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

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[1] https://www.ncbi.nlm.nih.gov/pubmed/23155743

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.

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      

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 

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

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[1] http://www.aarp.org/health/drugs-supplements/info-2017/opioid-drug-addiction-pain-pills.html

[2] http://www.aarp.org/health/conditions-treatments/info-2015/opioid-pain-medication-overdose.html

[3] https://www.cbsnews.com/news/teenage-opioid-addiction-begins-doctors-office/

[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

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?

Sign up for Family Centered PatientAdvocacy Training at Hofstra University, Hempstead, Long Island.  Register Her:  http://www.pulsecenterforpatientsafety.org/family-centered-patient-advocacy.html 

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.

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.

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.

On His Birthday

Help Me Celebrate His 30 Year Memory and Birthday

This July, my son Michael Louis Corina would have been 30 years old.  A milestone to many people and their families.  Michael (Mikey) died just before my 30^th birthday. I thought I would never celebrate another birthday.  Birthdays became unimportant and even painful. 

Although I never worked at making a day, date or event named after him, he has always been behind almost everything I do.  Patient safety was never about the one boy who died, it’s been about the many children who have died from preventable medical errors and all the families broken because of a medical system that does not include patients (even though

they say it does).

I was not involved in the study that medical errors are the third leading cause of death in the United States.  My work started long before that study was released when I saw this problem was not being addressed. 

Help us continue raising awareness in his memory.

Please consider this year helping make the number 30 meaningful with a donation of $30 (or any amount) which would mean you have thought of my son on his birthday this month.  A recurring donation of $30 will mean you remembered him for a year and will help us at Pulse Center for Patient Safety Education & Advocacy continue our important, lifesaving work.

Its as easy as going to our donation page to make your tax deductible donation!  

Donate Here 

And please visit www.pulsecenterforpatientsafety.org to see what we are doing!

Thank you and feel free to pass it on.