Wednesday, December 16, 2009

What is a Patient Safety Advocate? A Good Listener

Patient Safety Advocacy; Listen!

Listening can sometimes be difficult. We often think of ourselves as a good listener because we are physically present when someone speaks. But being a good listener and a patient advocate are very different.

As an advocate, we need to really listen and hear what the patient is saying and even feeling. When hospitalized, it is important to always have a notebook handy. Taking notes when the patient says something like “I haven’t eaten since noon yesterday” you will have that information available if the patient is resting and the nurse or doctor come in and ask “when was the last time the patient ate”?

When the doctor comes in to speak with the patient, always ask if you can stay. This helps keep the patient in control. Plan on taking notes as the doctor and the patient speak. The doctor will ask if there are any more questions. Ask the doctor to come back if he or she will be in the building for a little bit longer. When they leave the room, you will probably say that you wish you asked about………………. Write it down. When the doctor sticks her head back in you will be ready with any additional questions.

Listen for the patient’s worries and fears. Try to never say “don’t worry” it’s confusing to hear those words. “How can I help you to not worry?” or “what will make you feel better?” can be words that are not only more soothing, but more productive.

The patient may have underlying fears that you aren’t aware of. Help the patient to find them and address them if they can. The worries may not be about the surgery itself but may in fact be about the bills, children at home or lost time at work. By saying “don’t worry” you aren’t helping to address any of that.

Finally, listening is also about hearing what the patient says. Don’t push the patient to eat or drink if this is not your role. Be careful not to treat an adult patient like a child. When the patient says I’m not hungry and refuses to eat, this information goes back to the nurse or doctor. Usually sipping water or juice is fine. By pushing a patient to eat is to satisfy your own need to feel productive, useful or even in control. Be careful to not cross that line. You are there for the patient’s comfort and safety and not to be in control of the patient.

Tuesday, December 15, 2009

What is a Patient Safety Advocate? Helping the Patient Understand Their Care

Patient Safety Advocacy; The Patient Needs to Understand Their Care and Treatment

I have been invited to a few hospitals recently by the patient and / or family because of a similar trend that seems to be growing. The patient has no idea who is in charge of their care. The patient is getting mixed information from different doctors, none who seem to be in charge. Treatment is often contradictory. One doctor may say to get off a medication, another says to stay on it.

I have been asked to come help sort this out. I can see, usually with my first conversation, that there is a disconnect – it’s throughout the whole system. Here is a typical conversation I may have with the first person I turn to, the nurse in charge of the patient:

“Hello, my name is Ilene, I am a friend of (name). (Name) is confused about who her doctor is in charge of her care and has some questions. I’m wondering if you would have some time to talk to her and answer some questions.”

“I’m sorry, I can’t give you that information”.

“I did not ask for the information, I asked you to talk to the patient”.

“Who are you” they would ask again even though I told them I am a friend.
“I can’t give out any information about the patient”. Again I would have to repeat that I don’t want the information. It's for the patient.

Do you see a pattern?

At one visit, at a local nursing home, I had this conversation with the social worker. When she wouldn’t budge, I went to the director of nursing. He called the social worker after hearing my frustration. He couldn’t believe that the social worker wouldn’t budge. So, the nursing director followed me to the patient’s room to assure her that someone would be in the next morning to discuss her care and answer any questions.

Yes, I see a pattern here.

Make sure you use your words appropriately and say what you mean the first time.

Monday, December 14, 2009

What is a Patient Safety Advocate? Quiet!

Patient Safety Advocacy; Quiet!

A dear, long time friend of mine told me her husband was going to have surgery. It was pretty serious surgery that meant many days in the hospital recuperating. Any time anyone spends many days in the hospital, we can assume it’s pretty serious. Insurance companies just don’t pay to keep people in the hospital unless it’s really needed.

I offered, like I offer most people I know, to help. I would be her eyes and ears for her when she’s not there, I explained. I would check that he’s getting the correct medication and that he is comfortable and cared for by the staff. “Oh no” she told me, “I’m a bull”. I told her that I am not a bull. I become a partner with the medical staff. She backed down and explained that she speaks up for her husband. Demands he gets what he needs and is not afraid to make waves.

More power to her.

She called me the night of surgery at 6:00 pm. She was home, exhausted. Her husband was fine and resting at the hospital – alone. She decided to go home so he can rest. I bit my tongue and said a prayer.

This is where advocacy starts.

Being a patient’s advocate is not about talking to the patient. As an advocate, it is important to be able to sit quietly and read (find your own light not over the patient’s bed), or be quiet doing something else. The patient MUST rest. It may mean sitting outside in the hallway and follow the nurse or doctor in when they arrive. The patient should never feel that they have to talk to you or entertain you. There is no reason that family or friends should visit the patient soon after surgery. This is an important time for the patient to rest. The advocate can ask the patient about screening calls so the patient doesn’t have to talk. Now, with texting available, the patient can respond when they feel well enough to but still read their messages as they come in.

When the patient sleeps, the advocate may need to make sure the patient isn't rubbing or scratching under bandages following surgery. Keep the patient’s hands clean with antibacterial gel if possible.

Wipe down the bed rail with antibacterial cloths when the nurse leaves or the TV remote or nurses bell after each use.

These things can all be done and should be done in the quiet without disturbing the patient.

Friday, December 4, 2009

In patient safety, there is a spoken and unspoken “rule” that we are not supposed to blame the people who make errors. There is a system, in most cases that causes these errors to occur. This is known as the Swiss cheese model. This term is used regularly to explain how errors happen.

Because there is usually a system break down, where the error is not caught, if it makes it through the holes in the Swiss cheese, it is not just one persons fault. Therefore, we couldn’t possibly punish (suspend or fire) an employee who causes harm to a patient.

On my way back from the airport, following a 1 ½ day patient safety meeting, I was surprised to hear on the radio that the Secret Service agents who allowed a couple to crash President Obama's first state dinner were suspended.

In the newspaper today I read that Secret Service Director Mark Sullivan said it was “human error," which allowed these unknowns to intrude. For this, three men were suspended.

Although I am not advocating firing or suspending someone who makes an error, I’m just wondering why I am seeing this as a bit controversial. Care to comment? Please do.