Wednesday, February 18, 2015

The Talk on Joan Rivers Lawsuit

Joan Rivers and The Talk
I watched the show The Talk. It opened with the story of Joan Rivers death and a lawsuit her daughter Melissa is bringing against the doctors and facility where the procedure was performed that ultimately killed her.  

A host asked “If you were Melissa, would you be suing?” gives us the impression that everyone who has lost a family member sues.  They don’t and they often can’t.  Not every medical negligence case gets the media attention that Joan Rivers received helping to move it along.  

Sharon Osbourne tells the cheering audience that to make sure this never happens again she would not rest until they all lost their license and she had a “whole chunk of money”. 

Unfortunately,  Ms. Osbourne is leading people to believe that a big chunk of money is what will improve medical care in this country.  It won’t.  When the lawsuit is done and everyone is paid (and attorneys have every right to be paid for their services) what will the change be?  These doctors can go get a license in another state and though this exact behavior may not be the problem, these behaviors can happen again. 

Saturday, January 31, 2015

Making Meatloaf

Can You Really Repeat Back Everything?

During a recent classroom of nurses I was instructing, one of them asked if she is the patient's advocate shouldn't she be able to explain to the patient what the doctor said if the patient doesn't understand?

I gave her the "Meatloaf" lesson I have been working with for years.   "Who here has a wonderful meatloaf recipe" I asked the group.  One hand shot up, so I then asked who wants to go with me for dinner and have meatloaf?  Another hand went up.

I set the stage that the two of us were going to dinner to have meatloaf at Jayne's house and it was so wonderful, I asked Jayne to share the recipe with us.  I would love to make that meatloaf!  Jayne gave us the recipe.  "I use some pork and beef and an egg some seasoning and mix it all together and bake it".

I then asked the other nurses if they can repeat it.  She, nor the rest of the class could get the recipe exactly as it was shared, nor could they remember everything that was said.

So the answer is "no".  If the patient or their helping family member doesn't understand the treating clinicians instructions, diagnosis or information, the advocate is responsible for having the clinician explain it again until the patient understands it.  Too much information can be lost in the explanation.

The teach back method also is important for the same reason.  If the person receiving the meatloaf recipe writes it down, or repeats back what she heard, Jayne can verify that she has the information correct.  If Jayne just asked if we understood, it's too easy to just say "yes" and when we get home, we forgot what the actual recipe is.

Medical errors happen too often because of miscommunication.  An important part of patient safety is understanding each other.  Patients should never feel embarrassed or intimidated when  not understanding what is said, its also hard to remember a meatloaf recipe.

Wednesday, December 24, 2014

Reports Give False Hope

Don't Let Reports Fool You

Don’t let reports of hospitals doing poorly cause you false hope that you are automatically safe if you use another hospital. Newsday December 23, 2014 
We know that as well as bad things happening in hospitals, lives are saved each and every minute of each day.  But, I don’t want to take away from even one life being cut short because of a medical error, hospital acquired infection or unplanned outcome.  Reports that a hospital has lower ratings than another gives reason for leadership to pat themselves on the back – but even in the “best” hospitals people have bedsores, die from infections and can be given the wrong medication.  Even if they don’t make the news.  To let our guard down even for a second is a cause for concern.  
Never had a car accident?  So should you stop wearing your seat belt?  Cancel your insurance?  No.  We must use these reports only as an opportunity to continue the conversation, recognize we aren’t where we need to be yet and continue the education and advocacy that was started long ago.  This report is screaming that PULSE of NY is important and patient safety groups need to step it up a notch and work closer where the problem is – in the hospitals and at the bedside.

Saturday, November 29, 2014

Understanding HIPAA

HIPAA, So Misunderstood

HIPAA does not mean your clinician cannot share information with your family.  HIPAA does not mean that a doctor cannot share your information with another clinician.  Many of us, as well as the people who work in healthcare do not understand HIPAA.

Health Insurance Portability and Accountability Act of 1996 (HIPAA), provides protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of health information needed for patient care and other important purposes

If I do not object, can my health care provider share or discuss my health information with my family, friends, or others involved in my care or payment for my care?


Yes.  As long as you do not object, your health care provider is allowed to share or discuss your health information with your family, friends, or others involved in your care or payment for your care.  Your provider may ask your permission, may tell you he or she plans to discuss the information and give you an opportunity to object, or may decide, using his or her professional judgment, that you do not object.  In any of these cases, your health care provider may discuss only the information that the person involved needs to know about your care or payment for your care.  

Here are some examples:

·         An emergency room doctor may discuss your treatment in front of your friend when you ask that your friend come into the treatment room.
·         Your hospital may discuss your bill with your daughter who is with you at the hospital and has questions about the charges.
·         Your doctor may talk to your sister who is driving you home from the hospital about your keeping your foot raised during the ride home.
·         Your doctor may discuss the drugs you need to take with your health aide who has come with you to your appointment.
·         Your nurse may tell you that she is going to tell your brother how you are doing, and then she may discuss your health status with your brother if you did not say that she should not.

·         Your nurse may not discuss your condition with your brother if you tell her not to.
You may want information kept private - but it isn't always about HIPAA.  Privacy and ethical behavior can’t be disputed, HIPAA can.
Before your next medical appointment, read about HIPAA here:

Tuesday, November 18, 2014

Patient Safety Education; You Need PULSE of NY

Why You Need PULSE of NY

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