‘To err is human, to blame ... even more so’ (unknown).
It’s easy to feel powerless when you are hospitalized. Poorly designed hospital gowns which leave you half naked make it difficult for you to hold on to your dignity; and lying spread- eagled on the operation table can make even the strongest patient feel overwhelmed, scared and powerless. You are scared, and while the medical staff wants to help, they seem to be rushed and frazzled, and you are reluctant to intrude and upset their schedule.
Doctors have their hands full with patients and anxious relatives pestering them with questions. Nurses are multi-tasking and making copious notes on each patient. Residents are doing multi-shifts and probably haven’t had a good night’s sleep in several days (or is it weeks?). Hospitals are unfamiliar terrain, and can be a lot like a minefield. Hospital hazards for patients are hidden, but if you don’t know where the mines are, how will you be able to avoid them?
Even though nurses and doctors will do their best to provide the best care for all patients, the bitter truth is that hospital care can harm – and this can be a steep price to pay, just because you are clueless about what you can do to protect yourself. Preventable hospital hazards can result in harm to patients, or even death. These are called “Never Events”, and include disasters such as:
* A retained instrument in the abdomen after an operation
* A mismatched blood transfusion because of the wrong blood bag being given to a patient
* Surgery performed on the wrong body part
* Surgery performed on the wrong patient
In a perfect world, these kinds of disastrous slip-ups would never occur. While hospitals have their own safety training campaigns to improve their processes and protocols to stamp out Never Events, the fact remains that humans are fallible and that mistakes do occur. What can you do to ensure that these Never Events never happen to you or your loved one in the hospital? Partnering with the healthcare team is the best way patients can get the best care! However , some patients find that talking to their doctor can be challenging. Their fear is that it might upset the doctor, and damage their relationship. However, such worries are unfounded. Good clinicians routinely invite questions and help patients make intelligent decisions, based on their personal preferences.
If you have any concerns, please ask your doctor or nurse. You have a right to ask questions and get answers about your own health. There’s no need to be confrontational, but you do need to be assertive. Sometimes it feels like your doctor is too busy to talk to you, or maybe you’re embarrassed to ask some questions. If you are scared, you can ask the junior doctor or the nurse your queries, but you need to remember that messages can get garbled during transmission.
Remember that your nurses and doctors all want the same thing: for you to get better quickly. As the patient, you too are part of the health care team. It’s important that you prepare, listen carefully, and speak up when you need to. Because the time your doctor can spend with you is limited, you will feel less rushed if you prepare your questions in advance. Remember that Questions are the Answers, and the quality of the doctor’s answers will depend upon the quality of your questions! You can learn how to ask good questions at http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html. Here are some useful suggestions.
* Speak up if you have any questions or concerns, and if you don’t understand the answers, ask again. It’s your body and you have a right to know. If you ask a question you may feel like a fool for a short time, but if you don’t ask, you will remain a fool for ever
* Don’t shy away from asking about safety. For example, if you’re having surgery, ask the doctor to mark the area that is to be operated upon, so that there’s no confusion in the operating room
* Notice whether your caregivers have washed their hands before touching you. Hand washing is the most important way of preventing hospital-borne infections. Don’t be afraid to gently remind a doctor or nurse to do this. This should be an “always event”- a positive behavior that improves patient safety. If truth be told, even big, established hospitals are often understaffed and their nurses over-worked. Studies show that only one-third of doctors and nurses comply with the hand-washing routine. However, patients are hesitant to say anything because they don’t want to seem to be suggesting that hospital staff aren’t clean. Here’s a simple solution devised by Julia Hallisy, who is the founder of The Empowered Patient Coalition (http://empoweredpatientcoalition.org): “When our daughter was ill, we taped an eye-catching, easy-to-read sign to the door of her room. Using colored paper, we wrote ‘PLEASE WASH YOUR HANDS AND WEAR GLOVES AS APPROPRIATE’ in large, black letters. This simple reminder resulted in such an immediate and dramatic increase in compliance that the infection control specialist made her own signs and placed them on the doors to all of the rooms in the pediatric oncology unit.”
* Make a careful note of the time of the day when you receive your medication. If a nurse misses out the next dosage, remind her about it * Educate yourself about your diagnosis, the medical tests you are undergoing and your treatment plan
* Ask health care workers to introduce themselves when they enter your room and look for their identification badges. If you are unsure about their identity or occupation, ask! ** Make sure your nurse or doctor confirms your identity from your wristband or asks your name, before he or she administers any medication or treatment. Don’t hesitate to tell the health care professional if you think he or she has confused you with another patient * Verify that blood and other specimens taken from your body are labeled in front of you.
* Go to a hospital or clinic that is accredited and routinely undergoes rigorous on-site evaluation against established state-of-the-art quality and safety standards issued by the local medical authorities
* If you have any type of catheter or IV line, ask every day if that catheter and IV line can be removed. This can reduce the risk of hospital acquired infections
* Know your doctor and his team. Make friends with your nurses and the technicians – make sure they address you by name at least once every shift.
* While hospital management discourages tipping, a lot of family members find that giving gifts to the hospital staff helps to ensure that their patient gets VIP treatment. This isn’t something you should be doing as it encourages the hospital staff to discriminate between patients.
* Know whom to call for help in case of a medical emergency (how to activate a CODE Blue).
* Checklists can be your best defense against medical errors when you are hospitalized. They can serve as mine-detectors, and armed with the right checklists, you’ll know what to look out for. Equally importantly, these can teach you what to do, and what to say in order to get safe care. Even in the best hospitals, patient safety is a team effort. You can download comprehensive checklists free at http://patientsafetymovement.org/resources/#patient-checklists. In her book, Hospital Guide for Patients and Families, Julia Hallisy writes: “Don’t wait for staff members to breach protocol and then berate them. Avoid awkward situations by announcing your concerns to staff well in advance of the start of the procedure.”
Your medical records
Your medical records summarize your treatment course during your hospital stay, and are very valuable documents. While many hospitals treat these as their property, they are your records, and it’s a good idea to review them on a regular basis, to ensure that there are no errors in them. Some hospitals are reluctant to share the records with the patient, but this is an archaic attitude, and needs to be changed. You need to make sure that the notes are legible; complete and updated . All the lab results and scan reports should be filed in a timely fashion. If something is not clear or is missing , ask the nursing staff or the doctor.
Patient complaints can improve patient safety
You need to remember that as a patient, you are not just a passive recipient of medical care, but you can actively help to promote safety and reduce risk. One way is to complain if you have a bad experience, because these could be a result of unsafe systems and careless doctors. All of us have been in hospitals, either as patients or as visitors, and we know from personal experience that many hospital processes are broken. Since patients are at the receiving end of many near misses, patient feedback can help hospitals to promote positive changes.
Patient complaints are also useful markers of dysfunctional doctors, and the systematic analysis of patient complaints can help the hospital management to identify high risk physicians. Typically, 80% of the complaints will involve 20% of physicians, and these are the ones who jeopardize patient safety, by being rude or cutting corners.
The majority of these physicians are often not aware of their risky or unsafe technical and interpersonal behaviors. Patient complaints offer a powerful tool for identifying these error- prone, high-risk physicians and most physicians respond positively to feedback, because they know that this can help them to improve. Many will agree with the issues identified and will ask for help, while others may need to be fired, to stop them from harming other patients.