Saturday, October 29, 2011

Politics Religion and Patient's Safety

Politics Religion and Patient's Safety

You may not think that religion or politics would play a role in safe, quality healthcare, but it does every day. We just don’t always see it.

You may remember I wrote about the woman who couldn’t work for PULSE because we are a friend of the transgender community and do advocacy work helping to make sure their needs are met and they are treated safely and respectful (like anyone else). When I shared the experience with a local physician and asked about medical professionals not wanting to help patients who go against their religious beliefs, he explained that this is a common problem with abortion too.

Medical professionals who don’t want to help women who have an abortion must safely remove themselves from the situation.

Now I read about doctors in Kansas who are fighting the system that would keep women safe following an abortion.

Politics and religion have no place in healthcare. The law, is the law and needs to be followed. Talking openly about abortion and why women choose that road, or learning about people who are transgender and openly speaking about our differences will help people understand their similarities. It also will help to get laws past protecting the rights of people to not feel ashamed of who they are which will openly start a conversation and sensitivity training. If we aren’t addressing these areas, we will be allowing people with power to show their prejudice at the most inopportune times.

Friday, October 7, 2011

Health Literacy (Again)

More on Health Literacy

Health literacy is defined by the U.S. Department of Health and Human Services as “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions". Health literacy has become a medical term used by medical professionals to study, measure and learn communication skills with their patients (and their family).

I don’t consider myself a medical person but I do consider myself a patient safety advocate. And, since communication is one of the biggest problems with patient’s safety I will be addressing my own “Top Ten” list of how to improve health literacy.

#10. Stop using abbreviations –always. Don’t do it with friend, family or at work. Get out of the habit now. Don’t say the U.S. of A. Say “The United States of America”. Don’t say my GYN, say “My gynecologist”. Don’t say we are barbecuing dogs; say “we are barbecuing hot dogs”.

I was recently with a group of 9-12 graders and heard someone use the term LGBT. I stopped the speaker and asked if everyone in the group knew what that meant. One girl didn’t. We would assume a teenager knows that term but if it isn’t used by her friends or family, how could she know it? We need to speak in full sentences always so when speaking about healthcare, there are no surprises.

#9. Assume a patient can’t read. Healthcare workers handing patients forms to sign can ask “Do you need help with the forms?” This gives the patient the opportunity to say that they forgot their glasses, are too nervous to read the forms or anything else they want to say besides saying they won’t understand them. Friends or family accompanying the patient can ask too. Every time I go to the doctor I am handed forms to read and sign. I wonder what the person would say in a crowded waiting room if they can’t read.

#8. Have a private place to complete forms. Don’t make the patient feel embarrassed or self-conscious. Never react to an answer. If you learn the patient’s age or weight, go on to the next question and never bring it up again.

#7. The patient needs to repeat what the doctor said in their own words. And, the doctor needs to ask. “Take the pill 2 times a day for a week and then come back” The patient needs to now explain when they will take the pill. “I will take them at night” repeats the patient. “How many”? “I will take 2 at night with dinner so I remember” If the doctor wants one pill in the morning and one at night, is it at 7:00 AM and 7:00 PM? Make it easy. This isn’t about literacy it’s about explaining yourself so anyone can understand it.

I worked in the post office for 19 years and mailed packages all over the world. Recently I tried to figure out if it would benefit me to use the newer “flat rate” box to mail a package to my son in college or should I get boxes and mail them without the flat rate price. The clerk spent enough time with me until I understood. Is that about literacy too?

#6. Ask the doctor to come back. After an overload of information, whether in the hospital or the office, ask the doctor to give you a few minutes to think of the questions you may have. Write them down and gather your thoughts. The doctor or medical provider should suggest, “I know that was a lot of information, why don’t I see another patient and check back with you to make sure you still understand what I said”.

#5. If you don’t understand your doctor, and he has explained the same thing over and over, ask the nurse to explain it. You can tell me how to do something and what to do but if I didn’t get it the first three times you said it, you better either pick new words or get someone in who speaks in a way I understand it.

#4. People with accents aren’t deaf. People who are deaf, are not dumb. People who are elderly are not all frail, people who are young have a right to ask questions. People in wheelchairs can hear. Don’t talk to their transportation person and ignore the patient. If the patient has a disability, they probably know it. Don’t be afraid to acknowledge it and ask how you can help.

#3. If your doctor doesn’t spend the time explaining him/herself on more than one occasion, don’t be afraid to change doctors. Just because you have used this doctor for 20 years doesn’t make that doctor “good”. There are always new and competent doctors being trained. Look for a new one.

#2. Remember “making meatloaf”. You can share your meatloaf recipe with 10 people and no 2 will come out the same. If every detail isn’t shared, you may not get the outcome the doctor expects. Details, details, details!

#1. NEVER let a medical professional intimidate you! I was recently with a patient in the hospital and the doctor stood over her bed and said to the patient “What are you so worried about?” The patient, an educated woman, sick of being in the hospital started crying. I jumped in front of the doctor and said “Just answer the woman’s question”. Healthcare providers will get much further answering the patient’s questions and if not able to, tell them.  Be honest and forthright with the patient about your own limitations in communication.

If we don’t follow the care plan we are considered “noncompliant” if we don’t understand the care plan, we have low health literacy.

How about we just get everyone communicating a bit better?

Sunday, October 2, 2011

The Joint Commission Survey

A Hospital Survey

I hear talk from people about the way The Joint Commission works and what exactly is their role in keeping patient’s safe.

As an example of what may happen at a typical hospital following a tragic event, let’s follow a complaint about a young woman who dies from an infection in a Joint Commission-accredited hospital. The family reports the incident to The Joint Commission (the name was changed from Joint Commission on Accreditation of Healthcare Organizations, aka JCAHO).The Joint Commission takes the report, sends an acknowledgement letter to the family that the report was received, and offers to get back to the family after action is taken about the complaint. Weeks go by and they hear nothing. Assuming nothing is being done, the family tells people The Joint Commission is not doing anything; But that is not true.
The Joint Commission accredits more than 19,000 health care organizations, including hospitals, ambulatory care services, home care and mental health services. These customers pay The Joint Commission for their survey. Joint Commission surveys are more rigorous than the surveys of other accrediting organizations. The standards are much higher and the survey is more detailed and difficult to pass.
In the case of the infection-control related death illustrated above, a “for cause” survey may be done when a complaint is brought to the attention of The Joint Commission about a Joint Commission accredited organization. A team of surveyors go to the organization with no notice to the organization and evaluates the organization to determine if the organization is doing what they are supposed to. For example, they may not be complying with The Joint Commission’s infection control standards.

There are 294 Joint Commission standards. If there is a problem that is not life threatening, the surveyor will look for a pattern. If it is simple to fix, the surveyor will tell the organization to fix the problem immediately. If the problem is more complex, the surveyor will write up an RFI, Requirement for Improvement. If the accreditation decision will be affected, a report about the problems at the organization is presented to The Joint Commission’s Accreditation Committee. The committee meets with Joint Commission staff to review the problems.
In the case of the woman who died from an infection, if there were no patterns of breakdowns in infection control practices, no action would be taken upon the hospital where the young woman died. The death is tragic, but not because the organization was not doing what it was supposed to. In other instances, it could be a series of problems that led to this one death; similar to the Swiss Cheese effect ( ).
If there was a pattern of breakdowns in infection control practices at the organization where the woman died, the hospital would have to complete a written report and take immediate action to fix the problems.When health care organizations do not fix problems in a timely manner, Joint Commission staff may recommend that a follow-up survey be conducted, which could lead to preliminary denial of accreditation, or even denial of accreditation.
When accreditation is denied, the organization can request a hearing. The hearing is conducted by an independent panel, including a board member who is unknown to the organization, which reports their recommendations to the Accreditation Committee.
Although this process takes time, it “works” because it enables – and supports – the organization in its efforts to correct its problems so that care can continue to be provided to patients in a safe manner. I don’t think anyone really wants a hospital to close its doors. However, we should all want and expect excellence. That is best achieved if the health care facility follows the procedures and meets The Joint Commission standards.

Some people want the survey information made public. The state surveys are transparent so why shouldn't The Joint Commission survey be too?

The Joint Commission standards are much higher.  If the survey findings were open to the public, organizations may leave the Joint Commission and use the state survey system.  Since the states constant cutbacks, there may be many opportunities to cut back on surveys.  How could the state commit to offering a service if there isn’t enough staff.   I would fear the surveys may not get done at all.  When healthcare organizations pay for the service, there needs to be enough people to do the job.
And if you are concerned about your state being neutral in the process, check to see how much money is distributed in campaign funds……………..

Saturday, October 1, 2011

Patient's With Special Needs

A Special Kind of Patient

Part of my work with The PULSE of NY Patient Safety Advisory Council is working with specific groups and teaching them about patient safety and learning from them, what it is about the care they receive which makes them feel unsafe or, incapable of getting safe, quality care.

One of the groups I have been working closely with is people with disabilities. People who have various disabilities are an extremely unique patient. They can’t possibly be treated the same as all patients. They are often in need of additional and very specific care. Most importantly they need to be treated, as all patients with dignity and respect.

A patient who I recently visited in the hospital could not move her legs and had very limited use of her arms. She couldn’t turn her head and was very large, making it difficult to move her. Her mind is sharp and has a quick sense of humor but when the medical staff sees her, they want to assure her that they know what to do for her. There is no way anyone “knows” how to handle someone with disabilities unless they ask them. Some people have no feeling in their lower extremities, some do.

When trying to move her, staff pulled on her leg that has very limited movement and pulled her tendon, leaving her in terrible pain causing an additional day in the hospital while getting x-rays.

 Another patient I have been seeing had surgery and is unable to move her legs and most of her upper body. Most patients are encouraged to get out of bed immediately following surgery. In many cases these patients can’t. They need the support of staff to help move them and it is critical that they are moved constantly. Disabled patients have special needs for their toileting and movement. They may take extra time but it can be time well spent if they ask the patient, “How can I help you”.

 While at the hospital, I saw how hospital staff left for the patient in the next bed, also disabled, her breakfast tray on a table out of reach. Her son came and found she had not eaten since she arrived the day before.

This patient I was visiting asked me to move her leg for her. Something as simple as getting comfortable in bed is impossible when you can’t move. I helped shift her leg and watched her grimace. Fearful that I was hurting her she assured me it was ok and encouraged me to continue. She was grateful for my help. It lasted less than one minute. That afternoon she told me a nurse’s aide came in and when she asked for help moving her leg she went too fast and injured her.

When transferred to a rehabilitation center, she was given a bed too narrow. Not able to control her body in the sitting position, she feared she would fall out. The rails, she explained were just not high enough. With a phone call I got the hospital to send over her old bed.

Patients with disabilities need to speak up and hospital staff should be taught to listen. I was told once by a hospital administrator that they tell nurses to spend more time with patients with disabilities. “Do you” I asked him, “give them less patients or just tell them to work harder?” He agreed that there was no system in place to offering them the care they need.