Thursday, December 20, 2012

Who Knows What Really Happens?

Hey You,

Hey, you behind the big wooden desk.  Do you really know what goes on at the patient’s bedside?
When I arrived at the emergency room and visited with the billing department at 6:00 in the morning while the patient was brought into the emergency room, I was greeted by two women who were of another culture.  In between my conversation with one of them doing the billing, they spoke their native language to each other.  It probably would not have affected the patient’s care, but were I the patient, it surely would make me feel uneasy as this is my first impression.
A small community hospital, I was glad to be with a patient using a facility that I would probably use for myself.  Though they don’t have all the trauma needs as a much larger hospital just a short distance away, the fact that it is small, staff are known to be “nice” and this wasn’t a trauma case, I was confident all would go well.  No suspense, it did go well but what I witnessed anyway was still unsettling.
I was asked to sign that I received an admission packet, advanced directives and about 10 items on the list.  When I questioned that we received none of that, the woman handed me a Patient’s Rights manual and explained that everything else on the list is only for Medicare patients.  I wrote “not received / for Medicare only” and signed the bottom information of the form.  It was my impression that the woman handing me the forms to sign may have never read what I was signing.
When I arrived at the patient’s bedside, the nurse treating the patient  was using the light on her phone to check the patient’s throat.  When I commented on this she smiled as she threw her long hair back behind her shoulders and then ran her hands through her hair.
The area between patients was very close.  I can hear what was happening next to us but until the curtain was pulled back could not see.  I do know that next to us was a patient who was preparing to leave.  When she did leave, the curtain was fully pulled back.  The nurse pulled off all the bedding, lifted a nearby bin with her hand and placed the bedding in there.  She then threw over the bed the clean sheets, tied them in the back put a folded blanket on the bed and put equipment out -probably for an IV.  She straightened the bed table and walked away to escort a new patient to another bed, also close by. 
The bed was not washed, the rails were not wiped and the tray table was not cleaned.
I then watched as another nurse pulled bedding off another bed, discarded it and went behind the curtain with another patient.  A pattern I soon realized was quit disheartening.
Still in plain view I watched the nurse go about her duties, never to wash her hands.   I noticed that two sinks on our side of  the room, one right next to me, were dry.   In the short time I was there, they were never used.  As the new patient finished changing into a gown, the same nurse put on gloves, opened the wrapper for the IV and tied off the woman’s arm but before she started the IV she lifted off an IV obviously left from the last patient, opened a bin (I assume this was the garbage) using her foot and hand and dropped it in.  Same gloves, she went back pulled the curtain open and started the IV.
When my patient was ready to leave and was to get a shot, the nurse explained that it will hurt for the day and gave him a shot in the arm that he needed to work with.  She said “I hope you’re not right handed, I should have asked”. She giggled and walked away.
These may not be life threatening conditions.  This may even sound minor, silly or not worth discussing, but it only takes a small amount of germs to cause an infection.  It only takes a small amount of carelessness to start bigger problems and it takes one person to set an example for others.  When one, two or three people in an emergency department let their guard down, we are in for bigger problems.  I'm not sure that the people who are in the corporate offices, make the policies, write the checks and go to the patient safety conferences even know how to start watching for this breach of conduct.   I’m not sure I would feel safe there, and now I don’t know where I would go.

Tuesday, December 11, 2012

Kate Middleton's Privacy

Royal Privacy

King Edward VII's Hospital
Kate Middleton, Duchess of Cambridge becomes pregnant.  The complications from her pregnancy land her in King Edward VII Hospital in London where she is suffering from severe morning sickness.   DJ’s  Mel Greig and Michael Christian from an Australian radio show call the hospital pretending to be Queen Elizabeth and Prince Charles.  They ask the nurse who answers the phone, as a prank for the radio station, if they can speak to Kate. A nurse, Jacintha Saldanha patches them through.
Another nurse, who has not yet been identified picks up the call and offers information about Kate’s condition.  Not realizing this is a prank, this nurse tells the DJ’s detailed information about Kate Middleton’s condition, on tape for all the listeners to hear.
Three days later, after most of the world heard the phone call on the news, Jacintha Saldanha, a nurse at that hospital for four years, and the mother of two teens is found dead from an apparent suicide.
Could this have happened here, in the United States?  Aren’t we “protected” by HIPAA so this information would / should never get out?  What did this nurse who answered the phone, or the nurse who gave out the information but didn’t kill herself actually do wrong?
The hospital policy, as one article wrote “forbids employees to patch phone calls through to the ward”.  This is the only place Saldanha committed any wrong doing.  The nurse, who gave out the information to the DJ’s may have gone a bit overboard in the details, but there too committed no offense. 
The privacy we may expect as a patient in the hospital is our right to ask that information not be shared with family or friends. If that request is not made, there is no public policy in place that protects patients from having a family member get information from the doctor or nurse about our condition, were we the patient.  Healthcare workers usually do not freely give out personal information over the phone to callers to protect the patient’s privacy or because it can get to time consuming to share details with everyone who might call.  But, the HIPAA laws do not protect us from that conversation – although over and over again, medical professionals use HIPAA as the reason they won’t share information about a patient with family or friends.
The nurse who did give out the details may be reprimanded for not using better judgment and Saldanha may have broken the rule about passing on a phone call.  But the only tragedy here is that a woman (that I know nothing else about) took her own life instead of apologizing and now her children don’t have their mother.
I hope that this will be used as an opportunity for people to decide now who you want to have your information were you to be hospitalized.  Who will be your advocate or support person and have that conversation with them about your expectations were you to be suddenly incapacitated.   Were Kate Middleton to have a patient advocate at her bedside, or helping her husband, Prince William know their rights to privacy, there is always a chance the outcome may have been very different.
Registration is now open for Long Island Family Centered Patient Advocacy Training, Registration
See the following links for more information about HIPAA:
LI Patient Safety Advisory Council Information
HIPAA: Everything You Want to Know about Patient Privacy but Are Afraid to Ask! US Department Health and Human Services For Consumers HIPAA Video 

Sunday, December 9, 2012

PPAI 2nd Annual Conference

Professional Patient Advocate Institute

I just spent two days in Orlando at the second annual Professional Patient Advocate InstituteConference.  Day one consisted of a certificate program.  The training covered legal issues, hospital visits, billing and reimbursements, direct services, a business plan, marketing and family support.
You wouldn’t go to court without a lawyer someone said, so why enter the healthcare system without an advocate?
According to the PPAI, some facts to justify the need for a patient advocate; 52 million caregivers provide care to adults ages 18 and up with a disability or illness.   26% of employed adult children take care of a family member and the annual loss to American businesses due to caring for aging parents is $3 trillion.
Presently we are in the early stages of professional patient advocacy services.  This service is not regulated so we are in a unique position to begin preparing for what an advocate needs to do and how they could / should be helping a patient.  Whether it is billing or reimbursement, medication management or doctors visits, at the bedside in the hospital or understanding a care plan, patient advocates can play an important role in the future of healthcare. 
Many nurses are becoming advocates because the time spent at the bedside in nursing is diminishing and nursing no longer allows enough time for patient interaction.
The cost for an advocate can vary from a very high daily rate or a retainer to an hourly rate decided by predicting the needed services.
Another way to encourage advocacy is the way PULSE of NY teaches the family and friend of the patient.  This community based teaching is called Family Centered Patient Advocacy Services.  It focuses on the families need to participate.  This way, there is no charge and the people who know the patient best, want to help and be part of the support system are there for the patient with the needed tools learned at one of the half day workshops.
Day two at the conference focused on guest presenters starting with Trisha Torrey as the keynote.  Trisha started Every Patients Advocate a number of years ago following her own unfortunate experience using the healthcare system. 
Lisa Freeman, the PULSE ofNY contest winner attended her first contest with the professional scholarship of $500.00.  Lisa took a Family CenteredPatient Advocacy Training on February 7, 2012 which made her eligible to apply for the scholarship.
Consider becoming a family centered patient advocate and learn about patient safety.  The charge to take this program is minimal and the lessons will last a lifetime.
Register here for the January 12, 2013 training.  Family Centered Patient Advocate Training Registration.  

Tuesday, December 4, 2012

Hospital Ratings

Leapfrog Group Hospital Ratings

A recent report from the Leapfrog Group has rated hospitals across the country. The Leapfrog Group is an independent, national not-for-profit organization of employer purchasers of health care. The Leapfrog Group is a voluntary program aimed at mobilizing employer purchasing power to alert America’s health industry about health care safety, quality and customer value.
An A, B, C, D, or F score assigned to a hospital based on expert analysis of infections, injuries, and medical and medication errors that cause harm or death during a hospital stay—looked closely at how safe hospitals are for patients.
Locally, on Long Island, 5 hospitals scored an A and now have bragging rights to being the “safest” hospitals on Long Island, in New York and maybe in the country. 
One of these hospitals was reported by another group last spring as one of the worst hospitals in patient safety while at the same time winning an award for Excellence in Patient Safety from yet another group.
The CEO of a Midwestern hospital that scored low expressed reservations about how the Leapfrog Group compiles and validates the data it uses to compile scores.
A well known California hospital disputes their F score because they say one patient death in 2010 unfairly lowered its grade from a C to an F.
The senior vice president for a 101-year-old hospital, says he "patently disagrees" with his hospital's F grade, saying that's not reflected in current federally reported data.  "Much of what Leapfrog is using is three or four years old," he says, "and is based on some proprietary methodology, capriciously assigning adverse grades to someone."
Hospitals across the country scoring an A have a very different outlook. They boast to their commitment to patient’s safety, quality care and committed staff.
Years ago I went to a meeting and on the plane I read a magazine listing top hospitals.  I didn’t see a hospital that I knew was always winning awards.  When I saw a top administrator from this hospital, I mentioned that his hospital wasn’t listed.  He grabbed the magazine from my hands and sat in a corner reading it.  Upon his return just minutes later, he shared that this magazine is trash and their scoring doesn’t mean a thing.
Using these rating tools, whether it’s about your local hospital or physician, patient safety and quality care is a two way street and by being vigilant as patients or family members we can help control the outcomes.  Going into a hospital with an F rating might even keep you on guard and with good reason.  Ratings are a tool.  I know of too many people who were injured or died in “the best” hospitals.