Read and Sign
The woman typing on the computer was speaking fast and friendly to the patient about his care and treatment he was to do at home. She then handed him a book and said “read this and sign here”. As I sat in the corner observing this exchange, I asked if the doctor was also going to sign this consent. “Yes” she said. “This just explains what the doctor already told him”.
I sat in the quiet of the room as the patient read and the medical assistant typed her information. ”You know” I said breaking the silence, “You never even confirmed that he can read.” She never looked up, she laughed and told me that if he can sign his name, he can read enough. “Besides” she said, “you’d never find a lawyer to take the case”.
I was shocked at the thinking of this young girl working in a prestigious doctor’s office. Not only was I surprised at her thinking but also how bold she was to share her lack of concern that this patient may not be able to read. She didn’t care if he could read what he was signing but then brought up a lawyer in this patient’s relationship with this physician and medical practice.
I let it go, I knew the patient could read but it was a reminder of how far we have to go.
Friday, July 30, 2010
Tuesday, July 27, 2010
Literacy at Camp?
Camp Literacy?
I just returned from a wonderful week away at a “religious” camp for families. As a Unitarian Universalist I know I live out the values daily in my work and family life, but wondered what it would be like to have fun with 200 other people with the same values. As a youth director for 2 years in my own congregation and knowing that this Pennsylvania camp called UUMAC needed a youth coordinator, I thought it was time I tried this long awaited “vacation” – working or not.
I purposely left my business cards and patient safety brochures at home. I was not going to talk about patient safety nor was I going to think about work for a week. In the weeks leading up to UUMAC, I found myself staying up late planning for the youths projects and getting lost in this new plan I had for myself.
Even before I arrived at UUMAC I was hearing terms I never heard before. I had to prepare for “vespers” which was the evening worship or “Night Owls” which I learned real fast about the all night partying that went on. “Show Case” was the end of the week entertainment when all the workshops put on a show of their work, songs, writing or just fun stuff about the people in the group.
When I realized that I didn’t know what some of these terms meant, or didn’t know what to do with them such as “bridging” where I knew that the teens were going to adulthood but didn’t know how it affected me, I asked questions. Some of the young people seemed to like to explain to me what it all meant. Others would sometimes shrug. It reminded me constantly about how we must all be willing to share information to grow.
The religion of Unitarian Universalism must often be explained so others will be interested and participate. But it kept reminding me about my work and the effort it takes for people who work in medical care to explain to their patients important, often life saving information.
Each time I asked a question, and received a thoughtful explanation, I didn’t feel the need to label myself. But yet the term health literacy has taken on a life of it’s own when it should be part of our regular communication between people. As I look back at the willingness of people to share information at a camp or in our daily life, I wonder why it becomes so complicated for this to happen in healthcare.
I just returned from a wonderful week away at a “religious” camp for families. As a Unitarian Universalist I know I live out the values daily in my work and family life, but wondered what it would be like to have fun with 200 other people with the same values. As a youth director for 2 years in my own congregation and knowing that this Pennsylvania camp called UUMAC needed a youth coordinator, I thought it was time I tried this long awaited “vacation” – working or not.
I purposely left my business cards and patient safety brochures at home. I was not going to talk about patient safety nor was I going to think about work for a week. In the weeks leading up to UUMAC, I found myself staying up late planning for the youths projects and getting lost in this new plan I had for myself.
Even before I arrived at UUMAC I was hearing terms I never heard before. I had to prepare for “vespers” which was the evening worship or “Night Owls” which I learned real fast about the all night partying that went on. “Show Case” was the end of the week entertainment when all the workshops put on a show of their work, songs, writing or just fun stuff about the people in the group.
When I realized that I didn’t know what some of these terms meant, or didn’t know what to do with them such as “bridging” where I knew that the teens were going to adulthood but didn’t know how it affected me, I asked questions. Some of the young people seemed to like to explain to me what it all meant. Others would sometimes shrug. It reminded me constantly about how we must all be willing to share information to grow.
The religion of Unitarian Universalism must often be explained so others will be interested and participate. But it kept reminding me about my work and the effort it takes for people who work in medical care to explain to their patients important, often life saving information.
Each time I asked a question, and received a thoughtful explanation, I didn’t feel the need to label myself. But yet the term health literacy has taken on a life of it’s own when it should be part of our regular communication between people. As I look back at the willingness of people to share information at a camp or in our daily life, I wonder why it becomes so complicated for this to happen in healthcare.
Wednesday, July 14, 2010
Nurses Aids or No Nurse Aids
No, Fainting is Not OK
I thought it was wonderful that at this hospital there were no nurse’s aids. Not because I don’t think nurses aids are a good thing, but because the registered nurse did everything for the patient and got to know the patient well. Better chance of good outcomes when less people are involved – or so I thought. The nurse is more responsible to her five patients because it is just her and her patient. She must tend to every detail and be more aware.
Accept what happens when one patient needs extra assistance. As in the case when a patient needs to stand up after being in bed for almost three full days? The nurse told us that she needed other nurses to help. One nurse will change the bedding while two other nurses will help her out of bed.
As we waited and waited, the three nurses finally came in. Now I’m realizing that as many as fourteen other patients don’t have any nursing available at all. Even if one of these nurses was a charge nurse, and was only there to help anyways, that still leaves nine patients (our nurse’s four other patients and the helping nurse’s five patients) with no nursing care.
As one nurse scrambled to make the bed – with my help, two other nurses helped the patient and then needed to spend time with her standing, cleaning getting acclimated to being out of bed. As time was ticking away, patient’s somewhere very possibly, weren’t getting their medications notes weren’t being written up and someone’s water may be empty. Patients very easily could have been neglected. Then, when the nurses went back to work, after about 15 minutes, I’m sure they now had much more to do.
If this happens for two patients a day, and since this patient had to get up another time later and walk, how much lost patient care time is there? It may add up to hours in a day.
I shouldn’t be surprised than that on two occasions, the patient under my watch fainted. Unfortunately, the second time was as she was preparing to go home. This caused additional blood work, testing and costs. It became apparent that the patient was probably just dehydrated and, after days on her back with only standing and walking slightly two times a day, she became lightheaded.
How could this have been missed by the overworked nurses? Very easily. Should I have done something differently? Absolutely! After the first time the patient fainted, the nurse’s reaction was that it can be expected. Because of the lack of mobility, the nurses explained she may feel faint. But I know the bed was tilted for awhile so the blood would not rush all at once. Fainting should have been taken more seriously by me, her advocate as well as the nurses the first time. I should have insisted someone check her for dehydration (although not being a medical professional I don’t need to know what the problem is, I do need to make sure the problem – and fainting is a problem, is addressed) Nurses should have informed the doctor and everyone should have said “no, fainting is not ok” but an aid may have been better able to pick this up and spend more time recognizing this. If this patient was hurt in the fall, at a cost to the hospital, I'm sure changes would be made.
I thought it was wonderful that at this hospital there were no nurse’s aids. Not because I don’t think nurses aids are a good thing, but because the registered nurse did everything for the patient and got to know the patient well. Better chance of good outcomes when less people are involved – or so I thought. The nurse is more responsible to her five patients because it is just her and her patient. She must tend to every detail and be more aware.
Accept what happens when one patient needs extra assistance. As in the case when a patient needs to stand up after being in bed for almost three full days? The nurse told us that she needed other nurses to help. One nurse will change the bedding while two other nurses will help her out of bed.
As we waited and waited, the three nurses finally came in. Now I’m realizing that as many as fourteen other patients don’t have any nursing available at all. Even if one of these nurses was a charge nurse, and was only there to help anyways, that still leaves nine patients (our nurse’s four other patients and the helping nurse’s five patients) with no nursing care.
As one nurse scrambled to make the bed – with my help, two other nurses helped the patient and then needed to spend time with her standing, cleaning getting acclimated to being out of bed. As time was ticking away, patient’s somewhere very possibly, weren’t getting their medications notes weren’t being written up and someone’s water may be empty. Patients very easily could have been neglected. Then, when the nurses went back to work, after about 15 minutes, I’m sure they now had much more to do.
If this happens for two patients a day, and since this patient had to get up another time later and walk, how much lost patient care time is there? It may add up to hours in a day.
I shouldn’t be surprised than that on two occasions, the patient under my watch fainted. Unfortunately, the second time was as she was preparing to go home. This caused additional blood work, testing and costs. It became apparent that the patient was probably just dehydrated and, after days on her back with only standing and walking slightly two times a day, she became lightheaded.
How could this have been missed by the overworked nurses? Very easily. Should I have done something differently? Absolutely! After the first time the patient fainted, the nurse’s reaction was that it can be expected. Because of the lack of mobility, the nurses explained she may feel faint. But I know the bed was tilted for awhile so the blood would not rush all at once. Fainting should have been taken more seriously by me, her advocate as well as the nurses the first time. I should have insisted someone check her for dehydration (although not being a medical professional I don’t need to know what the problem is, I do need to make sure the problem – and fainting is a problem, is addressed) Nurses should have informed the doctor and everyone should have said “no, fainting is not ok” but an aid may have been better able to pick this up and spend more time recognizing this. If this patient was hurt in the fall, at a cost to the hospital, I'm sure changes would be made.
Saturday, July 3, 2010
Still Problems at the Bedside
Pennsylvania Bedside Patient Safety
One thing for sure is that anyone who works in healthcare doesn’t want to be hospitalized in the month of July. That’s when the new residents start at teaching hospitals. The new, never before touched a patient residents with the title “Doctor” before their name.
I was relieved to learn that the patient I was going to spend a week with in a Pennsylvania hospital this week was not going to be a teaching hospital but instead, a small rural hospital where everyone in the hallway says “hello” and nurses know the patient because there are no nurse’s aids. Instead, registered nurses are there who help each other and each other’s patients.
This seems like a good thing and for comfort, it is. This patient has a private room and I was given a recliner to sleep on and access to linens for me and the patient as well as the microwave and refrigerator for my comfort.
But, what does this say about safety? Nothing. Comfort and friendliness has nothing to do with safety, accept it made me, as the patient’s “friend” more comfortable speaking up about my discomfort.
Some of the things I noticed, and questioned were; The nurses never check arm bands because they only have 5 patients. They must have felt that they know their patients. When I asked about this practice they told me they always check, I never saw them check.
I had to ask the nurses, each shift to be sure that the medications are brought to the patient in the original wrappers. When I asked the nurse when I arrived how medication was distributed, and she told me she empty’s the pills into a cup at her nurse’s station, I thought I had entered a time machine – backwards. She agreed to bring the medications in their original wrappers in the future but this request had to be repeated each shift.
To have a cup of pills with no labels is not only dangerous for the patient, but for the nurse distributing them.
There is no comfort in seeing patient safety problems happen when sitting at a patient’s bedside. Knowing that qualified and caring nurses are still taking chances with a patient’s life, I have to wonder what kind of training they are getting in patient safety.
One thing for sure is that anyone who works in healthcare doesn’t want to be hospitalized in the month of July. That’s when the new residents start at teaching hospitals. The new, never before touched a patient residents with the title “Doctor” before their name.
I was relieved to learn that the patient I was going to spend a week with in a Pennsylvania hospital this week was not going to be a teaching hospital but instead, a small rural hospital where everyone in the hallway says “hello” and nurses know the patient because there are no nurse’s aids. Instead, registered nurses are there who help each other and each other’s patients.
This seems like a good thing and for comfort, it is. This patient has a private room and I was given a recliner to sleep on and access to linens for me and the patient as well as the microwave and refrigerator for my comfort.
But, what does this say about safety? Nothing. Comfort and friendliness has nothing to do with safety, accept it made me, as the patient’s “friend” more comfortable speaking up about my discomfort.
Some of the things I noticed, and questioned were; The nurses never check arm bands because they only have 5 patients. They must have felt that they know their patients. When I asked about this practice they told me they always check, I never saw them check.
I had to ask the nurses, each shift to be sure that the medications are brought to the patient in the original wrappers. When I asked the nurse when I arrived how medication was distributed, and she told me she empty’s the pills into a cup at her nurse’s station, I thought I had entered a time machine – backwards. She agreed to bring the medications in their original wrappers in the future but this request had to be repeated each shift.
To have a cup of pills with no labels is not only dangerous for the patient, but for the nurse distributing them.
There is no comfort in seeing patient safety problems happen when sitting at a patient’s bedside. Knowing that qualified and caring nurses are still taking chances with a patient’s life, I have to wonder what kind of training they are getting in patient safety.
Friday, June 25, 2010
Leadership & Body Language
Leadership Choices
I met with a physician administrator at a hospital recently. I know him primarily through my work in patient safety. I have learned over the years it becomes easy to notice physicians or administrators who are serious about patient safety and /or patient centered care.
The first thing he did was pull his chair away from his desk. The desk often acts as a barrier. He wanted to show me that there were no barriers and that we were “equal” when I came into his office. I have always admired this man for who he is, and now I was able to admire him for what he does.
He never looked at his watch. This almost became distracting to me as I started to wonder how long I was there and why he never looked at his watch. I started to wonder if there was a hidden clock behind my head and later learned there wasn’t. When I felt the meeting was over and left, I learned it was just about an hour. I would have never known that it was time to leave from him.
Finally, when his phone rang, he never flinched. He never looked at it ringing, never made a move to answer it. I was the only thing that mattered.
These behaviors are not instincts we are born with. When a phone rings it is an automatic move to answer it. These are learned traits that make someone special and serious about his or her work in patient centered care. It makes me realize that, as guests in the corporate world whether hospitals, doctors offices or another, we should expect nothing less .
I met with a physician administrator at a hospital recently. I know him primarily through my work in patient safety. I have learned over the years it becomes easy to notice physicians or administrators who are serious about patient safety and /or patient centered care.
The first thing he did was pull his chair away from his desk. The desk often acts as a barrier. He wanted to show me that there were no barriers and that we were “equal” when I came into his office. I have always admired this man for who he is, and now I was able to admire him for what he does.
He never looked at his watch. This almost became distracting to me as I started to wonder how long I was there and why he never looked at his watch. I started to wonder if there was a hidden clock behind my head and later learned there wasn’t. When I felt the meeting was over and left, I learned it was just about an hour. I would have never known that it was time to leave from him.
Finally, when his phone rang, he never flinched. He never looked at it ringing, never made a move to answer it. I was the only thing that mattered.
These behaviors are not instincts we are born with. When a phone rings it is an automatic move to answer it. These are learned traits that make someone special and serious about his or her work in patient centered care. It makes me realize that, as guests in the corporate world whether hospitals, doctors offices or another, we should expect nothing less .
Tuesday, June 15, 2010
Advocacy
Patient Advocacy Training
As I prepare to spend a week at an out of state hospital with a friend who is going for surgery, I reflect on all I have learned about patient safety and what I can do to be sure she is safe and receiving the best quality of care. Sadly, I recognize that her fate is ultimately in the hands of the professionals who will be treating her.
There are many things I can do for her comfort, the things I teach patient’s families to do. As a professional, things I would rarely do, as a friend, things I look forward to doing.
Making sure the patient is comfortable but also, spending the time to disinfect anything that is touched. The door knobs, TV remote and side rails to the bed. These things may be cleaned before a new patient comes in but also need to be done often while the patient is there. Especially, when there is surgery and wound care. Being sure the patient understands treatment, after care has all her questions answered. I will be keeping lists, lots of lists. She will only have to think about getting well.
Each time I do this it is a learning experience. There is no school for teaching patient advocacy as much as there is for living it. When I teach it next time, I will be using experiences I have from this trip, I’m sure. Positives and negatives that will become part of my next lesson.
I am deeply honored to be part of this experience. I am a lucky person.
As I prepare to spend a week at an out of state hospital with a friend who is going for surgery, I reflect on all I have learned about patient safety and what I can do to be sure she is safe and receiving the best quality of care. Sadly, I recognize that her fate is ultimately in the hands of the professionals who will be treating her.
There are many things I can do for her comfort, the things I teach patient’s families to do. As a professional, things I would rarely do, as a friend, things I look forward to doing.
Making sure the patient is comfortable but also, spending the time to disinfect anything that is touched. The door knobs, TV remote and side rails to the bed. These things may be cleaned before a new patient comes in but also need to be done often while the patient is there. Especially, when there is surgery and wound care. Being sure the patient understands treatment, after care has all her questions answered. I will be keeping lists, lots of lists. She will only have to think about getting well.
Each time I do this it is a learning experience. There is no school for teaching patient advocacy as much as there is for living it. When I teach it next time, I will be using experiences I have from this trip, I’m sure. Positives and negatives that will become part of my next lesson.
I am deeply honored to be part of this experience. I am a lucky person.
Thursday, May 27, 2010
Conversation About the Diagnosis
The Dreaded Diagnosis
I sat with the mother and her son when the doctor was about to give his diagnosis following a series of tests. The young adult child’s physical appearance and need for help with small tasks like caring for himself, cutting his food and even walking were becoming more and more apparent. A series of tests and doctor visits became a tradition for this mom and her oldest son.
She requested I attend the follow up visit with the neurologist to be an extra set of ears. I planned to take notes and help think of questions during the conversation and following it. None of us had any warning to what the doctor might say.
He listed many possibilities including Lupus and Multiple Sclerosis. I was quit taken back now picturing a person in a wheelchair or with a walker. I looked at the mothers face for an expression – there was none.
The doctor allowed for time to ask questions, take notes and while the mom had her conversation, I wrote down my questions. I didn’t want to interrupt her train of thought. I was, after all their guest. As the mom searched for words, I wondered to myself how someone is supposed to come prepared with questions after this diagnosis. One can’t prepare themselves.
As the mom searched for time and was thinking of more questions, I asked “may I ask some of my questions now?” She agreed to allow me to ask my list of questions and that gave her time to clear her mind and capture more time with the doctor. When I was done asking, she once again had her list of questions. The first sign that she was ready to resume her conversation, I stopped talking.
She needed to plan for additional tests and follow up appointments. After that there would be additional opportunities to meet with the doctor and do some more planning..
Being alone in the doctors office, especially when you might hear bad news, is never a good idea. But, knowing who the helper might be is just as important.
I sat with the mother and her son when the doctor was about to give his diagnosis following a series of tests. The young adult child’s physical appearance and need for help with small tasks like caring for himself, cutting his food and even walking were becoming more and more apparent. A series of tests and doctor visits became a tradition for this mom and her oldest son.
She requested I attend the follow up visit with the neurologist to be an extra set of ears. I planned to take notes and help think of questions during the conversation and following it. None of us had any warning to what the doctor might say.
He listed many possibilities including Lupus and Multiple Sclerosis. I was quit taken back now picturing a person in a wheelchair or with a walker. I looked at the mothers face for an expression – there was none.
The doctor allowed for time to ask questions, take notes and while the mom had her conversation, I wrote down my questions. I didn’t want to interrupt her train of thought. I was, after all their guest. As the mom searched for words, I wondered to myself how someone is supposed to come prepared with questions after this diagnosis. One can’t prepare themselves.
As the mom searched for time and was thinking of more questions, I asked “may I ask some of my questions now?” She agreed to allow me to ask my list of questions and that gave her time to clear her mind and capture more time with the doctor. When I was done asking, she once again had her list of questions. The first sign that she was ready to resume her conversation, I stopped talking.
She needed to plan for additional tests and follow up appointments. After that there would be additional opportunities to meet with the doctor and do some more planning..
Being alone in the doctors office, especially when you might hear bad news, is never a good idea. But, knowing who the helper might be is just as important.
Thursday, May 20, 2010
The Symphony and Leadership
Learning Leadership Through Music
What can a symphony orchestra teach us about leadership? Plenty, as I learned this week at the NPSF 12th Annual Congress in Orlando Florida. Over 700 attendees sat in the magnificent ballroom amongst many of the instruments to take part in this plenary session ready to kick off this meeting full of patient safety leaders.
As Conductor Roger Nierenberg led the orchestra, The Music Paradigm, through some magical sounds the audience of medical professionals, hospital administrators, patients and families sat amongst many of the players as the symphony shot music through our very soul. There to learn about patient’s safety, as a recent (just 2 days) graduate of the American Hospital Association, National Patient Safety Foundation Patient Safety Leadership Fellowship, I wondered if we were going to learn more, or just be part of this magnificent sound.
Abruptly, the music stopped. As the conductor, wearing a tuxedo with a white bow tie asked us all to choose a member of his orchestra to watch. Watch how they move, see where their eyes go and just pay attention to one. The music started again and I watched one of the violinists.
As the conductor called on audience members, they shared comments like the intensity of some members of the orchestra. As the 90 minutes like this went on, I saw how this was a powerful lesson in leadership, motivation, encouragement, observation and planning.
“Notice the skill of their hands, their movement” he told us. “but still it is one voice”. Teamwork and coordination is what makes this sound as spectacular as it was. As he encouraged members of his orchestra to play their own way, we were listening for how it sounded when each of them got caught up in his or her own “expertise” instead of participating as part of the team.
The conductor asked one musician on the trumpet to play a piece of music. The sound was only one note. “imagine studying music for thirty years” he said “and that’s what you have to do?” The audience laughed, a nervous moment as we all recognized ourselves as often feeling underutilized but still we must keep the spirit. No one here can separate from the team.
He brought some audience members on to the stage so they could hear the sound differently. They could see the whole orchestra as they were scattered throughout the audience. Another time he brought a physician up and held her hand while she conducted. Allowing him to gracefully move her arm, she explained later that she was there only to support. The best leaders are often there only be a supporting role.
Leaders are dedicated. There are many dedicated people who can stand out and lead. Then there are those who are part of the team who will do as little as possible without getting caught. He asked one of each of the instruments to play their best. The rest he suggested would get sloppy. Be lazy but look like you are working hard, he told them. As the cameras scanned the orchestra I could see some were not working as hard. The music still sounded fabulous. He knew the music sounded good. He explained that the goof offs get hidden in the crowd. “dysfunction hides while the best carry it for the others”. It just makes the hard workers work harder.
What can a symphony orchestra teach us about leadership? Plenty, as I learned this week at the NPSF 12th Annual Congress in Orlando Florida. Over 700 attendees sat in the magnificent ballroom amongst many of the instruments to take part in this plenary session ready to kick off this meeting full of patient safety leaders.
As Conductor Roger Nierenberg led the orchestra, The Music Paradigm, through some magical sounds the audience of medical professionals, hospital administrators, patients and families sat amongst many of the players as the symphony shot music through our very soul. There to learn about patient’s safety, as a recent (just 2 days) graduate of the American Hospital Association, National Patient Safety Foundation Patient Safety Leadership Fellowship, I wondered if we were going to learn more, or just be part of this magnificent sound.
Abruptly, the music stopped. As the conductor, wearing a tuxedo with a white bow tie asked us all to choose a member of his orchestra to watch. Watch how they move, see where their eyes go and just pay attention to one. The music started again and I watched one of the violinists.
As the conductor called on audience members, they shared comments like the intensity of some members of the orchestra. As the 90 minutes like this went on, I saw how this was a powerful lesson in leadership, motivation, encouragement, observation and planning.
“Notice the skill of their hands, their movement” he told us. “but still it is one voice”. Teamwork and coordination is what makes this sound as spectacular as it was. As he encouraged members of his orchestra to play their own way, we were listening for how it sounded when each of them got caught up in his or her own “expertise” instead of participating as part of the team.
The conductor asked one musician on the trumpet to play a piece of music. The sound was only one note. “imagine studying music for thirty years” he said “and that’s what you have to do?” The audience laughed, a nervous moment as we all recognized ourselves as often feeling underutilized but still we must keep the spirit. No one here can separate from the team.
He brought some audience members on to the stage so they could hear the sound differently. They could see the whole orchestra as they were scattered throughout the audience. Another time he brought a physician up and held her hand while she conducted. Allowing him to gracefully move her arm, she explained later that she was there only to support. The best leaders are often there only be a supporting role.
Leaders are dedicated. There are many dedicated people who can stand out and lead. Then there are those who are part of the team who will do as little as possible without getting caught. He asked one of each of the instruments to play their best. The rest he suggested would get sloppy. Be lazy but look like you are working hard, he told them. As the cameras scanned the orchestra I could see some were not working as hard. The music still sounded fabulous. He knew the music sounded good. He explained that the goof offs get hidden in the crowd. “dysfunction hides while the best carry it for the others”. It just makes the hard workers work harder.
Thursday, May 13, 2010
The Infectious Disease Doctor
The First Sign of Infection
I gave a presentation yesterday to a group of caregivers for mentally and intellectually challenged children and adults. The presentation was our Family Centered Patient Advocacy Training recognizing that these caregivers, who almost all were social workers, are often the support and / or advocate for the entire family. When they bring a client to the hospital, their skills are perfect for the patient’s needs but what about helping the hospital staff understand their needs and the patient’s safety?
When we discussed the part about infection, I explained that if there is any sign of infection or possible infection, that they need to insist on seeing an infectious disease doctor. Pharmacists, I explained specialize in medication and many doctors have their specialty but an infectious disease doctor specializes in infections.
A nurse in the audience, who was obviously in the business a long time commented. “Infectious disease doctors are always called in if there is an infection” she told us. She explained that it is the policy of hospitals to do that. I reminded her that if policies and procedures were always followed, I wouldn’t be there talking about errors and how to help prevent them. She continued expressing her concern that I may be poisoning the audience (my words not her) with what I was teaching.
Just earlier, a young woman asked how she can find out who the doctor in charge is when her family member was hospitalized. “I kept asking who was in charge and the group of doctors said they are all in charge working together”. I explained that this was probably the resident physicians protecting the attending physician from allowing you to get to him or her. There is an unspoken rule in healthcare that the residents should handle the problems and questions.
Thankfully, a woman with me, who is part of our Patient Safety Advisory Council, just saw last week the movie about Lewis Blackman who died because of just that reason. Lewis’ mother tried to get the attending physician to look at her son who was declining fast but instead, the new, young doctors, with less experience allowed Lewis to slip away until it was too late. I told the group about the movie and assured her that there is always someone in charge. If one person won’t take responsibility, keep going until you end up in the CEO’s office.
Back to the nurse; I let her know that some hospital staff, maybe the residents trying to protect the valuable time of the infectious disease doctor, may try to handle the problem themselves. With all good intentions, the residents may unknowingly be causing more harm by not getting the “experts” in fast. She was not satisfied and explained further, “Almost always the infectious disease doctor is called in”.
“That almost” I told her, “is why I am here”.
A woman on the other side of the room added to the conversation. Her father went in to the hospital last November for hernia repair, got an infection with all the symptoms, but it took a week to call in the infectious disease doctor. Her father died a short time later.
I rest my case.
I gave a presentation yesterday to a group of caregivers for mentally and intellectually challenged children and adults. The presentation was our Family Centered Patient Advocacy Training recognizing that these caregivers, who almost all were social workers, are often the support and / or advocate for the entire family. When they bring a client to the hospital, their skills are perfect for the patient’s needs but what about helping the hospital staff understand their needs and the patient’s safety?
When we discussed the part about infection, I explained that if there is any sign of infection or possible infection, that they need to insist on seeing an infectious disease doctor. Pharmacists, I explained specialize in medication and many doctors have their specialty but an infectious disease doctor specializes in infections.
A nurse in the audience, who was obviously in the business a long time commented. “Infectious disease doctors are always called in if there is an infection” she told us. She explained that it is the policy of hospitals to do that. I reminded her that if policies and procedures were always followed, I wouldn’t be there talking about errors and how to help prevent them. She continued expressing her concern that I may be poisoning the audience (my words not her) with what I was teaching.
Just earlier, a young woman asked how she can find out who the doctor in charge is when her family member was hospitalized. “I kept asking who was in charge and the group of doctors said they are all in charge working together”. I explained that this was probably the resident physicians protecting the attending physician from allowing you to get to him or her. There is an unspoken rule in healthcare that the residents should handle the problems and questions.
Thankfully, a woman with me, who is part of our Patient Safety Advisory Council, just saw last week the movie about Lewis Blackman who died because of just that reason. Lewis’ mother tried to get the attending physician to look at her son who was declining fast but instead, the new, young doctors, with less experience allowed Lewis to slip away until it was too late. I told the group about the movie and assured her that there is always someone in charge. If one person won’t take responsibility, keep going until you end up in the CEO’s office.
Back to the nurse; I let her know that some hospital staff, maybe the residents trying to protect the valuable time of the infectious disease doctor, may try to handle the problem themselves. With all good intentions, the residents may unknowingly be causing more harm by not getting the “experts” in fast. She was not satisfied and explained further, “Almost always the infectious disease doctor is called in”.
“That almost” I told her, “is why I am here”.
A woman on the other side of the room added to the conversation. Her father went in to the hospital last November for hernia repair, got an infection with all the symptoms, but it took a week to call in the infectious disease doctor. Her father died a short time later.
I rest my case.
Thursday, April 29, 2010
Hand Wahing and Patient Safety
Oh No, Another Hand Washing Story.......
Well, I'm pretty sure offended another medical professional. I hate when that happens. I am generally a nice person and would never purposely hurt someone’s feelings – even if I didn’t like them. But when this nurse came through like a whirlwind and took the patient’s temperature I couldn’t stop her.
When she reached for the tools to do a throat culture, I jumped into action……..
“Excuse me, you will wash your hands first right”? Saying anything else, delaying the words “wash your hands”, and she would have torn through the huge q-tip wrapper to be used for a throat culture and, as far as I’m concerned, possibly contaminate it.
“I washed before I came into the room”.
“You touched the pen and the clip board. I’m sure they weren’t washed”. I felt the tension rising and saw her body tighten as she put down the still wrapped tools.
As she walked over to use the antibacterial lotion, she told me in a tense voice “I’ve worked in the emergency room for 30 years and never got anyone sick and never got sick”.
I wanted to say she didn’t know that but realized she was defending her action of not washing - so I let it go.
“I’m sorry if I offended you” I told her.
She said she wasn’t offended. "It takes a lot to offend me".
She has been doing this a long time. Still, I could tell that she was upset.
When she completed her task, and left the room I got a “high five” from my young buddy that turned out to have a pretty bad infection which ended him up in this after hour’s clinic.
When the doctor arrived to do the complete exam, I told her “Before you even start, I am going to ask you to wash your hands before you examine him, even though I’m sure you did.” She looked at me oddly. “But” I went on “ I think I offended your nurse so I am giving you advance warning”. The doctor walked over to the sink and scrubbed up – no offense taken.
Well, I'm pretty sure offended another medical professional. I hate when that happens. I am generally a nice person and would never purposely hurt someone’s feelings – even if I didn’t like them. But when this nurse came through like a whirlwind and took the patient’s temperature I couldn’t stop her.
When she reached for the tools to do a throat culture, I jumped into action……..
“Excuse me, you will wash your hands first right”? Saying anything else, delaying the words “wash your hands”, and she would have torn through the huge q-tip wrapper to be used for a throat culture and, as far as I’m concerned, possibly contaminate it.
“I washed before I came into the room”.
“You touched the pen and the clip board. I’m sure they weren’t washed”. I felt the tension rising and saw her body tighten as she put down the still wrapped tools.
As she walked over to use the antibacterial lotion, she told me in a tense voice “I’ve worked in the emergency room for 30 years and never got anyone sick and never got sick”.
I wanted to say she didn’t know that but realized she was defending her action of not washing - so I let it go.
“I’m sorry if I offended you” I told her.
She said she wasn’t offended. "It takes a lot to offend me".
She has been doing this a long time. Still, I could tell that she was upset.
When she completed her task, and left the room I got a “high five” from my young buddy that turned out to have a pretty bad infection which ended him up in this after hour’s clinic.
When the doctor arrived to do the complete exam, I told her “Before you even start, I am going to ask you to wash your hands before you examine him, even though I’m sure you did.” She looked at me oddly. “But” I went on “ I think I offended your nurse so I am giving you advance warning”. The doctor walked over to the sink and scrubbed up – no offense taken.
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