Sunday, January 7, 2018

So Far Away

Living Far Away 

The woman on the phone sounded very upset.  She said I was referred to her by a person I would rather not name but it was a prominent political figure’s staff member.  I assumed now that this would not be easy because if it were, the other person would have handled it and not referred this person to me. 

The woman was calling about the care her mother was receiving in a local hospital.  I let her speak for about 10 minutes and when she took a breath, I said “you must be very angry over the care your mother is receiving.”  “Of course I am” she continued for another 5 minutes. 

Her elderly mother was alone in New York while the daughter on the phone was sick and also elderly in a state far away. I couldn’t blame her for the anger and frustration she must be feeling.  She explained that her mother has an infection and they refused giving her antibiotics.  She explained how much pain her mother is in and how she was not being cared for.  Over a period of three days of on-going phone calls which consisted of her telling me about her lack of finances her being black and nurses who don’t like “black people” her mother being alone and so far away, the long list of names of administrators, doctors and nurses she spoke to already and her mother’s dementia amongst other subjects, I finally had to ask “How can I help?”  She snapped back with “I don’t know, I was told to call you because this is what you do”.

I decided to go visit her mother.  I was well prepared for a serious concern of what I might find and my mind went in circles of how  I would handle it.  Upon entering her mother’s room, I noticed a small woman with her hair done in braids and a clean nightgown and clean bedding.  I checked her armband to be sure I had the correct person and asked her, her name.  The woman in the bed just stared at me.  I told her I was there to see how she was and her daughter was concerned.  She smiled.

The nurses aid came in and I introduced myself as a friend of her daughters and was just checking in.  I asked who does her hair in a braid so lovely on top of her head.  The nurses aid said they all take turns caring for her.  They seemed to genuinely like this patient.  The nurses aid, a black woman said she just ate. Yet there was no food on her face, her covers and she was clean. I asked about her infection and was told it is better.  I asked about antibiotics and was told she finished them.  The woman in the bed still wouldn’t talk so I scrubbed down a chair for myself and asked if I can sit with her.  She said “of course” with a smile.  We both laughed at the TV show she watched and at each commercial we talked a bit.  She said she was not in pain but didn’t know the plans for her future.

As a patient “safety” advocate my role is to be sure the patient isn’t in danger.  Of course I can’t guarantee the moment I left she wouldn’t be given the wrong medication or she wouldn’t try to get up and fall.  I did get to look for things like, was the nurse easily accessible and was the aid attentive.  Was the patient in clean sheets, well kept and was there antibacterial gel available and were the dispensers full. Did they wash before approaching the patient, were the floors clean and did they talk to the patient – and the patient next to her.  Most importantly, if this was my family member, would I be OK leaving her there.  If the answer is “yes” I can leave.  I left.

I called the daughter to report to her what I found.  I explained to the daughter that she is speaking so loud it’s hard to talk with her (she was yelling). 

Still the daughter was not happy with my report so we were able to move the conversation to the guilt she is feeling being so far away.

Friday, December 15, 2017

Medical Conferences

ANOTHER MEDICAL CONFERENCE
By Ilene Corina, Patient Safety Advocate
December 2017

Another medical conference on the topic of patient safety has just passed. There have been numerous conferences over the years, and I have attended many of them.  I usually leave inspired, excited and often overwhelmed by the upbeat and positive work being done in patient safety.

The usual program for such conferences has patient safety leaders talking about the wonderful work they are doing.  One or more patients, who may or may not be medical professionals, talk about the tragedy that brought them there that day. There will be presentations about the heartbreaking journeys of the family members of patients who died, patients who weren’t treated well, and many presentations offering insights for the healthcare professionals on how improvements can be made. Then there may be awards for the great work being done to save lives. 

While all this is happening, in a state far, far away, there is another side to this. A hospitalized patient is getting an incorrect diagnosis or the wrong medication, or is fighting a hospital-acquired infection. Have the healthcare professionals attending the conference remembered to tell their patient and those patients’ loved ones what they too should know about keeping safe?

I have said for years that patient safety should be seen as like wearing a seat belt. It is up to the driver (the medical team) to do the right thing, but if something goes wrong we (the patients) still should be wearing a seatbelt. Not because we are predicting something will go wrong, but because it might. Patients who know nothing about patient safety have no “seatbelt” are completely unprepared for the risks and unwanted outcomes.
These conferences need to be attended by representatives of business and industry — both management and rank-and-file employees — that is, the people who actually use the healthcare system. 

UPS has 434,000 employees
General Electric has more than 300,000 employees
Bank of America has 208,000 employees
Disney World has 62,000 employees
In 2006 a survey found that 14.5% of employees took Family Medical Leave in 2004. Of those, 35 percent took it more than once during the year. How many of these days off could have been avoided if there were fewer complications in healthcare?
Since between 200,000 and 400,000 people die each year from preventable medical errors, at a cost of as much as $19.5 billion[1], shouldn’t the corporate leaders of UPS, GE, Bank of America, Disney World and other major employers be sending their staff to patient safety conferences?
At what point does someone in healthcare say: “We’ve had enough training but it’s still not perfect. So now we must include patients, their families and their employers in this conversation.

Contact:  Ilene Corina (516) 579-4711 or icorina@pulsecenterforpatientsafety.org

Wednesday, December 6, 2017

Twenty Years of Choosing a Doctor

What a difference 20 years can make… well of course!

Twenty years ago I was speaking to the public at community meetings for older adults, civic organizations, religious communities and as I met people in the park, the train station and the malls.  I was asking them “what do you know about your doctor?” When they didn’t have an answer I would ask “what do you like about your doctor?”  I was asking this to people to introduce them to the need for physician profiles or a place to look up information about their doctor.  Not because they would be judging their doctor but so they can have some knowledge about this person they are hiring to make life or death decisions with them - or for them or for the person they love.

So, what has changed?  Twenty years later I still start my presentation about patient safety or patient centered care in the similar way and also ask the question: “who here likes their doctor?”  When the hands go up, I ask “Why?”  Twenty years ago people responded that the doctor was nice, had good office hours, took their insurance or they have been going to them for years.

The last few years I’ve noticed a shift.  Now I hear comments like; He explains things to me, I understand what he/she is saying and he/she spends time with me or he calls me back.  Even when in a high school, youth are interested in a doctor who talks to them and not their parent and when a doctor knows their name.


People are looking up information on their physician and using that as a guide to who they may use.  With so many specialists now it’s hard to know which clinician will be in charge of your care.  It looks like people are getting more sophisticated in deciding what they want and expect from their clinician.  So what is the point of asking if someone likes their doctor?  Because when I ask who doesn’t like their doctor and the hands go up, I remind them that the referrals are right there in the room.

Sunday, December 3, 2017

Holiday Visit in the Hospital

Hospital Visit During the Holidays


It’s holiday time so what is the best thing you can bring to someone if you visit them in the hospital?  Candy canes!  Not for the patient, but for the nurses, nurse’s aides and doctors who care for them.  Don’t bring them to the nurse’s station so they can get mixed in with all the other candy, cookies and gifts and no one knows who it came from, leave it in the patient’s room.  This way, staff will be coming in to check on the patient, and grab a candy cane.

I have been suggesting this for years.  Those who have taken my patient advocacy training know this.  As a patient advocate we need to be sure we are building bridges for the patient and staff.  Recently I asked a doctor to wash his hands and when he suggested he already did (I did not see him do it) I offered him a Twizzler if he did.  He took the wrapped candy and washed.  It broke the tension and I got what I need for the patient. 

Chocolates are also popular when nurses come in to read the box cover to see what they will get, they spend extra time with the patient at their bedside and it makes for more pleasant small talk.  Many years ago, I left a bouquet of lollipops at the patient’s bedside and when I returned all the nurses were walking around with lollipops in their mouth.

An assortment is always best.  Chocolate and Twizzlers or lollipops.  Don’t forget to offer it to the patient in the next bed or their guests because there may be a parade of staff coming in and talking about the new treat.      If someone is diabetic, don’t pursue it.

Usually staff will be hesitant from taking the “patient’s candy” but insist it’s for them.  Encourage them to take one and tell the others it's there.  They will be back.  I guarantee it!  See what else Pulse Center for Patient Safety Education & Advocacy  recommends bringing to the hospital: The Patient Assistant / Advocate Guide      

Saturday, October 21, 2017

Addiction and Dependency Could Stop-Get Involved Before the Prescription is Written

The Opioid Epidemic Can Stop Before the Medication Reaches the Patient

Yesterday I went to a program on Long Island hosted by the Long Island Association about the opioid crisis on Long Island.  While there are symposiums that address how to stop the problems of overdoses and drug addiction with education at the schools and in the community, there was nothing said about the public learning the dangers of pain medication the moment a pain medication prescription is written.

The I-STOP program which monitors prescription drugs and arresting clinicians who are over-prescribing doesn't help the person or the family of the person who died.  Punishing for what can be honest mistakes may deter the next clinician from writing a prescription, what about those people who need the medication - it doesn't help the person who has overdosed or is already addicted.

Medication errors, over-prescribing, addiction or dependency can be best avoided if the patient is informed to have someone with them following a medical procedure, surgery or injury before they are given the prescription. 

The warning is not offered at the hospital discharge or before.  Warnings to have a support person are not given when the prescription is given or picked up at the pharmacy.  Written material does no good if a person cant read, doesn't understand the information or the warnings.  As patient advocate is becoming a common term, such as bring an advocate with you to the doctor or hospital, we need to give them the tools of what are they there for.  Monitoring a friend or family members medication is a way to help avoid improper use of medication.

The father of a son who died from an overdoes shared the heartbreaking story of his son's addiction after a phyocal injury. Why aren't we talking about the reason so many people become addicted "after the injury".  Maybe because family gets involved only after the addiction or dependency has already started. www.pulsecenterforpatientsafety.org