"So? Which One Do I Use Doctor? Heat or Ice?

Heat has long been used to provide temporary relief of arthritis pain, and is used in many different forms. Contrast baths, whirlpools, electric pads, microwaveable gel packs, hydrocollator packs, infrared lamps, and hot showers are some of the different techniques used. Even warm tap water probably will meet some of your needs for heat therapy at home.

Heat can provide temporary relief of pain and stiffness, and can prepare you for physical activity or exercise. For example, morning stiffness is a common problem for many people with rheumatoid arthritis. Because your body has been still during the night you may need special help to get going in the morning. The following combination of techniques using heat can reduce the length and the severity of morning stiffness:


1. Sleep in a sleeping bag (which helps retain body heat) or with an electric blanket (following the manufacturer's instructions).


2. Take your aspirin or other anti-inflammatory medication an hour before you get out of bed in the morning. (Keep a few crackers at your bedside to take with the medication to avoid stomach irritation.)


3. Take a warm shower or bath immediately after you get up.


4. Then do limbering-up exercises after your shower or bath while you still feel warm.


Safety is important in choosing the form of heat you use. You should take great care to avoid burns or electric shocks. Heat must be used with much caution on any area of the body with poor circulation or where you cannot feel heat or cold normally. It should not be used over areas where your skin is fragile or broken.

Only mild heat is necessary to get results. You are aiming for a temperature just slightly above body temperature, and you do not have to apply heat for a long time. You will get full benefit by using heat for 20 minutes each time.

Moist heat is any technique in which water is used to conduct the heat, such as a bath or shower or hydrocollator packs. People with arthritis prefer moist rather than dry heat, such as a heating pad. Moist heat penetrates more deeply than dry. You will have to try both and see which is more effective and convenient for you.

Heating pads are available which provide either moist or dry heat, but they should be chosen and used with care. Make sure the pad is approved by the Underwriter's Laboratory. Look for those which have temperature control switches; those without temperature settings get hotter and hotter until you switch them off.

When using a pad, never lie on top of it and make sure you do not fall asleep while it is on. Severe burns can result! It may be wise to use a timer during the treatment. Check the instructions on use carefully. Regularly inspect the pad for any cracks in the plastic cover.

Hydrocollator packs are canvas bags containing silicone gel which retain heat for a long time. You can buy them in different shapes at pharmacies. Some people like them because they lose heat more slowly than most wet compresses. The pack is heated in water, wrapped in 8 to 10 layers of heavy toweling and placed over the painful joint.

The pack is heated in a large pot of water and placed on heavy towels. Place the surface with the thickest layer of toweling over the part to be treated.

Keep in mind that hydrocollator packs do have drawbacks. They are not practical if heat is needed for several joints, because each pack can be used for only one part at a time. They are also cumbersome to use and may be too heavy placed over a painful joint. If your hands are affected by your arthritis, it may be difficult for you to remove the heavy pack from the water with the tongs. So you may need help. Again, you must be very careful about burns. If you decide to try such a pack, follow the manufacturer's instructions carefully.

Microwaveable gel packs are popular. Follow the instructions carefully or else the bag containing the gel may leak? or even worse explode and cause serious burns!

Physical therapists sometimes use melted paraffin as a means of applying heat, particularly to the hands. There are units available for home use as well. Because they involve high temperatures, paraffin baths should be used with caution. Patients with osteoarthritis or rheumatoid arthritis involving the hands often find paraffin to be helpful.

You can buy nylon and spandex gloves which can reduce morning stiffness of the hands for some people when worn at night. The gloves are available in both men's and women's sizes.

It is important to wear adequate, warm clothing in cold weather. Some people find that knitted, woolen or fleece pullover cuffs on painful joints, especially the knees, ankles and elbows are helpful in keeping the joints warm and more comfortable in cold weather.

Some people with arthritis find that heat does not help them. In fact, the reverse is often best-cold compresses. Cold may be especially effective when active inflammation produces severe pain and joint swelling. Only trying different modalities will enable you to find out which is best for you.

It is easy to make a cold pack by filling a small plastic bag with a few ice cubes. A bag of frozen vegetables wrapped in a towel can be used. Place any cold pack over the painful joint with a layer of terry cloth toweling in between. The same precautions that apply to the use of heat should be observed when using cold. The maximum benefit is achieved in less than 20 minutes. You may wish to repeat this application several times a day.

For many people with arthritis an effective approach is alternating warm and cold water applications, a process called contrast baths. It is most useful for a hand or foot which can be dipped in a large pot filled with water. If you decide to give it a try, use a thermometer to check temperatures.

1. Fill one container 2/3 full with 110 degree F water.
2. Fill a second container 2/3 full with 65 degree F water.
3. Put your hands or feet completely into the warm water for three minutes; then put them into the cold water for one minute.
4. Repeat step #3 two more times.
5. End the treatment with three more minutes in the warm water; then carefully dry the hands or feet.


Finally?and very importantly? with acute musculoskeletal pain, and particularly with injuries, always use ice. The formula to remember is RICE...
Rest
Ice
Compression
Elevation

By Dr. Wei

22 Inside Tips on How You Can Make Your Arthritis Medicines Work Twice as Effectively in Half the..

This report will give you 22 important tips to make sure that you're getting the very best out of your arthritis treatment program.


1. Make absolutely sure that the nurse or doctor knows what allergies you have. Also, make sure that they know what other medicines you're taking and ask specifically about drug interactions and side effects.


2. Ask how the arthritis medicine should be taken. Sometimes arthritis medicines are taken best on an empty stomach and sometimes they're taken best on a full stomach. Also ask what time of day is best to take the medication. Some arthritis medicines should be taken in the morning and some should be taken in the evening.


3. If you have other medical illnesses, let the doctor or nurse know about that. If you have a previous history of ulcers, they should be informed.


4. Ask whether there is literature such as an Arthritis Foundation pamphlet available on the kind of medicine that you're going to be receiving. If not, ask if there are any other printed handouts. At the very least, the nurse should go over the medication with you.


5. Ask if the medicine comes as a generic. If it does not, at the very least, ask for a two-week supply of free samples.


6. If you have a common arthritic condition, ask whether any arthritis clinical trials are available in the area. This is a great way to get free medical care for your arthritis along with free medication for your arthritis.


7. Ask about other types of therapies that can be used along with the medicine. For instance, ice or heat to a painful area for 15-20 minutes two or three times a day can be quite effective.


8. Sometimes moist heat also can be effective. Ask your nurse or doctor which is better for you, ice or moist heat. If you're going to use moist heat, make sure it is moist heat rather than dry heat.


9. Sometimes assistive devices such as braces, splints, neck support pillows, canes, etc. may help your medicine work more effectively. Ask whether that's the case.


10. If no specific handouts or pamphlets are available from your doctor, ask whether you can have a photocopy of the pages from the Physician's Desk Reference made available to you. This is difficult to get through because of the vocabulary used, but contains a lot of important information that you may want to know.


11. Remember to ask about how the medicine should be monitored. Most arthritis medicines need to be monitored fairly frequently because of side effects. This is especially true in people over the age of 60.


12. Sometimes, as your arthritis gets better, it's possible to cut back on the amount of medicine you take. Ask about that.


13. Ask whether physical therapy modalities might be helpful in your case.


14. Make sure you let your nurse or doctor know whether you're taking any natural or vitamin supplements. These sometimes can interfere with the effectiveness of your arthritis medication.


15. If you see an article in a magazine about your medication, bring it into your nurse or doctor. Sometimes these articles contain good information. However, sometimes these articles contain misleading, or even worse, wrong information.


16. Ask about generic drugs. Sometimes generic drugs, while cheaper than brand name drugs, may not be as effective. Sometimes though, they can be just as effective. You need to ask.


17. Make sure that you periodically ask your nurse or doctor whether there are any new drugs available for your condition. Sometimes the new drugs are more effective, safer, and more convenient.


18. If, after you start taking your medicine, you notice anything that could be a side effect, call your physician immediately.


19. Ask if there are any Internet web sites that provide good information about the medication that you are taking.


20. Do not share medications with friends or relatives. Remember the medication that has been given to you is specific for your problem. To share your medication with another person can be extremely dangerous. Likewise, if you borrow some of your relatives or neighbors medication, you may run into a terrible problem.


21. If you smoke or drink alcohol, ask about potential problems with your arthritis medicines.


22. Make sure you get the proper monitoring. Many arthritis medicines need careful evaluation of blood And urine on a regular basis.

By Dr. Wei

"Foot Pain Relief At Last!"

"As an arthritis specialist, one area that I see people complain about more often than almost any other, is their feet." So says Dr. Nathan Wei, Clinical Director of The Arthritis and Osteoporosis Center of Maryland. "This is too bad because there are many treatments that can be helpful," Dr. Wei adds.

The foot is made up of 26 bones and 39 muscles...
The foot and ankle are designed to bear weight. The multiple joints in the feet are capable of adjusting to almost any terrain and the padding in the feet are designed to absorb shock.. The ankle joint allows the foot to move up and down, side to side, and inward and outward (inversion and eversion).

Not All Foot Pain Comes From The Foot!
Careful examination of the low back, hip, and knee should be performed because pain from these areas may affect the foot and ankle. In particular, pinched nerves in the low back can cause foot pain and weakness.

Ankle sprains are common- 25,000 people sprain an ankle every day! The goal of treatment is to relieve pain and prevent instability. Treatment of an acute sprain consists of rest, ice compression and elevation ("RICE"). Exercises to help stabilize and strengthen the ankle should be started.

Arthritis of the ankle may cause recurrent pain and swelling. Pain from arthritis typically is made worse by weight-bearing particularly on uneven ground. What this means is you should try to avoid excessive walking or running on uneven ground. Anti-inflammatory medication and proper foot support can do wonders.

Pain in the ball of the foot has many causes...



Foot strain occurs when a person "overdoes it." And the treatment is pretty straightforward. Rest.

Morton's neuroma (a benign nerve tumor usually located between the 3rd and 4th toes)

Tarsal tunnel syndrome (pinched nerve in the ankle)

Arthritis.



Other common causes of foot pain include:



Stress fractures may occur after excessive walking.

Achilles tendonitis causes pain in the back of the heel. Treatment consists of anti-inflammatory medicines, rest, a heel lift, and gentle stretching.

Plantar fasciitis causes pain in the bottom of the heel. Treatment includes rest, anti-inflammatory medication, heel cup, orthotics, stretching, and local steroid injection.

Flat foot.



Muscle strengthening exercises and orthotics are helpful. Two other common problems are:

Osteoarthritis, particularly common in the big toe. The big toe will point out to the side. When bursitis alongside the great toe joint develops, this condition is referred to as a bunion. Treatment involves proper padding and footwear. In extreme cases, surgery is required.

Neuropathy. This painful condition is particularly common in diabetics. This occurs when the small nerves in the feet are damaged. Symptoms include burning, tingling, and pain in the feet - worse at night.



Well fitted orthotics (arch supports) can alleviate not only foot and ankle pain but pain in the knees, hips, low back, and neck!!

We often take the ability to walk for granted. This ability involves the use of two engineering marvels- our feet and ankles. Because of the tremendous amount of force transmitted to the feet with walking, unique problems may develop. Attention to proper preventative care, i.e., comfortable shoes, sox, hygiene, support, along with proper prompt medical care can really put the brakes on foot pain.

By Dr. Wei

What You Should Know About Mixing Medications and Diet...

I had a call the other day from a potential client in a serious situation. He was young and had been diagnosed with CAD (Coronary Artery Disease), suffering from extremely high blood pressure and cholesterol, his doctor had put him on a medication that was suppose to lower and control these symptoms, and he had been on this medication for over 2 years.

During this time, this 24 year old man had developed a blockage in his hand that had become inflamed and eventually ruptured, causing the possibility of amputation. The situation was brought under control using anti-inflammatory means, but he remained on his cholesterol medication without adjustment even after this incident. About 6 months later, this young man was suffering from another blockage, but this time, it was in a critical area that couldn't be treated without specialization and the local doctors did not have the experience to treat him. These doctors told him that there was no one in the 4 state area that could serve him, he was desperate and afraid, and turned to me for help.

When he first called, I asked him some questions to help me understand his situation.

How old are you? (25)

Do you suffer from High blood pressure or high cholesterol? (yes)

Does your family have a history of high blood pressure, high cholesterol, heart disease, diabetes or insulin resistance? (yes)

Does you family have a history of bowel problems, colon cancer or colon polyps? (yes, my twin brother)

What is your Ethnic Origin? (English)

Are you physically active? (yes, when I can be)

Has your doctor put you on any medication (yes, and he named it)

At the time that you were put on this medication, did your doctor recommend a glycemic, low fat, low sodium diet? (no)

What kinds of foods have you been eating while on this medication? (regular foods, meat, vegetables, potatoes, you know, stuff in restaurants and stuff that is easy to fix at home)

With the condition that you currently have, do you suffer from loss of vision or blurred vision? (yes)

Are you suffering from Migraine headaches? (yes, constantly)

Are you suffering from the loss of motor skills, have difficulty walking, chewing, swallowing, lifting? (yes)

Are these symptoms constant, or do they come and go? (Constant)

Is this blockage behind your right eye? (yes)

What has your doctor recommended? (they have recommended that I be treated elsewhere, because they do not have a specialist here)

Have they recommended a place you should go or a specialist that you should see? (no, they can't even tell me what kind of doctor I should get)

My recommendations were for him to seek help immediately, within the next week.

I suggested that his doctors give him a letter of recommendation to see a Cerebral Neuro-Vascular Surgeon. He and his friends got on the Internet and found some specialists that could fit him in in the next few days. My fear was that the situation had gone on to long, and that he was in imminent danger. I told him that when he returned from his surgery, that he should call to make an appointment with me so that we could get his blood pressure and cholesterol under control, so this would not happen again.

He asked me why this had happened in the first place, he had taken his medications like they had been prescribed. I explained that when medications are used in the body, they have to not only act, but they are also acted upon.

When you use medications designed to reduce something in the body, you shouldn't add things that would cause the medications to have to compete or work harder to accomplish the goal. A cholesterol medication to control the fat in your blood, and then eat fat, or things that create fat. A diabetic medication to control blood sugar, and then eat sugar or carbs that convert to sugars. A medication used for the treatment of gout, then eat things that are high in acid or create acid. These kinds of things can make the medications ineffective, and a waste of time and money.

He said that he had been on this medication for two years, and that the cholesterol numbers had never been affected by the medication. I told him that there is a way to lower his cholesterol effectively, using a restrictive diet, exercise, and a few supplements along with his prescription, and that as soon as he returned with relative health, we would start him on his program.

For most people, when they become ill, they go to their doctors in search of a quick fix, a pill or a shot that will make things better instantly, that doesn't require any effort or discomfort on their part. The sad truth of the matter is that "possession" requires "responsibility", and "responsibility" requires "action".

By D.S. Epperson

Finally...Affordable Prescription Medication without Insurance.

If you are like many Americans, you are without health insurance. And the ranks of the uninsured are growing. According to the National Coalition on Health Care (NCHC), the number of uninsured was a record breaking 45 million in 2003. The growing number of uninsured is in large part being driven by individuals abandoning the corporate life to pursue their dreams as entrepreneurs and small business owners.

Unfortunately, this trend comes at a time when more and more medications are available to help treat the serious (and the not so serious) illnesses that many of us face today. But as you probably already know, without health insurance coverage, the prescription medications that you need are oftentimes too far out of reach; they are simply too expensive!

To make matters worse, most prescription medications cost far more in the United States than they do in other industrialized nations. These cost differences in conjunction with the fact that so many Americans do not have prescription medication coverage have spurred a national dialogue and heated debate. Despite these discussions, the needed regulatory changes have not materialized. Thus, the uninsured are left feeling that no affordable prescription coverage options exist.

Don't Give Up Hope: There Are Options!

Fortunately, however, you are not without options. In fact, it is likely that you can afford the medications that you need. How, you ask, is this possible? Well, read on!

There are two primary ways you can afford or save money on your prescription medication. They include participating in one of the many (National, State, and Pharmaceutical) assistance programs and/or purchasing your medication from pharmacies located outside of the U.S.

Assistance Programs: Save From 25% to 100%!

Most persons are not aware that there are hundreds of programs available that provide either discounted or even free prescription medications to eligible US citizens. In fact, there are over thirty different national programs, virtually every state in the U.S. offers some sort of prescription medication assistance, and there are more than 250 different assistance programs offered by the many domestic and foreign pharmaceutical companies.

As you can probably guess, navigating the many programs to find the one that best fits your needs can be difficult. Each program has different eligibility requirements, application requirements, etc. However, the work required to take advantage of the program that best fits your needs will likely pay off. If you are eligible for assistance through one these programs, you can expect to save from 25% to 100% on the cost of your prescription medication. Savings like that are hard to ignore. And luckily, there are powerful tools available to help you find the program that is best for you.

Purchasing Your Medication from Pharmacies outside the US

Assuming that you don't qualify for an assistance program, there is always the option of purchasing your medication from pharmacies located outside the US. While there are many pharmacies in many different countries that are willing to sell to US consumers, the best option is Canada. Why? The answer is twofold. First, buying from Canada is safer. The Canadian equivalent of the FDA, Health Canada, is stricter than the FDA (and other countries' regulatory agencies) in its approval of new drugs. Second, Canadian pharmacies, on average, can sell medications for far less than pharmacies in the U.S. and other countries. They can do so for the following reasons:

The Federal Patented Medicine Prices Review Board (PMPRB) regulates medications that are under patent. The PMRB dictates the maximum prices that can be charged in Canada for patented drugs.



Health insurers, such as the provincial drug benefit plans, negotiate with the major pharmaceuticals to secure more favorable pricing on the medications that they cover.



On average your $1 will buy you approximately $1.40 to $1.60 in medication from Canada.



Health Canada is much quicker to approve generic versions of patented medication. The result is generic medications, which always cost less than patented medications, are available sooner in Canada.



Although there are many Canadian pharmacies, there are only a select few that you will want to buy from. Just like in the US, there are plenty of people willing to rip you off. And where your health is concerned, you do not want to take a chance. As a result, navigating the Canadian pharmacy option can be confusing and difficult. Luckily, as with the assistance programs, there are powerful tools available to help you find the pharmacy that is best for you.

It's Simple to Start Saving

Just because you don't have health insurance doesn't mean that you can't afford the medication that you need. The many assistance programs available to US citizens combined with the viable option of buying your prescription medication from Canada present the uninsured with the ability to purchase the medication that they need. Visit Rx Savings Guide to learn more about the tools available to help you afford your prescription medication.

By Garin Clark

Integrative Medicine And Its Future

The NBC National News, quoted the Washington Post in March 2000 about the concerns that the FDA had over the mixing of supplements and conventional medications. There was concerns that millions of people are taking supplements (considered herbs, homeopathic, vitamins, minerals, amino acids, enzymes and some diet products) and having reactions when they mix these things with common and prescribed medications.

I have studied this phenomenon for over 20 years and do know for a fact that with conventional medications, these reactions are quite common. The AMA is calling for the FDA to reverse their ruling on supplements implemented in 1997.

Is this really the best approach?

Many Universities across the nation have closed their Ethno -botany and Botany labs, disallowing many with the gift in this field to aid in the search for new cures, and to determine which plants will have adverse reactions when combined with other chemicals

A good example is the treatment of Gout.

Mediations that are prescribed by traditional medicine are normally Allopurinal or Zyloprim and Colchicine (which, by the way, is a homeopathic remedy from the bulb of the Autumn Crocus) which decreases the reaction that causes uric acid in the blood. Allopurinal and Colchicine can be enhanced by a specialized diet and the elimination of some supplements that can cause an elevation of certain enzymes in the diet. Both of these drugs can also cause serious side effects and toxicity when taken in high doses and/or for a prolonged period of time.

The deficiency of certain nutrients can provoke an attack of gout, people who take antibiotics can increase the risk of an attack and a persons diet can certainly influence not only the severity of an attack, but the frequency of attacks.

There are other reactions that need to be taken into account also, and the is that Allopurinal and Colchicine has a negative effect on the liver after 6 months of use, which will make it harder for those drugs to work effectively. If you also add some supplementation, even a regular multi-vitamin into the system when the liver is already struggling to keep up with the demands of the system, this can cause an adverse reaction to the liver, in part because the liver has to work harder to absorb the micro-nutrients given in the multi-vitamin.

The balance between conventional medicine and alternative medicine is a delicate one. Right now, both schools of thought refuse to work together, and the general public is who suffers.

For some who suffered from allergies when Seldane was prescribed, this was a very concerning issue. When taking Seldane, patients were not told that taking the medication along with certain micro-nutrients could prove to be fatal, and was in a few cases across the United States.

In 1993, the New England Journal of medicine published an article in which researchers estimated that as many as 60 million people had participated in alternative medical care. A follow-up study to that one, which appeared in a 1998 issue of JAMA, estimated that the number of visits to alternative practitioners had increased more than 47 percent between 1990 and 1997 and that expenditures in 1997 for alternative medicine services exceeded 21 billion dollars.

In our small town we had a family practitioner that took care of the community needs. He was a wonderful man that always gave of his time, energy and knowledge freely. A week after he was diagnosed with Gastric Carcinoma, he called me for advice. I asked him why he would call me and ask me for help. He told me that he had watched the patients that he had diagnosed with this same disease die slow, painful and miserable death, even while they were on conventional medications. He said he knew that the traditional medications and protocols didn't work, he had diagnosed cancers, informed the patients, watched them slowly die and he wanted something else. I treated him for 9 months; the cancer did not advance in that time, it didn't go away either, but it didn't advance. I asked him to do both treatments together, traditional and integrative, but he refused. He had a friend that was a Oncologist and this friend finally convinced him to try some clinical trials at a couple of Universities. In order to do that, the family doctor had to come off all other protocols that he had been taking. They waited a few weeks for the nutrients to leave his body, then started him on a a protocol called PP6 and Thalidomide. A few days after the first treatment, he told his closest friend, "I've killed myself". Within a few weeks, he was totally incapacitated. He passed away some 5 months later, in sever pain and agony.

It's not always conventional medicine at fault....A cancer patient in N-stage was being treated by both conventional physician and naturopathic physician. Because the patient had been put on Prednisone he had become edemic. The Naturopath told the patient to come off the drug immediately, and then left town on a business trip. I got a call a few days later, the patients breathing was labored and he had fluid in his lungs. The massage therapist that called explained what had happened. I told her to call the man's medical physician immediately, the reduction of Prednisone is not suppose to be halted immediately without the patient undergoing repercussions . The patient paid the ultimate price for the bridge between alternative and conventional medicine. There is so much that can be integrated into both schools of thought and treatment. These stories are why the public is turning to other methods for treatment, most do a combination, which, as the previous story illustrates, can be detrimental to health, unless the health care giver has a knowledge of both fields and an understanding of the chemical reactions that can occur. It is always best to be responsible for your own health and treatment. No health care professional should be given total and complete control over another man's life. The need for knowledge is a necessity when deciding to integrate different methods of treatment for the health care provider involved, it could mean the difference between the life and death of a patient.

By D.S. Epperson

Increasing Patient Care and Reducing Liability in Seven Simple Steps

When an unconscious patient arrives in the ED, every hospital agrees that timely next of kin notification is vital. Not only is it important to have a family member present to comfort the patient, but to make informed decisions for his care and provide the medical history that can make the difference between life and death. From a liability standpoint, as we know all too well, having a family member making medical decisions, often means that if complications do arise, the family will be much less likely to sue, than if they hadn't been in attendance.

Although most hospitals make notification calls quickly, between personnel shortages and overworked staffers, that call can often be delayed or forgotten.

That's exactly what happened to Elaine Sullivan, a very active seventy-one-year-old woman, who slipped and fell, while getting into the bathtub. When paramedics arrived, they realized that injuries to her mouth and head had made her unable to communicate, or as the hospital later discovered, to give informed consent for her own care.

Although stable for the first few days, she began to slip into critical condition. On the seventh day, Elaine died. But that tragedy was soon overshadowed by another. Despite having her daughter's phone number and contact information clearly indicated on the front of her chart, the hospital failed to notify her family that she'd been hospitalized until six and a half days after her admission, only hours before she died, unnecessarily and alone.

Elaine Sullivan was my grandmother.

In her case, placing that phone call right away, would have saved her life. Not only would my mother Janet and I have had the time to fly back to Chicago to be at her bedside, but we would have made sure she received the care she needed. We also would have been able to give the physicians treating her, the medical history they needed to prevent the complications and drug interactions, responsible for her death.

After researching our own case and others like it, we realized that failing to notify a patient's next of kin wasn't an isolated problem - it's something that's been experienced by countless families nationwide. According to the CDC, nearly one million patients come into the ED every year unconscious or physically unable to give informed consent. And with the growing number of emergency room admissions and baby boomers turning into senior citizens, the problem is only going to escalate. We began meeting with medical and trauma professionals, to create an easy-to-implement solution to this growing problem, by bringing together the best practices of successful trauma teams from hospitals nationwide. The result is the Seven Steps to Successful Notification System.

The complete system is presented in The Seven Steps Information Kit, which is available for download, free of charge, on the NOKEP web site. It's filled with tools your staff can use on the patient care floor to identify and locate your unconscious patient's family or surrogate decision makers, identify John Does and improve patient care and satisfaction by locating patient's medical histories quickly and easily, while complying with HIPAA standards.

Even better, following the Seven Steps system provides the facility with a documentation of the steps taken to find the patient's next of kin, make the notification, and the staff members responsible for making it. This releases you from subsequent liability, while providing proof that your facility has met its statutory responsibility.

Here is a quick look at the Seven Steps.

Step 1: Patient status confirmed

The moment that your staff realizes that an ED patient is unconscious or physically unable to give informed consent, and that there is no family member or surrogate decision maker in attendance, a nurse or physician is tasked with following the notification process through to completion. The staff member indicates the patient's status on his chart along with the time, date and the staffer's initials.

Step 2: Examine the patient's personal effects for emergency contact numbers

If the patient doesn't have emergency contact information in his or her wallet, the staff member looks for it in the patient's personal effects. The System has a comprehensive checklist of places to locate this information, from the usual to the downright creative.

Step 3: Retrieve patient's home number

If the patient doesn't have emergency contact information, the staff member then looks for the patient's home number, going to step five if they find it and four if they do not.

Step 4: Seek other sources for contact information

Next, the staff member looks for the patient's emergency contact information or home phone number on records from previous admissions at the facility, or by calling his personal physician's office, or other locations on the checklist. If the staff member finds the information, he proceeds to step five - if not, step seven.

Step 5: Oversee or make the notification call

When a contact has been identified, the staffer places a call to make the notification. They note on the chart when the call was placed, whom they contacted, the phone number and the result.

Step 6: Need to follow up? Recall main contact or second number

If a message had to be left for the contact, or the contact doesn't come into the hospital within two hours, the staff member places one more call, to the first or a secondary contact. If no one is reached, the staff member proceeds to step seven.

Step 7: Shift to social service or police

When no contact name or number can be located, or if the staff member doing the notification, is unable to speak directly to the contact, they give the information to the social service department or to the local police department, as per your facilities' policy, for follow up.

Along with the Information Kit, the non-profit Next of Kin Education Project has created patient chart pages and notification worksheets using the Seven Steps, that you can purchase and customize to use as part of your own charting system. You'll find them on the NOKEP web site along with reminder products like mouse pads, posters and coffee mugs, to keep the Seven Steps at your staff's fingertips.

Just as doctors, nurses, and staffers from every department make up a team to improve the health of the patients in their care, family and friends can play an important part in contributing to the patient's well being. As a medical professional, you are a diagnostician, a caregiver and a healer. But most of all, you are the patient's advocate. And so is his family. This Kit contains tools that will help you and his family work together to increase his care, trust and take patient satisfaction to a whole new level.

By Laura Greenwald