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Cosmetic Medicines Ordering, Storage, Supply and Incident Reporting

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This article gives an overview of the systems and processes that must be followed by cosmetic clinics when supplying prescription medicines.

A prescription medicine or drug legally requires a qualified doctor, dentist, nurse or pharmacist to write a prescription for a named patient. The list of drugs and prescribing qualifications may vary in different countries.

A cosmetic clinic must ensure that all medicines are ordered, stored and supplied within the legislative and other relevant pharmaceutical guidelines available.

Therefore ordering, storage and supply of medicines for use within the practice must be undertaken according to appropriate procedures and guidelines to ensure all relevant legislation and pharmaceutical information is adhered to.

Any medicines stored within a typical cosmetic clinic are those used for aesthetic purposes, this includes drugs such as Botox ® and Hyaluronidase. These must be stored according to manufacturer’s guidelines in a locked refrigerator or locked cabinet as appropriate. The temperature of the refrigerator should be monitored and documented daily. If the temperature is found to be outside the recommended range the pharmacy supplier must be informed as soon as possible and if necessary the medicines are returned to the supplier and a new supply obtained.

Supply of Medicines and Maintaining Patient Records for Cosmetic Clinics

The Medical Practitioner is responsible for maintaining a record of medicines obtained from the supplier for use during treatment. A copy of the prescription is retained in the patient’s notes and the following information is noted in the Medicines IN register. The Medical practitioner must include the following details:

– the name of the medicine (generic)

– the dose provided by the pharmacy

– the amount provided by the pharmacy

– the format of the medicine (oral I IM etc)

– the batch numbers and expiry dates

The Medical Practitioner is responsible for ensuring that details of the medicines administered are recorded in the patient notes, including:

– the name of the medicine (generic)

– the dose provided

– the route of administration

– the batch number and expiry date of the medicine

– the date and time of administration

The Medical Practitioner must also document in the Medicines OUT register the name of the patient the medicine was administered to and the date and time of administration. This will ensure an audit trail is available for each practitioner.

All medicines not used or expired must be returned to the pharmacy.

In conclusion only a medical professional should be accepted on a cosmetic training course. This will ensure all practitioners have experience with the use of prescription only medicines and record keeping. The medical practitioner who facilitates a cosmetic intervention should be a qualified doctor, dentist, nurse or pharmacist. These specialists have the prerequisite medical experience plus understand their legal and ethical requirements in prescribing, dispensing and administration of such drugs.

Any errors with the medication must be recorded and reported.

Reporting a Medication Incident

A cosmetic clinic must ensure that all medication incidents follow local legislative and other guidelines for your country of practice. The following is based on the UK CQC guidelines.

All practitioners involved with medication prescribing, dispensing or administration must be aware of the procedures to be followed in the event of a medication error or near miss.

Medication errors or near misses will occur despite having risk procedures in place, and all personnel involved in medication prescribing, dispensing or administration are at risk of being involved an error or a near miss. Because of this, comprehensive reporting of all medication incidents is crucial to enable the organisation to learn from mistakes and improve practice wherever possible.

All incidents involving medication prescribing, dispensing or administration, ‘near misses’ and serious drug reactions must be documented on the Incident Report Form. A medication error is a preventable incident or omission that results in an increase in the risk of patient harm. A ‘near miss’ is a medication error that is discovered before it reaches the patient, thus preventing harm to the patient.

What to Report

The following are some of the issues that require an incident report:

– incorrect dose administered (both over and under dosing)

– incorrect route of administration

– incorrect rate of administration

– incorrect drug administered

– administration to the wrong patient

– failure to document administration in the patient’s medical notes

– administration of an expired drug

– prescribing errors

– incorrect labels

– allergies not recorded

– serious adverse effects including allergic reactions

Near Misses will also be recorded on the Incident Report form.

How to Report Medication errors

Medication errors involving administration to a patient will be documented in the patient’s notes. The Medical Practitioner should inform the patient.

The incident should be documented fully before the end of the day. This report form must be completed by the Medical Practitioner and given to the Practice Manager without delay.

Follow Up Procedures for Medication Errors

A follow-up is undertaken by the Medical Practitioner to ensure the safety of the patient. If necessary the patient must be referred to the nearest Emergency department for further review. The Practice Manager must undertake an investigation into the event ensuring a statement is taken from those involved.

The incident must be discussed at the next Clinical Governance meeting and an action plan developed to aim to prevent recurrence; this may include further training for the personnel involved.

Any severe medication incident must be reported to the within 24 hours of it occurring.

I hope you enjoyed the article. For more information about medicines and their regulations you can check with the Department of Health and MRHA in the UK. In the USA please refer to The Food and Drug Administration (FDA).

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How To Start A Roasted Corn Business

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Corn roasting is a simple yet very profitable small investment business. The successful corn roasters make full time living working just the summer months.

To start a roasted corn business you will need to acquire permits and business licenses from the health department and from the state. The following is a typical checklist to start your business.

1. Decide the size and the scale of the operation.

2. Decide on the menu for your concession business.

3. Purchase your equipment and tools.

4. Register your business.

5. Apply and obtain all the required licenses and permits needed to run a food concession business.

6. Secure events and have fun running your concession stand.

Permits, Licenses, and Inspection

Every state has laws governing business licenses and permits. Most likely, you will have to register your business with the state agency, so you can do business in the state. A tax ID number, business license number, and tax registration number can be issued to your business, depending on the state in which you are operating. You should verify with the city or county that the business location is zoned for that activity. You must have commercial liability insurance, both for your business and for your vehicle and trailer.

Health Department and Food safety

As a business owner and a food worker, you will be preparing food for other people. Contact the health department of your county or state to receive a copy of a food safety guide that will help you greatly in learning more about food safety. Roasted corn is considered a less hazardous food, but if you are going to sell potatoes and turkey legs you may have to pay higher fee.

Start-up Costs of a Corn Roaster Business

Brand new corn roaster with warranty: 10,000-$12,000.

Used corn roaster: $5,000-$8,000.

Additional equipment and accessories: $1,200-$2,000.

Used van or truck: $2,000-$10,000.

Food cost for first two events: $300-$1,000.

Event sign-up fee: $800-$3,000.

Fuel, utilities, and miscellaneous: $200.

Equipment Required to Start a Corn Roasting Business

A professional corn roaster, minimum 200-500 corns per hour.

Hot plate for melting butter

Steam table for storing cooked potatoes and turkey legs.

Two 20-lb. propane tanks

Fire extinguisher

Commercial quality tent

2 tables,

Hand washing unit (portable) very easy to assemble one

Mics. Little things

Google “Corn Roasters” and search for companies that will help you get started before buying the equipment if you are strapped for cash. One of the company Texas Corn Roasters help.

How to Find Events and Festivals

There are many sources for finding festivals and events, such as your vendor friends, the local Chamber of Commerce, auto racing, fairs and festivals, flea markets, rodeos, and theme parks. The Internet is one of the greatest sources for finding events. Many good sites provide this information. Always send a professionally done proposal with your application if you want to beat the competition.

Suppliers and Producers

Suppliers and produce wholesalers are your key to success in this business. You cannot afford to buy the food from retailers, so you must find producers capable of providing you quality food at wholesale costs. Every state and big town has a local supplier who delivers food supplies to local restaurants. “Wholesale food distributor” in the Yellow Pages is a good place to start. Corn is cheap if buy from a wholesaler.

Serving food at the festival

The way you serve can also improve your business. You will need certain condiments for every item you server. For instance sale, black pepper, Cajun spice, garlic powder, lemon pepper and more.

Signage

You have probably heard the saying “flash is cash.” It is very true when it comes to the festival business. You could have the most delicious food, best prices, well-trained staff, and a festival with thousands of people. If your booth fails to attract customers,, it is probably the poor signage.

Tribal knowledge

Like many other small profitable business the roasted corn business is run by tight lipped vendors who do not share tribal knowledge. There are not any website, or sources for a newbie to find any information. The tribal knowledge could help you make extra 25K a year. There is a very helpful book “Earn an entire year’s living with corn roaster”, that covers this business with very granular level of details. It is worth buying.

If you plan on making your concession business a full time job, consider an RV that can tow your corn roaster trailer and getting on the list of concession vendors that follow a fair rout.

Accounting and numbers are also very important aspect of this business. Festival Concession business offers financial and personal freedom like no other small business does.

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Finance

Digital Infrared Thermal Imaging In Medical Therapy

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Digital technology now makes Digital Infrared Thermal Imaging available to all. There now is a completely safe test that can aid in diagnosis, treatment and monitoring with absolutely no risk or radiation exposure.

DITI, or digital infrared thermal imaging, is a noninvasive diagnostic test that allows a health practitioner to see and measure changes in skin surface temperature. An infrared scanning camera translates infrared radiation emitted from the skin surface and records them on a color monitor. This visual image graphically maps the body temperature and is referred to as a thermogram. The spectrum of colors indicates an increase or decrease in the amount of infrared radiation being emitted from the body surface. In healthy people, there is a symmetrical skin pattern which is consistent and reproducible for any individual.

DITI is highly sensitive and can therefore be used clinically to detect disease in the vascular, muscular, neural and skeletal systems. Medical DITI has been used extensively in human medicine in the United States, Europe and Asia for the past 20 years. Until now, bulky equipment has hindered its diagnostic and economic feasibility. Now, PC-based infrared technology designed specifically for clinical application has changed all this.

Clinical uses for DITI include, defining the extent of a lesion of which a diagnosis has previously been made (for example, vascular disease); localizing an abnormal area not previously identified, so further diagnostic tests can be performed (as in Irritable Bowel Syndrome); detecting early lesions before they are clinically evident (as in breast cancer or other breast diseases); and monitoring the healing process before a patient returns to work or training (as in workman’s compensation claims).

Medical DITI is filling the gap in clinical diagnosis; X-ray, Computed Tomography, Ultrasound and Magnetic Resonance Imaging (MRI), are tests of anatomy or structure. DITI is unique in its capability to show physiological or functional changes and metabolic processes. It has also proven to be a very useful complementary procedure to other diagnostic procedures.

Unlike most diagnostic modalities DITI is non invasive. It is a very sensitive and reliable means of graphically mapping and displaying skin surface temperature. With DITI you can diagnosis, evaluate, monitor and document a large number of injuries and conditions, including soft tissue injuries and sensory/autonomic nerve fiber dysfunction. Medical DITI can offer considerable financial savings by avoiding the need for more expensive investigation for many patients. Medical DITI can graphically display the biased feeling of pain by accurately displaying the changes in skin surface temperature. Disease states commonly associated with pain include Reflex Sympathetic Dystrophy or RSD, Fibromyalgia and Rheumatoid arthritis.

Medical DITI can show a combined effect of the autonomic nervous system and the vascular system, down to capillary dysfunctions. The effects of these changes reveal an asymmetry in temperature distribution on the surface of the body. DITI is a monitor of thermal abnormalities present in a number of diseases and physical injuries. It is used as an aid for diagnosis and prognosis, as well as therapy follow up and rehabilitation monitoring, within clinical fields that include rheumatology, neurology, physiotherapy, sports medicine, oncology, pediatrics, orthopedics and many others.

Results obtained with medical DITI systems are totally objective and show excellent correlation with other diagnostic tests.

Thermographic screening is not covered by most insurance companies but is surprisingly affordable for most people. For more information or to find a certified clinic in your area, go to www.proactivehealthonline.com [http://www.proactivehealthonline.com].

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Hooray for the Federal Rules of Evidence!

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The Federal Rules of Evidence used in the United States federal courts and adopted by many states and the military are codification of many years of common law evidence rules. The development of the modern rules of evidence has been a process of nothing more than putting old wine into new bottles. If one can understand common law notions of evidence the Federal Rules will be easy to understand.

The purpose of the Federal Rules of Evidence is to secure fairness in administration of trials; eliminate unjustifiable expense and delay; and to promote the growth and development of the law of evidence in order that truth may be ascertained and proceedings justly determined. As a former trial lawyer and current law school professor who teaches the rules of evidence to students, I view the Federal Rules of Evidence, adopted by Congress in 1975 as a master work of putting the old common law wine into a new bottle. I have used the Federal Rules of Evidence throughout my career.

This article is not about any specific common law rule or rules that may have been put into the new bottle known as the Federal Rule of Evidence. Instead, I write this to show how influential and widespread has been the use of the rules. Forty-four states, Guam, Puerto Rico, the Virgin Islands, and the military have all adopted all or parts of the Federal Rules for use in their court systems. This is a very good trend because the evidence rules of most states will be roughly the same throughout the United States.

The following paragraphs provide fundamental information about the jurisdictions that have adopted evidence rules patterned on the Federal Rules. They include information concerning the date on which the local rules became effective and when amended, if at all:

ALABAMA. Adopted by the Alabama Supreme Court effective January 1, 1996. No amendments.

ALASKA. Adopted by the Alaska Supreme Court effective August 1, 1979. Last amended October 15, 2003.

ARIZONA. Adopted by the Arizona Supreme Court effective September 1, 1977. Last amended June 1, 2004.

ARKANSAS. Adopted by the Arkansas Supreme Court effective October 13, 1986. Latest amendment on January 22, 1998.

COLORADO. Adopted by the Colorado Supreme Court Effective January 1, 1980. Latest amendment July 1, 2002.

CONNECTICUT. Adopted by the judges of the Connecticut Superior Court effective January 1, 2000. No amendments.

DELAWARE. Adopted by the Delaware Supreme Court effective February 1, 1980. Latest amendment December 10, 2001.

FLORIDA. The Florida Evidence Code was enacted by the Florida Legislature effective July 1, 1979. Latest amendment July 1, 2003.

GEORGIA. Governor Nathan Deal signed a House bill which made the Georgia rules effective January 1, 2013. No amendments.

GUAM. Adopted by the Guam Judicial Council effective November 16, 1979. Latest amendment July 18, 2003.

HAWAII. Enacted by the Hawaii Legislature effective January 1, 1981. No amendments.

IDAHO. Adopted by the Idaho Supreme Court effective July 1, 1985. No amendments.

ILLINOIS. Adopted by the Illinois Supreme Court effective January 1, 2011. No amendments.

INDIANA. Adopted by the Indiana Supreme Court effective January 1, 1994. Latest amendment January 1, 2004.

IOWA. Adopted by the Iowa Supreme Court effective July 1, 1983. Latest amendment February 15, 2002.

KENTUCKY. Enacted by the Kentucky Legislature effective July 1, 1992. Latest amendment July 1, 2003.

LOUISIANA. Enacted by the Louisiana Legislature effective January 1, 1989. Latest amendment August 15, 2003.

MAINE. Adopted by the Maine Supreme Judicial Court effective February 2, 1976. Latest amendment July 1, 2002.

MARYLAND. Adopted by the Maryland Court of Appeals effective July 1, 1994. Latest amendment January 1, 2004.

MICHIGAN. Adopted by the Michigan Supreme Court effective March 1, 1978. Latest amendment January 1, 2004.

MINNESOTA. Adopted by the Minnesota Supreme Court effective April 1, 1977. Latest amendment January 1, 1990.

MISSISSIPPI. Adopted by the Mississippi Supreme Court effective January 1, 1986. Latest amendment May 27, 2004.

MONTANA. Adopted by the Montana Supreme Court effective July 1, 1977. Latest amendment October 18, 1990.

NEBRASKA. Enacted by the Nebraska Legislature effective December 31, 1975. Latest amendment July 13, 2000.

NEVADA. Enacted by the Nevada Legislature effective July 1, 2004. No amendments.

NEW HAMPSHIRE. Adopted by the New Hampshire Supreme Court effective July 1, 1985. Latest amendment January 1, 2003.

NEW JERSEY. Adopted by the New Jersey Supreme Court and the New Jersey Legislature through a joint procedure effective July 1, 1993. Latest amendment July 1, 1993.

NEW MEXICO. Adopted by the New Mexico Supreme Court effective July 1, 1973. The latest amendment became effective February 1, 2003.

NORTH CAROLINA. Enacted by the North Carolina Legislature effective July 1, 1984. Latest amendment October 1, 2003.

NORTH DAKOTA. Adopted by the North Dakota Supreme Court effective February 15, 1977. Latest amendment March 1, 2001.

OHIO. Adopted by the Ohio Supreme Court effective July 1, 1980. Latest amendment July 1, 2003.

OKLAHOMA. Enacted by the Oklahoma Legislature effective October 1, 1978. Latest amendment November 1, 2003.

OREGON. Enacted by the Oregon Legislature effective January 1, 1982. Latest amendment July 3, 2003.

PENNSYLVANIA. Adopted by the Pennsylvania Supreme Court effective October 1, 1998. Latest amendment January 1, 2002.

PUERTO RICO. Enacted by the Puerto Rico Legislature effective October 1, 1979. Latest amendment August 30, 1999.

RHODE ISLAND. Adopted by the Rhode Island Supreme Court effective October 1, 1987. No amendments.

SOUTH CAROLINA. Enacted by the South Carolina Legislature effective September 3, 1995. No amendments.

SOUTH DAKOTA. Enacted by the South Dakota Legislature effective July 1, 1978. No amendments.

TENNESSEE. Adopted by the Tennessee Supreme Court effective January 1, 1990. Latest amendment July 1, 2003.

TEXAS. Adopted by the Texas Supreme Court effective March 1, 1998. No amendments.

UTAH. Adopted by the Utah Supreme Court effective September 1, 1983. Latest amendment November 1, 2004.

VERMONT. Adopted by the Vermont Supreme Court effective April 1, 1983. Latest amendment May 27, 2003.

WASHINGTON. Adopted by the Washington Supreme Court effective April 2, 1979. Latest amendment September 1, 2003.

WEST VIRGINIA. Adopted by the West Virginia Supreme Court effective February 1, 1985. Latest amendment January 1, 1995.

WISCONSIN. Adopted by the Wisconsin Supreme Court effective January 1, 1974. Latest amendment March 30, 2004.

WYOMING. Adopted by the Wyoming Supreme Court effective January 1, 1978. Latest amendment February 28, 1995.

THE MILITARY. The Military Rules of Evidence were adopted by Executive order No. 12,198 March 12, 1980. Latest amendment by Executive Order No. 13,262 April 11, 2002.

THE COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS. No date of adoption found.

THE U.S. VIRGIN ISLANDS. No date of adoption found.

What an impressive list of adoptions and enactments patterned after the Federal Rules of Evidence! Several jurisdictions have not adopted rules of evidence based on the Federal Rules of Evidence. They are: California, the District of Columbia, Kansas, Massachusetts, Missouri, New York and Virginia.

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