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 

Sunday, October 1, 2017

Medication Safety, Addiction and Dependency
By Ilene Corina, Patient Safety Advocate,
Pulse Center for Patient Safety Education & Advocacy
September 2017

Community education, including high school programs and health classes on medication safety should include other patient safety information such as:
·         -The importance of the patient/ clinician relationship,
·         -Preparing for a doctor’s visit,
·         -Hospital discharge planning, and
·         -Communicating with a clinician for the best possible outcome.

Case Study
On September 19, 2017, a 60-year-old woman was hospitalized for a one-day surgery. After the procedure, she told nursing staff that she did not have uncontrolled pain and was OK with minimal pain medication.

I interviewed her following her hospital stay, after she went home with her husband.  Her husband did not have any training as an advocate and did not know what he was to look out for. When the patient was released, she was told her pain medication was at the pharmacy.  She was given very little instruction.

Below are some questions and her responses:

Q. What pain medication were you prescribed?
A. I was told it would be Percocet but when I got the prescription it was for oxycodone/Acetominephin. Nobody told me that that is the same thing until I asked. Percocet is the brand name.

Q. Were you given your prescription and instruction about its use while you were in the hospital?
A. They called it into the pharmacy and a family member had to pick it up. Very little instruction was provided in the hospital.

Q. How many pills were you prescribed?
A. Thirty pills each from two different doctors with seemingly no coordination between them.

Q. Did the physician or pharmacist talk to you about safe use of this medication?
A. No.

Q. Were you or your family member told about any possible side effects or dangers of the long term use of pain medication?
A. No. 

Q. Do you think if you requested another prescription for pain medication your doctor would give you more?
A. Yes

Q. Anything else you want to add?
A. The biggest issue I had was the lack of coordination between doctors within the same hospital facility. They almost appeared to be pushing the pain meds on me, even though I told the nurse I didn't think I would need them, didn't want them and could probably get away with just Tylenol or ibuprofen. The response was, “Better to have the pain meds and not need them than to need them and not have them”. The prescriptions just showed up at my pharmacy and were filled automatically even though I didn't request them.

I got two prescriptions for the same meds. The labels were really confusing and didn’t tell me how much to take and when.

Here's what one label says: “1 tablet orally every 4 hours as needed for moderate pain - for severe pain MDD: 4 tabs.”

The other label says: “1 tab orally every 4 hours as needed for moderate pain.             ”MDD:6

Both medications are exactly the same thing, why are the labels different and what does that first label mean? Do I take 4 tablets if I have higher pain?

I don't remember seeing either of the doctors who prescribed these medicines so wouldn't even know who to call. It was just "the hospital."

With two bottles of the exact same medication, were the patient to follow directions, she would be taking double the dose of pain medication. When a patient is prescribed a medication under one name and then given another, such as what happened here, the patient should be told this to avoid the patient taking both medications.

News and editorials repeatedly report that there is an “epidemic” of medication dependency, misuse, abuse and overdoses. 

According to AARP [1]
Opioid Addiction and Adults
      Almost one-third of all Medicare patients — nearly 12 million people — were prescribed opioid painkillers by their physicians in 2015.
     That same year, 2.7 million Americans over age 50 abused painkillers, meaning they took them for reasons or in amounts beyond what their doctors prescribed.
     The hospitalization rate due to opioid abuse has quintupled for those 65 and older in the past two decades
      Nearly 14,000 people age 45-plus died from an opioid overdose in 2015 — 42 percent of all such deaths in the U.S., according to the Centers for Disease Control and Prevention (CDC).
There is no real way to determine how many older adults overdose. When an older person does not wake up it is usually attributed to natural causes even when the cause was accidental overdose of opioids [2]

Medication errors, misuse and abuse are not only about older Americans.

A study in 2014 found that male teens who played sports were more likely to abuse opioid medication, compared to their peers who didn’t participate in sports. 
  
Teenagers who abuse opioid drugs, in most cases began when they received the medication from their doctor. Studies show that teens start taking drugs for medical reasons and then continue when they are no longer needed.[3]

The Bergen County, New Jersey Prosecutor’s Office found that the “vast majority” of heroin buyers caught in a 2015 sweep began abusing heroin after misusing pain relievers that were overprescribed for a medical or sports-related injury.[4]

Between 67 percent and 92 percent of patients reported that, after a surgical procedure, they had unused opioids left over from the prescription.[5]

The 2013 and 2014 National Survey on Drug Use and Health (NSDUH) found that 50.5 percent of people who misused prescription painkillers got them from a friend or relative for free. [6]

Conclusion
The public - patients and their family members - have the most at stake when it comes to patient safety: they face challenges regarding diagnosis, infection prevention, communication, health literacy, and medication management. Yet, too often, patient safety groups are left out of the educational process of informing other members of the public about patient safety initiatives and programs.  It is imperative that the general public becomes informed about patient safety which includes medication safety.

As the stories and statistics in the newspaper confirm, medication errors can start when the prescription is written, leading to addiction and dependency or worse. 

Communities need to have educational programs about “safe” medication use and encourage all people who receive prescription medication to have someone they trust to help with medications. A designated person, assigned by the patient, can help ask these important questions:

·         -How addictive is the medication?
·        - What are other options?
·         -Is the dosage prescribed the minimal need?
·         -How long does the physician want the individual  drug
·         -When and how does the physician plan to wean the patient off the pain medication?
·         -What is the plan if the pain persists after the pre-determined period?
·         -What are some signs that the patient may be getting dependent on medication?
·         -What should be done to help with any withdrawal symptoms?

To learn more contact Pulse Center for Patient Safety Education & Advocacy                                                           
Ilene Corina
Phone: (516) 579-4711
Fax: (516) 520-8105
E-mail: icorina@pulsecenterforpatientsafety.org



[2] http://www.aarp.org/health/conditions-treatments/info-2015/opioid-pain-medication-overdose.html
[4] https://www.healthline.com/health-news/teen-athletes-becoming-hooked-on-rescription-painkillers
[5] https://www.livescience.com/60012-leftover-opioids-after-surgery.html
[6] https://www.livescience.com/53856-opioid-facts.html

Thursday, August 24, 2017

System Errors or Human Errors

When Errors Happen is it The System?

When I am hired by a hospital or medical facility to speak to the staff about patient safety, my first thought is that this is a facility that cares about safety and patients.  Since my work is primarily about patients and their safety, it must mean they are serious.  Why else would I be there?

Still, there is never a guarantee.  I spoke a few years ago and a hospital.  Once for senior leadership and then for the “hands-on” patient staff.  A double presentation because they are “that serious” I thought to myself.  Unfortunately there is no guarantee no matter how hard they try, that patients will be safe.  I just read an article about that hospital and a patient who died because of the care he received.  Although there may be many others, this one made the news.  I truly believed that this hospital, in another state, was serious about patient safety and though I believe the people I was involved with there were serious, there are so many opportunities for errors to happen.

Most people in healthcare call the errors or unplanned deaths “system errors” not enough staff, distraction by a nurse or pharmacist or any number of reasons a mistake can happen.  In this case, as in many cases, this hospital’s system, in my opinion was working.  Instead someone may have cut corners or not went to leadership about the problems that ultimately caused this patient’s death.

When a family members calls to talk about a bad outcome at a local hospital, I suggest they speak to the hospital leadership.  The people who are running the facility may not even know that an injury occurred or why.  They need to know where the system, or people are failing.  I also looked carefully at this article – without all the facts and saw where a trained family member may have been able to save this patient’s life.  A trained family member may have been in a position to speak up and alert someone that something doesn’t seem right.   They didn’t and the patient died.  If they did, how would that be measured?