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?


Saturday, August 19, 2017

Listening Skills Learned


Is the Country's State a Practice in Listening?

As a patient advocate, it is my job to be objective and nonjudgmental.  I listen to the patient and their family and listen to the doctor or nurse explain to the family  whatever it is they need to explain.  It is not up to me to make decisions for the family.  It is not up to me to agree or disagree with the care plan.  It is up to me to be sure that information is given in a way that the patient and family understand and that if they don't, they can ask questions.

In my work, I often listen to patients who have special and unique needs to learn what their obstacles are for safe, quality medical care.  People with severe illnesses, families of people with dementia / Alzheimer's, young single mothers to name a few.  I learn from them what it's like to be them, though I don’t pretend to always understand it.   I also get to spend time at the bedside with families and to be with them during this often, difficult time of pain, sorrow and vulnerability.  Advocates who take our training learn the importance of these
skills.

So, what’s my point?  I also listen to conservative radio and liberal news, speak to people who have opposite views from my own and want to learn what makes them think the way they do.  I want to hear what makes people so different in their thoughts and ideas. There is a lot to learn about different viewpoints.   People are angry and frustrated with the way things are in today’s political setting.   

What is concerning is when people use words with no appropriate relationship to what they really mean.  Name calling, making fun of someone’s appearance, or using words not related to the problems being addressed.


As soon as people use, as part of their dislike for someone the way they look, walk, dress, their facial expression or hairstyle it takes away from the important facts that we need to concentrate on.  How boring this world would be if we all agreed.  For those of you who want to moderate, mediate and / or advocate for others, there is plenty of practice opportunities in today's daily conversation.

Friday, July 28, 2017

Helping at the Hospital

When a Patient Needs Support

The surgery went well.  There was no infection.  The medication was correct and the patient didn’t fall.  So why was this 24-hour hospital stay so awful that the patient talked about it for almost an hour as one of the worst experiences this patient ever had?

The humane and respectful behaviors we all expect from those caring for us were missing.  A cup of coffee when the patient requested it, the phone and remote within reach, retrieve a  fallen pillow on the floor, some crackers, a response to the call bell are just some of the things that can make a patients experience better in the hospital.  We all recognize that hospital staff are often overworked or short staffed yet a friendly response to a patients request can mean the world.

Families often need to work or go to school and can’t sit by the patient’s bedside.  But having someone available to meet these needs can really change the patient’s perspective of how their care was. And yes, it can mean a better outcome.  If the patient got out of bed to reach what fell on the floor and fell, that could cause serious injury and a substantial cost to the hospital and patient’s insurance.  Eating inappropriate food brought in by loved ones because the patient didn’t  have anything else to eat, might cause a problem with healing causing a longer hospital stay.


So, even though a patient may be sharing that there was the lack of comfort care, there are some concerns of patient safety that can be addressed.  If you know someone going to the hospital,  even if you have no patient safety training, consider bringing a book and sitting in the waiting room and check on the patient every 15 minutes.  You won’t be a burden and you can be sure the patient is getting what they need.

Wednesday, July 19, 2017

Let the Little Boy Cry

You Don't Know What I'm Thinking

A little boy about 10 years old fell off his bike and ran to the grownups to be patched up.  His mother and the other adults told him “don’t worry, you will be fine” without ever asking him what’s on his mind.

The next day his bandages had blood on them and it seemed his cuts may have opened up.  He brought his concerns about a bloody bandage to the grownups.  Again he was told don’t worry and this time was told no one ever died from blood on the bandage.  This was a second time the grownups decided he could not speak about his concerns.  Did they or he, even know what they were?

A wet, bloody bandage should not be OK on a hospitalized patient.  It should not be OK on a boy riding his bike.   Blood seeping through a bandage should be questioned.  Telling a child he /she won’t die because they have a cut or worse, is not addressing what they are concerned about.  Are we raising children to not question the care they receive because when they want to cry, they are told things like “you won’t die from that”?

Play this same scene out when a 60 year old woman has indigestion that seems ”weird” and the doctor says no one ever died from indigestion so she stops in her tracks from questioning the care she received. An adult questions that maybe she is getting the wrong medication - and a nurse says “stop worrying so much”.

When people are frustrated, scared or inconvenienced by sickness or an injury, healthcare providers as well as friends or family members often respond to what they, themselves think the patient / person is feeling or in ways that make themselves feel better.  They respond with what makes them comfortable in the conversation. 


In our Family Centered Patient Advocacy training tools we use a scenario of a woman screaming in the bed at a hospital that she wants to go home.  Nurses are too busy to release her, the doctor isn’t available and she has everyone on her floor angry at her.  When I asked her why she wants to go home she explained her child will be getting off the bus and she needs to be there.  One phone call to be sure her daughter was met at the bus stop and the patient was fine. No one asked why she was so desperate to leave.  They assumed she just didn’t want to be there.

Not asking what is troubling someone such as tell me why are you upset and crying, what are you concerned about or how can I help make you feel better, is closing the conversation to learning and even more important - building relationships.