Quality Care/Best Practices
The number one priority of the Washington State Medical Association (WSMA) is to make Washington a better place to practice medicine and to receive care. Improving the quality of care in our state is of utmost important to the WSMA and our physician members.
WSMA Preceptor and Other News
WSMA Preceptor
Our 4-page quarterly publication on news and comment, informing physicians and practice managers about emerging performance, costs and quality measurements that are becoming integral to health care. Preceptor is a members-only publication. To access, click here.
Cultural Competency In Health Services & Care
The Washington State Department of Health is pleased to announce a new resource to help health care providers serving diverse populations of patients. The Cultural Competency in Health Services and Care – A Guide for Health Care Providers is a tool in that effort. This guide is intended to increase the knowledge, understanding, and skills of those who provide health care in cross-cultural situations.
Read more...
WSMA Collaborates to Form Clinical Performance Improvement Network
The Washington State Medical Association has joined with the Puget Sound Health Alliance and the Washington Academy of Family Physicians to create the Clinical Performance Improvement Network (CPIN), an educational program designed to assist physician practices focus efforts on quality improvement. The collaborative effort will be led by Lance Heineccius, WSMA's director of performance improvement and lead technical staff for the newly revised WSMA Foundation for Health Care Improvement. Visit the CPIN webpage for more information.
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Helpful Search Engines
Epocrates Drug Search Tool
Discounted all-in-one mobile guide to drugs, diseases, and diagnostics.
WSMA members can now receive 20% off all Epocrates paid products. For information on this discount please email mml@wsma.org.
mdconsult.com
MD Consult brings leading medical resources together into one integrated online service to help you efficiently find answers to pressing clinical questions and make better treatment decisions. MD Consult has been adopted by more than 90% of North American medical schools and is used in over 1,700 healthcare organizations worldwide. With over a quarter million physician and professional users, MD Consult is the most respected online clinical information service.
Use of MD Consult requires paid subscription.
medworm.com
MedWorm is a medical RSS feed provider as well as a search engine built on data collected from RSS feeds. RSS stands for Really Simple Syndication and it is a technology used to simply publish and gather details of the very latest information on the internet.
MedWorm collects updates from over 5500 authoritative data sources (growing each day) via RSS feeds. From the data collected, MedWorm provides new outgoing RSS feeds on various medical categories that you can subscribe to, via the free MedWorm online service, or another RSS reader of your choice, such as Bloglines, Newsgator, Google Reader or FeedDemon.
Subscribing to MedWorm is free.
pogofrog.com
PogoFrog.com is a medical search engine for physicians. PogoFrog.com "jumps over the layman-focused clutter on the internet to find only credible medical information for physicians."
Subscribing to PogoFrog.com is free.
uptodate.com
UpToDate is an evidence based, peer reviewed information resource - available via the Web, desktop, and PDA. The UpToDate community includes our faculty of more than 3,800 leading physicians, peer reviewers, and editors and nearly 320,000 users. Our faculty writes topic reviews that include a synthesis of the literature, the latest evidence, and specific recommendations for patient care. Our users provide feedback to the editorial group. This community's combined efforts result in the most trusted, unbiased medical information available.
Use of UpToDate requires paid subscription.
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Guidelines
Clinical Laboratory Advisory Council (CLAC): Practice Guidelines
Practice guidelines as provided by Washington State Clinical Laboratory Advisory Council.
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Drug Exposed Newborns: Testing and Reporting
From the Washington state Department of Health, guidelines for testing and reporting drug exposed newborns in Washington State: PDF download
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Guidelines for HIV+ Pregnant Women
The Washington state Department of Health announced in early June 2011 the following practice materials have been revised and posted:
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WSM-ERF Guidelines
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Lasers in Skin Care Treatment
Rules pertaining to the use of laser, light, radiofrequency and plasma devices, adopted by the Washington State Medical Quality Assurance Commission.
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Medical Records Retention Guidelines
Guidelines on Retention of Medical Records when Closing a Practice from the Department of Health. [PDF]
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Medical Treatment Guidelines
The Department of Labor and Industries published Medical Treatment Guidelines, which cover 21 conditions, as an educational tool for medical providers treating injured workers.
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Office-Based Anesthesia Guidelines
Guidelines of the Washington State Medical Association [PDF]
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Pain Management Guidelines
New Information for Physicians and Physician Assistants: MQAC Rules for Management of Chronic Non-cancer Pain
The Medical Quality Assurance Commission (MQAC) has adopted its final rules for management of chronic noncancer pain. PLEASE NOTE THAT UNLIKE THE OTHER BOARDS AND COMMISSIONS, THE MEDICAL COMMISSION'S RULES FOR PHYSICIANS AND PHYSICIAN ASSISTANTS WILL NOT BECOME EFFECTIVE UNTIL JANUARY 2, 2012*. This was done in order to provide the physician community with enough time to prepare for and implement the many practice requirements set forth in the rules and to satisfy the CME requirements.
The MQAC has written a:
Letter to licensees regarding the pain rules. [PDF]
*NOTE: The MQAC pain rules, and the date they become effective apply only to MDs and physician assistants. Rules pertaining to DOs and osteopathic physician assistants, nurses, podiatrists and dentists all became effective on July 1, 2011.
New Summary of the MQAC Pain Rules Now Available!
The WSMA Department of Legal Affairs has prepared a detailed question and answer summary of the new MQAC rules [PDF] for the management of chronic non-cancer pain. This summary discusses questions such as:
- Do the pain rules apply to me and my practice?
- What is chronic non-cancer pain?
- What does "MED" mean?
- Do I have to take CME in order to treat patients with chronic non-cancer pain?
- What must I do before treating a patient with chronic non-cancer pain?
- And many more...
The summary does not substitute for reading the rules and familiarizing yourself with the requirements. But the summary presents the most important information in a way that is easy to read and allows physicians to quickly identify topics of interest. To accompany the summary, a copy of the pain rules [PDF] (which become effective January 2, 2012) is also available.
CME Recommendations: The WSMA has designed this flow chart [PDF] to assist you regarding recommendations for pain rules CME. The flow chart, in a few short steps, helps guide you to CME recommendations which may be most appropriate for your practice. Pain rules CME programs will be listed soon at the end of this section, and updated periodically. Stay tuned!
Background: The rules include a preamble, or intent section, which describes some of the background for the rules, and outlines MQAC's approach to evaluating practitioners' compliance with the rules. The rules themselves list very detailed requirements for patient evaluation, treatment plans, informed consent and written agreement for treatment, periodic review, and a mandatory consultation requirement for any patient that meets or exceeds a per day dosage amount of 120 milligrams morphine equivalent dose (MED). In addition, the rules identify certain exemptions from the consultation requirement, and outline the requirements of pain management specialists.
Educational outreach: The MQAC is offering an educational program on the new pain rules, which includes a video the commission has produced which can be part of a free 4 CME offering available through L&I. The MQAC has created a patient information pamphlet and FAQs. Go to the MQAC Pain Management website for details on their educational outreach.
Physicians Insurance (PI) is also preparing a detailed educational module for its insureds. Information regarding the PI program is not currently available, but check the PI website for updates.
The University of Washington (UW) presented a program on the pain rules, "Legislating Pain Care," on June 18, 2011. This 7-hour program was recorded for future playback on TVW (access here). In addition, UW has developed a "Pain Medicine Provider Toolkit" which brings together a number of useful, informative, and important resources regarding the treatment of chronic pain and the pain rules.
WSMA concerns: The WSMA submitted comments to the MQAC throughout the rulemaking process (see WSMA comments [PDF]). These comments included: (i) a definition of the word "shall" to allow flexibility of treatment based on clinical judgment; (ii) an amended definition of chronic non-cancer pain to exclude patients who require chronic, but low-dose and non-escalating, opioid treatment for their condition; (iii) delayed implementation of the rules; and (iv) addition of language to the preamble (intent section) which clarifies that treatment decisions are ultimately based on clinical circumstances and judgment, and that the rules do not define a standard of care. The MQAC repeatedly assured the WSMA that its comments would be incorporated into the final rules. This was clearly stated in a letter to the WSMA from Dr. Mimi Pattison (see Dr. Pattison's letter [PDF]). While the implementation date was pushed back to January 2, 2011, and the preamble was revised to accommodate the WSMA's suggested language, the definitions the WSMA recommended (and feels are critical) were not included in the final rules, leaving the rules unnecessarily prescriptive and problematic.
The WSMA is concerned about how the pain rules will be enforced because of an internal conflict within the rules. It is unclear whether the rules represent guidelines for clinical care of patients with chronic non-cancer pain (the message conveyed in the intent section), or if they are practice mandates (the message conveyed in the actual rules). The WSMA cannot predict how the MQAC will view variances from the rules once they become effective on January 2, 2012. This uncertainty also creates concern about potential liability implications. The intent section clearly states that the rules do not establish a standard of care. But the rules are written as mandates (i.e. "shall" or "must"), which would appear to indicate physicians must follow them when treating patients with chronic non-cancer pain. It remains unclear how a court might reconcile these two sections.
For all of these reasons the WSMA has pushed hard for the rules to be amended so they clearly state how they will apply to the care of patients with chronic non-cancer pain.
What happened next: On June 1, 2011, the WSMA, and the Washington Academy of Family Physicians (WAFP) sent a letter to the MQAC formally requesting amendment of the pain rules (see 6/1/2011 WSMA/WAFP letter [PDF]). The matter was briefly discussed at the June 3, 2011 meeting of the MQAC. The WSMA and WAFP sent a supplemental letter to the MQAC on June 7, 2011 further outlining their concerns (See 6/7/2011 WSMA/WAFP letter [PDF]). The WSMA and WAFP sent a similar letter to the MQAC on June 20, 2011 requesting amendment of the pain rules which apply to physician assistants (see 6/20/2011 WSMA/WAFP letter [PDF]). The MQAC has sixty (60) days to reopen public comments on the pain rules or to deny the WSMA's request.
The MQAC addressed the WSMA's request at its July 22 meeting. The MQAC denied the WSMA's request to reopen the rulemaking process, preferring instead to allow the rules to become effective on January 2, 2012 and monitor the effect of the rules.
The WSMA is currently reviewing its options, one of which still could involve taking the matter to the Joint Administrative Rules Review Committee.
The WSMA will keep you up to date with its efforts to have the rules reflect the realities of the physician-patient relationship in the treatment of patients with chronic non-cancer pain.
Other pain management guidelines
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The SCOAP Surgical Checklist Coalition
WSMA is an active member of the SCOAP Surgical Checklist Coalition which is working to place a SCOAP Surgical Checklist in every OR across Washington State by the end of 2009. This initiative will ensure that the necessary steps for safe surgery are consistently conducted thus reducing the risk of unnecessary surgical complications. The SCOAP Surgical Checklist promotes better communication and supports the use of best practices in the OR. The checklist is easy to use and takes minimal time to perform - time well spent in the interest of patient safety. See an informational video on the SCOAP Surgical Checklist and a demonstration of how to use it in the OR.
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Self-Prescribing or Treatment of Family Members
Self-Treatment or Treatment of Immediate Family Members from the Department of Health. [PDF]
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Resources
Child Profile
WSMA encourages all member physicians providing childhood immunization services to fully utilize the CHILD Profile system by enrolling all of their pediatric patients in this electronic immunizations registry and maintaining accurate, up-to-date immunization profiles on these patients.
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Cultural Competency In Health Services & Care
The Washington State Department of Health is pleased to announce a new resource to help health care providers serving diverse populations of patients.
A law passed in 2006 requiring all health care providers licensed by the department to receive multicultural health awareness education and training.
The Cultural Competency in Health Services and Care – A Guide for Health Care Providers is a tool in that effort. This guide is intended to increase the knowledge, understanding, and skills of those who provide health care in cross-cultural situations.
Download the guide. [PDF]
We hope it will broaden your awareness of health disparities, provide a better understanding of why cultural competency is important, and illustrate some of the resources available to you.
There are several online resources that offer continuing education credits. There are also resources with important information and statistics on the populations you serve.
For questions about this project, please contact Kris Reichl at Kristin.reichl@doh.wa.gov or (360) 236-4985.
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Death With Dignity Act Information
The Department of Health has developed a website for Death with Dignity Act information. The website address is www.doh.wa.gov/dwda.
The site contains links to:
Please note the Pharmacy Dispensing Record form [PDF] has been updated to include the patient's address, and all forms have a new mailing address P.O. Box 47856.
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Disaster Relief—How to Volunteer
The Health & Human Services Department launched a website that provides a single point of entry for health professionals across the nation to sign up to volunteer in advance of an emergency or disaster in their state.
The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) is a national network of state-based programs that verifies the identity, licenses and credentials of health professionals before an emergency happens.
The website would makes it easier and faster to register potential volunteers by connecting them with each state’s ESAR-VHP program. Health professionals include doctors, nurses, dentists, veterinarians, medical technologists, clinical social workers, medical records technicians and mental health counselors.
Registering with ESAR-VHP does not obligate health professionals to serve. Once registered, participants can opt in or out when contacted for volunteer service, according to Dr. Nicole Lurie, HHS’s assistant secretary for preparedness and response.
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Free Medical Books
Over the next few years, many important medical textbooks will be available online, free and in full-text.
More information on these free resources.
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Medical Marijuana
In November 1998, Washington voters passed Initiative 692 regarding the use of marijuana for certain terminal or debilitating conditions. The initiative became law on December 3, 1998. SB 5798, passed in March, 2010, added additional health care professionals who may authorize medical marijuana, specified what criteria must be met for tamper resistant paper under the statute, and made several other changes to the applicable statutes, including no longer allowing a copy of a signed authorization or a copy of the patient's medical record to substitute for the original signed authorization.
Frequently asked questions about the law, including a downloadable documentation of Health Care Professional’s Authorization to Engage in the Medical Use of Marijuana in Washington State.
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Physicians Desk Reference - MobilePDR (TM) - free download
Clinicians with a Palm Pilot, Compaq IPAQ or other PDA can now download "mobilePDR" for free, gaining instant access to concise drug information for the 1,500 most prescribed drugs.
Learn more.
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STD Partner Treatment
Policy regarding Treating Partners of Patients with Sexually Transmitted Chlamydia and Gonorrhea, adopted by the Washington State Medical Quality Assurance Commission.
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