"Hospitals want involved patients" - from the Chicago Tribune.
Good piece, but a bit outdated.
The Joint Commission's Speak Up! Program has been around for a few years (at least since I used it as a Patient Advocate 'rounding' in 2003-2004), but you rarely see a specific staff person within the acute care setting responsible for implementing the program.
Our hospital, however, had a team of 5 Patient Advocates rounding on inpatient floors discussing the Speak Up! Program with patients and families.
What, we found, however, upon administering the program is indicative of the healthcare system's larger 'chronic' issues....
The process looked a bit like this:
1. PA enters the room, cheerily confirms identity with double checks (name, armband) - after asking if we can chat about the program and if the patient would like privacy while we do so.
2. Hands patient or family member/friend/caregiver/partner Speak Up! brochure while we give the pitch, usually multitasking and wiping staff board, refilling water pitcher at bedside, etc. Some people don't want the paper or the pitch, so PA asks if any other questions or any assistance we can provide.
3. Asks if patient has any questions or if we can be of assistance. 9 times out of 10 answer is resounding "yes" and issue is NOT related to Speak Up! program but medical care continuity (ie are my labs in yet? When will I be discharged? Who is my new nurse? What's for lunch?)
4. Chase down medical staff (nurse, tech, or in VERY rare cases doc) if it's a medical issue. Otherwise repeat we are 'only' PAs and not qualified to give medical information, but we have feet, and lungs, and can thus chase down and corner medical staff who can give correct info. (This would be why I wore sneakers, Nike Prestos, to work).
5. Bug caregiving staff incessantly if big issue, deliver message and confirm 'report' handoff verbally (and usually in my notebook with time and staff name cited in case I later had to do a variance).
6. Return to patient room and report progress on issue/contact resolution. Deliver sunshine and a smile (or 50).
Final findings from a year spent as a Patient Advocate:
1. Patients want to be involved. (10-80-10 rule: 10 percent unwilling/inable to self-advocate and be participatory, 10 percent hyperengaged, Guitar hero healthcare types, and middle 80 percent may be involved at varying levels).
2. Family members want to be involved.
3. Many doctors don't know how to treat patients who are verbally self-advocating...but if someone whips out a notebook and starts taking notes during the conversation they're on best behavior.
4. Communication between docs and nurses is often FUBAR. The blame baton is passed back and forth like care delivery communication is a contact sport. The rest of us, including patients, are relegated to acting as befuddled spectators.
5. Top issues of concern to patients are related to the 3 Cs: cure, care, communication.
Every initiative that purports to encourage increasing 'guitar hero healthcare' or 'patient involvement' must take systemic deficiencies in addressing the 3Cs into account. To ignore any of them is to court systemic failure.
Right now Ted Eytan is continuing to push on the most complete, viable definition of Health 2.0 for consumer-centric, patient-directed care advocates. Take a look. It's important work.
Until we can define 'involved' patients at a basic level, hospitals will have a hard time connecting idealistic goals to real strategic planning.
Patient involvement, CONSUMER involvement, is a vital component to figuring out 'what's next' for Health 2.0, and beyond.
Yesterday I sat in a nearly empty room at HIMSS DC Summit 2008 watching Jay Parkinson present the first truly consumer-centric GP practice model (here's some WSJ coverage).
Jay's new practice, Hello Health, is opening it's first storefront July 1st in NYC. Pay attention policymakers, hospital execs - the future of healthcare is closer than you think.
Showing posts with label patient self advocacy. Show all posts
Showing posts with label patient self advocacy. Show all posts
30.1.08
What Consumers Can Do to Prevent Medication Errors
Read this article on MSNBC.com.
Sometimes I feel like there's not enough plain talk in medicine. So let's cut to the chase.
If you're conscious and cogent as a patient, you CAN assist your care team in preventing serious medication errors.
Can you prevent every error? Of course not. You don't have the knowledge your docs and nurses do. You do, however, have an opportunity to pay attention.
If you'll be out of it for a bit after a procedure, you can designate a family member/friend to assist.
Of course, you can't always predict when something will go awry (unplanned admission via ER/trauma, post-op fever or other complications, etc).
For this reason before any surgical procedure (or procedure with sedation etc.) I designate an advocate (usually the person who will be in the waiting room and will either stay in the hospital with me or drive me home).
Usually this is my mom, a super-nurse, or my husband, a super guy. My family knows if I'm unexpectedly injured, my husband and mom are designated advocates and decision-makers. They've both read my living will, and are aware of my beliefs regarding life support, resuscitation measures, etc.
If an admission or procedure is planned, however, it's much easier to lay out a process for learning your medication dosage and schedule, and tracking whether or not you're being given the correct meds.
As a patient, here's a system that's worked for me.
1. During rounds, I ask the physician to slowly repeat the names of all meds he/she is prescribing.
I repeat this procedure for each doctor on my care team (you may have different meds prescribed by different doctors).
If necessary, ask them to spell it out for you.
If you've had an adverse reaction to a medication the physician mentions in the past, NOW is the time to bring it up. Again. Even if a sensitivity/allergy is well-documented in your chart/plan of care.
Yes, I realize you may look and feel like a bit of a dolt. Yes, I realize docs have far better things to do with their time than spell out medications for me.
They will have far more time to treat other patients if I help prevent the costly complications of a med error.
2. When a nurse enters the room with meds, I ask him/her to please identify each pill (by name) and the strength/dosage.
If the nurse will not or can not identify a med, I can refuse to take it until she/he can do so. Note: You can always refuse a medication/treatment, even if its AMA - in which case the nurse should educate you about the risks of doing so. It's not a light matter to refuse treatment, so think carefully before doing so.
Only once in 3 inpatient hospital stays has a nurse responded to my medication ID request with anger/frustration, replying "it's your pain pill."
Usually the nurse will be extremely helpful, sometimes even offering further explanation, such as "This is Tylenol Number 3 PO - your doctor WhiteCoat has prescribed it for post-op pain every X hours. If you take it now, it will begin to work its way into your system before the physical terrorist gets here."
3. If you're really anal (or have a relative who's a nurse/doc/NP/really nosy at your bedside) you can write down the meds you're given (name, dosage) and the times they're administered.
This is particularly helpful for stepdown periods or other transitions between meds.
If I begin to develop a reaction to a new med for instance, I can refer caregivers to the list and read that I was given XYZ about 45 mins ago, and I noticed onset of symptoms 10 mins ago.
Likewise if you begin to develop breakthru pain, you can maintain a better timeline of which medications are not working for you.
I used this medication schedule at home after discharge as well.
It was very useful in tracking meds, not missing doses, setting alarms for night doses, etc.
We'd also note my pain level on a scale of 0-10 after each dose.
This helped me to step down off pain meds to good old Ibuprofen 24 hours after a bone graft procedure.
I *knew* I was ready because I had the actual data of decreasing pain right there in front of me. For patients who are hesistant to step down, keeping this schedule with corresponding pain measurements may be extremely helpful.
Again, this system worked for me. I don't believe this will work for everyone. I'm not saying it's universally applicable.
But for those of us interested enough in our own care and willing to work with our nurses and docs, who are working very hard to get us well, this is a rough plan of action you may wish to consider.
If I'm someday admitted to a hospital and I don't have to ask, ever, what medications I'm being given because the nurse enters and announces the dosage straight out (after checking my ID verbally and double-checking via my RFID ID bracelet), I'll know the era of e-patients, H2.0, and consumer medicine has finally arrived.
Sometimes I feel like there's not enough plain talk in medicine. So let's cut to the chase.
If you're conscious and cogent as a patient, you CAN assist your care team in preventing serious medication errors.
Can you prevent every error? Of course not. You don't have the knowledge your docs and nurses do. You do, however, have an opportunity to pay attention.
If you'll be out of it for a bit after a procedure, you can designate a family member/friend to assist.
Of course, you can't always predict when something will go awry (unplanned admission via ER/trauma, post-op fever or other complications, etc).
For this reason before any surgical procedure (or procedure with sedation etc.) I designate an advocate (usually the person who will be in the waiting room and will either stay in the hospital with me or drive me home).
Usually this is my mom, a super-nurse, or my husband, a super guy. My family knows if I'm unexpectedly injured, my husband and mom are designated advocates and decision-makers. They've both read my living will, and are aware of my beliefs regarding life support, resuscitation measures, etc.
If an admission or procedure is planned, however, it's much easier to lay out a process for learning your medication dosage and schedule, and tracking whether or not you're being given the correct meds.
As a patient, here's a system that's worked for me.
1. During rounds, I ask the physician to slowly repeat the names of all meds he/she is prescribing.
I repeat this procedure for each doctor on my care team (you may have different meds prescribed by different doctors).
If necessary, ask them to spell it out for you.
If you've had an adverse reaction to a medication the physician mentions in the past, NOW is the time to bring it up. Again. Even if a sensitivity/allergy is well-documented in your chart/plan of care.
Yes, I realize you may look and feel like a bit of a dolt. Yes, I realize docs have far better things to do with their time than spell out medications for me.
They will have far more time to treat other patients if I help prevent the costly complications of a med error.
2. When a nurse enters the room with meds, I ask him/her to please identify each pill (by name) and the strength/dosage.
If the nurse will not or can not identify a med, I can refuse to take it until she/he can do so. Note: You can always refuse a medication/treatment, even if its AMA - in which case the nurse should educate you about the risks of doing so. It's not a light matter to refuse treatment, so think carefully before doing so.
Only once in 3 inpatient hospital stays has a nurse responded to my medication ID request with anger/frustration, replying "it's your pain pill."
Usually the nurse will be extremely helpful, sometimes even offering further explanation, such as "This is Tylenol Number 3 PO - your doctor WhiteCoat has prescribed it for post-op pain every X hours. If you take it now, it will begin to work its way into your system before the physical terrorist gets here."
3. If you're really anal (or have a relative who's a nurse/doc/NP/really nosy at your bedside) you can write down the meds you're given (name, dosage) and the times they're administered.
This is particularly helpful for stepdown periods or other transitions between meds.
If I begin to develop a reaction to a new med for instance, I can refer caregivers to the list and read that I was given XYZ about 45 mins ago, and I noticed onset of symptoms 10 mins ago.
Likewise if you begin to develop breakthru pain, you can maintain a better timeline of which medications are not working for you.
I used this medication schedule at home after discharge as well.
It was very useful in tracking meds, not missing doses, setting alarms for night doses, etc.
We'd also note my pain level on a scale of 0-10 after each dose.
This helped me to step down off pain meds to good old Ibuprofen 24 hours after a bone graft procedure.
I *knew* I was ready because I had the actual data of decreasing pain right there in front of me. For patients who are hesistant to step down, keeping this schedule with corresponding pain measurements may be extremely helpful.
Again, this system worked for me. I don't believe this will work for everyone. I'm not saying it's universally applicable.
But for those of us interested enough in our own care and willing to work with our nurses and docs, who are working very hard to get us well, this is a rough plan of action you may wish to consider.
If I'm someday admitted to a hospital and I don't have to ask, ever, what medications I'm being given because the nurse enters and announces the dosage straight out (after checking my ID verbally and double-checking via my RFID ID bracelet), I'll know the era of e-patients, H2.0, and consumer medicine has finally arrived.
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