Thursday, March 26, 2009

The 2009 National Physician of the Year Awards

Imagine my surprise when my phone rang late last week and a woman on the phone asked if I were Ilene Corina. She had John Connolly on the phone and he wanted to speak to me. What could John Connolly, President and CEO of Castle Connolly Ltd want with me?

He was inviting me, and the PULSE volunteers to The 2009 National Physician of the Year Awards Ceremony. Held at the historic Hudson Theater at the Millennium Hotel, New York City.

Seven of us went and it was a lovely evening with speeches and recognition and fine food. But what was important is that we, or at least I, can recognize the great work that physicians do as they save lives, connect with patients and generally love their work. It does not take away, for a minute, the pain someone suffers when things go wrong or, an outcome in care is not what was expected.

I am glad to have the opportunities to celebrate healthcare as well as know the pain of the unpredicted. I wish everyone had that opportunity.

Friday, March 13, 2009


How do we choose where to have surgery? There is no easy answer. In most cases, we go where our doctor works or, if there is a choice, the hospital that we think has the best reputation. We can look up information on their infection rates or ask a nurse we know who works there, but none of these guarantee a “good” outcome to our surgery.

I had the opportunity to speak at a hospital in NY yesterday during Patient Safety Awareness Week and was very impressed with the attendance and audience participation. I was doubly impressed when I was greeted by the nurse in charge of surgery – before surgery, during surgery and after surgery, is how he explained what he is responsible for.

He told me about their “time out” which is done before a procedure so the medical team can check if they have the correct patient, if they are doing the correct procedure and if other safety measures are in place.

I was given a sign titled “Universal Protocol Time Out” with a script to be utilized before each procedure. It has the patient’s name, type of surgery or procedure and side or extremity with other check list information.

Any “no” answer it reads, stops the process. Not unlike a pilot in the cockpit, this sort of teamwork can really make patient feel confident and when done correctly, will make this part of the procedure a success 100% of the time.

I was given a Time Out pen that is given to patients to be sure the site of surgery is marked. I want terribly to open the seemingly sterile wrapper but instead, will keep it a souvenir.

The Time Out and marking the site of surgery are just a very few of the Joint Commission standards and basic safety tips. But, when a facility takes it seriously enough to put resources behind it, to be sure the medical teams have everything needed to make it fool proof, they should be recognized for taking patient safety seriously.

Was one person to slip, and forget to follow the standard procedures, the system may not work and patients, and their families may suffer. This is how I believe we should be choosing a hospital to have surgery but too bad we are usually not given this information. Maybe for Patient Safety Awareness Week next year this hospital will tell their patients how safety conscious they are so the patients can be that much more involved in choosing a hospital.

Thursday, March 12, 2009

Patient Safety Awareness Week, Reflections

It’s Patient Safety Awareness Week and as it comes to an end, I want to reflect back what this week has been like as a patient safety advocate. I am so grateful that the National Patient Safety Foundation recognizes the importance of patients and families having a voice in patient safety. But, at a national level, that’s often all it is, a voice. What is being done, at a local level to include the patient and the community in patient safety? In my opinion it is still a big fat nothing (at least in New York).

I had the honor of sitting in at a presentation at a NY City health system for their leadership and another on Long Island for their whole health system. In both cases, they talked about patient safety, told stories of injuries or death and shared statistics. The IOM report was mentioned that as many as 98,000 people die in hospitals each year from preventable medical errors. I can’t imagine that 10 years after that report, there is anyone in senior leadership who isn’t aware of it. And, if newer staff aren’t aware of the report, why aren’t the medical and nursing schools teaching it?

To hear these presentations are bittersweet, I know we need to talk about patient safety to make patient safety happen. Talking is the start. But there should be more than talk.

I really believe that with my own presentations, and I am doing quit a few of them the last few weeks, I am offering more to hospitals and medical staff on what can be done to reduce errors than what I hear at these presentations. What is needed now is what the Institute for Healthcare Improvement offers; best practices. I am offering best practices and ways to include the patient and family. But by inviting me in to speak, am I leaving them with anything to “do”? I think I am. Are they doing it? I may never know.

I know that medical staff are told what to do to reduce the rate of injury or death, and Patient Safety Awareness Week is a time to (maybe) celebrate all they are doing. It would give me greater satisfaction if they used this time to include the patient and their family in this work. The hospitals and health systems should be practicing safe care all year, they could celebrate any time. But for Patient Safety Awareness Week it could be better spent by informing patients, and the community about what their role is in partnering in their care.

Saturday, March 7, 2009

Patient Advocate

I spent 4 days at the bedside of a patient (and dear friend) which gave me another opportunity to practice and learn advocacy skills. There was nothing earth shattering about our stay but it sure was interesting.

I arrived before 8:00 each morning and stayed until after 9 PM. The registered nurses each had 4 patients with a certified nurse’s assistant having 10 patients. There was a “floater” nurse who helped when needed.

The hospital staff were unusually friendly. They smiled in the hallway and greeted each other as well as the patients. It was more like a hotel atmosphere than a hospital. This friendliness did not always lead into the patient’s room. Even though in most cases the nurse and nurse assistants were very friendly and kind, there were some who were not as patient or caring.

Kindness, I learned long ago is not a synonym for quality and being nice does not make for patient’s safety. Being kind and caring does open the door for a dialogue that can help avoid a bad outcome. For instance, when the night nurse gave the patient a new medication, the patient stopped him and asked why she was getting that and if there had been some mistake.

Years ago, I remember the nurses might say that “the doctor ordered it” so it was OK but in this case the nurse stopped and said he would check on it. He was pleasant and very willing to confirm the medication was correct, leaving the patient to believe it was OK to question.

Upon his return, the nurse explained why the patient was given the new medication. He continued, following his explanation to say that there are many medication errors made so it was good that the new medication was questioned. He was empowering the patient to speak up again in the future.

Another nurse came back the next day after doing a full search on why the patient’s mediation was different when questioned. This absolutely impressed the patient.

When a doctor came in to see the patient he chatted for awhile and then went over to examine her. As he took out his stethoscope I asked him to please wash before the examination. He explained “I did wash but will be happy to do it again” He left the room and returned drying his hands telling us “don’t ever hesitate to ask anyone to wash their hands, we all should be doing it” He too really empowered the patient to speak up and be involved.

The small things like treating the patient with dignity, covering them up for privacy and pulling the curtain were there for the nurses but not for the physical therapist. The PT continually compared the patient I was with to the patient in the next bed “she walked today so you can too” or telling us what she did with the patient in the next bed the day before. The patient in the next bed had the same procedure done a day earlier so the two women got along well and shared their pain and concerns but it was not for the PT to continually talk about the other patient – within hearing distance. This was both disappointing and wrong.

What was disappointing was the lack of information available to patients letting them know it’s OK to ask, question and speak up about their care. The empty walls in the hospital could have had patient safety posters, hand washing notices or friendly reminders about checking wrist bands, checking medications or letting us know who is I charge. It was also disappointing that the nurse was rarely available on some shifts and when the patient had questions, the nurse would scoot in and out without answering questions. The patient was not terribly sickly, so these areas are just cosmetic on what seemed to be a good, sound health system.