Tuesday, November 18, 2014
In a recent 30 minute presentation about patient safety I began to talk about the difference between a healthcare proxy and patient advocate. A woman in her later years shot her hand up and said “you need to have a friend who knows information about you in case you can’t speak” she told a room full of her peers. It was apparent as we continued the dialogue that she didn’t know what a healthcare proxy or advance directives are. We often assume people know what we are talking about. Patient care is a perfect example of language that is misunderstood and too often the receiver of the information is too intimidated to ask or feeling overwhelmed. They also may think they know information but until it’s time to follow instructions of a care plan – possibly like taking medication, they realize they don’t understand.
“Do you think that a patient’s bed rail needs to always be up to avoid falls?” I asked explaining that falls can cause serious injury and may add as much as $13,000 to a hospital stay. When most of the audience nodded, I explained how a patient, no matter their age, may try to climb out of their bed and this could be tragic. When visiting a friend in the hospital, if you know they may have fallen in the past, be sure the nurses know. “If you see a star or sometimes a picture of a slipper on the door” I explain, “do not encourage the patient to get up”.
The presentation I cover is about some basic topics costing healthcare billions of dollars each year. Falls, infections, literacy, medication and surgery also known as F.I.L.M.S. is the basis of the presentation. Other important topics are advance directives, communication for the best diagnosis and record keeping.
At one community program, audience members admitted that when discharged from the hospital, they left without understanding their next steps. Should they go back to the surgeon, their family physician or not at all? If they didn’t understand their medications they were given, some people have told me they wouldn’t get a prescription filled. Understanding before getting surgery that there are people to help in the hospital with questions or concerns might keep someone from being readmitted because they didn’t understand their care plan.
Most people are annoyed that they are asked on numerous occasions their name and birthday. When learning that this may help reduce errors, participants are encouraged to be sure every person who treats or transports them asks for 2 forms of ID and agree that now they will expect to be asked.
Choosing your advocate needs to be done before an emergency strikes. Will your helper be non-English speaking, over 95 years old and unable to hear with limited sight? Will your advocate or helper be someone who loves you so much they can’t think straight and cries continuously when your clinician talks to you about your cancer diagnosis?
Listening skills, communication examples and fun interaction can turn patient injury into a celebration of care going right.
Patient safety is not about us – or them. It’s everyone’s responsibility to be part of the team working around the patient for patient centered care. We all need to work together to keep a patient safe; friends, family and medical staff. It’s time the information about patient safety comes out of the hospital walls and lands in the laps of the public so changes can happen. If you’re looking for a community presentation that can last 45 minutes to *6 hours, call (516) 579-4711
*The PULSE of NY 6- hour workshop is a certificate programs. Fees may apply
Posted by Ilene at 3:06 PM
Thursday, October 23, 2014
Speaking in Plain Language
When I went to see this young man I arrived at his mother’s hospital floor before him. We connected through a mutual friend who thought I might be of some comfort or helpful. It was almost 10:00 AM and I was running late. Respectfully, I waited outside his mother’s room until he arrived. I have learned to stand in one spot, barely moving when I am visiting someone in the hospital. Being respectful and aware are the two most important things to me. My phone vibrated and he was calling from the lobby. Visiting hours start at 11:00 AM. I looked at the hospitals website before my visit. He said he was downstairs waiting for 11:00.
“Visiting hours” I told him, “are for other people. It’s not for you. Hold your head up high and walk past the sign. Act like you are a man in charge.” Minutes later the elevator door opened and a tall handsome young man walked out already in a sad place and now feeling even more vulnerable. My job was to help him feel empowered while not taking any more of his power away.
He introduced me to his mother who was unresponsive and at the end stages of cancer. The mask on her face, when removed to offer her sips of a drink, caused her saturations to drop frighteningly low. He did not want his mother to have the discomfort of this mask on her but the other masks weren’t working. We immediately started writing down the things he wanted to talk to the doctor about. The mask, her diet, her medications. As he thought out loud, I wrote his thoughts and questions in a notebook I brought for him to keep. He pulled out a notebook and started writing too.
When the doctors came, along with the young students in tow, the conversation turned to hospice and palliative care. It was 10:30 in the morning and before visiting hours. I now realized why the family never had a conversation with the doctors in charge of her care. By 11:00, they would be long past this room and on to other patients.
The attending physician told us that the palliative care team would be in to talk to him about his mother’s care sometime today. I asked the overwhelmed son if I may ask a question. “Sure” he said. “Does this mean he cannot use the bathroom, have lunch or leave the room because he may miss the team?” I asked pointing at the young man standing over me? “He has been waiting 5 days already.” The doctor went into his jacket pocket, pulled out a phone and called for the team to come up. Minutes later the doctor came with the students again following.
The kind and gentle physician who oversaw this department explained that to make her comfortable they would give her medication so she can rest comfortably and take the mask off. The conversation lasted less than 10 minutes. The physician asked what the son wanted to do and we requested the doctor’s contact information so he can decide. I asked if I can ask a question and when the son said “yes”, I asked the doctor so the patient’s son could hear clearly, “Are you saying that if you removed the oxygen and gave her medication to rest comfortably, she will die?” The doctor looked at me, at the son and back at me again and said. “Yes”.
Now, he can make an informed decision. Family was called, arrangements were made and she passed peacefully the next day. Her children hopefully, can live with no regrets. Rest in Peace
Posted by Ilene at 9:48 AM
Monday, October 13, 2014
Lessons from Ebola
Posted by Ilene at 7:45 AM
Tuesday, September 30, 2014
Be in Control
At a recent program, a woman said her doctor is making her take medications that she doesn’t want to take. Another patient said that she was kept in the hospital but she didn’t want to stay.
Too often patients think they are being forced to do things by some implanted learning that they are not in control.
“If you don’t want to take your medications” I told her “don’t” but there may be consequences; from getting sicker, to losing your beloved doctor who also may say he doesn’t want to care for you if you won’t follow instructions.
After an hour long presentation, I would hope that participants understand that they are in control of their medical care. Mistakes happen, clinicians may be wrong. They need to know what’s on your mind. Why won’t you take your medication? Why do you want to leave the hospital against medical advice (AMA)? These are things you should be able to talk to your health care team about. If you can’t, you need to change who your team is.
One person said she couldn’t imagine going to see the hospital leadership with her complaints. I asked her why she thought they were so untouchable. “If you were unhappy at a hair salon or at a restaurant, if you would speak to the manager or owner, it should be no different”. Complaining or constructive feedback are two different things. Hospitals want your business. They want you to tell all your friends how wonderful your surgery went. If you are not happy, speak up. If you’re in danger, move up….the ladder to the people in charge.
Posted by Ilene at 7:49 AM
Thursday, September 25, 2014
World Pharmacist Day - September 25
According to the International Pharmaceutical Federation (FIP), September 25 is World Pharmacists Day. What a great opportunity to remember that the pharmacist is your expert on medications - more than the physician, more than your friends and neighbors, it's the pharmacist who is there to answer your questions about medication mixtures, potential side effects and appropriate and proper measurement.
Here are some tips:
· Use only one pharmacists so they know all your medications
· Don't change the dose or stop medication without consulting with your clinician and even your pharmacist
· You are encouraged to read all labels and inserts but, if you start coming down with new ailments such as an upset stomach, achy joints, headaches or irritability, before seeing a new doctor check with your pharmacist about potential side effects
· After your clinician tells you about your medication, ask your pharmacist. The pharmacist is more up to date on warnings and new medications
· Your pharmacist can help you with a discussion with your clinician. If a medication doesn’t seem to be working for you, ask your pharmacist what he / she recommends so you can talk to your doctor about it
· Be sure your pharmacist has in your record all your allergies and any adverse reactions to medications
· Don’t ever be embarrassed to ask questions about your medication. Whether you are a waitress, hairstylist, postal worker or auto mechanic, we all have our knowledge and skills. Not understanding when or how to take medication is not something to be ashamed of. ASK!
· Consider choosing someone you trust to be your DMM, Designated Medication Manager
Don’t forget to visit www.ismp.org for more information. The Institute for Safe Medication Practice (ISMP) is the nation's only nonprofit organization devoted entirely to medication error prevention and safe medication use.
Posted by Ilene at 8:22 AM