Another Task Force

Is it a Task Force We Need?

A 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

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

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.

Planning for Home Care x

Listening to Her Words

When I answered the phone I could hear the panic and desperation in the woman’s voice.  I have met her at programs PULSE has hosted and knew that she is highly educated and by my standards very bright.  What could she possibly be so frantic about?

Her husband was hospitalized and coming home needing home care services.  Now she needs surgery and will be off her foot for a few weeks.  How will she care for her elderly husband?  Her concerns were reasonable but who can she share this panic with that she felt was unreasonable?

This woman, who has always been in control was feeling out of control.  A very reasonable feeling when already scared for her husband and now herself.  She didn’t want to hear the words “don’t worry” which is the reaction of most people.  She didn’t know it, I did, that she wanted to know how to get back in control.  That’s what we did.  I was surprised to learn she already had a home care agency picked out to help around the house for herself and her husband.  So what was I there for?

By allowing her to talk, prompting her with questions, I learned the representative of the home care agency was coming to visit.  By listening, I learned she was not prepared for that interview.  Together we thought of questions and what her, and her husband’s needs might be.  Interviewing the people from the home care agency as well as having a stranger in her home caring for her husband what was causing anxiety.  Helping her control this situation, unrelated to her surgery or her husband’s illness is what helped her through.

We can’t assume that we know what is upsetting someone.  Believing it was her concern about surgery or her sick husband would have wasted valuable time and would have steered her into a direction she didn’t need to go.

With her list of questions ready for the person from the home care agency, and her requests for how they should behave in her home, she now felt better and back in control. 

Patient Safety: An Endless Journey, sponsored by King Faisal Specialist Hospital &Research Centre, Saudi Arabia

My Trip to Saudi Arabia

It was a long, but uneventful trip traveling over 6,000 miles each way to Saudi Arabia.  I was invited to speak at the first International Quality & Patient Safety

Conference held in Jeddah.  Titled   Patient Safety: An Endless Journey which was sponsored by King Faisal Specialist Hospital &Research Centre.  The planning for this trip took months.

The planned attendance was about 350 but the crowds at registration on the first morning meant that they were unprepared for the last minute request for entry.  This was a medical community hungry for knowledge and information about keeping patients safe. 

The speakers, over 30 in all were from the US as well as the Middle East.  Topics included the role of the pharmacist, medical student education, employee engagement and the accreditation process.  My role was to include the patient and family in patient safety.

I was not only there to educate, but felt I learned a tremendous amount.  After my presentation I was flocked by women who wanted to know more and were willing to share with me their stories and their culture.  I was able to learn what are some of the things we, in America might take for granted and not understand.

I was sure to explain to my hosts that some of my content might not be what they, in their culture support or believe.  I was not there to give my opinion or try to change theirs.  But the work we do at PULSE with young, unmarried mothers, or the transgender community are ways to learn about communication and honesty.  Were their patients afraid to disclose information, they may not get accurate information from their patients.  

I had another chance to share why I do patient safety work and share my journey.  This seemed to touch the women.  One woman stood up after my presentation and said “This was the best presentation I have EVER heard in my life”.  Her, and a group of women came over after and asked me to pose for photos.  (Far from my area of comfort) They took out their cameras and started doing “selfies” with me.

In this culture, it is expected that children will take care of their elderly family.  They won’t be put into nursing homes.  This opens an important role in advocacy and communication.  Men must sign the consent for a wife to have a hysterectomy a c-section or any fertility treatment.  It is also not unusual for family to receive medical diagnosis before the patient does so they can break the news to their loved one.  Although this was just some of what was shared with me, I understand that there is clarity needed in these examples.  It’s not all that simple. 

In the American “culture” men can’t have 4 wives and women can drive for themselves and wear what they want.  In the Saudi culture woman can get married young and family arranges the marriage.  People may not agree with the way others live but that is an important part of respecting each other.  This is important in health care and treating patients.  It’s another step in the conversation.  I feel honored to have been a part of this first step and introducing the work of PULSE to this new community. 

Medical Care and the LGBT Community - L.G.B...............T.

Medical Care and the LGBT Community

Hospitals and medical staff are beginning to understand the importance of certain special concerns in treating the LGBT community. This group has special needs and sensitivity issues that may need to be addressed.

In fact, I believe that it is a serious mistake to group together the lesbian, gay and bisexual community with the transgender community – specifically transsexual. No, I am not transgender and I don’t even have family who are (not that I am aware of) but I study this topic, talk to people who are, and have been at the bedside as a patient safety advocate for people who are transgender.

The medical needs of the transgender community, in my non-medical opinion, are very different from those of the LGB community. Who you love — as in being L, G or B — is different from who you are. Just as important, is how transgender people see themselves. A lesbian may be very accepting of her body and may not cringe at the thought of exposing it. 

A transgender person, on the other hand, may have been ashamed their entire life of their body parts. Taking testosterone or hormones may have changed a transgender person’s body dramatically but without surgery; this can be surprising and confusing to healthcare workers who have not been taught about transsexuals and the stages in their transitions.

A woman who needs a prostate exam, or a pregnant man, should not be cause for alarm or even curiosity. This is not part of the lesbian and gay society. Many transgender people started off as gay or lesbian and some have become gay or lesbian. But that’s not always the case: as one friend explained to me, he is just a straight man now – almost.

Ilene Corina is the President of PULSE of NY, a community based patient safety organization and a patient safety consultant. She received a scholarship with the NPSF / AHA Patient Safety Leadership training where she studies patient safety in diverse populations on Long Island. One group she has worked with is the transgender community.

Join me and bring a friend!

Disruptive Behavior

Disruptive Behavior Can Change Outcomes

 

“Disruptive behavior” in healthcare is a fairly new term to explain medical professionals who may otherwise be called rude, arrogant and not easy to get along with. An article in USAToday describes disruptive doctors as a patient safety risk.  For many reasons they are a patient safety risk including that others won’t stand up to someone who is intimidating and probably bringing in money for the hospital or practice.

Arrogance, bullying and disruptive behavior is not only in the operating room.  It can be seen in meetings and in the board room. 

A few years ago, I was at a meeting with a number of high level medical professionals.  All who seemed to get a long and respect one another.  When one physician told a story of her caring for a patient and how the outcome affected her and can be important for others to learn from, another well respected physician, who didn’t agree that that experience should be counted as a “measurement” began to raise his voice and become argumentative and explain that she was wrong.  This physician was louder and much more aggressive to get his point across.  His comfort with his own behavior made me realize that this is not new.  I intervened and shared my displeasure.  When it was all over, the physician chairing the committee announced to the group of about 30 people, including the newcomers that it is wonderful that we can all share our thoughts and ideas in a conversation and still get along and be respectful.

I followed up in a letter to the leadership of this group, some who are deeply involved in “disruptive behavior” that this behavior was not respectful nor a conversation.  The physician who was telling her story was “attacked” (she admitted that to me).  Her colleague was rude, aggressive and being “disruptive”.  My letter was taken seriously and acted upon.

It is important that we, as patients are not afraid to speak up.  We MUST acknowledge that there are improvements being worked on in patient safety and improving the patient experience but it may never leave the c-suite.  If the information doesn’t get to the bedside, it is up to us, the patients and advocates working in patient safety to make sure patients and families feel supported when speaking up. 

If you feel disrespected by a sales person, auto mechanic or customer service representative, you have a choice to not return and give them your business.  The same holds true for medical professionals.  We can't live in a world thinking that we must tolerate behavior that makes us uncomfortable.  If they treat us, the patient that way, its probably affecting their work and their relationship with their team.

 

Rating Doctors

North Shore-LIJ Health System Raises the Bar Once Again

North Shore-LIJ Health System is now posting ratings from patients on-line to help choose a physician. 

Now patients who use doctors affiliated with North Shore LIJ Health System can expect that their concerns - and compliments will be used as a tool to hold physicians accountable for patient relations.   How many times have you felt that your physician didn’t spend enough time with you to explain a new medication, a procedure or a diagnosis? This dialogue and communication between patient and physician is crucial to help in getting the best care possible and better outcomes.

The site is simple enough to use.  Go to the system website, type in doctor search and you can start narrowing down your search.  In one instance I went from 374 choices and by choosing my insurance narrowed it down further to 236 and then by hospital – if you have a favorite hospital, narrowed it down to 79 physicians practicing in the field I searched.

Although in the time I spent searching, I couldn’t find any negative comments.  That leaves me to wonder where they are.  Are people just leaving a practice and moving on without filling out the survey?  This is a great opportunity for patients to help patients by getting the information out and for holding the physician responsible for their “patient relations”.

I would like to see it go one step further and let us know how the office staff treated us.  So often we have more interaction with the staff managing the practice.  That should be encouraged in comments.  Although this is not a guarantee for positive outcomes – there is never a guarantee, it is yet another tool for patients to be part of the team in making choices.   

Here is something else family and friends can do to help a loved one recently diagnosed or searching for a doctor.  Do the search. 

Watch a video explaining Rating Doctors

Peggy Lillis Foundation

Preventing C-Diff in Loving Memory

I had a very educational and eye opening experience being in the room with passionate advocates at the recent PeggyLillis Foundation symposium and training on C-Diff awareness and prevention.

This amazing group of people were there for one reason – learn about - and prevent the spread of c-diff.

These are the people who are hands on, loved ones and survivors of this awful, preventable infection.  According to the Centers for Disease Control Clostridium difficile was estimated to cause almost half a million infections in the United States in 2011, and 29,000 died within 30 days of the initial diagnosis.

There were an estimated 722,000 hospital acquiredinfections (HAI) in U.S acute care hospitals in 2011. About 75,000 hospital patients with HAIs died during their hospitalizations. More than half of all HAIs occurred outside of the intensive care unit.

According to the Mayo Clinic, C. difficile spreads mainly on hands from person to person, but also on cart handles, bedrails, bedside tables, toilets, sinks, stethoscopes, thermometers — even telephones and remote controls.  Illness from C. difficile most commonly affects older adults in hospitals or in long-term care facilities and typically occurs after use of antibiotic medications. However, studies show increasing rates of C. difficile infection among people traditionally not considered high risk, such as younger and healthy individuals without a history of antibiotic use or exposure to health care facilities.

Christian Lillis and Ilene Corina

At some point you may want to throw your hands up and give up telling healthcare professionals to wash.  What kind of disservice would we be doing for the public, for those people who shared their story at this conference, for the next generation of our children? 

Can we even for a second say that Peggy Lillis’ death didn’t matter?  It did, her beloved sons have made it their mission to educate and advocate and make their mothers life matter.   She must have been amazing to raise her children to do such great work. We owe it to her and to the people we love.  Next time you are with someone at the hospital in the emergency room or at the bedside you can say– “DO YOU KNOW PEGGY LILLIS WHO DIED FROM C-DIFF?  I DO!  NOW DON’T TOUCH MY LOVED ONE UNTIL I SEE YOU WASH!” 

Read Peggy's story here  http://peggyfoundation.org/story/peggy-lillis/