Friday, February 19, 2016

Another Task Force

Is it a Task Force We Need?

gentleman called me one afternoon. He was angry that his doctor would not fill his prescription for pain killers.  He didn’t trust his doctor anymore and wondered if his doctor of 15 years was mad at him because he was getting a second opinion.  I asked if his second opinion was to get medication and he said “yes”.  He swore to me that he is not addicted.  I listened carefully, let him tell his story and then asked him “how many people who are addicted, do you think are going to say they are addicted?”  He agreed.

An elderly gentleman told me that when he was on vacation, he ran out of pain pills and thought he was going through withdrawal.  He described a terrible experience.  When I spent some time researching what steps he might take and got back to him with some places that might assist, he said he didn’t want to get off his medication.  They are doing for him what they are supposed to – keeping him from feeling pain.

Nassau and Suffolk Counties have developed a heroin Task Force because of the epidemic of heroin overdoses on Long Island.  They are charged with investigating every heroin overdose on the Island in hopes of tracking the drugs to its source.

Now who wants to be the next overdose that will be “investigated”? Who wants to volunteer their child?  Why isn’t the source being investigated before the prescription – the very first prescription is filled, the public has to take medication safety seriously.

A recent Newsday article explains that the epidemic of heroin overdoses started with opiates such as OxyContin.  In 2012 it is said that over 2 million people were addicted.  A recent AARP article tells us that 46 Americans overdose on pain killers each day!

When I was sitting at the bedside of a patient leaving the hospital, the nurse called in her prescription ahead of time so it would be ready.  No warning, no instructions to be aware of addiction or dependency.  I was given a bottle of pills after my surgery.  No one asked who will be helping you with this prescription?  Who will be your DMM / Designated Medication Manager?

So the answer is to continue writing the prescriptions. Allowing patients to become dependent and then accuse them of “doctor shopping” to get their medications.  Punish doctors who want to give them medication or arrest people for selling pills to feed their heroin habit.  And this is where money will be spent?  On yet another task force?

Listen to this one young man, Steve Dodge, as he tells the reporter where he got started, on pain killers in the ninth grade Video.  It doesn't seem like anyone is listening to him!

Imagine if the task force focused on Before the Prescription is written?  Imagine if every patient was asked who will be your DMM and help you?  They will see if you are on your medications too long?  They will see if you are taking them correctly?  They can read that small print that the patient can’t see and bring the long list of medications, as well as pain killers to the pharmacist for review or to the doctor.

Imagine if we were able to control the problem before it became a problem and not after the next person dies?  But maybe that’s not where the money is?  I have been ignored by the Nassau County Health Commissioner when I went to see him about this.  I guess they want to put the money into another “task force”.

Maybe a discussion about medication safety on Long Island will open up some awareness BEFORE THE PRESCRIPTION IS WRITTEN

Saturday, February 6, 2016

Swiss Cheese and Patient Safety

What Does Swiss Cheese Have to Do With Patient Safety?

I don’t comment on specific medical error cases. Too often details come out later that we are unaware of.  We rarely get all the details in the media.   But, it does seem like the fact here is that a child had the wrong procedure done in the hospital and the doctor apologized.  Mix-Up Leads to Surgical Procedure on Wrong Baby

When it comes to patient safety and medical errors, these are the exact stories we are talking about that even patients and families can learn from.

In the PULSE of NY Family Centered Patient Advocacy Training, participants will learn about the SwissCheese Model of patient safety.  With all the safety process in place, how can this error reach the patient?  Too often it does and we, the patient and our families MUST learn how and why this happens so it doesn’t continue.  At any time anyone, including the patient or family must feel empowered to say “stop” something doesn’t seem right. 

At any time patients, their family and / or their advocate must understand the Swiss Cheese Model so they are aware of how errors happen.  Whether it is getting the wrong medication, the wrong procedure or even when hospital staff start discharging the wrong patient, if we don’t talk about it, it will continue.  Yes, these incidence will make the news but sadly not for the right reason.  We MUST use these stories to educate and advocate for patient safety.
Over and over again the healthcare system proves that they need the patient and family involved but sadly too often we are excluded from the conversation.

If you can join us for the next conversation and training, please register now – we always fill up.  Family Centered Patient Advocacy Training

Friday, February 5, 2016

Communication for Better Care

Respect and Communication in Medical Care

It’s not always about medical errors.  There are many opportunities for care to be less than OK when we use the healthcare system.  I have said it before, and I will say it again; no two cases are identical when it comes to unplanned results. So many problems can stem back to communication, and poor communication can be perceived as poor care.

A man does not want to leave the hospital and waits for a conversation with the social worker.  Hours go by and he is still waiting.  A person with nothing to do counts the minutes while the social worker is trying to help, without reporting back, the patient feels ignored. The hospital visit begins to spiral out of control because the patient is angry.

The patient doesn’t keep track of when he receives his medication and the nurse doesn’t tell him what medications he is getting.  When the patient thinks he was double dosed on his medication, the rest of his hospitalization is spent looking for additional errors.

A patient has questions but the nurse leaves the room before he gets to ask.  Now he feels ignored.

A patient needs to use the bathroom.  When it takes too long, according to the patient, for someone to come, the patient feels ignored and neglected.  An apology could have helped the patient feel respected.  If the CNA was apologetic instead of annoyed, the patient may have actually been sympathetic to the overworked nurse assistant.

How patients are treated very often make up the patient experience.  Kindness and respect can go a long way and may actually change an outcome.  A nurse who is rushed, a doctor who is not approachable may be closing doors to a patient sharing important information.

Hospitality in healthcare,  whether a smile or hello need to be taught early in training and reinforced constantly.  Patients and their family should “assume good intentions” and give staff an opportunity to be kind and respectful and be kind and respectful back.

As an advocate,  the intervention may be just to keep communication open, apologize for each side, and remind each party of the stresses during this time.  We should not be telling someone not to be angry, but instead acknowledge the anger and frustration and then offer to help get answers.  Telling someone how to feel is once again taking their independence away.  Allow a patient to be angry and frustrated.  Once their feelings are justified, they can usually be easily become more reasonable.