An affiliate of

Safe Care Campaign

The Safe Patient RES

URCE CENTER

A FREE Public Service of Patient Safety Partnership

Safe Patient Guides

Learning from our guides is easy. Choose what to learn YOUR WAY.

 

50 Sections of useful information include safe care tips, educational patient safety videos, advocacy resources, medication dictionaries, downloadable books, brochures and much more. Just choose your topic of interest, CLICK and GO!

TELL ME NOW! focuses on topics that are causes for immediate concern. By choosing a topic here, the guide leads you into the proper next actionable steps to address the concern.

The Safe Patient teaches patients how to best prepare for and proceed with safe medical care as well as ways to help prevent medical errors while receiving that care.

Tell Me NOW!

INDEX OF TOPICS

The Safe Patient

INDEX OF TOPICS

  • Section 1: I've just been admitted to the hospital. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    INSIST ON PROPER HAND HYGIENE FROM ANYONE WHO ENTERS YOUR HOSPITAL ROOM. (Whether they intend to touch you or not)

    It is important for patients and their family members to understand that it is critical that they insist on healthcare providers washing or sanitizing their hands in front of them prior to touching you (the patient).

     

    In fact, anyone who touches patients and / or objects in the hospitals room should wash or sanitize their hands before and AFTER doing so.

     

    This includes your doctor.

     

    ENLIST A FAMILY MEMBER OR FRIEND AS AN ADVOCATE.

     

    A personal medical care advocate is a person who helps a patients work with others who have an effect on the patient's health. In a hospital scenario when you are a patient, this definition usually applies to someone who can help oversee your day to day care and deal with caregivers and providers such as the doctors, nurses and if need be, administrators as well as your health insurance company.

     

    An advocate can help to facilitate your overall care - acting to resolve issues about things like delivery of care, medical bills, and many other things related to a patient's medical condition.

     

    An advocate can be a family member, friend or hired professional who can ask questions, write down information, and speak up for you when you can’t so you can get the care and resources you need for a best expected outcome.

     

    If you're facing a difficult medical decision or a hospital stay, it's a good idea to bring someone with you who can help you take an active role in your care when you're not fully up to it.

  • Section 2: My Doctor says I need surgery. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    SURGERY OR SECOND OPINION?

     

    In general, avoid surgery unless the problem threatens your health or disrupts your activities, less aggressive treatments have failed, other causes have been ruled out, tests show that surgery would help, and there's little hope of spontaneous recovery.

     

    And get a second opinion if you have the slightest doubt about whether you need the procedure.

     

    HOW TO SEEK A CREDENTIALED SURGEON

     

    You may find yourself in search of a qualified surgeon for any number of medical procedures, from simple minimally - invasive scopes to major life-saving surgeries. Ask your primary - care doctor to recommend a surgeon, if necessary from the list of doctors approved by your insurance company. For complicated or unusual problems, ask for the name of a recognized expert or search the medical literature to find someone who has published major articles about your problem. Then contact that physician and ask him or her to recommend someone in your locale.

     

    If you find a potential surgeon, ask is he/she is Board Certified. Having a board certification means that the physician has voluntarily chosen to undergo a process for obtaining a higher level of certification to indicate a certain level of expertise or specialization.

     

    Finally, talk with the prospective surgeon and ask how many operations of the type you need he or she has performed. Studies suggest that experience leads to higher success and lower complication rates. When deciding on a surgeon, remember that caseload may be more important than a surgeon's age. An analysis of Medicare data for nearly 461,000 patients found that while surgeons over age 60 with low surgical volumes had higher patient mortality rates on some procedures, those who continued to maintain high surgical caseloads had comparable outcome with surgeons ages 41 to 50.

     

    Also ask if the surgeon can provide references from patients willing to speak with you. Find out which hospitals the doctor admits patients to, and check their quality. Better hospitals tend to attract better doctors.

     

    How to check credentials

     

    Doctors are increasingly being put to the test. Experts have developed practice guidelines detailing how physicians should address everything from basic preventive care to complex chronic conditions such as congestive heart failure and diabetes. Researchers are even starting to measure how well doctors manage their practices, gathering data, for example, on how quickly patients can get an appointment and how long they are kept waiting once they have one.

     

    Health - care quality organizations - notably the nonprofit National Committee for Quality Assurance (NCQA) now gather data on how well doctors in managed-health-care plans follow practice guidelines. Then they use the results to grade those organizations. (To see how your health plan and others in your area fare, go to www.healthchoices.org.) Experts hope that eventually the grades will extend all the way down to practice groups and even individual physicians.

     

    Some health-insurance plans provide information for members on the educational and professional background and specialty certification of participating physicians, so you should start there. Also consult these general web sites:

     

    Administrators in Medicine (www.docfinder.org). Information on licensing and disciplinary actions taken against doctors in 18 states; links to state medical boards of remaining states. FREE.

     

    American Board of Medical Specialties (www.abms.org). Board certification means the person has completed an approved residency program and passed a detailed written exam in at least one of 24 specialty areas, such as family practice, internal medicine, or obstetrics and gynecology. FREE.

     

    American Medical Association DoctorFinder (webapps.ama-assn.org/doctorfinder). Comprehensive information, including educational history, board certification, and hospital admitting privileges, for the 40 percent of doctors who belong to the AMA. FREE.

  • Section 3: My son's been moved to the ICU. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    INSIST UPON PROPER HAND HYGIENE. IT CAN HELP SAVE YOUR PATIENT’S  LIFE.

     

    Hospital associated infections are infections that a patient acquires while in the hospital. (4,600 American patients contract these types of infections every single day while receiving medical care. 271 patients die everyday from their infections. This is no small matter.)

     

    Critically ill patients are most susceptible to becoming infected. The most common infections are caused by staphylococci and multi-drug resistant pathogens such as MRSA, VRE and resistant gram-negative rods.  Patients can become ill with bloodstream infections, surgical site infections, urinary tract infections and pneumonia.

     

    It is important for patients and their family members to understand that it is critical that they ask healthcare providers to wash or sanitize their hands in front of them prior to touching the patient. In fact, anyone who touches patients and / or objects in the hospitals room should wash or sanitize their hands before and AFTER doing so.

     

    This includes your doctor.

  • Section 4: I don't understand what my Doctor is talking about. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

     KEEP ASKING UNTIL YOU GET AN EXPLANATION YOU UNDERSTAND

     

    If you don’t understand the answers your doctor gives you, ask again, telling him / her you did not understand. Ask more questions if you still don’t understand something.

     

    Write down the answers if that will help you remember them and if you don’t know how to spell a medical term your doctor may use in his / her explanation, ask them to spell it for you so that you’ll have to to help communicate later with your friends or family. Also, you’ll have the proper spelling so you can do further research at another time if you wish.

     

    HAVE A FAMILY MEMBER OR FRIEND BE WITH YOU THE NEXT TIME YOU TALK TO THE DOCTOR (An Advocate)

     

    An advocate can be a family member, friend or hired professional who can ask questions, write down information, and speak up for you so you can better understand your illness and get the care and resources you need.

     

    If you're facing a difficult medical decision or a hospital stay, it's a good idea to bring someone with you who can help you take an active role in your care when you're not fully up to it.

  • Section 5: I have a bloodstream infection. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    MONITOR YOUR CARE

     

    Bacteremia is the presence of bacteria in the blood. The blood is normally a sterile environment, so the detection of bacteria in the blood (most commonly with blood cultures) is always abnormal.

     

    Bacteria can enter the bloodstream as a severe complication of infections, during surgery  or due to catheters and other foreign bodies entering the arteries or veins.

     

    Bacteremia can have several consequences. The immune response to the bacteria can cause sepsis and septic shock, which has a relatively high mortality rate. Bacteria can also use the blood to spread to other parts of the body causing infections away from the original site of infection.

     

    Treatment is with antibiotics.

     

    Specifically, here’s what you can do:

     

    Do not allow anyone to touch you without washing or sanitizing their hands first.

     

    If the bandage comes off or becomes wet or dirty, tell your nurse or doctor immediately.

     

    Inform your nurse or doctor if the area around your catheter is sore or red.

     

    Do not let family and friends who visit touch the catheter or the tubing.

     

    Make sure family and friends clean their hands with soap and water or an alcohol-based hand rub before and after visiting you.

  • Section 6: I have a urinary catheter. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    ASK EVERYDAY IF YOU STILL NEED TO BE CATHETERIZED

     

    Catheters (a device which drain the bladders of hospitalized patients) that are left in place longer than needed may result in bloodstream infections and life - threatening blood clots.

     

    Catheters are made to be closed drainage systems. This means that the path from the tip of the catheter inserted into the bladder, to the bag which catches urine, is closed. A closed system decreases the chance of getting an infection. It also decreases the chance of the catheter breaking and urine spilling out. People with catheters and their caregivers should avoid detaching parts of the catheter along the closed system unless it is necessary.

     

    Larger, sterile, drainable, two liter drainage bags or smaller sterile leg bags are used to collect your urine. To keep a closed system, these bags are connected directly to the catheter. If you use a leg bag to collect urine, a larger drainage bag may be attached at night with a special connector. Some plastic drainage bags should be changed every 5 to 7 days. Ask your caregiver how often your drainage bag should be changed.

     

    KEEP DRAINAGE BAG BELOW THE LEVEL OF THE BLADDER BUT DO NOT LET IT REST ON THE FLOOR

     

    Drainage bags must be kept below the level of the bladder. This will allow gravity to help drain the urine, and will stop urine from flowing back into your bladder. Urine that flows back into your bladder increases your risk of an infection. Do not let the drainage bag rest on or touch the floor. The tubing that goes from your urethra to a leg bag should be secured to your thigh with special tape, a leg strap, or a drain tube stabilizer. Allow extra tubing between the urethra and the point where the tubing is secured to your thigh.

  • Section 7: I have a complaint about the quality of care. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    SPEAK TO THE NURSE SUPERVISOR

     

    Share your concerns as soon as possible. By speaking up, you may prevent a medical error from occurring and harming your loved one.

     

    Some patient families are afraid of some sort of retribution from care staff when they have a complaint. Although this is a possibility, the vast majority of nurses are committed professionals who want the same good care for your loved one that you do.

     

    If your complaint is with one person in particular, tell the Nurse Supervisor why and see if the two of you can’t come to some sort of satisfying solution.

     

    If nothing changes or you remain dissatisfied with your patient’s care, speak up again. And again.

     

    IF YOU DO NOT GET A RESPONSE THAT YOU ARE SATISFIED WITH, ASK TO SPEAK TO A HOSPITAL ADMINISTRATOR

     

    Sometimes we are met with a response different than we’d hoped. If this happens and you continue to have serious concerns that could affect your patient’s care, calmly request to see a Hospital Administrator.

     

    At this level of hospital management, your concerns will most likely be taken seriously and some sort of satisfactory solution worked out.

  • Section 8: Many of the caregivers do not wash their hands. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    SPEAK UP AND FIRMLY INSIST UPON PROPER HAND HYGIENE

     

    Politely but firmly make it clear to everyone that walks into the hospital room that you expect and insist upon proper hand hygiene.

     

    This means that everyone who comes into the room (whether they intend to touch the patient or not) must wash their hands with soap and water in front of you or sanitize their hands with alcohol - based gel, in front of you.

     

    If they walk in and tell you they already gelled in the hallway, calmly say something like, “That’s great but I need you to do it again in front of me. Thanks!”

     

    SPEAK TO THE NURSE SUPERVISOR

     

    If the lack of proper hand hygiene continues speak to the Nurse Supervisor as soon as possible. By speaking up, you may prevent an infection from occurring and harming your loved one.

     

    REFUSE TO ALLOW THE OFFENDER TO TOUCH YOUR PATIENT

     

    If a caregiver outright refuses to wash or sanitize their hands in front of you, calmly tell them that you do not want them to touch the patient. Politely ask that they leave the patient’s room and then get the Nurse Supervisor.

     

    If the Nurse Supervisor cannot address your concern, then ask to speak to a Hospital Administrator who can.

  • Section 9: My doctor says I have MRSA. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    First understand that there is a difference between being colonized with MRSA and having a MRSA infection. Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics.

     

    In the community, most MRSA infections are skin infections. More severe or potentially life-threatening MRSA infections occur most frequently among patients in healthcare settings.

     

    Being colonized is when a person carries the organism/bacteria but shows no clinical signs or symptoms of infection. Many people are colonized but not infected, experiencing no harm or ill effects of the colonization.

     

    MRSA infections are a problem among people who have weak immune systems and are in hospitals, nursing homes, and other heath care centers. Infections can appear around surgical wounds or invasive devices, like catheters or implanted feeding tubes. Symptoms of MRSA...

     

    Actionable Steps You Can Take Right Now

     

    DEFINE WHETHER YOU ARE COLONIZED OR HAVE A MRSA INFECTION

     

    Ask your doctor if you are colonized or infected. The answer calls for a vastly different path of next steps.

     

    IF YOU ARE INFECTED

     

    If you are in the hospital, it is important that you ask to see an I.D. Professional. That means an Infectious Disease specialist. They can come look at your case and confer with your physician as to the best course of treatment and most appropriate next steps.

     

    If you are not hospitalized, ask your doctor what he / she suggests as a course of treatment. Remember that MRSA infections are potentially contagious and as so, much care must be taken to prevent spread of the infection to others.

     

    For more important information on MRSA and how to best proceed, visit:

     

    Safe Care Campaign Website

  • Section 10: My father has something called C.difficile. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    SPEAK TO YOUR PATIENT’S CAREGIVERS ABOUT THEIR NEXT STEPS IN TREATMENT OF CHOICE

     

    Clostridium difficile, also known as C. diff, is a species of bacteria that causes diarrhea and other intestinal disease when competing bacteria are wiped out by antibiotics.

     

    C.difficile is the most serious cause of antibiotic-associated diarrhea and can lead to a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics.

     

    The C. difficile bacteria, which naturally reside in the body, become overpopulated and the the bacterium releases toxins that can cause diarrhea with abdominal pain, which may become severe.

     

    Often, it can be cured simply by discontinuing the antibiotics responsible. In more serious cases, oral administration of metronidazole or vancomycin is the treatment of choice.

     

    INSIST ON PROPER HAND HYGIENE DURING THE CARE OF YOUR PATIENT

     

    Critically ill patients are most susceptible to becoming infected. The most common infections are caused by staphylococci and multi-drug resistant pathogens such as MRSA, VRE and resistant gram-negative rods.  Patients can become ill with bloodstream infections, surgical site infections, urinary tract infections and pneumonia.

     

    It is important for patients and their family members to understand that it is critical that they ask healthcare providers to wash or sanitize their hands in front of them prior to touching the patient. In fact, anyone who touches patients and / or objects in the hospitals room should wash or sanitize their hands before and AFTER doing so.

     

    This includes your doctor.

     

    ASK TO SEE AN INFECTION PREVENTIONIST

     

    If you are in the hospital, it is important that you ask to see an I.D. Professional. That means an Infectious Disease specialist. They can come look at your case and confer with your physician as to the best course of treatment and most appropriate next steps.

  • Section 11: My father has VRE. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    Enterococci are gram-positive bacteria that can be found in the digestive and urinary tracts of some people. Vancomycin Resistant Enterococci (VRE) is particularly dangerous to people whose immune systems are weakened.

     

    While infection of healthy individuals is uncommon, it is possible that they could be colonized with newly-resistant bacteria. Van-A is resistant to both vancomycin and teicoplanin. In the US, linezolid is commonly used to treat VRE, as teicoplanin is not available.

     

    VRE can be carried by healthy people who have come into contact with the bacteria. The most likely place where such contact can occur is in a hospital.

     

    ASK FOR AN INFECTIOUS DISEASE PROFESSIONAL TO HELP OVERSEE YOUR PATIENT’S CASE

     

    If you are in the hospital, it is important that you ask to see an I.D. Professional. That means an Infectious Disease specialist. They can come look at your case and confer with your physician as to the best course of treatment and most appropriate next steps.

     

    INSIST ON PROPER HAND HYGIENE DURING THE CARE OF YOUR PATIENT

     

    Critically ill patients are most susceptible to becoming infected. The most common infections are caused by staphylococci and multi-drug resistant pathogens such as MRSA, VRE and resistant gram-negative rods.  Patients can become ill with bloodstream infections, surgical site infections, urinary tract infections and pneumonia.

     

    It is important for patients and their family members to understand that it is critical that they ask healthcare providers to wash or sanitize their hands in front of them prior to touching the patient. In fact, anyone who touches patients and / or objects in the hospitals room should wash or sanitize their hands before and AFTER doing so.

     

    This includes your doctor.

  • Section 12: My son has a central line. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    WHAT IT IS AND WHAT YOU CAN DO

     

    A central venous catheter, or central line, is a tube inserted into a major blood vessel in the neck, chest or groin to serve as a temporary portal for injected medications and fluids, or blood sampling in patients who need them frequently.

     

    Because central lines also provide quick access in emergencies, some patients often have them for weeks or longer. But if inserted incorrectly and, more importantly, mishandled after that, the central line can become a contaminated gateway for bacteria to enter directly into the patient’s bloodstream.

     

    While there is nothing you can physically perform, you can help oversee the condition of the central line.

     

    Simple precautions like:

     

    Regularly changing the dressing covering the central line

    Changing the tubes and caps attached to it

    Cleaning the line before and after use

    Rigorous hand washing before handling the line ...

     

    are all essential to keeping bacteria away. Make sure that you ask the care staff about all of these precautions.

     

    ASK EVERYDAY IF THE CENTRAL LINE MAY BE REMOVED

     

    Daily review of central line necessity will prevent unnecessary delays in removing lines that are no longer clearly necessary in the care of the patient.  Many times, central lines remain in place simply because of their reliable access and because personnel have not considered removing the line.  However, it is clear that the risk of infection increases over time as the line remains in place and that the risk of infection is decreased if removed.

  • Section 13: My surgical wound looks red and swollen. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    NOTIFY YOUR CARE STAFF IMMEDIATELY AND SHOW THEM YOUR OBSERVATION

     

    Notify your doctor if you have a post operative wound and develop any of the following:

     

    Worsening bleeding from the wound

    Worsening swelling under the wound surface

    Worsening wound pain

    Wound pain lasting more than 10 days

    Abnormal opening or separation of the wound

    Swollen lump under the skin

    Pus draining from the wound

    Worsening skin redness

    Red streaks traveling away from the wound

  • Section 14: I have a catheter-associated urinary tract infection. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    MAKE SURE YOU ARE STARTED ON AN APPROPRIATE COURSE OF ANTIBIOTICS

     

    Most catheter-associated urinary tract infections can be treated with antibiotics and removal or change of the catheter. Your doctor will determine which antibiotic is best for you.

     

    ASK FOR AN INFECTIOUS DISEASE PROFESSIONAL TO HELP OVERSEE YOUR CASE

     

    If you are in the hospital, it is important that you ask to see an I.D. Professional. That means an Infectious Disease specialist. They can come look at your case and confer with your physician as to the best course of treatment and most appropriate next steps.

     

    INSIST THAT NO ONE TOUCH YOU WITHOUT FIRST WASHING OR SANITIZING THEIR HANDS

     

    Not even your doctor.

  • Section 15: My mother has been attached to a ventilator. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    HEAD OF THE BED

     

    Elevation of the head of the patient’s bed has been correlated with reduction in the rate of ventilator-associated pneumonia.  The recommended elevation is 30 to 45 degrees.

     

    Do not lower the head of the bed in order to make your patient feel more comfortable; it will put them in danger of infection, allowing bacteria-laden secretions to go down their throats.

     

    ORAL CARE

     

    Certain hospitals with zero or close to zero

    ventilator - associated pneumonia (VAP) rates perform frequent and vigorous oral care several times a day. Ask your patient’s caregivers about this practice.

     

    SEDATION VACATIONS

     

    To wean patients off sedation/neuroblockers while on a ventilator. Ask your patient’s caregivers about the possibility of sedation vacations.

  • Section 16: I have a ventilator-associated pneumonia. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation.

     

    APPROPRIATE ANTIBIOTICS

     

    Ask your patient’s caregivers about the type of antibiotic they plan to use to treat their infection. It is important that it is the correct type and amount.

     

    INSIST UPON PROPER HAND HYGIENE

     

    Insist that no one enter your patient’s room without washing or sanitizing their hands in front of you - EVERY SINGLE TIME. This includes doctors.

     

    Proper hand hygiene can help prevent infection of many kinds and this is of the greatest importance for a patient with a weakened immune system.

     

    ASK TO SEE AN INFECTIOUS DISEASE PROFESSIONAL

     

    An infectious disease professional is normally on staff and can be procured to oversee your patient’s case. He / she will work with the doctors to help your patient recover from this potentially life - threatening infection.

     

    More Information on VAP:

     

    HEAD OF THE BED

     

    Elevation of the head of the patient’s bed has been correlated with reduction in the rate of ventilator-associated pneumonia. The recommended elevation is 30 to 45 degrees.

     

    Do not lower the head of the bed in order to make your patient feel more comfortable; it will put them in danger of infection, allowing bacteria-laden secretions to go down their throats.

     

    ORAL CARE

     

    Certain hospitals with zero or close to zero ventilator -associated pneumonia (VAP) rates perform frequent and vigorous oral care several times a day. Ask your patient’s caregivers about this practice.

     

    SEDATION VACATIONS

     

    Ask your patient’s caregivers about the possibility of sedation vacations.

  • Section 17: My sister's condition seems to be going down hill. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    ASK TO MEET WITH THE PATIENT’S CARE TEAM

     

    Often, a patient family member will first recognize that their loved one is noticeably in a declining state of health even if treatment of a condition seems to be going as planned.

    If this happens, ask for a meeting with the patient’s doctor or care team to share your concerns and review the patient’s overall situation and potential next steps.

     

    SEEK THE ADVICE OF ANOTHER DOCTOR OR SPECIALIST

     

    If you are still unsure of the actual condition of your patient and remain unsettled, it is OK to request a second opinion or the professional advice of another specialist. Remember, as your patient’s advocate, you are their eyes and ears, and yes, sometimes even their mouth to alert others when more help is necessary.

  • Section 18: My baby is in the Neonatal ICU. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    The Neonatal Intensive Care Unit (NICU) is an intensive care unit created for sick newborns who need specialized treatment.

     

    Sometimes the NICU is also called:

     

    a special care nursery

    an intensive care nursery

    newborn intensive care

     

    Babies may be sent to the NICU if:

     

    they're born prematurely

    experienced difficulties during their delivery

    they show signs of a problem in the first few days of life

     

    Only very young babies (or babies with a condition linked to being born prematurely) are treated in the NICU - they're usually infants who haven't gone home from the hospital yet after being born. How long these infants remain in the unit depends on the severity of their illness.

     

    Actionable Steps You Can Take Right Now

     

    ASK FOR AS MUCH INFORMATION AS POSSIBLE REGARDING YOUR BABY’S CONDITION AND CARE

     

    Some things you might want to ask the neonatologist and/or the nurses include:

     

    How long will my baby be in the unit?

    What, specifically, is the problem?

    What will be involved in my baby's treatment and daily care?

    What medicines will my baby have to take?

    What types of tests will be done?

    What can my baby eat and when?

    Will I be able to nurse or bottle-feed my baby and if so, when and how?

    What can I do to help my baby?

    Will I be able to hold or touch my baby?

    How often and for how long can I stay in the unit? Can I sleep there?

     

    HAND HYGIENE IS NOT OPTIONAL

     

    Be vigilant upon insisting that everyone who comes into the NICU absolutely must wash their hands when they enter. (There will be a sink and antibacterial soap in the room and near the entrance of the NICU.) This is a crucial part of keeping the NICU environment as clean as possible so the babies won't be exposed to infections. Some units require visitors to wear hospital gowns, particularly if a child is in isolation. You may also need to wear gloves and a mask.

     

    Ask the nurses what you're allowed to bring into the unit  - the risk of infection limits what you can leave with your baby. Some parents like to tape pictures to the isolette or decorate the incubator. If you want to give your child a stuffed toy, ask the staff first.

     

    When you're in the NICU, keep noise and bright lights to a minimum. Try not to bang things on the isolette or infant warmer, talk in a loud voice, or slam doors. If you're concerned about light, ask a nurse if you can drape a blanket partially over the isolette. Most important, let your baby sleep when he or she needs to.

  • Section 19: This medication makes me feel funny. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    TELL SOMEONE RIGHT NOW.

     

    If you are on medication that is making you feel strange or bad, tell someone you trust right now. Immediately inform your doctor or if you are in the hospital, call a nurse. Perhaps you are allergic to the medication or you may be experiencing an adverse reaction that stems from one drug mixing with another that you are currently taking.

     

    At this time make sure to tell your doctor if you take any herbal or supplements that he or she may not have originally known about.

     

    CALL BUTTON, POISON CONTROL CALL OR TRIP TO THE EMERGENCY ROOM?

     

    If you are very alarmed at your unusual symptom or set of symptoms:

     

    ... and are currently hospitalized, call a nurse immediately.

    ... and are at home, call a Poison Control Hotline: 1-800-222-1222 right now!

    ... and feel that you are in a dire emergency, either go to the nearest Emergency Room or dial 911 and order an ambulance.

  • Section 20: My brother is developing open red sores. Now What?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    INFORM THE CARE STAFF THAT YOU THINK YOUR PATIENT IS DEVELOPING BED SORES

     

    Then show the sores to the caregivers to confirm if that is indeed what they are.

     

    Pressure ulcers (also called bed sores or decubitus ulcers) are skin wounds caused by pressure from lying or sitting in one position too long. This can become a serious, life threatening problem among patients in a long - term care setting like an extended hospital stay or a nursing home. Pressure ulcers most often occur in bony areas such as the heels, elbows, or buttocks.

     

    WAYS TO HELP PREVENT THE POSSIBILITY OF WORSENING SORES

     

    Each day, look all over the patient’s body for any skin changes or sores.

     

    Keep your patient as clean and dry as possible.

     

    Make sure they eat a healthy diet and drink enough water.

     

    Decrease pressure on their skin. If possible, remind them to shift position often when they are sitting or lying down. For patients who cannot move, ask caregivers if they may be moved into a new position at least once every two hours. If needed, ask your caregivers if a special mattress that helps prevent pressure ulcers is available.

Patient Safety Partnership has attempted to address the topics that the healthcare community experts have defined as being the issues that are most pressing and pertinent to medical safety. While we have focused on specific areas of most frequent incidences of harm, we will be adding topics of interest as often as we can to make the site as helpful and informative as possible.

  • Section 21: WHAT ARE MEDICAL ERRORS?

    Medical errors happen when something that was planned as a part of medical care doesn't work out, or when the wrong plan was used in the first place. Medical errors can occur anywhere in the health care system:

     

    • Hospitals
    • Clinics
    • Outpatient Surgery Centers
    • Doctors' Offices
    • Nursing Homes
    • Pharmacies
    • Patients' Homes

     

    Errors can involve:

     

    • Medicines
    • Surgery
    • Diagnosis
    • Equipment
    • Lab reports

    They can happen during even the most routine tasks, such as when a hospital patient on a salt-free diet is given a high-salt meal.

    Most errors result from problems created by today's complex health care system. But errors also happen when doctors and their patients have problems communicating. For example, a recent study supported by the Agency for Healthcare Research and Quality (AHRQ) found that doctors often do not do enough to help their patients make informed decisions. Uninvolved and uninformed patients are less likely to accept the doctor's choice of treatment and less likely to do what they need to do to make the treatment work.

  • Section 22: PREVENTING MEDICAL ERRORS

    Who's Job is it Anyway?

     

    Preventing medical errors is everyone’s job; everyone involved in the care of a patient should not only do their job according to their training and expertise but should follow the most current best practices available to ensure best outcomes.

     

    In addition, it is not solely the physician’s job to

    oversee a patient’s care, it is a team effort with all involved potentially acting as stop - gaps in order to prevent harm.

     

    Having said this, it is also the patient’s responsibility to do whatever is they can to educate themselves in how they will receive safest care.

     

    Until we as consumers insist upon best, safest care, our health care culture cannot evolve in the way that many of us hope.

     

    When can this begin to happen, who will it help and when? Together, we must decide. As Don Berwick, former CEO of IHI, current Director of CMS best put it, “Some is not a number, soon is not a time.”

  • Section 23: PATIENT SAFETY FACTS

    40,000 Incidences of Harm Occur in U.S. Hospitals Every Single Day

     

    Patient safety is a serious public health issue.

     

    The Institute for Healthcare Improvement (IHI) estimates that 15 million incidents of medical harm occur in U.S. hospitals each year.

     

    This estimate of overall national harm is based on IHI's extensive experience in studying injury rates in hospitals, which reveals that between 40 and 50 incidents of harm occur for every 100 hospital admissions.

     

    With 37 million admissions in the United States each year, this equates to approximately 15 million harm events annually - or 40,000 incidents of harm in U.S. hospitals every day.

     

    IHI defines "medical harm" as unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment) that requires additional monitoring, treatment or hospitalization, or results in death.

     

    Medical Errors Cost Medicare $8,800,000,000.00 Resulting in 238,337 Preventable Deaths of Medicare Patients

     

    In their fifth annual Patient Safety in American Hospitals Study, HealthGrades Inc. cites that errors in treatment resulted in 238,337 potentially preventable deaths of Medicare patients in the U.S., costing $8.8 billion.

     

    HealthGrades Inc. analyzed over 41 million patient records for the study and found that approximately 3 percent of all Medicare patients suffered from some medical error - which equates to about 1.1 million Patient Safety Incidents (PSIs) from 2004 - 2006.

     

    In the report, HealthGrades describes medical errors as, “The failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim … (including) problems in practice, products, procedures, and systems."

     

    There were 270,491 actual hospital deaths that occurred among patients who developed one or more of 16 PSIs and the report states that using previous research, they calculated that 238,337 of these were attributable to patient safety incidents and potentially preventable.

     

    Americans Continue to Experience Medical Mistakes

     

    Consumers Union conducted a poll of more than 2,000 Americans to learn about their experiences with health care - associated infections, preventable medical errors and preventive care.

     

    • Almost 1 in 5 (18%) say they or an immediate family member have experienced a dangerous infection following a medical procedure.
    • 69% of these respondents said they had to be admitted to a hospital or extend their stay because of these infections.
    • 1/3 of the Americans surveyed report that medical errors are common in everyday medical procedures.
    • 13% have had their medical records lost or misplaced.
    • 9% have been given the wrong medicine by a pharmacist when filling their doctor's prescriptions.

    Office of Inspector General Says Almost 14% of Hospitalized Medicare Patients Experienced Adverse Events

     

    Almost fourteen percent of hospitalized Medicare patients experienced adverse events during their hospital stays, according to a report by the Office of the Inspector General. The report also found that an additional 13.5 percent of Medicare beneficiaries experienced events during their hospital stays that resulted in temporary harm.

     

    Physician reviewers estimate that 44 percent of all events were preventable. Preventable events were linked most commonly to medical errors, substandard care, and lack of patient monitoring and assessment. The researchers recommend greater oversight as well as financial incentives to improve care and reduce errors. (Source: The Office of the Inspector General, November 2010)

  • Section 24: SERIOUS REPORTABLE EVENTS

    A serious reportable event (SRE) is an incident involving death or serious harm to a patient resulting from a lapse or error in a healthcare facility.

     

    The National Quality Forum (NQF) coined the term to refer to "preventable, serious, and unambiguous adverse events that should never occur.”

     

    SREs have also been referred to as "never events” although this term has some opposition within the healthcare community.

     

    An increasing number of states require that SREs are reported.

     

    The NQF has compiled a list of 28 SREs in six categories:

     

    Surgical events include:

     

    • Performing a surgery on the wrong body part
    • Performing a surgery on the wrong patient
    • Performing the wrong surgery on a patient
    • Leaving a foreign object in a patient

    Product or device events include:

     

    • Death or disability as a result of contaminated drugs or faulty devices received through a healthcare facility.
    • Patient death or serious disability resulting from the wrong device used or a device functioning other than as intended.
    • Patient death or serious disability associated with intravascular air embolism that occurs while in care.

     

    Patient protection events include:

     

    • Sending an infant home with the wrong parents.
    • Death or serious harm suffered when a patient leaves the facility without permission.
    • Suicide, or attempted suicide that results in serious harm, while a patient in a healthcare facility.

     

    Care management events include:

     

    • Death or serious harm as a result of a medication error, such as the wrong dosage, wrong medication or medication given to the wrong patient.
    • Death or serious disability as a result of being given incompatible blood or blood products.
    • In a low risk pregnancy, maternal death or serious harm as a result of labor or delivery in a healthcare facility.
    • Stage 3 or 4 pressure ulcers (bed sores) acquired during care.
    • Artificial insemination conducted using the wrong egg or donor sperm.

     

    Environmental events include:

     

    • Death or serious disability as a result of electric shock.
    • Delivery of the wrong gas in an oxygen line.
    • Death or serious disability resulting of a fall while in care.
    • Patient death or significant disability as a result of the use of restraints or bedrails while in care.

     

    Criminal events include:

     

    • Any patient care conducted by an unauthorized person.
    • Patient abduction.
    • Sexual assault of a patient while in care.
    • Death or serious injury of a patient or staff member as a result of an assault on the grounds of a healthcare facility.

     

    The NQF report Safe Practices for Better Healthcare recommends 30 practices for the reduction of risk to patients.

  • Section 25: A MOTHER"S LETTER TO A HOSPITAL CEO

    (By Victoria Nahum, whose stepson Josh died from a healthcare - associated infection in 2006)

     

    Our son died in your hospital 7 days ago. He caught an infection there as a result of his medical care while being treated for something else that put so much pressure on his brain that it caused part of it to be pushed into his spinal column, leaving him a helpless ventilator - dependent quadriplegic and ending his short but unforgettable life among us all.

     

    In the week since his death, the days I live have small worth to me. I am numb now. I bring my husband coffee in the morning but he doesn’t smile or speak when I do; he doesn’t even look at me. He sits, hands in lap, shoulders rounded, wearing a mask of pain that I have never seen before; it is not a face I recognize when he is wearing it. I wish it would go away.

     

    His voice is low and quiet and I am uncomfortable with its somber tone. We speak infrequently lately because it feels like no good words remain for us. Our son is dead. What good thing can be spoken now?

     

    Gentle words that others have for us fall inadequately upon deaf ears. Angry words I rehearse in my head won’t help anything at all; spoken aloud they would change nothing for the better, they just sound mean, even to me. Explanations I seek out and find, full of swaggering, inflated medical terms come far, far - so ridiculously far too late.

     

    Here, now my husband and I sit. We have too many questions and they are all useless. “Why?” is the most impossible one of them all. How I wish he would just stop asking me that. I have no proper answer to comfort him. I am momentarily lost.

     

    So what then? And is it really, “What then?” or should it rather be, “How then?” How then might we prevent this from happening again to anyone, ever?

     

    I wonder.

     

    When our son was ill, I watched your nurses come in and out of his room by the hour and rather than just noticing random women with a regular job to do, I instead saw what angels looked like, masquerading in scrubs with name tags and stethoscopes to complete the disguise, caring for him generously and genuinely with real humanity integrated into their sense and deed of significant duty. I heard endearing compassion in their voices and saw true concern in their eyes that made me want to be like them somehow. Their gestures were warm and their care was competent. To them, our son was their own personal mission. They cared for him well; I would tell anyone – I believe they did their best. I know so.

     

    I got to know your nurses. They are devastated by our son’s death … So that it doesn’t happen again, I want you to empower them to save their patients with appropriate procedures and whatever rock-solid rules that they see fit to execute in the name of safer, better healthcare so they and you, may forego the sadness and futility you all must feel when a patient dies on your shared watch.

     

    I spoke at length with your doctors who treated our son. I felt their frustration when their prescribed treatment did not work. I heard the disappointment in their voices when they spoke of how they did not succeed with their plan for his recovery; the failure they felt was noticeable. It hurt them to lose a patient … So it doesn’t happen again, I want you to help your doctors to achieve good, quality care with expected medical outcomes they can be proud of, even if it costs you another $10 per patient or surgical procedure for a preventive measure or device you didn’t want to pay for. In the end, the ounce of prevention costs so little in comparison to the loss of another life.

     

    I’ve listened to your administrators who seem ashamed and afraid and go blah, blah, blah, shrinking back at the issue of the death of our son. Shamelessly, instead of offering right words of authenticity and community, I hear cheap words of faked rationalization globbed in paralyzing fear. You do your hospital no good thing to allow them to act in this manner … So it doesn’t happen again, I want you to teach them to sincerely speak kind and genuine words that suggest shared knowledge of loss. Let them acknowledge fragility; perhaps even responsibility. Do not allow them to suggest that the status quo at your hospital is sufficient when our son is dead from his care. Empower your people to offer hope for a better future of proactive participation with a board of directors willing to improve care on every floor, in every room, for every patient. Demonstrate your honor and regret in appropriate amounts. Leave a significant mark in your community and make a deep imprint of high reputation and of real character that all great men and women do, as you take responsibility for deeds done under your own roof. It’s called stepping up to the plate.

     

    I’ve been a patient as well as a caregiver, an advocate and family member. I’ve felt both trusting and helpless; I’ve acted as a participant as well as a bystander. I’ve had times when I was educated with full knowledge of an issue and I have been ignorant in my lacking of medical understanding … So it doesn’t happen again, I want you to show my family and me how we can contribute as important members of our own personal medical team so that we all, together with your staff, can effect our own best good, expected outcome. If you are unable to show us how to do that, then identify, invest in and empower those who can and do it as part of your chosen service to the practice of medicine. Respect that we can be capable, thinking, proactive partners in our own medical care instead of un - savvy outsiders who never went to medical school. Healthcare needs teamwork to work. We need to know how to “Prepare for Care” and we look to you for direction in doing that.

     

    Dear CEO, I hope you read this letter, this PLEA FROM A MOTHER aloud. Tell your board that my husband and I do not want anything for the loss of our dear son but a dramatic and effective plan for change that will make a difference for others who trust healthcare in general and your hospital specifically. We look to you to partner with us as patients and caregivers so that we may all be safe and well, both now, and in the future.

     

     

    Sincerely,

    Victoria Nahum

  • Section 26: PATIENT SAFETY TOOLS

    These tools do not provide medical advice. They are intended for informational purposes only. They are not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read.

     

    If you think you may have a medical emergency, immediately call your doctor or dial 911.

     

     

     

     

     

    Check your symptoms. Use the symptom checker to select parts of the body where you are experiencing symptoms.

     

     

     

     

     

     

     

    Merck is committed to bringing out the best in medicine. As part of that effort, Merck has created The Merck Manuals, a series of healthcare books for medical professionals and consumers.

     

    As a service to the community, the content of The Manuals is now available in enhanced online versions as part of The Merck Manuals Online Medical Library. The Online Medical Library is updated periodically with new information, and contains photographs, and audio and video material not present in the print versions.

     

     

     

     

     

  • Section 27: PATIENT SAFETY MEDIA

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    SPEAK TO THE NURSE SUPERVISOR

     

    Share your concerns as soon as possible. By speaking up, you may prevent a medical error from occurring and harming your loved one.

     

    Some patient families are afraid of some sort of retribution from care staff when they have a complaint. Although this is a possibility, the vast majority of nurses are committed professionals who want the same good care for your loved one that you do.

     

    If your complaint is with one person in particular, tell the Nurse Supervisor why and see if the two of you can’t come to some sort of satisfying solution.

     

    If nothing changes or you remain dissatisfied with your patient’s care, speak up again. And again.

     

    IF YOU DO NOT GET A RESPONSE THAT YOU ARE SATISFIED WITH, ASK TO SPEAK TO A HOSPITAL ADMINISTRATOR

     

    Sometimes we are met with a response different than we’d hoped. If this happens and you continue to have serious concerns that could affect your patient’s care, calmly request to see a Hospital Administrator.

     

    At this level of hospital management, your concerns will most likely be taken seriously and some sort of satisfactory solution worked out.

  • Section 28: YOUR RIGHTS AS A PATIENT

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    SPEAK UP AND FIRMLY INSIST UPON PROPER HAND HYGIENE

     

    Politely but firmly make it clear to everyone that walks into the hospital room that you expect and insist upon proper hand hygiene.

     

    This means that everyone who comes into the room (whether they intend to touch the patient or not) must wash their hands with soap and water in front of you or sanitize their hands with alcohol - based gel, in front of you.

     

    If they walk in and tell you they already gelled in the hallway, calmly say something like, “That’s great but I need you to do it again in front of me. Thanks!”

     

    SPEAK TO THE NURSE SUPERVISOR

     

    If the lack of proper hand hygiene continues speak to the Nurse Supervisor as soon as possible. By speaking up, you may prevent an infection from occurring and harming your loved one.

     

    REFUSE TO ALLOW THE OFFENDER TO TOUCH YOUR PATIENT

     

    If a caregiver outright refuses to wash or sanitize their hands in front of you, calmly tell them that you do not want them to touch the patient. Politely ask that they leave the patient’s room and then get the Nurse Supervisor.

     

    If the Nurse Supervisor cannot address your concern, then ask to speak to a Hospital Administrator who can.

  • Section 29: SAFE PRACTICES FOR BETTER HEALTHCARE

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    First understand that there is a difference between being colonized with MRSA and having a MRSA infection. Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics.

     

    In the community, most MRSA infections are skin infections. More severe or potentially life-threatening MRSA infections occur most frequently among patients in healthcare settings.

     

    Being colonized is when a person carries the organism/bacteria but shows no clinical signs or symptoms of infection. Many people are colonized but not infected, experiencing no harm or ill effects of the colonization.

     

    MRSA infections are a problem among people who have weak immune systems and are in hospitals, nursing homes, and other heath care centers. Infections can appear around surgical wounds or invasive devices, like catheters or implanted feeding tubes. Symptoms of MRSA...

     

    Actionable Steps You Can Take Right Now

     

    DEFINE WHETHER YOU ARE COLONIZED OR HAVE A MRSA INFECTION

     

    Ask your doctor if you are colonized or infected. The answer calls for a vastly different path of next steps.

     

    IF YOU ARE INFECTED

     

    If you are in the hospital, it is important that you ask to see an I.D. Professional. That means an Infectious Disease specialist. They can come look at your case and confer with your physician as to the best course of treatment and most appropriate next steps.

     

    If you are not hospitalized, ask your doctor what he / she suggests as a course of treatment. Remember that MRSA infections are potentially contagious and as so, much care must be taken to prevent spread of the infection to others.

     

    For more important information on MRSA and how to best proceed, visit:

     

    Safe Care Campaign Website

  • Section 30: PREVENTING MEDICAL ERRORS IN CHILDREN

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    SPEAK TO YOUR PATIENT’S CAREGIVERS ABOUT THEIR NEXT STEPS IN TREATMENT OF CHOICE

     

    Clostridium difficile, also known as C. diff, is a species of bacteria that causes diarrhea and other intestinal disease when competing bacteria are wiped out by antibiotics.

     

    C.difficile is the most serious cause of antibiotic-associated diarrhea and can lead to a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics.

     

    The C. difficile bacteria, which naturally reside in the body, become overpopulated and the the bacterium releases toxins that can cause diarrhea with abdominal pain, which may become severe.

     

    Often, it can be cured simply by discontinuing the antibiotics responsible. In more serious cases, oral administration of metronidazole or vancomycin is the treatment of choice.

     

    INSIST ON PROPER HAND HYGIENE DURING THE CARE OF YOUR PATIENT

     

    Critically ill patients are most susceptible to becoming infected. The most common infections are caused by staphylococci and multi-drug resistant pathogens such as MRSA, VRE and resistant gram-negative rods.  Patients can become ill with bloodstream infections, surgical site infections, urinary tract infections and pneumonia.

     

    It is important for patients and their family members to understand that it is critical that they ask healthcare providers to wash or sanitize their hands in front of them prior to touching the patient. In fact, anyone who touches patients and / or objects in the hospitals room should wash or sanitize their hands before and AFTER doing so.

     

    This includes your doctor.

     

    ASK TO SEE AN INFECTION PREVENTIONIST

     

    If you are in the hospital, it is important that you ask to see an I.D. Professional. That means an Infectious Disease specialist. They can come look at your case and confer with your physician as to the best course of treatment and most appropriate next steps.

  • Section 31: COMMUNICATING WELL WITH CAREGIVERS

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    Enterococci are gram-positive bacteria that can be found in the digestive and urinary tracts of some people. Vancomycin Resistant Enterococci (VRE) is particularly dangerous to people whose immune systems are weakened.

     

    While infection of healthy individuals is uncommon, it is possible that they could be colonized with newly-resistant bacteria. Van-A is resistant to both vancomycin and teicoplanin. In the US, linezolid is commonly used to treat VRE, as teicoplanin is not available.

     

    VRE can be carried by healthy people who have come into contact with the bacteria. The most likely place where such contact can occur is in a hospital.

     

    ASK FOR AN INFECTIOUS DISEASE PROFESSIONAL TO HELP OVERSEE YOUR PATIENT’S CASE

     

    If you are in the hospital, it is important that you ask to see an I.D. Professional. That means an Infectious Disease specialist. They can come look at your case and confer with your physician as to the best course of treatment and most appropriate next steps.

     

    INSIST ON PROPER HAND HYGIENE DURING THE CARE OF YOUR PATIENT

     

    Critically ill patients are most susceptible to becoming infected. The most common infections are caused by staphylococci and multi-drug resistant pathogens such as MRSA, VRE and resistant gram-negative rods.  Patients can become ill with bloodstream infections, surgical site infections, urinary tract infections and pneumonia.

     

    It is important for patients and their family members to understand that it is critical that they ask healthcare providers to wash or sanitize their hands in front of them prior to touching the patient. In fact, anyone who touches patients and / or objects in the hospitals room should wash or sanitize their hands before and AFTER doing so.

     

    This includes your doctor.

  • Section 32: THE FAMILY AS ADVOCATES

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    WHAT IT IS AND WHAT YOU CAN DO

     

    A central venous catheter, or central line, is a tube inserted into a major blood vessel in the neck, chest or groin to serve as a temporary portal for injected medications and fluids, or blood sampling in patients who need them frequently.

     

    Because central lines also provide quick access in emergencies, some patients often have them for weeks or longer. But if inserted incorrectly and, more importantly, mishandled after that, the central line can become a contaminated gateway for bacteria to enter directly into the patient’s bloodstream.

     

    While there is nothing you can physically perform, you can help oversee the condition of the central line.

     

    Simple precautions like:

     

    Regularly changing the dressing covering the central line

    Changing the tubes and caps attached to it

    Cleaning the line before and after use

    Rigorous hand washing before handling the line ...

     

    are all essential to keeping bacteria away. Make sure that you ask the care staff about all of these precautions.

     

    ASK EVERYDAY IF THE CENTRAL LINE MAY BE REMOVED

     

    Daily review of central line necessity will prevent unnecessary delays in removing lines that are no longer clearly necessary in the care of the patient.  Many times, central lines remain in place simply because of their reliable access and because personnel have not considered removing the line.  However, it is clear that the risk of infection increases over time as the line remains in place and that the risk of infection is decreased if removed.

  • Section 33: THE IMPORTANCE OF HAND HYGIENE

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    NOTIFY YOUR CARE STAFF IMMEDIATELY AND SHOW THEM YOUR OBSERVATION

     

    Notify your doctor if you have a post operative wound and develop any of the following:

     

    Worsening bleeding from the wound

    Worsening swelling under the wound surface

    Worsening wound pain

    Wound pain lasting more than 10 days

    Abnormal opening or separation of the wound

    Swollen lump under the skin

    Pus draining from the wound

    Worsening skin redness

    Red streaks traveling away from the wound

  • Section 34: PATIENT ADVOCACIES (Directory)

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    MAKE SURE YOU ARE STARTED ON AN APPROPRIATE COURSE OF ANTIBIOTICS

     

    Most catheter-associated urinary tract infections can be treated with antibiotics and removal or change of the catheter. Your doctor will determine which antibiotic is best for you.

     

    ASK FOR AN INFECTIOUS DISEASE PROFESSIONAL TO HELP OVERSEE YOUR CASE

     

    If you are in the hospital, it is important that you ask to see an I.D. Professional. That means an Infectious Disease specialist. They can come look at your case and confer with your physician as to the best course of treatment and most appropriate next steps.

     

    INSIST THAT NO ONE TOUCH YOU WITHOUT FIRST WASHING OR SANITIZING THEIR HANDS

     

    Not even your doctor.

  • Section 35: WAYS TO BECOME EDUCATED

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    HEAD OF THE BED

     

    Elevation of the head of the patient’s bed has been correlated with reduction in the rate of ventilator-associated pneumonia.  The recommended elevation is 30 to 45 degrees.

     

    Do not lower the head of the bed in order to make your patient feel more comfortable; it will put them in danger of infection, allowing bacteria-laden secretions to go down their throats.

     

    ORAL CARE

     

    Certain hospitals with zero or close to zero

    ventilator - associated pneumonia (VAP) rates perform frequent and vigorous oral care several times a day. Ask your patient’s caregivers about this practice.

     

    SEDATION VACATIONS

     

    To wean patients off sedation/neuroblockers while on a ventilator. Ask your patient’s caregivers about the possibility of sedation vacations.

  • Section 36: WHAT CAN YOU DO TO STAY SAFE?

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation.

     

    APPROPRIATE ANTIBIOTICS

     

    Ask your patient’s caregivers about the type of antibiotic they plan to use to treat their infection. It is important that it is the correct type and amount.

     

    INSIST UPON PROPER HAND HYGIENE

     

    Insist that no one enter your patient’s room without washing or sanitizing their hands in front of you - EVERY SINGLE TIME. This includes doctors.

     

    Proper hand hygiene can help prevent infection of many kinds and this is of the greatest importance for a patient with a weakened immune system.

     

    ASK TO SEE AN INFECTIOUS DISEASE PROFESSIONAL

     

    An infectious disease professional is normally on staff and can be procured to oversee your patient’s case. He / she will work with the doctors to help your patient recover from this potentially life - threatening infection.

     

    More Information on VAP:

     

    HEAD OF THE BED

     

    Elevation of the head of the patient’s bed has been correlated with reduction in the rate of ventilator-associated pneumonia. The recommended elevation is 30 to 45 degrees.

     

    Do not lower the head of the bed in order to make your patient feel more comfortable; it will put them in danger of infection, allowing bacteria-laden secretions to go down their throats.

     

    ORAL CARE

     

    Certain hospitals with zero or close to zero ventilator -associated pneumonia (VAP) rates perform frequent and vigorous oral care several times a day. Ask your patient’s caregivers about this practice.

     

    SEDATION VACATIONS

     

    Ask your patient’s caregivers about the possibility of sedation vacations.

  • Section 37: CHOOSING A DOCTOR

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    ASK TO MEET WITH THE PATIENT’S CARE TEAM

     

    Often, a patient family member will first recognize that their loved one is noticeably in a declining state of health even if treatment of a condition seems to be going as planned.

    If this happens, ask for a meeting with the patient’s doctor or care team to share your concerns and review the patient’s overall situation and potential next steps.

     

    SEEK THE ADVICE OF ANOTHER DOCTOR OR SPECIALIST

     

    If you are still unsure of the actual condition of your patient and remain unsettled, it is OK to request a second opinion or the professional advice of another specialist. Remember, as your patient’s advocate, you are their eyes and ears, and yes, sometimes even their mouth to alert others when more help is necessary.

  • Section 38: CHOOSING A HOSPITAL

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    The Neonatal Intensive Care Unit (NICU) is an intensive care unit created for sick newborns who need specialized treatment.

     

    Sometimes the NICU is also called:

     

    a special care nursery

    an intensive care nursery

    newborn intensive care

     

    Babies may be sent to the NICU if:

     

    they're born prematurely

    experienced difficulties during their delivery

    they show signs of a problem in the first few days of life

     

    Only very young babies (or babies with a condition linked to being born prematurely) are treated in the NICU - they're usually infants who haven't gone home from the hospital yet after being born. How long these infants remain in the unit depends on the severity of their illness.

     

    Actionable Steps You Can Take Right Now

     

    ASK FOR AS MUCH INFORMATION AS POSSIBLE REGARDING YOUR BABY’S CONDITION AND CARE

     

    Some things you might want to ask the neonatologist and/or the nurses include:

     

    How long will my baby be in the unit?

    What, specifically, is the problem?

    What will be involved in my baby's treatment and daily care?

    What medicines will my baby have to take?

    What types of tests will be done?

    What can my baby eat and when?

    Will I be able to nurse or bottle-feed my baby and if so, when and how?

    What can I do to help my baby?

    Will I be able to hold or touch my baby?

    How often and for how long can I stay in the unit? Can I sleep there?

     

    HAND HYGIENE IS NOT OPTIONAL

     

    Be vigilant upon insisting that everyone who comes into the NICU absolutely must wash their hands when they enter. (There will be a sink and antibacterial soap in the room and near the entrance of the NICU.) This is a crucial part of keeping the NICU environment as clean as possible so the babies won't be exposed to infections. Some units require visitors to wear hospital gowns, particularly if a child is in isolation. You may also need to wear gloves and a mask.

     

    Ask the nurses what you're allowed to bring into the unit  - the risk of infection limits what you can leave with your baby. Some parents like to tape pictures to the isolette or decorate the incubator. If you want to give your child a stuffed toy, ask the staff first.

     

    When you're in the NICU, keep noise and bright lights to a minimum. Try not to bang things on the isolette or infant warmer, talk in a loud voice, or slam doors. If you're concerned about light, ask a nurse if you can drape a blanket partially over the isolette. Most important, let your baby sleep when he or she needs to.

  • Section 39: WHAT TO DO WHEN YOU ARE ADMITTED

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    TELL SOMEONE RIGHT NOW.

     

    If you are on medication that is making you feel strange or bad, tell someone you trust right now. Immediately inform your doctor or if you are in the hospital, call a nurse. Perhaps you are allergic to the medication or you may be experiencing an adverse reaction that stems from one drug mixing with another that you are currently taking.

     

    At this time make sure to tell your doctor if you take any herbal or supplements that he or she may not have originally known about.

     

    CALL BUTTON, POISON CONTROL CALL OR TRIP TO THE EMERGENCY ROOM?

     

    If you are very alarmed at your unusual symptom or set of symptoms:

     

    ... and are currently hospitalized, call a nurse immediately.

    ... and are at home, call a Poison Control Hotline: 1-800-222-1222 right now!

    ... and feel that you are in a dire emergency, either go to the nearest Emergency Room or dial 911 and order an ambulance.

  • Section 40: ABOUT YOUR MEDICAL TEAM

    While safe, proper care consists of many complex components we are offering some of the most effective good next steps necessary on your path to a best expected outcome. These steps are by no means all you must do; they are simply the least you should know as you receive your medical care.

     

    Actionable Steps You Can Take Right Now

     

    INFORM THE CARE STAFF THAT YOU THINK YOUR PATIENT IS DEVELOPING BED SORES

     

    Then show the sores to the caregivers to confirm if that is indeed what they are.

     

    Pressure ulcers (also called bed sores or decubitus ulcers) are skin wounds caused by pressure from lying or sitting in one position too long. This can become a serious, life threatening problem among patients in a long - term care setting like an extended hospital stay or a nursing home. Pressure ulcers most often occur in bony areas such as the heels, elbows, or buttocks.

     

    WAYS TO HELP PREVENT THE POSSIBILITY OF WORSENING SORES

     

    Each day, look all over the patient’s body for any skin changes or sores.

     

    Keep your patient as clean and dry as possible.

     

    Make sure they eat a healthy diet and drink enough water.

     

    Decrease pressure on their skin. If possible, remind them to shift position often when they are sitting or lying down. For patients who cannot move, ask caregivers if they may be moved into a new position at least once every two hours. If needed, ask your caregivers if a special mattress that helps prevent pressure ulcers is available.

  • Section 41: WHEN YOU"RE HAVING SURGERY

    If you are planning to have surgery, you will need to know some basic facts. Knowing what to expect before and after surgery and what questions to ask may help you feel less worried and more in control.

     

    Learn About:

     

                    Information you need before surgery

                    What to do to prepare for surgery

                    Informed consent and advance directives

                    What happens the day of surgery

                    What to expect during your recovery

     

    Hand Hygiene

     

    Best medical outcomes begin with a central foundation of good hand hygiene practices and procedures. If you don’t see them do it, tell caregivers you’re concerned about healthcare associated infections and politely demand clean care.

     

    That means you want them to wash their hands in front of you, even if they already before they came into the room. Don’t be embarrassed to ask them to wash or sanitize. It’s not an option anymore; it’s a recognized standard of basic care.

     

    Remember, you’re not being rude to politely demand to be touched with clean hands. Good hand hygiene is literally a matter of life and death.

     

    The Centers for Disease Control states that if proper hand hygiene practices using soap and water or antiseptic hand sanitizers were followed as outlined in their guidelines, 30 - 40% of these infections could potentially be avoided. In real-life numbers, that means that as many as 680,000 American patients per year would not become infected and nearly 40,000 would not die. Wash your hands, save a life? Yes.

     

    Before Surgery

     

    Once you and your health care provider have agreed that you need surgery, you will need some details. Your health care provider or nurse should provide the following information:

     

    Who will be involved in the surgery? Your health care provider will explain who will perform the operation and who will be part of the surgical team.

     

    Where and when will it take place? Outpatient surgery (also called ambulatory or same – day surgery) does not always take place in a hospital. It may be done in a health care provider’s office, surgical center, or clinic. The patient arrives for surgery and usually returns home on the same day. Inpatient surgery takes place in a hospital. The patient usually checks in on the day of surgery and remains for a few days or more after surgery.

     

    What should you do before surgery? You may need to have certain tests and exams. Some types of surgery require special preparation. You may need to set up appointments and make arrangements. Getting these things done on time will help you avoid delays in having your surgery.

     

    The Health Care Team

     

    Your health care provider leads a team of health care professionals who will work together to care for you before, during, and after your operation. Nurses will assist your doctor during surgery, perform special tasks, and help make you more comfortable. A resident or fellow may help during your surgery. Residents are doctors who have finished medical school. They are getting special training by working with your doctor. A fellow is a fully trained doctor who is doing additional training in a specialized area.

     

    The anesthesiologist is the person who is in charge of giving anesthesia and checking its effects. Sometimes anesthesia is given by a nurse – anesthetist who works under the direction of an anesthesiologist.

     

    Health Tips

     

    There are things you can do before your surgery to help it go smoothly and help you heal more quickly. Talk with your health care provider about the following:

    If you smoke, try to stop smoking before your operation. General anesthesia affects the normal function of your lungs. Any period of not smoking helps. It is best if you quit at least 2 weeks before surgery. If you cannot quit, even slowing down helps. Quitting smoking before surgery has the following benefits: Your risks related to anesthesia will be lower. Wound healing is faster. The risk of pneumonia, an infection of the lungs, is decreased.

     

    If you are taking medication, ask if you should keep taking it before or after the operation. Make sure your health care provider knows all of the medications you are taking, including those that have been prescribed for you and those that are bought over - the - counter, such as vitamins, herbs, or other supplements. Some medications should not be taken before an operation. Others may conflict with other medication prescribed for you.

     

    Follow a special diet before surgery if your health care provider suggests it.

     

    If you have diabetes, maintaining good control of your glucose levels before surgery may improve healing.

     

    Informed Consent and Advance Directives

     

    Your health care provider will explain what is involved in your treatment before you can agree to it. This process is called informed consent. You will be asked to sign a consent form before surgery. This form says that you were involved in the decision-making process with your health care provider. Many consent forms describe the type of operation you will have, who will do it, what condition it is meant to treat or evaluate as well as the risks, benefits, and alternative treatments. Read it closely. Ask questions if there is something you do not understand.

     

    Informed Consent

     

    As part of informed consent, your health care provider should talk to you about the following things:

     

                    What will be done

                    Why you need it (benefits of the surgery)

                    Risks of the surgery

                    Risk of not having any treatment

                    What other choices you may have

     

    You should make sure you understand this information. Do not be afraid to ask questions. Have your health care provider go over anything that is not clear to you. If it is not possible for you, the patient, to sign the form, have a stand-in decision maker sign it for you.

     

    An advance directive is a legal document that tells your health care providers about the types of care you want to receive if you are not able to make medical decisions. Advance directives should be considered before you have surgery. You can obtain advance directive forms from your health care provider, legal office, or state health department.

     

    Pre-surgical Checkup

     

    A week or two before your surgery, you may need to have a physical exam and tests, which may include lab tests of your blood and urine, a chest X -ray, and an electrocardiogram. An electrocardiogram is a test of heart function with an instrument that prints out the results as a graph. Tell your health care provider about any changes in your health, medications, or symptoms that occur before your operation, even minor colds or infections.

     

    There is a simple, painless nasal swab test for a potentially dangerous pathogen called Staphylococcus aureus, also known

    as MRSA (Methicillin-resistant Staphylococcus aureus). The test identifies people who are potential reservoirs of infection. You can carry MRSA in your nose or on your skin without displaying symptoms. Approximately 1 in 5 people carry it and if you test positive for this bacteria, your surgeon should know so he/she can take extra precaution to protect you from an avoidable surgical infection.

     

    Transmission could occur when a colonized patient rubs his / her nose before shaking hands with the doctor who comes in for an examination. The doctor could then carry the bacteria to another patient on his hands or on equipment he's handled. To limit MRSA's spread, patients who test positive would be isolated; everyone entering a patient's room would put on sterilized gowns, gloves and masks; and strictest hand-washing regimens would be instituted.

     

    An approach called Active Surveillance Culturing could reduce MRSA infections in hospitals by more than 70 percent. Talk to your doctor about this test well prior to your scheduled surgery.

     

    The Day Before Surgery

     

    Depending on the type of surgery, your health care provider may want you to use a laxative and eat lightly. Do not drink alcohol 24 hours before surgery. You also may be asked to use an enema at home a day or two before some types of surgery.

     

    You may be told not to eat or drink anything for 6–12 hours before surgery. If you have had something to eat or drink during this time, tell your health care provider. If you have diabetes, ask the health care provider when you can have your last meal. Your health care provider will also tell you which medicines you may take with a sip of water on the morning of surgery.

     

    If you’ll be having an invasive procedure or surgery, tell your doctor that you are concerned about health care-acquired bacterial infections and ask if using a surgical soap or antiseptic cleanser prior to your procedure would be a safeguard you could incorporate into your personal plan for safe care. Chlorhexidine Gluconate (the active ingredient in the solution) destroys bacteria, which helps prevent infections during and after surgery. It is usually available without a prescription at your local pharmacy. If not, they’ll be happy to order it for you.

     

    The Day of Surgery

     

    You will be asked to arrive early to prepare for the surgery. Be sure you have your insurance card.

     

    Before leaving home, shower, wash your hair, and remove any nail polish or acrylic nails. Do not wear make up. Leave jewelry and other things of value at home. All jewelry usually needs to be removed from your body before the operation. If you will be staying overnight, bring only those items you will need, including a case for glasses, contact lenses, or dentures.

     

    You will be given an ID bracelet. It will include your name, birth date, and health care provider’s name. Make sure this information is correct. It will be used to identify you throughout your stay in the hospital.

     

    Be prepared to go over your health history, as well as any drug allergies, or allergies to food or latex (some surgical gloves are made of latex). You will be asked what medications you are taking. It may be helpful to bring a list.

     

    Preoperative Preparation

     

    Just before surgery, preoperative preparation takes place. The steps vary, but you may experience the following. You may be asked to remove the following items:

     

                    Dentures and bridges

                    Hearing aids

                    Contact lenses and glasses

                    Wigs, hairpins, combs, and barrettes

                    Jewelry

     

    You will change from your clothes into a hospital gown and maybe a cap. Steps may be taken to help prevent deep vein thrombosis, a risk with all types of surgery. You may be given special stockings to wear, or inflatable devices may be put on your legs. You may be given drugs to reduce the risk of deep vein thrombosis.

     

    You will be taken to an area to wait until the surgical team is ready for you. Some places allow family members or friends to wait with you.

    Your health care provider or team will confirm your name, birth date, and type of surgery before you go to the operating room.

     

    Prior to a surgical procedure, make certain the care staff identifies you with the correct FIRST and LAST name and that they tell you what type of surgery is about to be performed.

     

    Ask to have the surgical site marked with a permanent marker and be involved in marking the site. This means that the site cannot be easily overlooked or confused (for example, surgery on the right knee instead of the left knee.)

     

    Ask questions. You should speak up if you have concerns. It’s okay to ask questions and expect answers that you understand. Think of yourself as an active participant in the safety and quality of your health care. Studies show that patients who are actively involved in making decisions about their care are more likely to have good outcomes.

     

    Prior to surgery, have caregivers clip, rather than shave any surgical site with a razor. A razor may inadvertently create tiny nicks in the skin, creating easy access for harmful, potentially deadly bacteria to be introduced into the newly vulnerable area. More than 30 years of scientific evidence has demonstrated that shaving surgical sites before  operations actually increases the risk of sometimes deadly infections.

     

    Your body usually functions best at its normal temperature (98.6°F). This is true during most kinds of surgery, too. Keeping your body at its normal temperature during your surgical experience can help prevent infections. Today, there are several ways to keep surgical patients at normal body temperature. One of the most common and effective methods is “forced - air” warming. Warm air flows through forced-air warming blankets and gowns that can be used before, during and after surgery. There are more than 100 scientific papers on the importance of maintaining normal body temperature and the benefits of forced-air warming. Ask your surgeon about ways he/she plans to maintain your body temperature before, during and after surgery.

     

    Discuss with your doctor the well-documented link between uncontrolled glucose levels and an increased risk of infection. High blood glucose levels compromise the immune system and leave patients vulnerable to infections. Conversely, controlling blood glucose for patients has been shown to reduce infections and death. IHI says, “Hyperglycemia encourages the development and spread of infection. Testing of blood sugar, especially in diabetic patients, allows staff to control the levels in the patient’s body after surgery.”

     

    An anesthesiologist will discuss which type of anesthesia you will receive during the operation. A tube called an intravenous (IV) line may be placed into a vein in your arm or wrist. It is used for supplying your body with fluids, medication, or blood during and after the surgery. You may be given medication to help you relax. You also may be given other medications that your doctor has ordered, such as antibiotics to reduce the risk of infection.

     

    In the Operating Room

     

    After you have been taken into the operating room, you will be moved to the operating table. Monitors will be attached to various parts of your body to measure your pulse, oxygen level, and blood pressure.

     

    The surgical team may again ask you your name, date of birth, and what operation you are having. A final review of medical records and tests may be done. This final confirmation is called a “time-out,” and it is done for your safety. The time-out may be done before you are given a sedative, or you may not be awake during the time-out.

     

    If you are having general anesthesia, it will be given through your IV line. After you are asleep, a tube called a catheter may be placed in your bladder to drain urine.

     

    After Surgery

     

    Once the operation is over, you will be moved into the recovery area. This area is equipped to monitor patients after surgery.

     

    Many patients feel groggy, confused, and chilly when they wake up after an operation. Let your nurse know if you have a headache or nausea. You may have muscle aches or a sore throat shortly after surgery. These problems should not last long. You can ask for medicine to relieve them. You will remain in the recovery room until you are stable.

     

    Recovery

     

    During your recovery, be sure to ask for enough pain relievers to keep you comfortable. You may receive antibiotics and other medicines.

    You may still have an IV line for fluids. It may take a few days before you are able to eat solid food. Sometimes the pain medicine may cause you to have little memory of the day of surgery.

     

    As soon as possible, your nurses will have you move around as much as you can. You may be encouraged to get out of bed and walk around soon after your operation. You may feel tired and weak at first. The sooner you resume activity, the sooner your body’s functions can get back to normal.

     

    Ask that your doctor to swipe the flat part of his / her stethoscope (the part that touches your body) with an alcohol wipe prior to using it to touch you. This part of the instrument is often contaminated with pathogens and is sometimes casually carried by doctors from room to room, patient to patient.

     

    If you are in the hospital for an extended period bedsores many become a problem. Bedsores are ulcers that occur on areas of the skin that are under pressure from lying in bed, sitting in a wheelchair, and/or wearing a cast for a prolonged period of time. Bed sores can occur when a person is bedridden, unconscious, unable to sense pain, or immobile. A bed sore develops when blood supply to the skin is cut off for more than two to three hours. As the skin dies, the bed sore first starts as a red, painful area, which eventually turns purple. Left untreated, the skin can break open and become infected. A bed sore can become deep, extending into the muscle. Once a bed sore develops, it is often very slow to heal. Bed sores often occur in the buttocks area (on the sacrum or iliac crest), or on the heels of the feet. They are much easier to prevent than to treat so prevention is job one. If you do develop these ulcers, keeping them from becoming infected is crucial to your overall recovery.

     

    Change your position frequently and consistently. Avoid lying directly on your hipbones. Keep your knees and ankles from touching. Use small pillows or pads but avoid placing a support directly behind your knee - it can severely restrict blood flow. Use a pressure-reducing mattress or bed if possible.

     

    Daily skin inspections for pressure sores are an integral part of prevention; inspect your skin thoroughly at least once a day; a family member or caregiver can help if you're not able to do it yourself.

     

    If you're confined to bed, pay special attention to your hips, spine and lower back, shoulder blades, elbows and heels. If you see skin damage or any sign of infection such as drainage from a sore, a foul odor, and increased tenderness, redness and warmth in the surrounding skin, get medical help immediately.

     

    Going Home

     

    After outpatient surgery, you will most likely be able to go home within hours. After inpatient surgery, you will stay in the hospital until your health care provider says you can go home.

     

    Before you leave, a nurse or other health care provider will go over any instructions on diet, medicine, and care for your incision. You will be told what things or activities you should avoid and for how long.

     

    Questions You Should Ask Before You Go Home

     

                    What medicines should I take and when?

                    Can I also take vitamins, herbs, and supplements?

                    What and when should I eat?

                    What signs of complications or infection should I look for?

                    When should I see my health care provider again?

                    What will happen to my stitches or staples?

                    When and how can I shower or bathe?

                    How much weight can I lift, and can I bend over?

                    When can I drive, and when can I go back to work?

     

    You should know who to call if you have a problem and what things you should call your health care provider about, such as a fever or increased vaginal bleeding. Also remember that many pain medications cause constipation. Ask your health care provider what he or she recommends to prevent this problem.

     

    You should not drive right after outpatient surgery. Arrange to have someone drive you home when you are ready to check out. Do not operate heavy machinery, make important legal decisions, or drink alcohol for the next 24 hours.

     

    If you have had major inpatient surgery, it will most likely take a month or more before you are ready to resume your normal schedule. Minor operations require less recovery time, but you may need to cut back on certain activities for a while.

     

    Finally ...

     

    Having an operation can make you anxious. Knowing what to expect will help you feel more at ease and may help you get better faster. Each type of surgery is different. Your health care provider will discuss the details about the surgery with you and answer any questions you may have. The more you know about your operation, the more you can take part in getting well.

  • Section 42: PREVENTING MEDICAL ERRORS

    Check Your Medicines

     

    Tips for Using Medicines Safely:

    Use this checklist to help avoid medication errors. Simple checks could save your life!

     

    Bring a list or a bag with all your medicines when you go to your doctor's office, the pharmacy, or the hospital. Include all prescription and over-the-counter medicines, vitamins, and herbal supplements that you use.

     

    If your doctor prescribes a new medicine, ask if it is safe to use with your other medicines. Remind your doctor and pharmacist if you are allergic to any medicines.

     

    Ask questions about your medicines. Make sure you understand the answers and bring a notepad to write them down.

     

    Choose a pharmacist and doctor you feel comfortable talking with about your health and medicines. Take a relative or friend with you to ask questions and remind you about the answers later.

     

    Make sure your medicine is what the doctor ordered. Does the medicine seem different than what your doctor wrote on the prescription or look different than what you expected? Does a refill look like it is a different shape, color, or size than what you were given before? If something seems wrong, ask the pharmacist to double check it. Most errors are first found by patients.

     

    Ask how to use the medicine correctly. Read the directions on the label and other information you get with your medicine. Have the pharmacist or doctor explain anything you do not understand. Are there other medicines, foods, or activities (such as driving, drinking alcohol, or using tobacco) that you should avoid while using the medicine? Ask if you need lab tests to check how the medicine is working or to make sure it doesn't cause harmful side effects.

     

    Ask about possible side effects. Side effects can occur with many medicines. Ask your doctor or pharmacist what side effects to expect and which ones are serious. Some side effects may bother you but will get better after you have been using the medicine for a while. Call your doctor right away if you have a serious side effect or if a side effect does not get better. A change in the medicine or the dose may be needed.

     

    For more information, visit: Agency for Healthcare Research and Quality and: U.S. Department of Health & Human Services.

  • Section 43: PREVENTING PRESSURE ULCERS

    What Are Pressure Ulcers?

     

    Pressure ulcers (also called bed sores or decubitus ulcers) are skin wounds caused by pressure from lying or sitting in one position too long. This can become a serious, life threatening problem among patients in a long - term care setting like an extended hospital stay or a nursing home. Pressure ulcers most often occur in bony areas such as the heels, elbows, or buttocks. They can be mild or severe. Millions of people get pressure ulcers each year.

     

    Here are some ways family members can help prevent pressure ulcers in your patient:

     

    1. Each day, look all over the patient’s body for any skin changes or sores.
    2. Keep your patient as clean and dry as possible. This is needed because soiled or wet skin increases the chance that a person will get pressure ulcers.
    3. Make sure they eat a healthy diet and drink enough water.
    4. Decrease pressure on their skin. If possible, remind them to shift position often when they are sitting or lying down. For patients who cannot move, ask caregivers if they may be moved into a new position at least once every two hours. If needed, ask your caregivers if a special mattress that helps prevent pressure ulcers is available.
    5. Ask the care staff: Is our family member (patient) at risk for pressure ulcers? What type of food and how much water should our family member eat and drink? What are you doing to decrease pressure on his or her skin?
  • Section 44: PATIENT FALLS: HOW TO PREVENT THEM

    Each year in the United States, thousands of patients are injured in accidental falls during their hospital stays.

     

    While this may not seem like much of a likelihood, patients, attempting to get out of an unfamiliar high-situated hospital bed, on medication that can make them dizzy and other circumstances, can all lead to potentially dangerous accidents.

     

    In the hospitalized elderly, a seemingly benign overnight procedure can instantly turn into a worse one carrying with it a more extended stay if they fall and break a hip or worse.

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    In the Hospital and Out: How big is the overall problem?

     

    One out of three adults age 65 and older falls each year. Among those age 65 and older, falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.

    In 2007, over 18,000 older adults died from unintentional fall injuries.The death rates from falls among older men and women have risen sharply over the past decade.

     

    In 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 581,000 of these patients were hospitalized.

     

    In 2000, direct medical costs of falls totaled a little over $19 billion - $179 million for fatal falls and $19 billion for nonfatal fall injuries.

     

    What outcomes are linked to falls?

     

    Twenty percent to 30% of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.

     

    Falls are the most common cause of traumatic brain injuries, or TBI. In 2000, TBI accounted for 46% of fatal falls among older adults.

     

    Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.

     

    Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and loss of physical fitness, which in turn increases their actual risk of falling.

     

    PREVENT FALLS AT HOME:

     

    How can older adults prevent falls at home on an everyday basis?

     

    Older adults can take several steps to protect their independence and reduce their chances of falling. They can:

     

    Exercise regularly. It’s important that the exercises focus on increasing leg strength and improving balance. Tai Chi programs are especially good.

     

    Ask their doctor or pharmacist to review their medicines - both prescription and over the counter - to reduce side effects and interactions that may cause dizziness or drowsiness.

     

    Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision.

     

    Make their homes safer by reducing tripping hazards, adding grab bars and railings, and improving the lighting in their homes.

     

    Additional ways to lower hip fracture risk include:

     

    Getting adequate calcium and vitamin D in your diet.

    Undertaking a program of weight bearing exercise.

    Getting screened and treated for osteoporosis.

     

    IN NURSING HOMES

     

    Each year, an average nursing home with 100 beds reports 100 to 200 falls. About 1,800 older adults living in nursing homes die each year from fall -related injuries. Those who experience non-fatal falls can suffer injuries, have difficulty getting around and have a reduced quality of life.

     

    How big is the problem?

     

    In 2003, 1.5 million people 65 and older lived in nursing homes. If current rates continue, by 2030 this number will rise to about 3 million.

     

    About 5% of adults 65 and older live in nursing homes, but nursing home residents account for about 20% of deaths from falls in this age group.

     

    Each year, a typical nursing home with 100 beds reports 100 to 200 falls. Many falls go unreported.

     

    As many as 3 out of 4 nursing home residents fall each year. That’s twice the rate of falls for older adults living in the community.

     

    Patients often fall more than once. The average is 2.6 falls per person per year.

     

    About 35% of fall injuries occur among residents who cannot walk.

     

    How serious are these falls?

     

    About 1,800 people living in nursing homes die each year from falls.

     

    About 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures.

     

    Falls result in disability, functional decline and reduced quality of life. Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation.

     

    Why do falls occur more often in nursing homes?

     

    Falling can be a sign of other health problems. People in nursing homes are generally more frail than older adults living in the community. They are generally older, have more chronic conditions, and have difficulty walking. They also tend to have problems with thinking or memory, to have difficulty with activities of daily living, and to need help getting around or taking care of themselves. All of these factors are linked to falling.

     

    What are the most common causes of nursing home falls?

     

    Muscle weakness and walking or gait problems are the most common causes of falls among nursing home residents. These problems account for about 24% of the falls in nursing homes.

     

    Environmental hazards in nursing homes cause 16% to 27% of falls among residents. Such hazards include wet floors, poor lighting, incorrect bed height, and improperly fitted or maintained wheelchairs.

     

    Medications can increase the risk of falls and fall-related injuries. Drugs that affect the central nervous system, such as sedatives and anti-anxiety drugs, are of particular concern.

     

    Other causes of falls include difficulty in moving from one place to another (for example, from the bed to a chair), poor foot care, poorly fitting shoes, and improper or incorrect use of walking aids.

    QUICK TIPS TO PREVENT FALLS IN HOSPITALS:

     

    1. When receiving care as a patient, stay in bed when on medication that makes you dizzy and use the nurse call button for assistance.

    2. When Ambulatory, wear non-skid shoes or slippers to help prevent a fall.

    3. If you normally need to use a cane or walker, do so, even if that nearby robe, book or bathroom is just feet from your bed.
  • Section 45: HOSPITAL DISCHARGE & HOME RECOVERY

    Discharge Planning

     

    What is discharge planning?

     

    Medicare says discharge planning is "A process used to decide what a patient needs for a smooth move from one level of care to another." Only a doctor can authorize a patient's release from the hospital, but the actual process of discharge planning can be completed by a social worker, nurse, case manager or other person. Ideally, and especially for the most complicated medical conditions, discharge planning is done with a team approach.

     

    In general, the basics of a discharge plan are:

     

    Evaluation of the patient by qualified personnel

    Discussion with the patient or his representative

    Planning for homecoming or transfer to another care facility

    Determining if caregiver training or other support is needed

    Referrals to home care agency and/or appropriate support organizations in the community

    Arranging for follow-up appointments or tests.

     

    The discussion needs to include the physical condition of your family member both before and after hospitalization; details of the types of care that will be needed; and whether discharge will be to a facility or home. It also should include information on whether the patient's condition is likely to improve; what activities he or she might need help with; information on medications and diet; what extra equipment might be needed, such as a wheelchair, commode, or oxygen; who will handle meal preparation, transportation and chores; and possibly referral to home care services.

     

    Why is good discharge planning so important?

     

    Effective discharge planning can decrease the chances that your relative is readmitted to the hospital, help in recovery, ensure medications are prescribed and given correctly, and adequately prepare you to take over your loved one's care.

     

    Not all hospitals are successful in this. Although both the American Medical Association and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) offer recommendations for discharge planning, there is no universally utilized system in US hospitals. Additionally, patients are released from hospitals "quicker and sicker" than in the past, making it even more critical to arrange for good care after release.

     

    Studies have shown that as many as 40 percent of patients over 65 had medication errors after leaving the hospital, and 18 percent of Medicare patients discharged from a hospital are readmitted within 30 days. This is not good for the patient, not good for the hospital, and not good for the financing agency, whether it's Medicare, private insurance, or your own funds. On the other hand, research has shown that excellent planning and good follow-up can improve patients' health, reduce readmissions and decrease healthcare costs.

     

    Even simple measures help immensely. For example, you should have a telephone number(s) accessible 24 hours a day including weekends, for care information. A follow-up appointment to see the doctor should be arranged before your loved one leaves the hospital. Since errors with medications are frequent and potentially dangerous, a thorough review of all medications should be an essential part of discharge planning. Medications need to be "reconciled," that is, the pre-hospitalization medications compared with the post-discharge list to see that there are no duplications, omissions or harmful side effects.

     

    Under the best of circumstances, the discharge planner should begin his or her evaluation when the patient is admitted to the hospital.

     

    The care giver's role in the discharge process

     

    The discharge staff will not be familiar with all aspects of your relative's situation. As caregiver, you are the "expert" in your loved one's history. While you may not be a medical expert, if you've been a caregiver for a long time, you certainly know a lot about the patient and about your own abilities to provide care and a safe home setting.

     

    The discharge planners should discuss with you your willingness and ability to provide care. You may have physical, financial or other limitations that affect your caregiving capabilities. You may have other obligations such as a job or childcare that impact the time you have available. It is extremely important to tell hospital discharge staff about those limitations.

     

    Some of the care your loved one needs might be quite complicated. It is essential that you get any training you need in special care techniques, such as wound, feeding tube or catheter care, procedures for a ventilator, or transferring someone from bed to chair.

     

    If your loved one has memory problems caused by Alzheimer's disease, stroke, or another disorder, discharge planning becomes more complicated, and you will need to be a part of all discharge discussions. You may need to remind the staff about special care and communication techniques needed by your loved one. Even without impaired memory, older people often have hearing or vision problems or are disoriented when they are in the hospital so that these conversations are difficult to comprehend. They need your help.

     

    If you or your family member are more comfortable speaking in a language other than English, an interpreter is needed for this discussion on discharge. Written materials must be provided in your language as well. Studies have shown that numerous, and sometimes dangerous, errors can be made in home care when language is not taken into account at discharge. Because people are in a hurry to leave the hospital or facility, it's easy to forget what to ask.

     

    Getting help at home

     

    Listed below are common care responsibilities you may be handling for your family member after he or she returns home:

     

    Personal care: bathing, eating, dressing, toileting

    Household care: cooking, cleaning, laundry, shopping

    Healthcare: medication management, physician's appointments, physical therapy, wound treatment, injections, medical equipment and

     medical techniques

     Emotional care: companionship, meaningful activities, conversation.

     

    Community organizations can help with services such as transportation, meals, support groups, counseling, and possibly a break from your care responsibilities to allow you to rest and take care of yourself. Finding those services can take some time and several phone calls. The discharge planner should be familiar with these community supports, but if not, your local senior center or a private case manager might be helpful. Family and friends also might assist you with home care.

     

    If you need to hire paid in-home help, you have some decisions to make. Unfortunately, these hiring decisions are often made in a hurry during hospital discharge. You might be handed a list of agencies, with instructions to decide which to use—but often without further information. This is another good reason discharge planning should start early—as caregiver, you'll have time to research your options while your loved one is cared for in the hospital.

    Think about both your needs as a caregiver and the needs of the person you are caring for, including language and cultural background.

     

    You have a choice between hiring an individual directly or going through a home care or home health care agency. Part of that decision may be affected by whether the help will be "medically necessary" i.e., prescribed by the doctor, and therefore paid for by Medicare, Medicaid or other insurance. In that case, they will most likely determine the agency you use. In making your decisions, consider the following: home care agencies take care of all the paperwork for taxes and salary, substitutes will be available if the worker is sick, and you may have access to a broader range of skills. On the other hand, there may be a more personal relationship if you hire an individual directly, and the cost is likely to be lower. In either case, try to get recommendations for hiring from acquaintances, nurses, social workers and others familiar with your situation.

     

    Discharge to a facility

     

    If the patient is being discharged to a rehab facility or nursing home, effective transition planning should ensure continuity of care, clarify the current state of the patient's health and capabilities, review medications, and help you select the facility to which your loved one is to be released.

     

    Too often, however, choosing a facility can be a source of stress for families. You may have very little time and little information on which to base your decision. You might simply be given a list of facilities, and asked to choose one. To help, a private geriatric care manager (for whom you will pay an hourly fee) or a social worker can offer much needed advice and support. There are also online sources of information that rate nursing homes, for example.

     

    Convenience is a factor - you need to be able to easily get to the facility - but the quality of care is very important, and you may have to sacrifice your convenience for the sake of better care.

     

    Paying for care after discharge

     

    You might not be aware that insurance, including Medicare, does not pay for all services after a patient has been discharged from the hospital. However, if something is determined by the doctor to be "medically necessary" you may be able to get coverage for certain skilled care or equipment. You will need to check directly with the hospital, your insurer or Medicare to find out what might be covered and what you will have to pay for. Keep careful records of your conversations.

     

    What if you feel it's too early for discharge?

     

    If you don't agree that your loved one is ready for discharge, you have the right to appeal the decision. Your first step is to talk with the physician and discharge planner and express your reservations. If that isn't enough, you will need to contact Medicare, Medicaid or your insurance company. Formal appeals are handled through designated Quality Improvement Organizations. You should know that if the QIO rules against you, you will be required to pay for the additional hospital care. The hospital must let you know the steps to take to get the case reviewed.

     

    Improving the system

     

    As we have mentioned, discharge planning is an inconsistent process which varies from hospital to hospital. Who does it, when it's done, how it's done, what kind of follow-up is mandated, and whether caregivers are assessed for their ability to provide care and included as respected members of the discussion are all elements that differ from setting to setting.

     

    In general, hospitals make money only when beds are occupied, so in many cases, discharge and transitional care planning become "orphan" services that produce no revenue. Despite its benefits, which clearly increase the well-being of patients and caregivers, discharge/transition planning is often not given the attention it deserves, and indeed, ineffectual planning often serves to add to patients' and caregivers' stress.

     

    Discussions among experts on improving transitional care and discharge planning have centered on improvements that emphasize education and training, preventive care and including caregivers as members of the healthcare team. Some studies have revealed that surprisingly simple steps can help. For example, sending the summary of care to the patient's regular doctor increases the likelihood of effective follow-up care. Likewise, telephone calls from knowledgeable professionals to patients and caregivers within two days after discharge help anticipate problems and improve care at home.

    Broader recommended changes in practice and policy include:

     

    Formally recognize the role families and other unpaid caregivers play, include them as part of the healthcare team, and assess their capabilities and willingness to provide care.

     

    Coordinate care across sites, from hospital to facility to home. Improve communication between hospital and community-based services.

     

    Develop better educational materials, available in multiple languages, to help patients and caregivers navigate care systems and understand the types of assistance that might be available to them, both during and after a hospital stay.

     

    Improve training for healthcare staff, including ways to respond to language, culture and literacy differences.

     

    Simplify and expand eligibility for public programs. Make transitional care a Medicare benefit; change reimbursement policies to cover more home-based care in addition to institutional care. Reward hospitals and physicians that improve patient well-being and reduce readmissions to hospitals.

     

    Conclusion

     

    Multiple studies have explored the importance of effective discharge planning and transitional care, and have highlighted the very real benefits in improved patient outcomes and lower re - hospitalization rates. Several pilot programs have illustrated those benefits, but until healthcare financing systems are changed to support such innovations in care, they will remain unavailable to many people. Caregivers, patients and advocates are continuing their efforts to alter our healthcare system to make discharge planning a priority. With our graying population, these changes are ever more necessary.

     

    Some Basic Questions for Caregivers to Ask

     

    Questions about the illness

     

    What is it and what can I expect?

    What should I watch out for?

    Will we get home care and will a nurse or therapist come to our home to work with my relative? Who pays for this service?

    How do I get advice about care, danger signs, a phone number for someone to talk to, and follow-up medical appointments?

    Have I been given information either verbally or in writing that I understand and can refer to?

    Do we need special instructions because my relative has Alzheimer?s or memory loss?

     

    What kind of care is needed?

     

    Bathing

    Dressing

    Eating (are there diet restrictions, e.g., soft foods only? Certain foods not allowed?)

    Personal Hygiene

    Grooming

    Toileting

    Transfer (moving from bed to chair)

    Mobility (includes walking)

    Medications

    Managing symptoms (e.g., pain or nausea)

    Special equipment

    Coordinating the patient’s medical care

    Transportation

    Household chores

    Taking care of finances

     

    Questions when my relative is being discharged to the home

     

    Is the home clean, comfortable and safe, adequately heated/cooled, with space for any extra equipment?

    Are there stairs?

    Will we need a ramp, handrails, grab bars?

    Are hazards such as area rugs and electric cords out of the way?

    Will we need equipment such as hospital bed, shower chair, commode, oxygen tank? Where do I get this equipment?

    Who pays for these items?

    Will we need supplies such as adult diapers, disposable gloves, skin care items? Where do I get these items?

    Will insurance/Medicare/Medicaid pay for these?

    Do I need to hire additional help?

     

    Questions about training

     

    Are there special care techniques I need to learn for such things as changing dressings, helping someone swallow a pill, giving

    injections, using special equipment?

    Have I been trained in transfer skills and preventing falls?

    Do I know how to turn someone in bed so he or she doesn’t get bedsores?

    Who will train me?

    When will they train me?

    Can I begin the training in the hospital?

     

    Questions when discharge is to a rehab facility or nursing home

     

    How long is my relative expected to remain in the facility?

    Who will select the facility?

    Have I checked online resources such as www.Medicare.gov for ratings?

    Is the facility clean, well kept, quiet, a comfortable temperature?

    Does the facility have experience working with families of my culture/language?

    Does the staff speak our language?

    Is the food culturally appropriate?

    Is the building safe (smoke detectors, sprinkler system, marked exits)?

    Is the location convenient? Do I have transportation to get there?

     

    For longer stays

     

    How many staff are on duty at any given time?

    What is the staff turnover rate?

    Is there a social worker?

    Do residents have safe access to the outdoors?

    Are there special facilities/programs for dementia patients?

    Are there means for families to interact with staff?

     Is the staff welcoming to families?

     

    Questions about medications

     

    Why is this medicine prescribed? How does it work? How long the will the medicine have to be taken?

    How will we know that the medicine is effective?

    Will this medicine interact with other medications?prescription and nonprescription? or herbal preparations that my relative is taking now?

     Should this medicine be taken with food? Are there any foods or beverages to avoid?

    Can this medicine be chewed, crushed, dissolved, or mixed with other medicines?

    What possible problems might I experience with the medicine? At what point should I report these problems?

    Will the insurance program pay for this medicine? Is there a less expensive alternative?

     Does the pharmacy provide special services such as home delivery, online refills or medication review and counseling?

     

    Questions about follow-up care

     

    What health professionals will my family member need to see?

    Have these appointments been made? If not, whom should I call to make these appointments?

    Where will the appointment be? In an office, at home, somewhere else?

    What transportation arrangements need to be made?

    How will our regular doctor learn what happened in the hospital or rehab facility?

    Whom can I call with treatment questions? Is someone available 24 hours a day and on weekends?

     

    Questions about finding help in the community

     

    What agencies are available to help me with transportation or meals?

    What is adult day care and how do I find out about it?

    What public benefits is my relative eligible for, such as In-Home Supportive Services or VA services?

    Where do I start to look for such care?

     

    Questions about my needs as a caregiver

     

    Will someone come to my home to do an assessment to see if we need home modifications?

    What services will help me care for myself?

    Does my family member require help at night and if so, how will I get enough sleep?

    Are there things that are scary or uncomfortable for me to do, e.g., changing a diaper?

    What medical conditions and limitations do I have that make providing this care difficult?

    Where can I find counseling and support groups?

    How can I get a leave from my job to provide care?

    How can I get a respite (break) from care responsibilities to take care of my own healthcare and other needs?

  • Section 46: HOW TO KNOW WHEN TO FIRE YOUR DOCTOR

    How to Know When to Fire Your Doctor

     

    In a perfect world your physician should be your “go to” medical expert, your treatment and care  partner and someone you trust to help your oversee your general health and physical well - being.

     

    Unfortunately, life isn’t not perfect and neither are doctors. Certainly, none of us expect perfection in anyone but are there some warning signs that perhaps this doctor is not the right one for you. Maybe it’s time you switched. Here are some signals:

     

    1. Your doctor seems preoccupied or disinterested as you explain your symptoms and begins to offer advice before you’re finished describing your symptoms.

    2. Your doctor is quick to about prescribe “flavor of the week” medications that are newly available. He does not really explain what the medicine is, why you need it, how will help your situation, long - term effects, or if there is a plan to get you off of it. You notice promotional items for the medication all over his office.

    3. Your doctor seems to know a less about your condition that you do.

    4. Your doctor appears to be humoring you when you describe a symptom or something you read about a certain treatment. He is often skeptical of any information you bring him without explaining his hesitancy. You feel like he is being condescending.

    5. He is late in approving refills for prescription medications. His office does not return calls and if you page him after hours for an emergency he doesn't call back for a long time.

    6. Your doctor doesn't believe you when you tell him you are in deep pain. He is hesitant to prescribe pain medication, even when your pain level is extreme and you have a proven record of being a responsible patient who does not abuse pain medications.

    7. Your doctor seems to appear annoyed when you wish to get a second opinion or see a different kind of specialist. He does not comply when you ask him to fax his notes to another physician who should be in the loop of your treatment.

    8. He basically behaves as if he is semi-retired or is usually simply unavailable to see you.  He is rarely present in the office anymore and when he is, his schedule is too busy to get you in.

    9. When you see the doctor, it feels like he doesn’t remember anything about your ongoing condition even though you have been his patient for many years and follow his advice.
  • Section 47: WE ARE ALL IN THIS TOGETHER

    We’re All in This Together

     

    A small group of thoughtful people could change

    the world. Indeed, it's the only thing that ever has.

     

    - Margaret Mead

     

     

    Unfortunately, many patients or their family members take up the mantle of activism after they have experienced a harming event such as a medical error or the loss of a loved one.

     

    Nonetheless, they effectively turn that bad experience into a mission-driven passion to effect change for the benefit of others.

     

    If you are just one person with a similar passion, don’t make the mistake of feeling insignificant or powerless. Your focus and committed energy can indeed make a difference for the future.

  • Section 48: WHEN YOUR PATIENT IS ADMITTED TO THE ICU

    When Your Patient is Admitted to the ICU

     

    One of the most upsetting situations you could ever experience in your life is a sudden phone call that summons you to the hospital where a loved one has been admitted to their Intensive Care Unit (ICU).

     

    In addition to your high level of worry and upset, you find yourself thrust into a strange environment of scary machines, unfamiliar devices and what seems like an endless procession of caregivers entering and exiting the room.

     

    The ICU is a very intense area and can create a great deal of tension and stress for patients and families. Here are some helpful suggestions for you how deal with the challenges ahead.

     

    Communication

     

    Whenever you are in the room with your patient, try to speak in a calm, clear manner. Make short positive statements. For instance, many family members assume because their loved one is on a ventilator they cannot hear. Most of the time the patient can indeed hear you.

     

    Do not discuss any unpleasant matters in your love one's room. If your love one's condition is critical, discuss this or other problems outside the room. For example, do not discuss financial matters, or family disagreements, etc.

     

    Acknowledge and recognize any discomfort or disorientation your loved one may be experiencing. For example, you may tell them, "You're are in the ICU and you have a tube to help you breath. This is just temporary and we will get the nurse to give you some medication to make you more comfortable. You are doing great and making progress." Offer short phrases that offer support and reassurance. For example, "Mom, it’s Nancy, I'm here with you and you are doing much better. Everyone is taking good care of you."

     

    Do not ask the patient questions that cannot be answered. Use a board so the patient can point to a word such as “pain”.  This allows your loved one to make his need known. Most ICU's have these boards available or will make one for you. It is not unusual for patients to be aggravated, frustrated, or not be interested in communicating. Be patient with them, the frustration level will decrease and perhaps another method of communication will work better for them.

     

    Simple hand gestures may work as well, such as: Thumbs Up = "Good"  and Thumbs Down = "Bad".

     

    Hold your loved one's hand or touch them gently (be sure to check with the ICU staff first). Be sure that you have washed or sanitized your hands prior to ever touching them and insist that anyone entering the room wash or sanitize their hands, even if they do not intend to touch the patient. Hand hygiene is the NUMBER ONE way to help prevent your patient from acquiring a potentially life threatening infection while in the ICU.

     

    Orient your loved one to the surroundings, for example, the date and time of day. You may want to make a sign each day with the date on it and place it where they can easily see it (for example, on the wall at the foot of their bed). Describe what the different noises are to help ease any fear or anxiety they may have about them.

     

    Read your loved one's favorite prayers, poems, books, stories, or bible verses.

     

    Music may be allowed in the ICU when appropriate. Again be sure to check with the ICU staff for guidance.

     

    General suggestions that may be helpful to family members:

     

    Ask the critical care staff to explain to you what the current status of your love one is, so you understand what is going on and why.

     

    Ask for suggestions on what would be helpful at this time for your loved one.

     

    If you are emotional and or upset either leave the room. It may be helpful to request a Chaplin or social worker to help you to calm down and help you feel reassured, or sit quietly at the bedside. It may only be harmful to your loved one to speak when you are angry or upset. Request your church Chaplin, the hospital Chaplin, or a social worker if you feel you need further support for yourself or for your loved one during the hospitalization.

     

    Consider setting up a family visitation schedule to spend time at the hospital, this prevents one person from becoming exhausted. For example:

     

    Dad visits from 10:00 am to 12:00 pm

    Mary visits from 11:30 am to 2:00 pm

    John visits from 2:30 pm to 3:30 pm

     

    It is important for family members to remember to be supportive of each other. Don't forget to take care of yourself and be kind and patient with each other.

     

    Consider texting through MMS or emailing a list of concerned family and friends so everyone can get frequent updates on your love one's condition. Multiple phone calls to the Critical Care Unit staff can be time consuming and the staff wants to be at your loved one's bedside.

     

    Have two designated family members that communicate with the physicians and nurses in regard to your loved one's daily progress, and then those family members can update everyone else. You may want to keep a journal of information, questions, and answers. The critical care staff does not have time to answer the questions of multiple family members - they are very busy people and have your love one's best interest at heart.

     

    Allow your loved one periods of rest, this is a critical part of the healing process.

    Just sit quietly at the bedside, speak only if your loved one wakes up. Offer support and comfort.

     

    ICU Psychosis

     

    The ICU is a busy place filled with all types of noise. Unfortunately, patients do not get much rest, and sleep deprivation along with narcotic drugs can contribute to confusion in the intensive care unit, called ICU Psychosis due to the critical care environment and illness itself. Many elderly patients become confused just being removed from their homes into a different environment, or in the dark of night, even when they are not particularly ill.

     

    ICU Psychosis can be upsetting and quite disturbing for the family members as well as the patient. In some situations, the patient must be physically restrained and or placed in velcro restraints to keep them safe in their beds so they do not harm themselves or others. Do not be alarmed; this is temporary and will pass.

     

    ICU psychosis is a disorder in which patients in an intensive care unit (ICU) or a similar setting experience a cluster of serious psychiatric symptoms. Another term that may be used interchangeably for ICU psychosis is ICU syndrome. ICU psychosis is also a form of delirium, or acute brain failure.

     

    Some of the Causes of ICU psychosis

     

    Sensory deprivation

    Sleep disturbance and deprivation

    Continuous light levels: Continuous disruption of the normal bio -  rhythm with lights on continually (no reference to day or night)

    Stress

    Lack of orientation: A patient's loss of time and date

    Sensory overload

    Pain which may not be adequately controlled in an ICU

    Medication (drug) reaction or side effects

    Infection creating fever and toxins in the body

    Metabolic disturbances

    Dehydration

     

    As the patient continues heal from the illness or injury, medications are typically decreased. Normal sleep patterns gradually return and the patient recovers from the confusion of ICU psychosis. The act of communication will aid the patient in the process of returning to normal orientation. You will find the hospital staff very helpful in offering suggestions that will be beneficial to your loved one as the healing process continues. Various types and levels of communication will be of benefit at different stages of the recovery process.

     

    Summary

     

    Even though the ICU can be a frightening place and constitute a terrible time for family members who worry about the well-being of their loved one, it is also a place of healing.

     

    Remember to always ask questions and if you do not understand the answer, ask again. Bring a journal or notebook and make hourly or daily notes that include questions you have for the doctors, a list of new medications or procedures performed on your patient, a summary of how you feel your patient is progressing, etc.

  • Section 49: WHERE TO GO FOR GRIEF SUPPORT

    Where to Go for Grief Support

     

    The aftermath of medical harm is often emotionally painful. Sadness, anger, even guilt and bouts of depression are all common responses and how individual people respond can vary enormously.

     

    People feeling loss or grief generally pass through many stages and do not pass through them one at a time or in any predetermined sequence.

     

    An initial stage of shock or disbelief is often the first stage. This happens when the reality of what has occurred hits home. Some people describe it as a feeling of being in a dream that they cannot wake from.

     

    Another stage is one of acute anguish. It can last from weeks to months and feelings of depression can occur now and may include outbursts of intense anger, weeping and/or disconsolate silence. Many people experience loss of sleep; some feel physical aches and pains. Some people feel a need to voice their upset to whomever will listen. All of these types of disturbances are normal, however, the degrees to which they occur may not be.

     

    If you have experienced medical harm or are grieving from the harm done to, or the loss of, a loved one it is important that you are able to work through it in a way that is right for you. Some people rely on a strong support system of friends and family in order to do this, while others are hesitant to reach out to anyone at all.

     

    If you are seeking support after experiencing any sort of medical harm there is help from people who have had similar experiences of harm and loss.

     

    HELP IS NEARBY

     

    MITSS: Medically Induced Trauma Support Services is a non-profit organization founded in June of 2002 whose mission is “To Support Healing and Restore Hope” to patients, families, and clinicians who have been affected by an adverse medical event. Medically induced trauma is an unexpected outcome that occurs during medical and/or surgical care that affects the emotional well being of the patient, family member, or clinician.

     

    MITSS provides educational support groups for patients and their families who have been affected by medical error or unanticipated outcomes led by a clinical psychologist.  MITSS also provides support groups for nursing professionals finding themselves at the “sharp end” of an adverse medical event.

     

    For Patients and Family Support please email: support@mitss.org

    For Caregivers Support please email: caregivers@mitss.org

    For Healthcare Organizations Support please email: healthorg@mitss.org

     

     

    MAME: Mothers Against Medical Error supports victims of medical harm. If you or a loved one have suffered medical injury or poor medical care, they can help. Mothers Against Medical Error is a group of parents whose mission is to promote safety in our medical system providing support for victims of medical harm. You may contact them at:

    Email: mamemoms@gmail.com

    Telephone: 1-803 254 8804

    Website: http://www.mamemomsonline.org/

     

     

    PULSE: Persons United Limiting Substandards and Errors (in Health Care) provides support to patients and families who have experienced medical errors or adverse events as they seek closure.

     

    PULSE services include:

     

    • Counseling services for patients and families after a medical error.
    • Support groups with occasional guest speakers. (some locations)
    • One-on-one support and guidance for patients and their families.
    • 24-hour access to mental health services and patient consultants.
    • Information from some of the most well known people in healthcare advocacy.
    • Early intervention after a medical error to defuse anger and help communicate the families needs with the provider.

     

    Email: Ilene Corina

    Telephone: New York (516) 579-4711 If you live outside New York, call:
    1(800) 96-PULSE

    Website: http://www.pulseofny.org

     

     

     

     

     

    Telephone:

    Website:

    617-232-0090 Toll free: 1-888-36MITSS (1-888-366-4877)

    http://www.mitss.org/index.html

    Email:

    Telephone:

    Website:

    Ilene Corina

    New York (516) 579-4711 If you live outside New York, call 1(800) 96-PULSE

    http://www.pulseofny.org

  • Section 50: HOW TO PREVENT INFECTIONS

    WAYS PATIENTS CAN HELP PREVENT THEIR OWN INFECTIONS:

     

    • BECOME A PROACTIVE PATIENT

      The medical industry has come to find that truly superior health care comes in part, from a harmonious team effort between proficient caregivers and educated patients who become partners in their own medical care. A proactive patient has a much better chance of experiencing a best expected medical outcome.
      The 3 most important TIPS for patients are:

     

    1. Become Proactive. Take an interest in and try to oversee your own care if possible.

    2. Recruit a Care Advocate. Everybody needs a friend who can help look out for them, especially when they’re sick.

    3. Absolutely INSIST on proper and compulsive hand hygiene from everyone who comes into your hospital room. Every single time. This includes your doctor.

     

    • RECRUIT A “CARE ADVOCATE”

      While many people are taken ill instantly and find themselves in emergency situations, many others have the opportunity to recruit an advocate to assist in the hospital or during the time of their scheduled medical procedure. Sometimes another set of ears to hear what the doctor said or another pair of hands to help you get a faraway object on the other side of the hospital room is a huge help. More than that, care advocates can help navigate your care, write down appointment times and locations and come up with great questions you would never think of.

    • INSIST ON COMPULSIVE HAND HYGIENE

      Hands are the number one way bacteria is transmitted in a hospital environment. Be sure to tell everyone who touches you that you expect them to wash or sanitize their hands before they touch you. The CDC recommends that caregivers wash or sanitize their hands before and AFTER touching patients or objects in the hospital room. This includes your doctor.

    • DISCUSS THE ADMINISTRATION OF PRE-INCISIONAL ANTIBIOTICS WITH YOUR SURGEON

      It has been reported that up to 40 percent of surgical cases requiring preoperative antibiotics did not receive them preoperatively.
    • CHLORHEXIDINE GLUCONATE (CHG)

      If you’ll be having an invasive procedure or surgery, tell your doctor that you are concerned about health care-acquired bacterial infections and ask if using a surgical soap or antiseptic cleanser prior to your procedure would be a safeguard you could incorporate into your personal plan for safe care.
    • ASK ABOUT A MRSA SCREENING

      If you’ll be having a surgical procedure, ask your surgeon to have you tested for methicillin - resistant Staphylococcus aureus (MRSA) at least one week before you come into the hospital.
    • CATHETER CARE

      Catheters are long, thin, flexible plastic tubes inserted into your body to deliver or remove fluids.
    • ASK YOUR CAREGIVERS TO WIPE OFF THEIR STETHOSCOPES

      Ask that your doctor to swipe the  flat part of his / her stethoscope (the part that touches your body) with an alcohol wipe prior to using it to touch you.
    • CLIP INSTEAD OF SHAVE

      Prior to surgery, have caregivers clip, rather than shave any surgical site with a razor. A razor may inadvertently create tiny nicks in the skin, creating easy access for harmful, potentially deadly bacteria to be introduced into the newly vulnerable area.
    • PREVENTING BEDSORES (also known as Pressure Ulcers / Decubitus Ulcers)

      Bedsores are ulcers that occur on areas of the skin that are under pressure from lying in bed, sitting in a wheelchair, and/or wearing a cast for a prolonged period of time. Bed sores can occur when a person is bedridden, unconscious, unable to sense pain, or immobile.
    • MAINTAINING NORMOTHERMIA

      Your body usually functions best at its normal temperature (98.6°F). This is true during most kinds of surgery, too. Keeping your body at its normal temperature during your surgical experience can help prevent infections.
    • POSTOPERATIVE MONITORING OF BLOOD SUGAR

      Discuss with your doctor the well - documented link between uncontrolled glucose levels and an increased risk of infection.
    • NOTIFY NURSE OF DISCOMFORT, REDNESS OR SWELLING

      Avoid unnecessary complications whenever possible. Potential infections are nothing to scoff at. Here are some things to keep in mind during your hospital stay:

© 2010 - 2015 Patient Safety Partnership | All Rights Reserved