Tuesday, August 23, 2016
Epi Vs Narcan
These past few weeks the high cost of Epinephrine (or EpiPens) has made the news. It’s not that new. In March a story came out in ModernHealthcare about the high cost of this life saving drug. Around the same time I was working with teens who sat at my dining room table and we talked about patient safety and being an Involved and Informed patient. A young man at 16 years old with nu allergies questioned why Narcan is free to the public and his EpiPen is so expensive.
We know that many more people will die from drug overdose than allergies but isn’t that the system once again using “measurement” to decide who lives and who dies? If I had serious allergies and in my financial situation I might be hoping that prayer could work just as well.
Then I realized that if the pharmaceutical companies make a lifesaving medication, people who die from overdosing can come back and buy more medications from the pharmaceutical companies – look who gets rich off this.
What we really need is to encourage Jiff and/or Skippy and/or Peter Pan to go into the business of making EpiPens so those people who are allergic to nuts can eat them.
Saturday, August 20, 2016
Why John Walsh is Important to Patient Safety
I admire John Walsh. You may know him as a television show host finding criminals, The Hunt and years ago he hosted America’s Most Wanted. Or you may know him as the dad of a murdered child. He is both. And, 35 years after his son’s murder he still calls himself the father of a murdered child. That’s who he is. No apology.
I met John Walsh years ago when I was a guest on his talk show. (You can see I haven’t changed a bit) I asked him what makes him an “expert” in what he does. He is not a police officer, detective, or crime fighter. He is a dad. He said he learned everything he could and worked hard letting people know what he knew.
I admire that in a person. He believes in something and all these years later he is fighting for what he believes in.
I wish patient safety had a little bit of that support. Imagine if all the law enforcement would say “Mr. Walsh we don’t need your help we can do this”? Instead he is welcome as a partner in fighting crime. Why then is it so difficult for the healthcare professionals and the foundations that help fund their programs to recognize that medical errors and injuries that happen at the bedside need the support of a community willing to help?
I’m not sure I would call myself an expert. But, through PULSE Center for Patient Safety Education & Advocacy (Formerly PULSE of NY) I do have close to 1,000 hours as a bedside advocate witnessing errors, breakdown in communication and misunderstandings that might cost a patient their life and many, many hours working with people after an injury of death of a loved one. My volunteering as a board member with TheNational Patient Safety Foundation and The Joint Commission – both for over 10 years each, I understand how these “mishaps” can be corrected and how, if they are not taken seriously it is similar to playing Russian Roulette with a patient’s life. Patients and the family who say something and are ignored, rarely have a place to take that information to have the system fixed.
If it is true that medical errors are the third leading cause of death in this country, and there is no reason to doubt this, everyone needs to get on the same page and work together to not fight crime – but fight the system of errors which is left to only the often overworked medical professionals to deal with on their own.
Wednesday, July 27, 2016
The Pickle Jar
I threw the pickle jar in the garbage. I wasn’t sure if it was washed good enough and I didn’t want to wait to recycle day. So I threw the pickle jar in the garbage.
If you asked me if I recycle I would say “of course” because actually I do – but not always would be the more honest answer. I’m not sure where the magazines go so sometimes I throw them in the trash. Yes, I recycle. Sometimes if a can has sharp edges and I don’t know what to do I throw it in the trash. Yes, I recycle.
I care about the earth too yet often enough I forget - or actually I am knowingling breaking rules for convenience. Convenience so I don’t have to find an answer or don’t have to obey the rules? Either way these rules are there for a reason and if I am breaking these rules, my behavior may effect someone else.
Imagine if medical professionals did that. Oh never you might think?
A patient needs two people to lift her. The nurse does it herself and drops the patient injuring herself and the patient. Asking name and birth date – takes too long. Introduce themselves to the patient – why bother, I told them yesterday who I was. Check medication with the patient in case the doctor stopped the medication and the order is not in the chart. Why bother?
If you think they might cut corners, ask your clinician to check your medication, introduce themselves, wash their hands and explain information so you can understand it. Just because they want to cut corners don’t let it be with you. Even if the hospital you are visiting encourages staff to do these things and have been recognized for their work, doesn't mean the person walking into your room, or your family members room knows this. Help them not cut corners.
Cutting corners and breaking rules is not a good thing for patient safety (or the environment)
Saturday, June 25, 2016
Drug Free School Zone
I drove past a sign in front of a school that said “Drug Free School Zone”. I wondered if I were starting a family would this give me confidence that my children would be safe from illegal drugs.
Then I hear a commercial that if I buy a mattress, I will sleep better.
The mayor just said that the people going to today’s parade will be safe because of the added police protection.
Here lies a serious problem (my opinion) with society. I think people believe what they want to believe even when there is room for error. That means the best, or safest hospital in the country must have all the latest safety equipment? Or do they have the best food, clean sheets and nice rooms?
I had a conversation last week at a meeting with a woman who I know is highly respected in her business world. We talked about her colleague, someone we both knew who was very, very sick. She told her colleague that he has to go into a NY City hospital for his very serious condition. “It’s the best place to be” she told me she explained to him. This was going back about six months.
I asked her why she thought so and she said it’s just the best. But her colleague insisted on using a Long Island hospital and she told me she couldn’t believe it.
We are often led to believe through advertisements or just because we want someone to have the answers that things will be done for us. There will be no drugs at the Drug Free School Zone or we will be safe at the parade. But, we still need to be on the look out at that parade and be part of the safety process. How can our safety possibly be guaranteed – ever? It is those of us on the ground who have to be prepared. The parents who think a safe zone for their children means that their child won’t become involved in illegal drug behavior is mistaken. They most certainly can. The person picking up that drug or smoking that joint (or not) is the only one who can really make a change. Not the sign or even the adults who talk about drug use in schools.
The woman who insisted that NY City hospitals are the only place to be didn’t even have a favorite. Just any hospital would be better she said. I didn’t want to debate her on the topic so I just gently explained that there are some great hospitals and healthcare workers on Long Island and if he is closer to family he will have visitors and in an emergency he will be close to his doctors. I explained that it is up to him, and his family to active and engaged and part of that team for the best outcomes. She said she knew that and he is involved but still “nope” the city is the best place to be.
I asked her how her colleague is today. She told me he is fine. I rest my case.
Saturday, May 28, 2016
Advocates for Patients
Part three of the FamilyCentered Patient Advocacy Training came with enthusiasm from the group. By the third evening, though tired from a long day’s work, each participant seemed glad to be there and were now getting to know each other. A mix of classwork, conversation and lecture, each shared experience with the group is based on truth. With over 700 hours at the bedside of patients and hundreds of hours in the past 20 years of my patient safety work in the community, there are more than enough stories to share and learn from.
To be respectful of the people who have shared their stories, or who have allowed me to be part of their hospitalization, it is very important to me that each story and experience is given the utmost respect. I often remind the group that this is personal, and we are learning from real experiences.
This allows for during role play sudden, unexpected changes that a patient safety advocate must be ready for. If all patient experiences went well, and there was no need for a partner at the bedside, than medical errors probably would not be the third leading cause of death in the country. The reason more isn’t done, in my opinion, is because there are so many different ways that things can go wrong. Advocates, especially patient safety advocates, need to be ready.
In this past session, a young man who missed the first two classes and came over an hour late to the last class wants to be an advocate. We already went over almost everything we were going to - including ethics. Our ethics is based on the Alliance ofProfessional Health Advocates (APHA) Code of Ethics.
In the last class, we discuss the case of a young transgender man who was hospitalized and the situation turns to the possibility of sharing a hospital room with a non-transgender person. I explain at the beginning of this session that we may not agree with how someone lives, but professional (some in the group will not become professional advocates) need to be respectful that they are in need of services and we do not discriminate (Ethics #9). In this part of the class, the advocates-in-training work this out.
When the class was over and everyone left, the young man came to me with an older female friend who also took the class and who he obviously looked up to and shared his concern over the experience of a transgender person having the right to choose his room. (There are no quotes here-just my memory of the conversation).
The young man (possibly just out of high school) told me about his long term illness, on-going hospitalizations and concern that his rights might be violated were he to be forced to share a room with a transgender person. Why are they the only ones’ who have rights he asked me repeatedly?
As a young black man, I tried to use that as an example. Would a white man be able to say he did not want to be in the room with a black man, Asian man or Hispanic man? His friend, the older woman said that was different because in a hospital, patients are exposed and may be naked. They also seemed offended that I would use this comparison.
I realized that after a discussion, I was not going to change their mind so I decided to listen and become educated. What was this they were so against? Something I could not possibly understand in the few short minutes. I was grateful to come face to face with someone who shared their views which were not mine. Whether or not I believed in the same principles as them. We all walk this earth together and there are people with different views.
I asked if they would be willing to be an advocate for a transgender person and they both said “no”.
Then I had to think about that question for myself. Would I be willing to be an advocate for them, if they wanted their room changed because of who was in the next bed.
I welcome your feedback but please say who you are for an on-going discussion.
Next class starts August 3, 5:30 PM