Friday, July 30, 2010

Reading Your Consent

Read and Sign

The woman typing on the computer was speaking fast and friendly to the patient about his care and treatment he was to do at home. She then handed him a book and said “read this and sign here”. As I sat in the corner observing this exchange, I asked if the doctor was also going to sign this consent. “Yes” she said. “This just explains what the doctor already told him”.

I sat in the quiet of the room as the patient read and the medical assistant typed her information. ”You know” I said breaking the silence, “You never even confirmed that he can read.” She never looked up, she laughed and told me that if he can sign his name, he can read enough. “Besides” she said, “you’d never find a lawyer to take the case”.

I was shocked at the thinking of this young girl working in a prestigious doctor’s office. Not only was I surprised at her thinking but also how bold she was to share her lack of concern that this patient may not be able to read. She didn’t care if he could read what he was signing but then brought up a lawyer in this patient’s relationship with this physician and medical practice.

I let it go, I knew the patient could read but it was a reminder of how far we have to go.

Tuesday, July 27, 2010

Literacy at Camp?

Camp Literacy?

I just returned from a wonderful week away at a “religious” camp for families. As a Unitarian Universalist I know I live out the values daily in my work and family life, but wondered what it would be like to have fun with 200 other people with the same values. As a youth director for 2 years in my own congregation and knowing that this Pennsylvania camp called UUMAC needed a youth coordinator, I thought it was time I tried this long awaited “vacation” – working or not.

I purposely left my business cards and patient safety brochures at home. I was not going to talk about patient safety nor was I going to think about work for a week. In the weeks leading up to UUMAC, I found myself staying up late planning for the youths projects and getting lost in this new plan I had for myself.

Even before I arrived at UUMAC I was hearing terms I never heard before. I had to prepare for “vespers” which was the evening worship or “Night Owls” which I learned real fast about the all night partying that went on. “Show Case” was the end of the week entertainment when all the workshops put on a show of their work, songs, writing or just fun stuff about the people in the group.

When I realized that I didn’t know what some of these terms meant, or didn’t know what to do with them such as “bridging” where I knew that the teens were going to adulthood but didn’t know how it affected me, I asked questions. Some of the young people seemed to like to explain to me what it all meant. Others would sometimes shrug. It reminded me constantly about how we must all be willing to share information to grow.

The religion of Unitarian Universalism must often be explained so others will be interested and participate. But it kept reminding me about my work and the effort it takes for people who work in medical care to explain to their patients important, often life saving information.

Each time I asked a question, and received a thoughtful explanation, I didn’t feel the need to label myself. But yet the term
health literacy has taken on a life of it’s own when it should be part of our regular communication between people. As I look back at the willingness of people to share information at a camp or in our daily life, I wonder why it becomes so complicated for this to happen in healthcare.

Wednesday, July 14, 2010

Nurses Aids or No Nurse Aids

No, Fainting is Not OK

I thought it was wonderful that at this hospital there were no nurse’s aids. Not because I don’t think nurses aids are a good thing, but because the registered nurse did everything for the patient and got to know the patient well. Better chance of good outcomes when less people are involved – or so I thought. The nurse is more responsible to her five patients because it is just her and her patient. She must tend to every detail and be more aware.

Accept what happens when one patient needs extra assistance. As in the case when a patient needs to stand up after being in bed for almost three full days? The nurse told us that she needed other nurses to help. One nurse will change the bedding while two other nurses will help her out of bed.

As we waited and waited, the three nurses finally came in. Now I’m realizing that as many as fourteen other patients don’t have any nursing available at all. Even if one of these nurses was a charge nurse, and was only there to help anyways, that still leaves nine patients (our nurse’s four other patients and the helping nurse’s five patients) with no nursing care.

As one nurse scrambled to make the bed – with my help, two other nurses helped the patient and then needed to spend time with her standing, cleaning getting acclimated to being out of bed. As time was ticking away, patient’s somewhere very possibly, weren’t getting their medications notes weren’t being written up and someone’s water may be empty. Patients very easily could have been neglected. Then, when the nurses went back to work, after about 15 minutes, I’m sure they now had much more to do.

If this happens for two patients a day, and since this patient had to get up another time later and walk, how much lost patient care time is there? It may add up to hours in a day.

I shouldn’t be surprised than that on two occasions, the patient under my watch fainted. Unfortunately, the second time was as she was preparing to go home. This caused additional blood work, testing and costs. It became apparent that the patient was probably just dehydrated and, after days on her back with only standing and walking slightly two times a day, she became lightheaded.

How could this have been missed by the overworked nurses? Very easily. Should I have done something differently? Absolutely! After the first time the patient fainted, the nurse’s reaction was that it can be expected. Because of the lack of mobility, the nurses explained she may feel faint. But I know the bed was tilted for awhile so the blood would not rush all at once. Fainting should have been taken more seriously by me, her advocate as well as the nurses the first time. I should have insisted someone check her for dehydration (although not being a medical professional I don’t need to know what the problem is, I do need to make sure the problem – and fainting is a problem, is addressed) Nurses should have informed the doctor and everyone should have said “no, fainting is not ok” but an aid may have been better able to pick this up and spend more time recognizing this. If this patient was hurt in the fall, at a cost to the hospital, I'm sure changes would be made.

Saturday, July 3, 2010

Still Problems at the Bedside

Pennsylvania Bedside Patient Safety

One thing for sure is that anyone who works in healthcare doesn’t want to be hospitalized in the month of July. That’s when the new residents start at teaching hospitals. The new, never before touched a patient residents with the title “Doctor” before their name.

I was relieved to learn that the patient I was going to spend a week with in a Pennsylvania hospital this week was not going to be a teaching hospital but instead, a small rural hospital where everyone in the hallway says “hello” and nurses know the patient because there are no nurse’s aids. Instead, registered nurses are there who help each other and each other’s patients.

This seems like a good thing and for comfort, it is. This patient has a private room and I was given a recliner to sleep on and access to linens for me and the patient as well as the microwave and refrigerator for my comfort.

But, what does this say about safety? Nothing. Comfort and friendliness has nothing to do with safety, accept it made me, as the patient’s “friend” more comfortable speaking up about my discomfort.

Some of the things I noticed, and questioned were; The nurses never check arm bands because they only have 5 patients. They must have felt that they know their patients. When I asked about this practice they told me they always check, I never saw them check.

I had to ask the nurses, each shift to be sure that the medications are brought to the patient in the original wrappers. When I asked the nurse when I arrived how medication was distributed, and she told me she empty’s the pills into a cup at her nurse’s station, I thought I had entered a time machine – backwards. She agreed to bring the medications in their original wrappers in the future but this request had to be repeated each shift.

To have a cup of pills with no labels is not only dangerous for the patient, but for the nurse distributing them.

There is no comfort in seeing patient safety problems happen when sitting at a patient’s bedside. Knowing that qualified and caring nurses are still taking chances with a patient’s life, I have to wonder what kind of training they are getting in patient safety.