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.
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.
One of 4 empty sanitizers
I found just from a room
to the cafeteria

A broken hand sanitizer

Thursday, March 10, 2011

Who is Don Berwick?

The Don! 
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?
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.