grass-fed” for beef and “pasture-raised” for eggs.

One important caveat: The term “natural” does not equal organic. Natural is an unregulated term that can be applied by anyone and is therefore potentially misleading.

While commonly seen food labels such as “all natural,” “free-range,” or “hormone-free” signify that the food has been raised or grown humanely, only the “USDA Organic” label indicates that a food is certified

However, unsprayed foods, as mentioned above, can often be considered “as good as” organic. Local farmers may not have the financial resources to undergo the lengthy, expensive USDA (United States Department of Agriculture) certification process.

The main consideration is how the food is grown or raised, not whether it has a specific sticker on the package.

If assisted living, nursing center, and post-acute care providers can develop business relationships with local farmers who practice pesticide-free farming methods, this is an excellent way to ensure residents receive high-quality, safe, nutritious food.

What’s Really In Organic And Nonorganic Foods

The Environmental Working Group (, a nonprofit organization that specializes in research and advocacy in the areas of toxic chemicals, agricultural subsidies, public lands, and corporate accountability, compiled two lists using USDA data on the amount of pesticide residue found in nonorganic produce after it had been washed.

The “Dirty Dozen” foods tested positive for a minimum of 47 different chemicals when conventionally grown, while the “Clean 15” are safer to buy as conventional, as they contain little to no trace of pesticide once harvested (see sidebar).

Genetically modified organisms (GMOs) are life forms that have been genetically engineered. Genetic engineering (GE) is the process of taking genes from one strain of a plant, animal, or virus and inserting them into another, with the goal of reproducing characteristics of the original species in the receiving species.

The U.S. government first sanctioned pharmaceutical gene splicing in 1982. However, GE and GM foods didn’t make their way onto supermarket shelves until 1994.

Although three government agencies are involved in the GMO approval process (the USDA, Environmental Protection Agency, and Food and Drug Administration), there are no mandated pre-market safety studies. As with pesticides and drugs, safety testing for GMOs is done by the companies that produce them, raising concern about ethics and conflict of interest.

Side Effects

Unintended health impacts from GMOs can include:

■ Allergens. Because the addition of new genetic material changes protein sequences, GMO could produce known or unknown allergens—especially in people with weakened immune systems.

■ Nutritional deficiency. Altered DNA could decrease levels of important nutrients in the
GE crop.

■ Increased toxins. Genetic engineering could inadvertently increase naturally occurring plant toxins—or introduce a new toxic strain created by the marriage of genes.

■ Antibiotic resistance. An antibiotic resistant gene inserted into most GM crops may pose the most serious health hazard, since there is the possibility that these genes might transfer to pathogenic bacteria in human bodies and create new, antibiotic-resistant super-diseases.

The Organic Advantage

In addition to eliminating the potential health and environmental hazards posed by pesticides, GMOs, irradiation, and additives, organically grown produce actually confers health benefits, according to new research. Organic foods are better for a senior’s body because they have more nutritional value, contain more antioxidants, and promote biodiversity.

Organic foods contain higher levels of vitamin C, calcium, magnesium, and iron, while also containing more antioxidants.

Food scientists at the University of California, Davis, found that organically grown fruits and vegetables show significantly higher levels of cancer-fighting antioxidants than conventionally grown foods.

In addition, pesticides and herbicides reduce the production of phenolics—chemicals that act as a plant’s natural defense and are also good for human health. Organic fertilizers, however, appear to boost the levels of these anti-cancer compounds.

Another benefit of organic foods is that they promote biodiversity. According to a study, “The Biodiversity Benefits of Organic Farming,” organic farms had five times as many wild plants and 57 percent more species. The organic farms also had more birds, spiders, and non-pest butterflies than nonorganic farms.

Amara Rose is a personal and business coach with a broad background in health and positive aging. She is a contributing columnist to seniors housing publications. Rose can be reached or (800) 862-0157 

Dutch Uncles…

Dutch Uncles…

Bill Myers, senior editor, Provider Magazine.
Bill Myers, senior editor, Provider Magazine.
Good morning, ProviderNation.
A postcard from the Dutch awaits us this morning. Folks there have opened a living center called De Hogeweyk, or Dementiavillage. Architecture blogger Kelsey Campbell-Dollaghan gives us a tour:
“Hogeweyk, from a certain perspective, seems like a fortress: a solid podium of apartments and buildings, closed to the outside world with gates and security fences. But, inside, it is its own self-contained world: Restaurants, cafes, a supermarket, gardens, a pedestrian boulevard, and more.”
The idea appears to be catching on. Already, Campbell-Dollaghan tells us, a similar place has opened in Switzerland, this one made up to look like a Swiss village from the 1950s. And the Great, Grey Lady tells us that unnamed “companies” are looking into the place, too.
For Campbell-Dollaghan, the moral of the story is simple:
“What Hogeweyk reveals, though, is the culturally ingrained way we distinguish between those who do and don’t suffer from dementia. By treating residents as normal people, Hogeweyk seems to suggest that there isn’t such a huge difference, deep down—just differing needs. By designing a city tailored to those unique needs, residents avoid the dehumanization that long-term medical care can unintentionally cause.”
Not exactly news for those who have long committed to person-centered care, of course. But then, there are some who are afraid that “person-centered care” has become such a buzz word that it’s being drained of its meaning.
But, speaking of quality care: Mad props to the fine folks at Timberview Care Center, who have just received a shout-out from Oregon regulators for their commitment to patient safety and care. (Bill Myers is senior editor at Provider magazine. You can reach him at or follow him on Twitter, @ProviderMyers.)

'Take Me Out to the Ballgame' Takes Residents Out Of Shell

'Take Me Out to the Ballgame' Takes Residents Out Of Shell

Caregivers in the St. Louis area have found a low-tech, low-cost, high-impact way to reach those stricken with dementia. The treatment even has its own theme song. The first line goes, “Take me out to the ballgame…”
Providers at Veterans’ Administration centers in and around St. Louis, as well as the National HealthCare Corp. home in the St. Louis suburb of Maryland Heights, are gearing up for next week’s Opening Day by reconvening what they’re calling “The Cardinals Reminiscence League.”
It’s a chance for those with mild- to moderate-stage dementia to get together to talk ball, around a team that is closer to a civic religion than a professional franchise. Twice a month, members of the league get together to swap stories (or tall tales—it’s baseball, after all) about their local heroes. Occasionally, memorabilia will make the rounds, and members will get to (say) touch Stan Musial’s bat (the equivalent, for you infidels, of sipping from the Holy Grail).
“Talking about the Cardinals just brings them right back to childhood—it brings them back to who they were,” NHC Administrator Susan Taylor tells Provider. “There’s a huge comfort to our residents because it brings them back to a better part of their world.”
At least once per year, the members even get to make a pilgrimage to the Holy of Holies—Busch Stadium. And they get to sit in the dugout.
For obvious reasons, the league is enormously popular, says Marla Berg-Weger, professor of social work at St. Louis University, but it has already worked miracles.
“It is one of those moments where you think, yes, this is why we do the work that we do,” Berg-Weger tells Provider. “I sat through several groups, and I watched these guys who clearly have dementia pull up memories from decades ago. It’s just heartening.”
It’s an especially effective way to reach the men of the home, NHC’s Taylor says.
“Since there are so many women here, it’s great to be able to have some male bonding,” she says. “Just to have that feeling of, ‘This is who I am.’”
It’s not exclusively a boys’ club, though. In fact, the annual visit of team mascot Red Bird often sets the ladies all a-twitter, Taylor says.
Further, the talk isn’t limited to baseball.
One aging veteran who hadn’t spoken up during most of the sessions was suddenly reminded, while talking about baseball during the 1940s, of his military service, and he went on as though he were recounting the day before, Berg-Weger says.
One league facilitator also noticed the effect the league had on some of the women in the group.
“These women told stories about their childhood, of their teenage boyfriends, first jobs, and their own children,” the facilitator said. “At one successful session, a woman brought a photo album from a vacation she had taken. The photos were passed around, and more stories of travels and vacations were told.”
The league was inspired by a similar program in Scotland, where fanatics of the local soccer (football) clubs who were suffering from mild to moderate dementia got together to relive the glory days on the old pitch, Berg-Weger says.
Berg-Weger wrote up the St. Louis league in the February issue of the Journal of the American Medical Directors’ Association. One of the hidden benefits of the league is how much rest it can give to families and friends caring for their loved one, she tells us.
If the comments from caregivers are any indication, the league is boffo.
“My dad really enjoys the Cardinal Reminiscence League,” one new fan wrote. “It is one of the big highlights in his life, and I know he would miss this special event.”
Another commenter said, “These are memories to keep forever and share with your grandchildren.”
Yet another said, simply, “We sincerely hope there will be more programs like this throughout the country to give others with Alzheimer’s a chance to remember their childhood.”
Former federal health care official and veteran person-centered care activist Karen Schoeneman certainly hopes so, too.
“It’s an excellent idea,” she says, “because it taps into the feeling part, rather than a fact part. I am seeing great activity departments, and I’m seeing homes and assisted living centers do this a whole lot more. The theory is, find what’s left. And that’s the emotional part.” 
The great thing about such groups is that they can be about anything, Schoeneman says.
“Dessert, ice cream, music—it’s common to us that emotional experiences are stored in many places in the brain,” she says. “It can be something as simple as Thanksgiving dinner. Something as simple as just putting poultry spices in a pot of warm water stirs memories.”
Indeed, Berg-Weger, the program coordinator, says she and her colleagues in the Alzheimer’s Association are already working on a “toolkit,” with basic principles and practices that will help other providers form their own versions of the league.
“It’s a work in progress,” she says. “Hopefully by spring, early summer, [the toolkit] will be rolled out and made available. “It’s going to be available to anyone who wants it. It could be movies, it could be religion—this could be around anything that people have a common, long-term shared history with.”
But just try forming another team’s league round Maryland Heights, NHC’s Taylor says: “We’re Cardinal Nation over here.”
(Email Bill Myers at Follow him on Twitter, @ProviderMyers.)

All The Stars Have Aligned For Lincoln Square

All The Stars Have Aligned For Lincoln Square

 The ‘client facility’ credits North American Health Care  For its huge turnaround.

Lincoln SquareDelta Valley Convalescent Home in Stockton, Calif., was not exactly known for the high quality of its care. A few years ago, in fact, it racked up more than 600 points in its annual survey. Employees at the hospital across the street remarked that when walking past the convalescent home on warm days, when its windows were open, the stench of urine was overwhelming even from the sidewalk. Within the local medical community, Delta Valley was referred to as “Death Valley.”
But then in 2009, Delta Valley was sold. The new owners contracted with a consulting firm that had stated its goal was to help all of its client facilities achieve a five-star rating from the Centers for Medicare & Medicaid Services (CMS).
The owners embarked on a multimillion dollar remodel, instituted a radical change in culture that empowered employees to improve the lives of those they care for, and incorporated technology to enable easy tracking of quality indicators. The owners also increased the number of caregivers per patient and rebranded the facility Lincoln Square Post-Acute Care.
Last year, Lincoln Square was ranked the No. 1 provider of post-acute services in its county, based on hospital discharge data. Its surveys had improved so much that it received a five-star rating on the CMS Nursing Home Compare website. And its 2013 annual survey turned up not a single deficiency. Not one.
Last September, after that survey was complete, 50 or more Lincoln Square employees gathered to hear from the surveyors how they’d fared, says Ben Pyper, Lincoln Square’s administrator.

“Our state surveyors—because they knew how bad Delta Valley had been—the two surveyors couldn’t even get out the words ‘zero deficiencies’ without crying,” he says. They weren’t alone. “Half of our staff was crying,” he says. “It was a tremendously emotional experience.”

How They Did It

The 68-bed facility’s new owners focused a lot of attention on staff, says Pyper.
Although the change in the facility's culture resulted in the departure of some of the employees who had worked there when it was named Delta Valley, many more remained and embraced the changes, Pyper says.
“There were people here craving a better experience for their patients, and they’re still here now,” says Pyper, saying these individuals were at all levels and included dietary personnel, certified nurse assistants (CNAs), nurses, and Activities Director Michelle Adams and Social Services Director Lorena Mora.
“They’ll tell you they were just craving a change like this. They were doing everything they could to give the best care, but because of limitations of ownership and management” weren’t able to do as much as they would have liked, he says.
In addition, the overall number of staff was increased. “A lot of good care is just giving patients the [amount of] time they need for good care,” Pyper says. “Our philosophy is to give outstanding patient care, and everything else will fall in line behind that. We staffed up and hired great nurses that we had to recruit from other facilities, hospitals, and right out of school,” and then they provided a lot of training, he says.

Involving All Staff In Quality Assurance

Beyond that, most components of providing care and services seem to be looped through a pervasive quality assurance (QA) process.
“Having a solid QA process allows us to make changes quickly and effectively and follow up on them,” says Pyper. “That’s how you develop a culture where people actually care about who their patients are and who they’re working with. Say I’m a CNA and I noticed that the macaroni salad we’re serving, nobody’s eating that. So I’m going to make a suggestion to my supervisor” that a different salad be served, Pyper says.
“We take that suggestion to our QA meeting, and we actually make a change; we replace the macaroni salad with a nice broccoli salad. So that CNA feels empowered and thinks, ‘I made a difference in my patient’s life.’” So having a QA process where suggestions turn into change results in staff who personally feel invested in the process, Pyper says.

Aggressive Feedback Solicitation, Technology Support

But perhaps the most important group whose feedback is solicited weekly is made up of residents and their families. It’s called the Guardian Angel Program.
Pyper and his team found that paper customer service surveys given to families or residents don’t generate enough of a response to be optimally useful.
Instead, Pyper and all of the department heads at Lincoln Square interview residents every Tuesday and call a family member of each resident every Friday (or else catch them while they’re at the facility for an in-person interview).
The interviews are conducted using a set of questions developed in the QA meeting, which are designed to elicit any concern, no matter how small, the individual may have had over the past week.
The information gathered through the interviews is brought back to the monthly QA meeting, where changes are proposed and considered and, if appropriate, their implementation is designed.
“I can’t think of a better QA process than that—straight from the front lines we hear about food, care, lighting, or whatever feedback they may have,” says Pyper. “It’s working well. For us, it’s wonderful. If you don’t know what your customer is thinking, then you’re at a disadvantage. You have to know what they’re thinking, wanting, and expecting for their loved one’s care, and we have to try to meet that—especially if you want to be the best in the county.”
Lincoln Square also put technology to work in its QA efforts, using a tool called SNF QAPI. Staff throughout the facility put data into the system, and it automates everything from reminders to perform specific tasks to tracking and measuring the results of a clinical program more closely.
“We’re able to all get on it and check in and measure data,” says Pyper, “and that really helps, because it’s so complex trying to turn around the culture and go from terrible care to great care.”

The Essential Role Of North American Health Care

Pyper gives a lot of the credit for the facility’s phenomenal success to North American Health Care (NAHC).
The relationship between NAHC and its 35 “client facilities,” of which Lincoln Square is one, is complicated. While the client facilities are all standalone entities, they benefit from many NAHC services, which range from managing payroll to providing consultant services on everything from physical plant maintenance to clinical care. Individual client facilities (including Lincoln Square) may even have a board of directors composed of the same individuals that are on the NAHC board. In fact, some of the owners of Lincoln Square also have ownership interests in NAHC.
In 2008, NAHC announced a new goal: helping all of its client facilities achieve five-star ratings on Nursing Home Compare.Lincoln Square
It was a lofty goal, but it only took NAHC five years to do it. Last year, every single one of NAHC’s 35 client facilities received the coveted five-star rating.
“I think we would not be able to [achieve a five-star rating] without them,” says Pyper. “I know that for a fact. NAHC has given me as the administrator what it takes to take care of my patients. I need people who are experts on medical records and best practices, and they’re always there to support us with that. We always have best practices at our fingertips.”
One of the NAHC services that directly impacts a facility’s rating on Nursing Home Compare is the mock surveys conducted a couple times a year at each facility. The mock surveys occur without notice so the facility’s actual practices can be examined.
NAHC sends teams composed of former state surveyors to inspect the facilities from top to bottom, exactly as the state surveyors do. Any issues noted by the mock surveyors are pointed out to the facility, which then must develop and submit a written plan on how it will correct the issue. How well the plan worked is checked during a second survey.
The process is highly beneficial, says Pyper. “It calms our nerves” about the real state survey, he says. “Our staff know the regulations better because we’re having to address them. The same team spends a day or two with our nursing team, following the nurses around the building, coaching them and giving them constructive criticism.”
Pyper says the process is invaluable. “People like to learn and be challenged,” he says. “It’s when you get bored that you get complacent and don’t care anymore about what you’re doing.”

Kathleen Lourde is a freelance writer based in Dacoma, Okla.

FDA: New opioid overdose treatment can be administered at home

 The Food and Drug Administration has approved a prescription treatment that can be used by family members or caregivers to treat a person known or suspected to have had an opioid overdose.

Evzio (naloxone hydrochloride injection) rapidly delivers a single dose of the drug naloxone via a hand-held auto-injector that can be carried in a pocket or stored in a medicine cabinet. It is intended for the emergency treatment of known or suspected opioid overdose, which is characterized by decreased breathing or heart rates or loss of consciousness.

Drug overdose deaths, driven largely by prescription drug overdose deaths, are the leading cause of injury death in the U.S., surpassing motor vehicle crashes. In 2013, the CDC reported the number of drug overdose deaths had increased steadily for more than a decade.

Naloxone rapidly reverses the effects of opioid overdose, for which it is the standard treatment. However, existing naloxone drugs require administration via syringe and are most commonly used by trained medical personnel in EDs and ambulances.

“Overdose and death resulting from misuse and abuse of both prescription and illicit opioids has become a major public health concern in the United States,” Bob Rappaport, MD, director of the Division of Anesthesia, Analgesia and Addiction Products in the FDA’s Center for Drug Evaluation and Research, said in a news release.

“Evzio is the first combination drug-device product designed to deliver a dose of naloxone for administration outside of a healthcare setting. Making this product available could save lives by facilitating earlier use of the drug in emergency situations.”

Evzio is injected into the muscle or subcutaneously. Once turned on, the device provides verbal instruction to the user describing how to deliver the medication, similar to automated defibrillators.

Family members or caregivers should become familiar with all instructions for use before administering to individuals known or suspected to have had an opioid overdose. Family members or caregivers also should become familiar with the steps for using Evzio and practice with the trainer device, which is included along with the delivery device, before it is needed.

Because naloxone may not work as long as opioids, repeat doses may be needed. Evzio is not a substitute for immediate medical care, and the person administering Evzio should seek further, immediate medical attention on the patient’s behalf.

In one pharmacokinetic study of 30 patients, a single Evzio injection provided equivalent naloxone compared to a single dose of naloxone injection using a standard syringe. The use of Evzio in patients who are opioid dependent may result in severe opioid withdrawal. Abrupt reversal of opioid depression may result in nausea, vomiting, sweating, tachycardia, increased blood pressure, uncontrollable trembling, seizures and cardiac arrest.

The FDA reviewed Evzio under the agency’s priority review program, which provides for an expedited review of drugs that appear to provide safe and effective therapy when no satisfactory alternative therapy exists, or offer significant improvement compared to marketed products. The product was granted a fast-track designation, a process designed to facilitate the development and expedite the review of drugs to treat serious conditions and fill an unmet medical need.

Evzio is being approved ahead of the product’s prescription drug user fee goal date of June 20, the date the agency originally scheduled to complete review of the drug application.

Send comments to or post comments below.

Woman faces sentence in breast feeding overdose death

Woman faces sentence in breast feeding overdose death
Columbia, S.C. • A judge has sentenced a South Carolina woman to 20 years in prison for killing her 6-week-old daughter with what prosecutors say was an overdose of morphine delivered through her breast milk.
A Spartanburg County jury found 39-year-old Stephanie Greene guilty of homicide by child abuse Thursday. The former nurse said nothing in court Friday during her sentencing.
A pathologist testified the infant had what could have been a lethal level of morphine for an adult in her system in November 2010. Prosecutors say Greene hid her pregnancy and didn’t tell doctors she was breast feeding so they would continue prescribing painkillers.
Greene’s lawyer says he will appeal because there is no evidence this level of morphine can pass through breast milk.
Follow Jeffrey Collins on Twitter at

Utah CNA class (Virtual day)

April 6th Virtual Day and CNA class

Salt Lake CNA class
Utah two week CNA class

Phlebotomy class Salt Lake City

Here our pictures from the March 31 phlebotomy class in Salt Lake

An excellent time was has by all. Thanks Steve for being such a great teacher. The next phlesbotomy class starts on April 14th at 5 p.m.