Issue link: https://digital.copcomm.com/i/1176470
6 Working Nurse l WorkingNurse.com October 14–November 18, 2019 ON THE QUICK Nursing & Healthcare News "Safer Than Cigarettes" FDA goes after JUUL, flavored e-liquids H oping to reduce the alarming popularity of vaping among young people, the FDA is cracking down on flavored e-liq- uids and warning e-cigarette maker JUUL against inappro- priate marketing. Marketing Reps in Schools! JUUL is the leading U.S. e-cigarette manufacturer and has led an industry trend towards extremely high-nicotine e-liquids. Now, the FDA alleges that JUUL has marketed its products in inappropriate ways, some of them directed at kids. U.S. law prohibits man- ufacturers from claiming that their tobacco prod- ucts are safer than other forms of tobacco unless they first submit appro- priate scientific evidence to the FDA. The agency says JUUL has failed to do so, despite marketing its products as "much safer than cigarettes." "JUUL has ignored the law," says Acting FDA Commissioner Ned Sharpless, M.D., "and, very concerningly, has made some of these statements in school to our nation's youth." He cited a recent Congressional hearing where witnesses claimed that JUUL marketing reps had told students JUUL was "totally safe" and "would be better for the kid to use" than regular cigarettes. Non-Tobacco Flavors Two days after warning letters went out to JUUL, the FDA announced a new enforcement plan intended to remove most non- tobacco-flavored e-liquids from the market. Data from the National Youth Tobacco Survey strongly suggests that the availability of fruit- and candy-flavored liquids entices kids to try vaping. In a prepared statement to Congress on September 25, Sharpless clarified that "FDA is not 'banning' flavors, as has been described in some news reports. Rather, FDA intends to enforce existing law that limits the marketing of such products." According to CDC Director Robert R. Redfield, M.D., "Any tobac- co product use, including e-cigarettes, is unsafe for youth. Nicotine can harm the developing adolescent brain. We must do everything we can to reduce the use of e-cigarettes among middle and high school students." WN ER Doctors and EHR Documentation Study finds half of electronic notes are wrong! I t's a truism among healthcare professionals that doc- umentation in the EHR is complicated and time-con- suming. According to a new study, those electronic notes are also often wrong. Concerns About Accuracy Almost every clinician working in modern healthcare has an opinion about EHRs. Even those who see them as ulti- mately beneficial often gripe about the complexity of electronic documentation, which cuts into time spent with patients and creates opportunities for error. Now, a study published September 18 in JAMA Network Open raises some worrying questions about the accuracy of EHR documentation. For the study — led by Cedars-Sinai's Carl Berdahl, M.D., M.S., and group of physicians from UCLA, UC Santa Cruz, Stanford, and Alameda Health System — researchers sent observers to watch and record ER physicians' interactions with patients and then compared those observations with the notes the doctors recorded in the EHR. The results: Only about half (53.2 percent) of the physical examination notes the physicians entered and just 38.5 percent of their review of systems notes were validated by the observers. Autofill and Financial Incentives The study's authors concede that in some instances, the observers — many of whom were not physicians — may have missed or misunderstood nuances of the doctors' patient interactions. Overall, however, the accuracy of the documentation appeared quite low. The authors offer two possible reasons for the inaccu- racy: EHR systems that rely heavily on autofill/auto-popu- lated text, which can cause a variety of errors that the cli- nician may not notice, and payer policies that create "financial incentives to generate lengthy documentation." Removing those financial incentives, the authors sug- gest, might be the best way to improve documentation accuracy and ensure that electronic health records emphasize quality over quantity. WN For direct links to the websites cited, find these articles at WorkingNurse.com FRUIT AND CANDY Flavors like mango and creme brulee entice young people to try e-cigaretttes. VAPING UPDATES