Wednesday, July 27, 2016

Recycle the Pickle Jar

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

Where are the Best Hospitals?

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

Who are We to Advocate For?

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
Register Here

Saturday, May 14, 2016

Adding to the Transgender Bathroom Conversation

People Who Are Transgender & Bathrooms is That Today's Priority?

Why does the lives of transgender people affect all of us?  Why does it matter to all non transgender people where a transgender person uses the bathroom?  Because it is more than using the bathroom, it is about a society who doesn’t understand and instead of learning, builds a wall. Today it’s about people who are transgender, tomorrow will be about something else.  Leave things as they’ve always been and maybe it will all go away?  Well it won’t go away so we need to be talking about it.

I have been writing about experiences of people who are transgender since 2009 as they use the healthcare system. I had the opportunity at that time to speak about my experiences at the Transgender Day of Remembrance honoring people who are transgender and are murdered because of who they are.

If there is a fear of men, dressing up as a woman to commit a crime in the ladies room, men can do that now.  What is stopping a criminal from dressing in women’s clothing and stalking a rest room now?  This is not about being a person who is transgender, it’s about not having the resources to fight crime. It’s another way for the same people who are voted in to keep us safe by hiring enough protection now being told they must protect us from criminals – not transgender people. 

People who are transgender (in my experience) when using the bathroom they do what they have to do and get out.  There is no conversation and no one is exposed. Personally it’s probably better if we all do that!

Some questions come up in healthcare and how hospitals are supposed to find private rooms for patients who are transgender.  Yes, that would be ideal for all patients to be in private rooms to avoid the spread of infection and for privacy.  But, has anyone been to an emergency room where people lay sometimes for hours (or even days) and are separated by a curtain, all their business is being heard and sometimes their bed is in a hallway! 

When I spoke in another country about patient safety I realized, maybe too late I probably shouldn’t be speaking about people who are transgender or some other topics I spoke about.  We have to be sensitive to other cultures.  I may not approve of their having 4 wives or that women can’t drive but it’s the respect for each other that we need to be focusing on.   

The public must be more tolerant that we are walking this earth together and need to be respectful of each other even if it’s not comfortable.  More attention needs to be on the side of acceptance.  (If you are reading this, you are probably there already)

Sunday, May 1, 2016

Is Your hospital an A or Clean?

Hospital Report Cards

Another release of hospital report cards can leave you shocked that a hospital you thought was wonderful, is now reported at a “C” or worse.  A hospital where you were injured, the nurses were not available to you or you got a hospital acquired infection is now reported to have an “A”.  What does this mean to the average patient and / or family?

It means plenty, and it means nothing.  How do you choose your hospital?  It’s probably where your doctor tells you he wants you to go.  Some people may then look at the Department of Health website, or Leapfrog hospital report cards and then what?  If you don’t like what you see will you tell your doctor you don’t want to go?  Will you look for a new doctor in the midst of a heart attack?  Maybe you can start looking for a new doctor who is affiliated with the A rated hospitals now, just to find out that if you were admitted, your doctor doesn’t go there to visit you because they have hospitalists working there.

I think the report cards are for the hospitals to brag to each other.  They use this as an opportunity to market in the news or on a commercial.  But, even with that, its buyer beware.  Hospital report cards don’t guarantee patient safety for each patient.  It’s just another tool to help make a decision. 

There is no guarantee even the hospitals with an A rating year after year there won’t be a medication mix up, a surgical error or a patient won’t get an infection.   There is no guarantee that the food tray will be within reach, the nurse will remember to wash her hands or the garbage won’t overflow.  There is no guarantee that you will be treated with dignity by every employee or you will understand your medication or discharge process.  There is never a guarantee.  Just keep vigilant, active in your care, have your family and / or friends as your support system and chances are things might go better than expected – at any hospital.