Training May 2, 2011
Our Latest training, Family Centered Patient Advocacy was another success. I measure success by how much I learn too. By sharing experiences with the people who come to this program, we can all learn. It is important to recognize that as a fairly new idea, we must be open to listening.
The feedback was all positive, the participants improved on the post-test and the interaction was lively. The audience, mostly community and non-medical people did have a sprinkling of 2 or 3 nurses who shared their ideas which at times were not always what I would support. But, that’s part of the learning process.
I suggest an “advocate” call themselves a family friend, this way there isn’t another professional in the room. This has come with experience that when I have called myself the patient’s advocate the doctor in the room or a nurse caring for the patient may seem annoyed that now there is just another professional in the room they may have to answer to. Family and friends have become acceptable participants and even encouraged to be with the patient. Some medical staff find an advocate to be an unwelcome third party.
But, times could be changing. Some people in that classroom were going to call themselves the patient’s advocate. That may mean the adult daughter of the patient or a friend of the patient. It can also mean they may want to start a business and use a professional name. For whatever reason, I would be happy to know that given my experience people have heard my suggestions but are bold and independent enough to choose what is best for them.
After another training a participant told me he decided to not ask the doctor to wash his hands before touching the patient who was visiting the doctor for a well visit. When I asked why, he said he needed to choose where he was going to take the conversation and he didn’t want that challenge. I completely understood.
When we hold trainings about patient safety, we are giving the tools as we know it from training, reading and participating with others with the same interest. As an advocate I learn new things constantly. I watch for the doctor to wash his hands or use antibacterial lotion. I take notes and am respectful to the patient. Each time there may be an incident that will be different than another time. There isn’t usually a right or wrong way to do something. It is just having the knowledge and information to feel empowered to use it if needed.
Monday, May 9, 2011
Sunday, May 8, 2011
The Problem With Patient's Safety
Patient's Safety 2011
The biggest problem with patient’s safety, as I see it, is that the public, when describing their care as “wonderful” are usually talking about the nice medical professionals. Nurses who are warm and nurturing, the respiratory therapist who talked about his vacation with the patient or the doctor who loved to hear about the patient’s family may be nice people but may very well not be practicing safe care.
Once in a while I will hear someone say “everyone washed their hands” or “everyone asked me my name and birthday” but that seems to be more rare than regular. We are still talking about hand washing and common patient safety tools like checking that it’s the right patient as if these errors are new. This is old stuff and we should be moving onto newer and more complicated things to save lives.
The biggest problem with patient’s safety, as I see it, is that the public, when describing their care as “wonderful” are usually talking about the nice medical professionals. Nurses who are warm and nurturing, the respiratory therapist who talked about his vacation with the patient or the doctor who loved to hear about the patient’s family may be nice people but may very well not be practicing safe care.
Once in a while I will hear someone say “everyone washed their hands” or “everyone asked me my name and birthday” but that seems to be more rare than regular. We are still talking about hand washing and common patient safety tools like checking that it’s the right patient as if these errors are new. This is old stuff and we should be moving onto newer and more complicated things to save lives.
Tuesday, April 26, 2011
Simulators
Visiting a Sim Lab
I was invited by an administrator of a large health system to visit their simulation lab. I get very excited with this sort of patient safety education because it is an opportunity for medical professionals to train in team work, cooperation, as well as policy, procedures and communication skills. After all, pilots don't fly the first time they are in a cock pit. They start off in simulators.
I just can’t imagine medical training on real people any more. No wonder there are so many errors and miscommunication is one of the biggest pieces.
I often ask a nurse who is caring for the patient I am with “How long have you worked here?” If she says one year or ten years I’m not sure if it matters. But, it helps to know if the nurse is fairly familiar with the surroundings.
We can start asking soon if they have been trained on simulators. That may actually make a difference.
I was invited by an administrator of a large health system to visit their simulation lab. I get very excited with this sort of patient safety education because it is an opportunity for medical professionals to train in team work, cooperation, as well as policy, procedures and communication skills. After all, pilots don't fly the first time they are in a cock pit. They start off in simulators.
I just can’t imagine medical training on real people any more. No wonder there are so many errors and miscommunication is one of the biggest pieces.
I often ask a nurse who is caring for the patient I am with “How long have you worked here?” If she says one year or ten years I’m not sure if it matters. But, it helps to know if the nurse is fairly familiar with the surroundings.
We can start asking soon if they have been trained on simulators. That may actually make a difference.
Tuesday, April 12, 2011
Quality of Care
Where is the Quality of Care Going?
I thought I have seen it all, but I can be wrong. I was called to this Long Island hospital by the adult son of an elderly woman. His mom, he told me was in her bed all day at the hospital, had bedsores and he was pretty confident she wasn’t eating because no one helped her eat. He had no other family and since he lived with his mom, he feels obligated to help her stay independent. He worked during the day, went there every night at dinner time to help her eat. He felt it was just short of abuse but he didn’t know what to do.
I showed up at 11:30 AM. She was clean and resting and it turns out the son hired someone to clean her in the morning. A young man came in with a lunch tray and put it on the table at least 2 feet out of her reach. I watched as a young woman went to the patient in the next bed, also an elderly woman, and moved the bedpan from the chair to the windowsill so she can sit down.
I sat for another hour and watched the nurse come in and change her IV bag, never looking at her wrist band (but I assume she would say she knows who she is) so I asked who that medication was for. At that point she looked at the name on the medication.
I came back at 4:30 and the tray of food was never touched. Her bedsores “large enough to put a fist in” were examined by a nurse who unwrapped and then rewrapped the wounds putting the same tape and bandages back on. I asked why she did that since she was struggling with the tape sticking to everything and she said she just measures the wounds – she doesn’t treat them.
I was there to try to find out who would speak to the son and help coordinate his mother’s care. The case manager said “you have to speak to the doctor”. The doctor is not available in the evening when the son can be there. It became a huge run around in a complete circle. This woman was not getting “care” she was existing - and the hospital was getting paid for this lack of care.
This morning, my first call was from a young woman. She was going to meet with her mother’s doctors at a hospital. The care she said is awful. She is in a dangerous place and she didn’t know what to do.
Yup, same thing.
I thought I have seen it all, but I can be wrong. I was called to this Long Island hospital by the adult son of an elderly woman. His mom, he told me was in her bed all day at the hospital, had bedsores and he was pretty confident she wasn’t eating because no one helped her eat. He had no other family and since he lived with his mom, he feels obligated to help her stay independent. He worked during the day, went there every night at dinner time to help her eat. He felt it was just short of abuse but he didn’t know what to do.
I showed up at 11:30 AM. She was clean and resting and it turns out the son hired someone to clean her in the morning. A young man came in with a lunch tray and put it on the table at least 2 feet out of her reach. I watched as a young woman went to the patient in the next bed, also an elderly woman, and moved the bedpan from the chair to the windowsill so she can sit down.
I sat for another hour and watched the nurse come in and change her IV bag, never looking at her wrist band (but I assume she would say she knows who she is) so I asked who that medication was for. At that point she looked at the name on the medication.
I came back at 4:30 and the tray of food was never touched. Her bedsores “large enough to put a fist in” were examined by a nurse who unwrapped and then rewrapped the wounds putting the same tape and bandages back on. I asked why she did that since she was struggling with the tape sticking to everything and she said she just measures the wounds – she doesn’t treat them.
I was there to try to find out who would speak to the son and help coordinate his mother’s care. The case manager said “you have to speak to the doctor”. The doctor is not available in the evening when the son can be there. It became a huge run around in a complete circle. This woman was not getting “care” she was existing - and the hospital was getting paid for this lack of care.
This morning, my first call was from a young woman. She was going to meet with her mother’s doctors at a hospital. The care she said is awful. She is in a dangerous place and she didn’t know what to do.
Yup, same thing.
Monday, April 11, 2011
Using Home Visits
Healing From The Heart
I returned the call late on a weekend evening to a person who is disabled. Her legs don’t work at all and her hands cause her difficulty. She was angry and seemed scared. She was in the emergency room the night before. She was having difficulty breathing and may have a pneumonia she told me. Her doctor wants her back to the hospital but she knows, that if she had the proper medication, she would be fine. “I have a nebulizer” she told me. “I just need a prescription for the medication”. I wondered what the doctor’s choices, if he really cared deeply for his patients could actually be.
It’s not my practice to make referrals but felt I could in this case. I suggested she may want to look at a Nurse Practitioner I know who makes house calls. I know many people who use his services. They all like him but I know him socially, not as a medical professional. He has a background of working with the disabled (his long-time companion is blind) and I have seen him interact lovingly with the elderly. He is someone who is in this job for all the right reasons.
He went to see her at her home and the message I got in the morning is that he was a “godsend”. Imagine if healthcare was always like this?This woman, about my age, runs a fairly large business. She is bright and charming and very, very well respected in the community she serves. She can articulate her needs, assertive but also gentle. She has lived in her body her entire life and knows her limitations. She did not want to go back to the hospital. In her wheelchair, though electric and responsible, becomes a bother. Why, she wondered can’t the doctor just call in a prescription?
I returned the call late on a weekend evening to a person who is disabled. Her legs don’t work at all and her hands cause her difficulty. She was angry and seemed scared. She was in the emergency room the night before. She was having difficulty breathing and may have a pneumonia she told me. Her doctor wants her back to the hospital but she knows, that if she had the proper medication, she would be fine. “I have a nebulizer” she told me. “I just need a prescription for the medication”. I wondered what the doctor’s choices, if he really cared deeply for his patients could actually be.
It’s not my practice to make referrals but felt I could in this case. I suggested she may want to look at a Nurse Practitioner I know who makes house calls. I know many people who use his services. They all like him but I know him socially, not as a medical professional. He has a background of working with the disabled (his long-time companion is blind) and I have seen him interact lovingly with the elderly. He is someone who is in this job for all the right reasons.
He went to see her at her home and the message I got in the morning is that he was a “godsend”. Imagine if healthcare was always like this?This woman, about my age, runs a fairly large business. She is bright and charming and very, very well respected in the community she serves. She can articulate her needs, assertive but also gentle. She has lived in her body her entire life and knows her limitations. She did not want to go back to the hospital. In her wheelchair, though electric and responsible, becomes a bother. Why, she wondered can’t the doctor just call in a prescription?
Saturday, April 9, 2011
The Wrongful Death Law
NY State and The Wrongful Death Law
Parents of children who die because of their medical care have, for years complained that they can’t find legal representation because of the “Wrongful death law”. The same is true for the adult children of senior citizens.
New York State strictly limits the types of damages recoverable in wrongful death cases, so careful attention is needed when proving recoverable losses. These recoverable damages can include pre-death conscious pain and suffering and economic or financial damages — these are not limited to actual financial loss. For example, a child’s loss of parental moral, intellectual, physical training and guidance has an economic value.(http://www.yournewyorkinjurylaw.com/wrongful-death/)
Many patients or family members have been turned away because there may not be enough money in the case (it may take more money to explore the case or pay for expert witnesses than could, or would be collected). These survivors are often left with no answers but until the statute of limitations runs out, hold on to a dream that some attorney would take their case and, at the very least, answer the question of “what happened?”
New York State's Estate Powers and Trust Law is considerably narrow in the damages which it allows for wrongful death claims. (http://www.smileylaw.com/Articles/Recovery-Under-NY-s-Wrongful-Death-Statute.shtml)
Attorneys will tell the family that they have a “good” case but because of the high cost, and very little financial gain from the death of a child or senior citizen, retired with very little income, housewife who does not work outside the home or single adult with no children, it is just not worth their time. So, for years there has been a grassroots interest in changing the “wrongful death law”.
But is there really such a thing? And if so, are there exceptions?
I just received a three page letter from a local law firm that shares some of the cases they were involved in resolving.
• $700,000.00 for a 64 year old woman for damage to a tendon when a steroid was administered and complicated by an infection.
• Settled on $550,000.00 - A sickly 69 year old man died when he was administered an improper cardiac catheterization.
• $1,100,000.00 for the undiagnosed lung cancer of a 79 year old man.
• $1,050,000.00 for the death of a single man with no children who died from undiagnosed melanoma.
• A 75 year old woman died during hip replacement surgery. This case settled for $550,000.00.
• For a 2 year old child who died from undiagnosed meningitis the case settled prior to prior to jury selection on $1,175,000.00.
In other states, parents have received compensation for their child’s death and have used that money to start foundations. They have moved their own agenda forward in memory of their family member even without a lawsuit or financial compensation. Families of those who have died because of their medical care have founded organizations, developed programs and have shared their stories graciously to help educate others.
A lawsuit is usually not about the money, it’s about answers but sometimes, families should be entitled to financial compensation with or without a lawsuit. But, I’m not sure I would be comfortable hiding behind the wrongful death law as a reason an attorney won’t take a case.
There are many facts behind these settlements we don't know. But, if attorneys are agreeing to take some cases, they need to do something for those cases they turn away.
Parents of children who die because of their medical care have, for years complained that they can’t find legal representation because of the “Wrongful death law”. The same is true for the adult children of senior citizens.
New York State strictly limits the types of damages recoverable in wrongful death cases, so careful attention is needed when proving recoverable losses. These recoverable damages can include pre-death conscious pain and suffering and economic or financial damages — these are not limited to actual financial loss. For example, a child’s loss of parental moral, intellectual, physical training and guidance has an economic value.(http://www.yournewyorkinjurylaw.com/wrongful-death/)
Many patients or family members have been turned away because there may not be enough money in the case (it may take more money to explore the case or pay for expert witnesses than could, or would be collected). These survivors are often left with no answers but until the statute of limitations runs out, hold on to a dream that some attorney would take their case and, at the very least, answer the question of “what happened?”
New York State's Estate Powers and Trust Law is considerably narrow in the damages which it allows for wrongful death claims. (http://www.smileylaw.com/Articles/Recovery-Under-NY-s-Wrongful-Death-Statute.shtml)
Attorneys will tell the family that they have a “good” case but because of the high cost, and very little financial gain from the death of a child or senior citizen, retired with very little income, housewife who does not work outside the home or single adult with no children, it is just not worth their time. So, for years there has been a grassroots interest in changing the “wrongful death law”.
But is there really such a thing? And if so, are there exceptions?
I just received a three page letter from a local law firm that shares some of the cases they were involved in resolving.
• $700,000.00 for a 64 year old woman for damage to a tendon when a steroid was administered and complicated by an infection.
• Settled on $550,000.00 - A sickly 69 year old man died when he was administered an improper cardiac catheterization.
• $1,100,000.00 for the undiagnosed lung cancer of a 79 year old man.
• $1,050,000.00 for the death of a single man with no children who died from undiagnosed melanoma.
• A 75 year old woman died during hip replacement surgery. This case settled for $550,000.00.
• For a 2 year old child who died from undiagnosed meningitis the case settled prior to prior to jury selection on $1,175,000.00.
In other states, parents have received compensation for their child’s death and have used that money to start foundations. They have moved their own agenda forward in memory of their family member even without a lawsuit or financial compensation. Families of those who have died because of their medical care have founded organizations, developed programs and have shared their stories graciously to help educate others.
A lawsuit is usually not about the money, it’s about answers but sometimes, families should be entitled to financial compensation with or without a lawsuit. But, I’m not sure I would be comfortable hiding behind the wrongful death law as a reason an attorney won’t take a case.
There are many facts behind these settlements we don't know. But, if attorneys are agreeing to take some cases, they need to do something for those cases they turn away.
Thursday, April 7, 2011
Health Affairs Symposium
Health Affairs Symposium Washington DC
The host of today’s program in Washington DC opened the symposium with an introduction about what the next four hours will bring. Leaders in patient safety research were to share their findings as it appears in the papers published by Health Affairs, A leading journal of health policy and research supporting the writings of various health issues and research.
This time it was patient safety and quality healthcare. In her opening remarks, the host said to the audience of, I suppose, writers, researchers and medical professionals “Imagine what the public would think if they knew what we know”. Those words would ring in my ears and set the stage for the rest of the program for me.
When I had an opportunity to speak, I told the audience that of course the patients need to be told. How else can patients make informed decisions when they don’t know the errors that might happen with their treatment? How can there be “informed consent” when the public is not told about ALL the possible outcomes and that means the possibility of mistakes?
The term noncompliant came up a few times. Patients who do not follow the doctors care plan are considered noncompliant. But maybe they are just not trusting because they know they aren’t being given all the information needed to make informed choices.
Speakers were from hospitals, research consulting firms, The Joint Commission and the National Patient Safety Foundation. Each did a research paper, which was published by Health Affairs on some aspect of patient safety or quality. Dr. Mark Chassin, President of the Joint Commission spoke about the recent work with high reliability organizations.
He also said that every week there are still as many as 40 wrong site / wrong patient surgeries – completely preventable by following procedures such as marking the site. This too is something patient’s must be made aware of – over 2,000 wrong procedures a year?
I asked a group of hospital administrators sitting on this panel, how do you know that what you are doing is getting to the bedside. At the top, there are policies and standards set, “I know in many cases they are not being followed at the bedside”. I told them about my many hours at the bedside with patients and simple patient safety policies are not followed. How are they, I asked them, involving patients because that is how to ensure procedures are being followed?
If you really want to see patient safety improve, I suggested that this program goes “on the road” and speak in every community. Share these statistics and numbers and see the groundswell of change come from the public.
The host of today’s program in Washington DC opened the symposium with an introduction about what the next four hours will bring. Leaders in patient safety research were to share their findings as it appears in the papers published by Health Affairs, A leading journal of health policy and research supporting the writings of various health issues and research.
This time it was patient safety and quality healthcare. In her opening remarks, the host said to the audience of, I suppose, writers, researchers and medical professionals “Imagine what the public would think if they knew what we know”. Those words would ring in my ears and set the stage for the rest of the program for me.
When I had an opportunity to speak, I told the audience that of course the patients need to be told. How else can patients make informed decisions when they don’t know the errors that might happen with their treatment? How can there be “informed consent” when the public is not told about ALL the possible outcomes and that means the possibility of mistakes?
The term noncompliant came up a few times. Patients who do not follow the doctors care plan are considered noncompliant. But maybe they are just not trusting because they know they aren’t being given all the information needed to make informed choices.
Speakers were from hospitals, research consulting firms, The Joint Commission and the National Patient Safety Foundation. Each did a research paper, which was published by Health Affairs on some aspect of patient safety or quality. Dr. Mark Chassin, President of the Joint Commission spoke about the recent work with high reliability organizations.
He also said that every week there are still as many as 40 wrong site / wrong patient surgeries – completely preventable by following procedures such as marking the site. This too is something patient’s must be made aware of – over 2,000 wrong procedures a year?
I asked a group of hospital administrators sitting on this panel, how do you know that what you are doing is getting to the bedside. At the top, there are policies and standards set, “I know in many cases they are not being followed at the bedside”. I told them about my many hours at the bedside with patients and simple patient safety policies are not followed. How are they, I asked them, involving patients because that is how to ensure procedures are being followed?
If you really want to see patient safety improve, I suggested that this program goes “on the road” and speak in every community. Share these statistics and numbers and see the groundswell of change come from the public.
Friday, March 25, 2011
Hospital Stay Infection History
The History of an Infection
I introduced myself to the nurse as a friend of the patient. I then humbly ask, would you mind washing your hands before you treat her. “I’m not treating her” she snaps at me. “I’m just getting her vitals”. The patient lies helplessly in her bed, bloodied through her bandages under the warm blankets and sheets from a large surgical site - that I am supposed to hope doesn’t get infected through prayers?
The nurse mumbles something about all she does all day is wash her hands and use gel but that’s not enough. I carefully wash, with disinfectant wipes, the door knobs that must be touched to open and close the doors. I wash the whole doors opening in case that was touched and then everything the nurse touches.
An hour later, the cleaning woman comes in and wearing green gloves, empties the garbage by the door and in the bathroom. I hear the spray bottle in the bathroom then the wet, dirty mop glides across the floor. She uses the same gloved hand to open the doorknob of the bathroom and turn on the water in the sink. The same gloved hand that emptied the garbage, handled the dirty mop and picked garbage off the floor. As she leaves, I follow with my own gloved hand now and grab a long string of sanitary wipes off her cart. I asked her permission and she gladly agrees.
On a trip to the cafeteria, in this small community hospital, I counted 4 hand sanitizers which were empty. One was broken.
On my third day, a little tired from sleeping on a chair, in sweat pants, a flannel shirt, no make up and hair messy, I visited the administrative office of infection control. I knocked and a man opened a door of a room no bigger than a large closet. I asked him if I can see his hospital infection rates. I had my friend and colleague in Florida do a search on-line of this hospitals infection rates and it came up fairly low. The infection rates were worse than the average in this state and throughout the country. I thought I would ask the administration if they would explain it or give me different numbers. “I can’t do that” he explained that it would have to go through his superiors. I told him that I looked at the public information and his hospital didn’t look very good. He agreed and was familiar with the websites I offered and shared another website with me to use. He cleaned off a chair of stacks of papers and asked me to sit down. I asked if I can share what I have seen.
He allowed me to share in detail some of what I saw and told me he is the whole infection control department. There is a large staff turnover so people who are trained to clean leave and train the next one who leaves and trains the next one. He has no middle management to oversee it. This hospital also filed for bankruptcy last year. I asked him if he was aware of the push back from nurses being asked to wash. "You give out literature in the admission packets that says we are supposed to ask" I explained to him. I asked if he knew that the country is encouraging patient participation. "I know" he said. I asked if he was aware of NPSF, IHI and The Joint Commission. "Yes, I know" he said with a shrug.
I found myself sympathizing with him as a human being, being honest and stuck in a dilemma. I can’t imagine that he wanted his department to be the cause of problems. But I can see, he was at a loss of what to do.
Reporting him to senior management would probably cause him to either lose his job or cause him more grief. I can’t imagine a hospital in this condition could suddenly come up with money to pay more staff, fix the broken hand sanitizers or train the people appropriately. My guess is that his superiors know the problems but are not addressing them or, are too disconnected from the front line staff to have any clue. Either way, I can’t imagine that they want to make changes – or they would.
What this hospital needs is a camera crew to come in and show the public what they are getting into when they enter this hospital. I would not want to see this hospital, or any hospital close. I want to see them improve care. That’s all anyone wants.
After my own 3 day stay in the hospital, I can see firsthand where hospitals are still failing us. We are vulnerable when sick but the senior staff in hospitals will not make themselves as vulnerable as I was when hospitalized. Or, any patient is. They will go in to their hospital with the words Director of Quality, CEO or Nursing Director taped to their forehead. They will be treated differently than someone like myself who went in as a “regular” patient, unprepared as to what I found during my own hospitalization or the patient / friend who entrusted me to keep her safe during her one week stay.
There is a disconnect between the administration who makes the decisions and the people who work at the bedside. The problems need to be addressed. I don’t have all the answers but I do have some.
I left the infection control office and headed back to my friends room frustrated that nothing there will change. As I passed the room next door to her it was closed off to visitors. That patient was infected.
I introduced myself to the nurse as a friend of the patient. I then humbly ask, would you mind washing your hands before you treat her. “I’m not treating her” she snaps at me. “I’m just getting her vitals”. The patient lies helplessly in her bed, bloodied through her bandages under the warm blankets and sheets from a large surgical site - that I am supposed to hope doesn’t get infected through prayers?
The nurse mumbles something about all she does all day is wash her hands and use gel but that’s not enough. I carefully wash, with disinfectant wipes, the door knobs that must be touched to open and close the doors. I wash the whole doors opening in case that was touched and then everything the nurse touches.
An hour later, the cleaning woman comes in and wearing green gloves, empties the garbage by the door and in the bathroom. I hear the spray bottle in the bathroom then the wet, dirty mop glides across the floor. She uses the same gloved hand to open the doorknob of the bathroom and turn on the water in the sink. The same gloved hand that emptied the garbage, handled the dirty mop and picked garbage off the floor. As she leaves, I follow with my own gloved hand now and grab a long string of sanitary wipes off her cart. I asked her permission and she gladly agrees.
 |
| Bloody Container was like this for days |
This is my 2nd day (30th hour) at this hospital that I witnessed this “cleaning” of my patient’s room and the second trip to this hospital in 2 years where the same behavior took place. I had to ask the cleaning woman to wipe the blood off the sharp’s container, not because I was afraid for the germs associated with it to infect anyone but because the site of it was unsettling. She did on the second day.
On a trip to the cafeteria, in this small community hospital, I counted 4 hand sanitizers which were empty. One was broken.
On my third day, a little tired from sleeping on a chair, in sweat pants, a flannel shirt, no make up and hair messy, I visited the administrative office of infection control. I knocked and a man opened a door of a room no bigger than a large closet. I asked him if I can see his hospital infection rates. I had my friend and colleague in Florida do a search on-line of this hospitals infection rates and it came up fairly low. The infection rates were worse than the average in this state and throughout the country. I thought I would ask the administration if they would explain it or give me different numbers. “I can’t do that” he explained that it would have to go through his superiors. I told him that I looked at the public information and his hospital didn’t look very good. He agreed and was familiar with the websites I offered and shared another website with me to use. He cleaned off a chair of stacks of papers and asked me to sit down. I asked if I can share what I have seen.
He allowed me to share in detail some of what I saw and told me he is the whole infection control department. There is a large staff turnover so people who are trained to clean leave and train the next one who leaves and trains the next one. He has no middle management to oversee it. This hospital also filed for bankruptcy last year. I asked him if he was aware of the push back from nurses being asked to wash. "You give out literature in the admission packets that says we are supposed to ask" I explained to him. I asked if he knew that the country is encouraging patient participation. "I know" he said. I asked if he was aware of NPSF, IHI and The Joint Commission. "Yes, I know" he said with a shrug.
I found myself sympathizing with him as a human being, being honest and stuck in a dilemma. I can’t imagine that he wanted his department to be the cause of problems. But I can see, he was at a loss of what to do.
Reporting him to senior management would probably cause him to either lose his job or cause him more grief. I can’t imagine a hospital in this condition could suddenly come up with money to pay more staff, fix the broken hand sanitizers or train the people appropriately. My guess is that his superiors know the problems but are not addressing them or, are too disconnected from the front line staff to have any clue. Either way, I can’t imagine that they want to make changes – or they would.
What this hospital needs is a camera crew to come in and show the public what they are getting into when they enter this hospital. I would not want to see this hospital, or any hospital close. I want to see them improve care. That’s all anyone wants.
After my own 3 day stay in the hospital, I can see firsthand where hospitals are still failing us. We are vulnerable when sick but the senior staff in hospitals will not make themselves as vulnerable as I was when hospitalized. Or, any patient is. They will go in to their hospital with the words Director of Quality, CEO or Nursing Director taped to their forehead. They will be treated differently than someone like myself who went in as a “regular” patient, unprepared as to what I found during my own hospitalization or the patient / friend who entrusted me to keep her safe during her one week stay.
There is a disconnect between the administration who makes the decisions and the people who work at the bedside. The problems need to be addressed. I don’t have all the answers but I do have some.
I left the infection control office and headed back to my friends room frustrated that nothing there will change. As I passed the room next door to her it was closed off to visitors. That patient was infected.
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| One of 4 empty sanitizers I found just from a room to the cafeteria |
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| A broken hand sanitizer |
Thursday, March 10, 2011
Who is Don Berwick?
The Don!
The Institute for Healthcare Improvement has brought patient safety and quality care to the fingertips of the medical professionals. Dr. Don Berwick knows about patient’s safety. Dr. Berwick shares his personal stories about unreliability and “terrifying” healthcare at conferences. You can watch him share his story here. Don Berwick - What Patient Centred Care Really Means.
How do patient “activists” learn about patient safety? It’s the people like Dr. Berwick, who set the bar high, that help people like myself understand the complexity of medical care. Dr. Berwick is a well -respected leader in the patient safety community whether it’s the patient’s turned patient safety experts or the hospital administration, Dr. Berwick is the national champion.
So, you can only imagine the groundswell of excitement when Don Berwick was chosen to lead our country Centers for Medicare & Medicaid Services (CMS) Someone who is a brilliant leader in healthcare and a supporter of patient safety was going to help run the country.
But now, there is a strong Washington force out Dr. Berwick. Patient safety advocates are gathering their momentum and starting letter writing campaigns to help keep Dr. Berwick in his post. Imagine, losing something that was so good, so fast?
Most people don’t know the name. Even people who work in healthcare don’t know who Don Berwick is. But if you mention the 100K Lives Campaignand now the 5 Million Lives Campaign, their ears will perk up. Dr. Don Berwick was the brainchild behind the 100K Campaign and the President of the organization that ran it.
The Institute for Healthcare Improvement has brought patient safety and quality care to the fingertips of the medical professionals. Dr. Don Berwick knows about patient’s safety. Dr. Berwick shares his personal stories about unreliability and “terrifying” healthcare at conferences. You can watch him share his story here. Don Berwick - What Patient Centred Care Really Means.
How do patient “activists” learn about patient safety? It’s the people like Dr. Berwick, who set the bar high, that help people like myself understand the complexity of medical care. Dr. Berwick is a well -respected leader in the patient safety community whether it’s the patient’s turned patient safety experts or the hospital administration, Dr. Berwick is the national champion.
So, you can only imagine the groundswell of excitement when Don Berwick was chosen to lead our country Centers for Medicare & Medicaid Services (CMS) Someone who is a brilliant leader in healthcare and a supporter of patient safety was going to help run the country.
But now, there is a strong Washington force out Dr. Berwick. Patient safety advocates are gathering their momentum and starting letter writing campaigns to help keep Dr. Berwick in his post. Imagine, losing something that was so good, so fast?
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| Dr. Don Berwick |
I wonder if this doesn’t work, and Dr. Berwick, just as qualified as the next person to fill this position doesn’t make it, will we have the real proof in hand that our government is corrupt? How could they possibly justify putting someone else in?
Saturday, March 5, 2011
Sick From Across the Miles
When an Emergency Strikes from Far Away
The most important thing to take with you to the hospital is a friend who at least can act as your advocate. A friend who sits in a corner and doesn’t write notes, plan with you what questions need to be asked or doesn’t make sure hospital policies are followed, is not much help. That’s why training someone to be your advocate is so important.
I have been an advocate for many people. I have sat at the bedside day and night through many different surgeries and procedures. Usually, there is nothing unusual that happens. But recently, when a friend went to California for surgery, I couldn’t go and another friend went. She was trained as an advocate and I had no doubt she would do everything that needed to be done.
But, following surgery and a week after recuperating, with just days before returning home, the advocate felt chest pains and ended up in the local hospital emergency room having a heart attack. The patient now became the advocate in a strange city thousands of miles away from home.
Forced to make a decision, the patient came home, leaving her friend in a hospital where she felt staff was kind and gentle and sympathetic. Not to mention both women were transsexuals and the first hospital she ended up in was a Catholic hospital. Still, there and in the second hospital, both women felt they were treated well.
The advocate, now the patient came home a few days later to friends and family who were glad she was home. A collection was taken and quickly we raised the money to pay for her airline ticket.
What are some of the lessons here?
Always carry a list of all your medications, surgeries and allergies. Were she not conscious, no one planned on the advocate needing this information.
Carry doctor’s names and phone numbers. A fast call home may have saved this patient time if she couldn’t speak for herself.
Carry your insurance information and be sure your travel companion knows where the information can be found.
Before you choose an advocate, or a travel partner, know something about their health. In this case, it wasn’t the first time this woman had a heart attack.
And, when traveling, if there is an emergency, get a “point” person to help with travel plans and contact friends and family. An advocate may be best at the bedside but there are plenty of things that can be done from afar. The advocate (turned patient) put me down as someone who can receive information which allowed me to help, by phone in her decision making and plans. The less she needed to think about being alone, or travel was more energy she could use on gaining her strength. Careful to never take away her chance to make decisions, I am confident that the teamwork helped her get her strength back and make a full recovery.
The most important thing to take with you to the hospital is a friend who at least can act as your advocate. A friend who sits in a corner and doesn’t write notes, plan with you what questions need to be asked or doesn’t make sure hospital policies are followed, is not much help. That’s why training someone to be your advocate is so important.
I have been an advocate for many people. I have sat at the bedside day and night through many different surgeries and procedures. Usually, there is nothing unusual that happens. But recently, when a friend went to California for surgery, I couldn’t go and another friend went. She was trained as an advocate and I had no doubt she would do everything that needed to be done.
But, following surgery and a week after recuperating, with just days before returning home, the advocate felt chest pains and ended up in the local hospital emergency room having a heart attack. The patient now became the advocate in a strange city thousands of miles away from home.
Forced to make a decision, the patient came home, leaving her friend in a hospital where she felt staff was kind and gentle and sympathetic. Not to mention both women were transsexuals and the first hospital she ended up in was a Catholic hospital. Still, there and in the second hospital, both women felt they were treated well.
The advocate, now the patient came home a few days later to friends and family who were glad she was home. A collection was taken and quickly we raised the money to pay for her airline ticket.
What are some of the lessons here?
Always carry a list of all your medications, surgeries and allergies. Were she not conscious, no one planned on the advocate needing this information.
Carry doctor’s names and phone numbers. A fast call home may have saved this patient time if she couldn’t speak for herself.
Carry your insurance information and be sure your travel companion knows where the information can be found.
Before you choose an advocate, or a travel partner, know something about their health. In this case, it wasn’t the first time this woman had a heart attack.
And, when traveling, if there is an emergency, get a “point” person to help with travel plans and contact friends and family. An advocate may be best at the bedside but there are plenty of things that can be done from afar. The advocate (turned patient) put me down as someone who can receive information which allowed me to help, by phone in her decision making and plans. The less she needed to think about being alone, or travel was more energy she could use on gaining her strength. Careful to never take away her chance to make decisions, I am confident that the teamwork helped her get her strength back and make a full recovery.
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