Making Meatloaf

Can You Really Repeat Back Everything?


During a recent classroom of nurses I was instructing, one of them asked if she is the patient's advocate shouldn't she be able to explain to the patient what the doctor said if the patient doesn't understand?

I gave her the "Meatloaf" lesson I have been working with for years.   "Who here has a wonderful meatloaf recipe" I asked the group.  One hand shot up, so I then asked who wants to go with me for dinner and have meatloaf?  Another hand went up.

I set the stage that the two of us were going to dinner to have meatloaf at Jayne's house and it was so wonderful, I asked Jayne to share the recipe with us.  I would love to make that meatloaf!  Jayne gave us the recipe.  "I use some pork and beef and an egg some seasoning and mix it all together and bake it".

I then asked the other nurses if they can repeat it.  She, nor the rest of the class could get the recipe exactly as it was shared, nor could they remember everything that was said.

So the answer is "no".  If the patient or their helping family member doesn't understand the treating clinicians instructions, diagnosis or information, the advocate is responsible for having the clinician explain it again until the patient understands it.  Too much information can be lost in the explanation.

The teach back method also is important for the same reason.  If the person receiving the meatloaf recipe writes it down, or repeats back what she heard, Jayne can verify that she has the information correct.  If Jayne just asked if we understood, it's too easy to just say "yes" and when we get home, we forgot what the actual recipe is.

Medical errors happen too often because of miscommunication.  An important part of patient safety is understanding each other.  Patients should never feel embarrassed or intimidated when  not understanding what is said, its also hard to remember a meatloaf recipe.

Reports Give False Hope

Don't Let Reports Fool You

Don’t let reports of hospitals doing poorly cause you false hope that you are automatically safe if you use another hospital. Newsday December 23, 2014 

We know that as well as bad things happening in hospitals, lives are saved each and every minute of each day.  But, I don’t want to take away from even one life being cut short because of a medical error, hospital acquired infection or unplanned outcome.  Reports that a hospital has lower ratings than another gives reason for leadership to pat themselves on the back – but even in the “best” hospitals people have bedsores, die from infections and can be given the wrong medication.  Even if they don’t make the news.  To let our guard down even for a second is a cause for concern.  

Never had a car accident?  So should you stop wearing your seat belt?  Cancel your insurance?  No.  We must use these reports only as an opportunity to continue the conversation, recognize we aren’t where we need to be yet and continue the education and advocacy that was started long ago.  This report is screaming that PULSE of NY is important and patient safety groups need to step it up a notch and work closer where the problem is – in the hospitals and at the bedside.

Understanding HIPAA

HIPAA, So Misunderstood

HIPAA does not mean your clinician cannot share information with your family.  HIPAA does not mean that a doctor cannot share your information with another clinician.  Many of us, as well as the people who work in healthcare do not understand HIPAA.

Health Insurance Portability and Accountability Act of 1996 (HIPAA), provides protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of health information needed for patient care and other important purposes. 

If I do not object, can my health care provider share or discuss my health information with my family, friends, or others involved in my care or payment for my care?

Answer:

Yes.  As long as you do not object, your health care provider is allowed to share or discuss your health information with your family, friends, or others involved in your care or payment for your care.  Your provider may ask your permission, may tell you he or she plans to discuss the information and give you an opportunity to object, or may decide, using his or her professional judgment, that you do not object.  In any of these cases, your health care provider may discuss only the information that the person involved needs to know about your care or payment for your care.  

Here are some examples:

·         An emergency room doctor may discuss your treatment in front of your friend when you ask that your friend come into the treatment room.

·         Your hospital may discuss your bill with your daughter who is with you at the hospital and has questions about the charges.

·         Your doctor may talk to your sister who is driving you home from the hospital about your keeping your foot raised during the ride home.

·         Your doctor may discuss the drugs you need to take with your health aide who has come with you to your appointment.

·         Your nurse may tell you that she is going to tell your brother how you are doing, and then she may discuss your health status with your brother if you did not say that she should not.

BUT:

·         Your nurse may not discuss your condition with your brother if you tell her not to.

You may want information kept private - but it isn't always about HIPAA.  Privacy and ethical behavior can’t be disputed, HIPAA can.

Before your next medical appointment, read about HIPAA here:

http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html

Patient Safety Education; You Need PULSE of NY

Why You Need PULSE of NY

In a recent 30 minute presentation about patient safety I began to talk about the difference between a healthcare proxy and patient advocate.  A woman in her later years shot her hand up and said “you need to have a friend who knows information about you in case you can’t speak” she told a room full of her peers.  It was apparent as we continued the dialogue that she didn’t know what a healthcare proxy or advance directives are.  We often assume people know what we are talking about.  Patient care is a perfect example of language that is misunderstood and too often the receiver of the information is too intimidated to ask or feeling overwhelmed.  They also may think they know information but until it’s time to follow instructions of a care plan – possibly like taking medication, they realize they don’t understand.

“Do you think that a patient’s bed rail needs to always be up to avoid falls?” I asked explaining that falls can cause serious injury and may add as much as $13,000 to a hospital stay.  When most of the audience nodded, I explained how a patient, no matter their age, may try to climb out of their bed and this could be tragic.  When visiting a friend in the hospital, if you know they may have fallen in the past, be sure the nurses know.  “If you see a star or sometimes a picture of a slipper on the door” I explain, “do not encourage the patient to get up”.

The presentation I cover is about some basic topics costing healthcare billions of dollars each year.  Falls, infections, literacy, medication and surgery also known as F.I.L.M.S. is the basis of the presentation.  Other important topics are advance directives, communication for the best diagnosis and record keeping.

At one community program, audience members admitted that when discharged from the hospital, they left without understanding their next steps.  Should they go back to the surgeon, their family physician or not at all?  If they didn’t understand their medications they were given, some people have told me they wouldn’t get a prescription filled.  Understanding before getting surgery that there are people to help in the hospital with questions or concerns might keep someone from being readmitted because they didn’t understand their care plan.

Most people are annoyed that they are asked on numerous occasions their name and birthday.  When learning that this may help reduce errors, participants are encouraged to be sure every person who treats or transports them asks for 2 forms of ID and agree that now they will expect to be asked.

Choosing your advocate needs to be done before an emergency strikes.  Will your helper be non-English speaking, over 95 years old and unable to hear with limited sight?  Will your advocate or helper be someone who loves you so much they can’t think straight and cries continuously when your clinician talks to you about your cancer diagnosis?  

Listening skills, communication examples and fun interaction can turn patient injury into a celebration of care going right.

Patient safety is not about us – or them.  It’s everyone’s responsibility to be part of the team working around the patient for patient centered care.  We all need to work together to keep a patient safe; friends, family and medical staff.  It’s time the information about patient safety comes out of the hospital walls and lands in the laps of the public so changes can happen.  If you’re looking for a community presentation that can last 45 minutes to *6 hours, call (516) 579-4711

*The PULSE of NY 6- hour workshop is a certificate programs.  Fees may apply

http://www.pulseofny.org/

Another Set of Ears

Speaking in Plain Language

When I went to see this young man I arrived at his mother’s hospital floor before him.  We connected through a mutual friend who thought I might be of some comfort or helpful.   It was almost 10:00 AM and I was running late.  Respectfully, I waited outside his mother’s room until he arrived.  I have learned to stand in one spot, barely moving when I am visiting someone in the hospital.  Being respectful and aware are the two most important things to me.  My phone vibrated and he was calling from the lobby.  Visiting hours start at 11:00 AM.  I looked at the hospitals website before my visit.  He said he was downstairs waiting for 11:00.

“Visiting hours” I told him, “are for other people.  It’s not for you.  Hold your head up high and walk past the sign.  Act like you are a man in charge.”  Minutes later the elevator door opened and a tall handsome young man walked out already in a sad place and now feeling even more vulnerable.  My job was to help him feel empowered while not taking any more of his power away.

He introduced me to his mother who was unresponsive and at the end stages of cancer.  The mask on her face, when removed to offer her sips of a drink, caused her saturations to drop frighteningly low.  He did not want his mother to have the discomfort of this mask on her but the other masks weren’t working.   We immediately started writing down the things he wanted to talk to the doctor about.  The mask, her diet, her medications.  As he thought out loud, I wrote his thoughts and questions in a notebook I brought for him to keep.    He pulled out a notebook and started writing too.

When the doctors came, along with the young students in tow, the conversation turned to hospice and palliative care.  It was 10:30 in the morning and before visiting hours.  I now realized why the family never had a conversation with the doctors in charge of her care.  By 11:00, they would be long past this room and on to other patients.

The attending physician told us that the palliative care team would be in to talk to him about his mother’s care sometime today.  I asked the overwhelmed son if I may ask a question. “Sure” he said.   “Does this mean he cannot use the bathroom, have lunch or leave the room because he may miss the team?”  I asked pointing at the young man standing over me?  “He has been waiting 5 days already.”    The doctor went into his jacket pocket, pulled out a phone and called for the team to come up.  Minutes later the doctor came with the students again following.

The kind and gentle physician who oversaw this department explained that to make her comfortable they would give her medication so she can rest comfortably and take the mask off.  The conversation lasted less than 10 minutes.  The physician asked what the son wanted to do and we requested the doctor’s contact information so he can decide.  I asked if I can ask a question and when the son said “yes”, I asked the doctor so the patient’s son could hear clearly, “Are you saying that if you removed the oxygen and gave her medication to rest comfortably, she will die?”  The doctor looked at me, at the son and back at me again and said.  “Yes”.

Now, he can make an informed decision.  Family was called, arrangements were made and she passed peacefully the next day.  Her children hopefully, can live with no regrets.  Rest in Peace

Ebola is Worse?

Lessons from Ebola

People come into this country with Ebola and we see professionals wearing hazmat suits to treat patients because Ebola is contagious and deadly.  90,000 people die from hospital acquired infections each year in this country and we are still asking medical professionals to wash their hands.

Take Control of Your Care

Be in Control

 

At a recent program, a woman said her doctor is making her take medications that she doesn’t want to take.  Another patient said that she was kept in the hospital but she didn’t want to stay. 

Too often patients think they are being forced to do things by some implanted learning that they are not in control.

“If you don’t want to take your medications” I told her “don’t” but there may be consequences; from getting sicker, to losing your beloved doctor who also may say he doesn’t want to care for you if you won’t follow instructions.

After an hour long presentation, I would hope that participants understand that they are in control of their medical care.  Mistakes happen, clinicians may be wrong.  They need to know what’s on your mind.  Why won’t you take your medication?  Why do you want to leave the hospital against medical advice (AMA)?  These are things you should be able to talk to your health care team about.  If you can’t, you need to change who your team is.

One person said she couldn’t imagine going to see the hospital leadership with her complaints.  I asked her why she thought they were so untouchable.  “If you were unhappy at a hair salon or at a restaurant, if you would speak to the manager or owner, it should be no different”.  Complaining or constructive feedback are two different things.  Hospitals want your business.  They want you to tell all your friends how wonderful your surgery went.  If you are not happy, speak up.  If you’re in danger, move up….the ladder to the people in charge.

World Pharmacist Day

World Pharmacist Day - September 25

According to the International Pharmaceutical Federation (FIP), September 25 is World Pharmacists Day.  What a great opportunity  to remember that the pharmacist is your expert on medications - more than the physician, more than your friends and neighbors, it's the pharmacist who is there to answer your questions about medication mixtures, potential side effects and appropriate and proper measurement.

Here are some tips:

·         Use only one pharmacists so they know all your medications

 

·        Don't change the dose or stop medication without consulting with your clinician and even your pharmacist

 

·        You are encouraged to read all labels and inserts but, if you start coming down with new ailments such as an upset stomach, achy joints, headaches or irritability, before seeing a new doctor check with your pharmacist about potential side effects

 

·        After your clinician tells you about your medication, ask your pharmacist.  The pharmacist is more up to date on warnings and new medications

 

·        Your pharmacist can help you with a discussion with your clinician.  If a medication doesn’t seem to be working for you, ask your pharmacist what he / she recommends so you can talk to your doctor about it

 

·        Be sure your pharmacist has in your record all your allergies and any adverse reactions to medications

 

·        Don’t ever be embarrassed to ask questions about your medication.  Whether you are a waitress, hairstylist, postal worker or auto mechanic, we all have our knowledge and skills.  Not understanding when or how to take medication is not something to be ashamed of.  ASK!

 

·       Consider choosing someone you trust to be your DMM, Designated Medication Manager

Don’t forget to visit www.ismp.org for more information. The Institute for Safe Medication Practice (ISMP) is the nation's only nonprofit organization devoted entirely to medication error prevention and safe medication use. 

 

 

Running a Hospital

Running a Hospital

 

I met with leadership in a large hospital and we talked about the work I am doing with vulnerable populations who use the healthcare system, many his hospital.  When I told him that there are stories of medical professionals being less than sympathetic and kind to people with disabilities, transgender patients or young, unwed mothers he seemed surprised.  “Not all the stories are from your hospital”, I explained to him not wanting him to become defensive.  But I knew some of them were.

 

He told me that all of his staff are sensitive and caring to the patients that go to this hospital.

“All of them?” I questioned with my best startled voice without wanting to sound sarcastic.  He paused and said that maybe some physicians were tired after many surgeries but they were all caring. (I wasn’t even talking about physicians).

I then asked him if he visits patients at the bedside and he said he does.  This conversation wasn’t going to work.  It would become a back and forth with him defending his facility and the staff who works for him.  This is, to me, one of the biggest problems in healthcare.  Where medical errors can happen, where there can easily be a breakdown in communication, how readmissions can occur and patients and their families may not be satisfied but not sharing this information because it falls on deaf ears.

If it were my hospital I would be begging for details.  Tell me what you heard, I would be asking, or where can we improve? I would want to know.  Instead our short conversation was about how wonderful this hospital was.  It felt similar to a parent defending their child that everyone else knows is a bully.  I was not saying that this hospital wasn’t wonderful in many ways.  I started out our visit complimenting what I saw and things I have heard.  I understand that he wanted me to know how well they are doing in many areas.  But, I also know that I would have become a bigger fan the next time I got a complaint or call about someone’s safety if I knew that the leadership was ready to listen.

Joan Rivers, My 2 Cents

Joan Rivers, Death of a Legend

I rarely comment on specific cases of medical injury and this won’t be different.  There is usually more to the story than we will ever know and I don’t like to give energy to a situation that the professionals are already reviewing.  But, it wouldn’t be fair if I didn’t comment on the death of Joan Riversjust because I am such a big fan of hers, the press surrounding her death and the fact that her death came 2 weeks before our Comedy for a Cause, Patient Safety isn’t Funny But Laughter is Still the Best Medicine fund-raiser.  She could have been a headliner but patient safety is probably something her family has never even thought of.

Most people who have never lived through a tragedy such as this don’t realize that it is not the specifics of a case that matters, it’s that when someone goes in for medical treatment, they are supposed to get better or at least not worse.  Sure, all procedures are risky but for those of us who have lived it, this public attention of Joan Rivers rocks some of us to the core and trust must start all over again.