A hospital can be extremely frightening and overwhelming.
Hospitals generally are loud, cold, and sterile mazes of chaos. Unfortunately medical errors happen and it’s estimated that nearly 100,000 people die of medical errors each year.
As a registered nurse on the front lines of the health care, I understand how important it is for patients and their families to take charge and be an advocate for their health.
In my role as an administrative head nurse, I always encourage patients and family members to be proactive in their health care. I am passionate about encouraging patients to be proactive and kudos to CNN, and Consumer Reports for recently addressing the issue of patient safety; andThe Wall Street Journal for recently addressing the issue of parents being active to ensure their child’s safety in hospitals.
I’ve written on this topic before, I have been quoted in national magazines, talked about it on web/TV and I’ll continue to speak out regarding this critical topic.
While hospital safety may seem daunting, the good news is that you can be an empowered patient and help eliminate medical mistakes.
My top tips to keep you safe in a hospital
Carry your medication list and personal medical history form with you
During your admission assessment, whether you were brought to the ER or directly admitted to the hospital, you will be asked multiple times by multiple staff for a list of your medications, past hospitalizations, if you have any allergies and emergency contact numbers. Carry this personal medical history and medication form in your wallet at all times; in case of an emergency or for a scheduled hospital visit; you’ll be prepared.
Believe you are empowered: Give yourself permission to be in charge, an engaged patient
Unless you know how to be assertive and believe that you are an empowered patient all the tips in the world won’t help. Treat your doctors and nurses as partners in your health care team.
Communicate in a non-threatening manner
Communication between patients and health care professionals are critical for positive patient outcomes. Communication is imperative for patient safety and good quality patient care. In a hospital, which is a very fast-paced environment, where seconds can mean the difference between life and death, it’s crucial that communication flows consistently and thoroughly between patients, their families and staff. Speaking up and communicating needs to be continuous.
The Joint Commission, otherwise known as JCAHO, launched a national campaign in 2002 to urge patients to become active in their health care to help prevent errors. Speak Up™ encourages patients to:
Speak up if you have questions or concerns, and if you don’t understand, ask again…
Any breakdown in communication can result in a breakdown of quality patient care, and the results can be devastating. If you don’t understand something, ask for clarification. If you need assistance, ask!
If you find that communication between you and your doctor or nurse is not flowing, and your questions are not being answered, or if you do not feel your needs are met, you ask to speak to the nurse manager. (On evenings, nights, weekends and holidays, it may be the administrative head nurse, assistant director of nursing or nursing supervisor who will help you address any issues.)
Germs are lurking throughout the hospital
Don’t assume that your doctor, nurse or anyone else that comes in contact with you just washed their hands. It’s okay to ask them if they’ve just washed their hands. After all hand washing is the single most effective way to stop the spread of infections.
Make sure your visitors wash their hands. Washing your hands for 30 seconds with warm soapy water will do the trick. If a sink isn’t nearby, alcohol based hand sanitizers work great. In fact, some hospitals even make hand dispensers available not only by each patient’s room door, but inside each room.
Make sure you ask anyone that comes in contact with you if they have clean hands. It’s okay to ask them if they’ve washed their hands. It’s not rude, you’re not being obsessive–you are keeping yourself safe and alive. You do not want any infections.
Bring a trusted family member with you
Ask a trusted family member or friend to be your patient advocate. The hospital environment can be very frightening and overwhelming and often answering simple questions can be difficult.
If you have an advocate with you they can speak up on your behalf and answer questions for you. Make sure your advocate understands your plan of care and whether there is an advance directive. An advance directive will allow a designated person to make medical decisions for you in case you are unable to.
Understand the medications that are ordered for you in the hospital. When the nurse administers your medication, make sure you understand what it is for and its potential side effects. Also, make sure your nurse identifies you as the correct patient before any medications are administered.
Before administering any medications the nurse should perform five checks: Right Patient, Right Drug, Right Dose, Right Route, and Right Time. If you believe you are about to receive the wrong medication let your nurse know immediately.
Going home? Not so fast!
When discharge instructions are handed to you, make sure to review them with your doctor or nurse. In most cases, it will be your nurse. Go over each step. Repeat back the information.
If you need to write down information that will help you decipher what the doctor or nurse tells you, than do so. If you are given prescriptions for medications, make sure you understand what you will be taking. Be clear about how to take your prescription, when to take it, the dosage, and any side effects. Also ask if it will interfere with any other medications that you may be taking.
*This blog post was originally published at Health in 30*
After surgery I am often asked, “When can I get back in the tanning bed?” I say something like, “I would rather you not use a tanning bed. You need to protect you new scar from the sun, that includes tanning beds, for at least 6 months.”
“But, if I cover up the scar, when can I get back in the tanning bed?” is the usual response.
I then counter with, “IF you feel you must, then yes cover the scars. Please, limit or reduce the time you spend in the tanning bed. I would rather you not use a tanning bed.”
Most see “no harm” in using a tanning bed. After all, it’s not like laying out in the sun for hours. Too many see tanning beds as a “safe” way to get a tan. It isn’t.
These same experts have moved tanning beds and ultraviolet radiation into the top cancer risk category, deeming both to be as deadly as arsenic and mustard gas. The new classification also puts them in the list of definite causes of cancer, alongside tobacco, the hepatitis B virus and chimney sweeping, among others.
I would not mind tanning bed extinction. Regular use increased the risk of melanoma. It is much better to have a “peaches and cream” complexion or to use self-tanning creams. Skin cancer is no fun.
One of the most dangerous times for a patient is during the transition, or “handoff,” between providers. This is due to a number of reasons. First, the original provider(s) may not relay all the information he or she knows about the patient to the next provider(s). Second, the accepting team may take it for granted that everything is known about the patient, and therefore not take a complete history or perform an adequate physical examination. Third, if the patient initially looks good, the accepting providers may be lulled into a false sense of security, and not anticipate a deterioration in the patient’s condition.
We know this problem to exist in the hospital setting. Survey of doctors-in-training suggests that handoffs may commonly lead to patient harm. Last year (2008) in September, there was a blog written by Elizabeth Cooney in the Boston Globe that stated, “a 2006 survey of resident physicians at Massachusetts General Hospital found that handoffs commonly lead to patient harm, according to an article in The Joint Commission Journal on Quality and Patient Safety.” More than 50 percent “of the 161 medical or surgical residents who responded to the anonymous survey said they recalled at least one occasion in their last month-long rotation when a patient suffered from flawed handoffs.” Approximately “one in nine said the harm that resulted was significant.” The respondents said that “if the patient was coming from the emergency department or from another hospital, problematic handoffs were more likely.”
This holds true in the field. Unless the new treatment team makes the assumption that they need to begin their assessment of the patient’s condition from scratch, they are more likely to make a mistake. Obviously, such caution depends on the possible severity of the patient’s condition and the rescue/environmental situation. If I can get a decent handle on a patient’s condition, and there is little or no risk of me missing something, I will tailor my questioning and examination to suit the circumstances. However, I always start from the position that something has been hidden from me, of course not intentionally, and that the patient’s initial assessment has underestimated the problem(s).
I cannot begin to tell you how many times I have found something that was missed, or have accepted the care of a patient just as he or she began to “crash.” This is in no way a criticism of others, just a common fact of medical care. Previous rescuers may have been tired, the conditions may not have been conducive to a full examination, the patient may have been withholding information, or the situation may have just taken its natural course and worsened. Regardless, it’s my responsibility to learn what I can as quickly as I can about my patient, so that nothing slips through the cracks.
Here are some simple rules to follow:
1. If the situation permits, ask your new patient to repeat his or her history. If they are reticent to engage in a long conversation, at least try to get them to relate current relevant events.
2. Repeat as much of the physical examination as you can. Explain to the patient that you have assumed their care, and that in order to do the best that you can on their behalf, it’s important for you to understand their issues and to be able to monitor their progress based up the exam.
3. Assume that until you have talked to the patient or otherwise obtained a comprehensive history, and performed a physical examination with your own hands, eyes, and ears, that you do not know as much about your patient as you could.
4. If a patient is under your care for a prolonged time, or if you are managing a situation prone to rapid or undetected deterioration, interview and examine your patient as often as is necessary and practical. If you must be absent from a patient for a longer period than is prudent between examinations, delegate the responsibility to someone else.
image of leg splinting courtesy of www.princeton.edu
Dr. Jeremy Joslin is a wilderness medicine aficionado and has without question posted the greatest number of intelligent and useful comments to posts at this blog. So, I’m pleased to learn that he has created a very useful iPhone application named TickDoctor.
TickDoctor provides a stunning visual atlas of the most common ticks encountered in North America. Although not yet comprehensive, most common ticks are represented. For each tick species, the user is able to identify males, females, and nymphs. In many instances, there are included images of the engorged female, which often looks very different from its non-fed state.
More than just a beautiful atlas, TickDoctor provides instructions for prevention of tick bites and how to remove them if bites should occur. If a bite has occurred, or if you’re just plain curious, Dr. Joslin has included medically relevant data on each species, describing which diseases have been associated with it.
While this application should never substitute for the advice of a physician, it will help guide you to the identification of the tick in question and provide a framework of reference for dealing with “what to do next.”
I’ve been informed by Jeremy that, “if you have a great photo of a tick and want it considered for the next application update, let me know. You can do this by posting a comment and I’ll follow up with you. We’re always interested in making the atlas better.”
My health club’s outdoor pool’s hot tub has a new sign:
“No children under 12 allowed in the hot tub…this includes dangling feet and dipping toes!”
It’s very large and placed in front of the entrance to the hot tub at the stairs. Not only can you not miss it, you can’t miss reading it – the letters are huge and neatly written.
You only have to be at the club for a few minutes to see why the need for the sign:
1. This week, the high heat: in this weather, kids will dehydrate quickly and put themselves at risk for heat-related illnesses. Just not worth the few minutes in the very hot water. Kids may already be relatively dehydrated if not drinking enough in heat waves so time in hot water will hasten the onset of heat illnesses in that situation.
2. Parents were already ignoring the smaller posted signs.
3. Hot tubs are really grown-up venues and actually have a therapeutic function. They are not toys or meant as recreation so shouldn’t be used or fostered as such.
Adults, too, shouldn’t be in a hot tub for very long when the outside temperature is in the mid 80’s and above with high humidity. We, too, can become dehydrated and put ourselves at risk for heat exhaustion and heat stroke. However, sometimes us adults need the hot tub for therapeutic reasons, such as after exercise, to aid in the healing of injury, arthritis, etc. That’s how I use the hot tub and why I found myself sitting in it for a few minutes on an 85 degree, very humid day. My healing back needed a few minutes of intense heat and those jets after my usual swim. I kept my eye on the time and after 10 minutes got out and downed some cold water.
The sign did keep away most people and most older kids and adults did respect it. But, a few blatantly did not. One mom actually read the sign for a good few minutes and then when her toddler tossed a fit because she wanted to go in she finally relented but said “only your toes…that’s allowed.” Well, actually not. The sign specified no toes specifically so I’m not sure how she made the leap that her daughter’s toes were the exception.
Her daughter didn’t dip for long before a lifeguard came over and shooed her away. The mom looked miffed but hopefully will be wiser next time and not attempt to pull one over on the staff or the rest of the people there to have fun and were willing to follow the rules.
Safety aside, the ultimate issue here, the other important issue is teaching our kids that rules are meant to be followed. If we break the rules and don’t follow them ourselves, our kids will grow up thinking they, too, can break rules, that they are “above the rules”. Those are the kids who tend to get themselves into all sorts of trouble as teens. The seeds of risk taking and bad behavior do start young and are often planted by watching us.
So, have a blast this summer but follow the posted rules. You’ll not only keep your kids safe today…but tomorrow, too.
For more information on heat illness in kids, click here.
*This blog post was originally published at Dr. Gwenn Is In*
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A hospital can be extremely frightening and overwhelming.
