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Health Care is a journey. This journey may be difficult at times due to the complex nature of our health care system. The following articles were designed to help you through this maze.

Within each article you will receive critical information to help you improve your health care experience. These strategies and techniques are woven into a “real life” example of how our health care system works. Our goal is to provide you with useful tools to assist you in attaining the best health care possible.

We believe one piece of knowledge or information may make a difference in your or a loved one’s health.. Maybe, just maybe, we can make a difference in your health or the health of someone you love with this information.

“LISTEN TO ROSE” by Brent C. Aleshire, MSW

I was standing outside the office of Rose, a nurse who schedules surgery for the hospital. She was speaking to a patient, and her voice was clear and firm. “Don’t do it,” she told the patient.

When Rose saw that I was within earshot of her conversation, she smiled and shook her head at the telephone. Again, I heard her say, “Don’t do it.” This time, her voice was stronger and even more convincing (or so I thought) than the first time. “If it were me,” she continued, “I would not have the surgery. I don’t think you have considered all the options.”

A moment later, Rose ended the conversation with the following statement: “Very well, your surgery is tomorrow morning at 8 o’clock. Be here at 5:45 a.m. for pre-admission.”

The next day, I saw Rose in the corridor of the hospital’s Intensive Care Unit, embracing the patient’s wife. Both women had tears in their eyes. Later that day, Rose told me that something had gone terribly wrong during the surgery, and the outcome looked bleak.

I like patient advocates, and Rose was one of the best. Her clinical experience, compassion and years of listening to patients enabled her to identify situations where people did not have sufficient information to make an educated decision on their course of care. Rose knew in her mind and heart that the proposed surgery was not in this patient’s best interest. She could tell that the patient had accepted the doctor’s recommendation for surgery without a full evaluation of all possible treatment options.

The patient/doctor relationship should be built on trust and mutual respect. However, an informed and empowered health care consumer must always ask questions about tests, medications, diagnoses and especially surgery. Being empowered means taking control of your health care and being able to gain the information necessary to make informed decisions.

Often, patients do not have enough information about all available treatment options to make an informed decision. When patients have more information, they tend to opt against surgery when a more conservative yet effective alternative is available.

But getting the information necessary to make an educated decision depends on asking the right questions. Often, we don’t even know where to begin. Experience tells us that the passive patient who remains uninformed and takes little part in medical care may be less prepared to manage their specific medical condition. Questions provide an opportunity to increase your understanding of the medical process, including plans for treatment and follow up care. Before any surgery is performed, make sure to ask the right questions regarding surgery.

Before any surgery is administered, make sure to ask the following questions:

  • What operation are you recommending?
  • Why do I need this operation?
  • Are there alternatives to surgery?
  • Have they been considered?
  • What are the benefits of having the operation?
  • What are the risks?
  • What happens(or could happen)if I don’t have this operation?
  • Where can I get a second opinion?
  • What has been your experience in performing this operation?
  • Where will the operation be performed? ## This does make a difference!
  • (hosptials and surgery centers are safer than having surgery in the
    doctor’s office!)

  • What kind of anesthesia (general, local) will I need?
  • How long will it take to recover?
  • How much will the operation cost?

Like Rose, I too am a patient advocate. I want patients to receive the best medical care possible. In short, asking questions is good for you. This simple intervention on your part will decrease anxiety, increase your sense of control and contribute to better health.

“FLU SHOT IN AM” by Brent C. Aleshire, MSW

The doctors’ order seemed pretty straight forward to me. Emily was to receive her flu shot in the morning before she left the hospital. It was early December, right in the middle of flu season and Emily’s doctor realized that his patient was not yet protected from this year’s flu. The order was then written, Flu Shot in AM.

On the day of Emily’s release from the hospital her family had gathered to help pack her belongings, wish her well and provide emotional support. Emily was being transferred to a skilled nursing facility for continued convalescence and rehabilitation. Fortunately for Emily, the ambulance was over one hour late in arriving. That delay allowed the hospital staff to “double check” all of the doctor’s orders. It was discovered, to everyone’s surprise that the flu shot had not been given as ordered. Why?

There can be many reasons why the order was not carried out. Perhaps it was a “systems” problem or a human error. Millions of events like this happen every day in our nations’ hospitals. The risk of something going amiss on an airplane is 1 in 2 million, but a person faces a 1 in 200 risk of an error in a hospital. Fortunately, the majority are caught in time like Emily’s. However, many are not. Sometimes they are never noticed, ever!

The hospital industry is continually looking for ways to “safeguard” their patients. Until they “fine-tune” our health care system, it seems to make sense that we as patients and caregivers be alert to these types of situations. Therefore, don’t be afraid to ask if the test was ordered, if the medication was given, if the x-ray was read, etc. Modern medicine still depends on “old fashioned” memory of staff to carry out orders.

Keep track, to the best of your ability, if all your physician orders are being carried out. Use a personal health care journal or diary to assist with this tracking. Being involved in your own health care will help safeguard your future.

Emily waved good-bye with a sore arm but thankful in the knowledge she most likely would not catch the flu this season.

Footnote: Each year, 60,000 adults in the United States die needlessly because they don’t get vaccinated against flu and pneumonia. Additional deaths occur from other vaccine-preventable diseases. Ninety percent of flu-related deaths occur in people age 65 or older. Ask your doctor if a vaccine is indicated for you.

“The Pharmacist’s Nightmare” by Brent C. Aleshire, MSW

It was about 3 p.m. when I found out the nursing home staff needed to speak with me right away. They were organizing a new patient’s medication and could not read the order sheet. That morning, the patient had been transferred to the facility from the hospital where I was director of Social Services.

Apparently, the nursing staff at the facility could not reach the doctor who wrote the medication orders because he had already left town for the weekend. His associate had not returned their phone calls, and the facility pharmacist wanted to settle the matter before going home.

These calls were not uncommon during my 20 years as a health care social worker. Early on in my career, I wondered how pharmacists could read doctor orders. Often, the handwriting was hard to read at best, and sometimes completely illegible to an “untrained” eye like mine. Nonetheless, orders were processed. Little did I know how many times the pharmacist would call the doctor to clarify orders.

In this particular case, the patient had been at the facility for several hours without receiving medication. Questions arose. Was this a crisis situation? Were there medications that needed to be administered right away? The nursing staff had requested to see copies of the patient’s record to review medications that had been given at the hospital, in an effort to “decode” the doctor’s illegible orders.

Was the staff overreacting? Take a look at a copy of the actual order http://r.pm0.net/s/c?2p8.7pfc.1.4aa7.aj
and ask yourself the following questions: Can you read it? Is there a chance that some of these orders may be misinterpreted? If you were a nurse or pharmacist, would you like to take that chance? If you were the patient, would you be comfortable with this kind of “guessing game?”

This is a dramatic but true example of how accidents can (and do) occur. Unfortunately, it happens all too often. Both pharmacists and doctors agree that drug errors are a problem. As the number of drugs and medications increase, medications with similar names can be mistaken on a prescription.

To ensure your safety, be sure to ask your doctor to carefully review discharge instructions. Also, request written information about all your medications. Review this information with your pharmacist as well.

This story illustrates the importance of staying involved and getting the information you need to avoid this type of “nightmare.”

“Aren’t You Curious?” by Brent C. Aleshire, MSW

There we were, having a nice conversation when the CNA (Certified Nursing Assistant) entered the room to check Charlie’s glucose (blood sugar). We continued to talk as the CNA “pricked” his finger to obtain the required sample of blood for the glucose monitor. The CNA finished her task, recorded the number on her form, and left the room.

Charlie kept on talking and never inquired about his “blood sugar” results. As we spoke, I thought to myself, “Aren’t you curious?” “Don’t you want to know if your blood sugar is within normal limits?” But Charlie didn’t, and I knew it.

There are millions of “Charlie’s” out there in our health care system. People who take it for granted that all is well and the medical community will tend to their needs.

How wonderful life would be if that were the case. The problem is that life in our health care system doesn’t work that way. What you don’t know can hurt you! In the case of diabetes, new reports suggest millions of people should “know their numbers”.

According to the American Diabetes Association, 18.2 million people in the United States, or 6.3% of the population has diabetes. While an estimated 13 million have been diagnosed with diabetes, there are 5.2 million people (or nearly one-third) who are undiagnosed and untreated.

Diabetes is considered a “silent” disease as there may be no symptoms for up to 10 years after it’s’ onset. Unfortunately, about 50% of patients have blood vessel damage by the time of diagnosis.

To further our concern, a managed healthcare executive reports that only one-third of doctors in this country provide care that meets standards set by the American Diabetes Association.

With this alarming information in mind it becomes imperative that all of us become very “curious” about our health. According to current guidelines, testing for diabetes should be considered every three years beginning at age 45.

In addition, if you weigh more than your ideal weight and have a family history of diabetes, you should discuss testing with your health care provider during a regular check-up, according to the National Center for Chronic Disease Prevention and Health Promotion.

What are your numbers? Dare to Know! I urge you to find out. Keeping your blood glucose levels close to normal substantially reduces your risk of developing diseases of the eye, kidney, nerves, and heart.

Taking an active role in your own medical treatment may be one of the most important decisions of your life. Research suggests that patients who take a more active role in visits with their physician may have a greater sense on control and better health outcomes.

For a valuable diabetes information resource list go to: http://www.cdc.gov/diabetes/pubs/tcyd/resources.htm

Remember; to receive the health care you need and deserve, be involved, be active and of course be a little “curious.”

“THUD!” by Brent C. Aleshire, MSW

Thud! It was an unmistakable sound. All of us at the nurses station heard it. The physical therapist sitting next to me jumped up and was the first to arrive in her room. Alice was on the floor and the wheelchair was on top of her. She had fallen straight forward, “strapped in” her wheelchair. Alice struck her head on the floor with a very solid impact.

Help was there immediately. Unfortunately, the damage was already done. Nurses and therapists surrounded her and the doctor was summoned. X-rays, CT scans and a cervical collar was ordered. Every effort was made to be sure that no potential injury was overlooked.

When the sense of urgency had subsided, and we knew that Alice would be alright, her family was contacted. Once they were assured that their mother was okay, the question then turned to; How did this happen?

The staff believe Alice simply fell asleep in her wheelchair and fell forward. If this were the case, one might assume that no one is to blame, “accidents happen”. However, nothing could be further from the truth. Hospitals are in the business of caring for their patients. Their mission is to safe guard the patients under their watch.

All patients are to be assessed upon admission for the potential of falls. An “action plan” is then implemented to decrease the likelihood of a fall. Unfortunately, the “action plan” is not always followed.

The incidence of falls in hospitals is an alarming number. National averages indicate that annually, acute care general hospitals experience approximately 1,000,000 fall occurrences, per year. Sadly, 30% of those falls will result in injuries. Of those injuries, 5% or 52,500 will receive serious trauma such as a hip fracture.

It is safe to assume that all patients are at some degree of risk of falling. Impaired mental status (i.e. confusion, disorientation), impaired memory, as well as those patients taking medications that act on the central nervous system, such as sedatives and tranquilizers may increase the chance of falling.

New products are on the market to assist hospital staff protects their patients. Bed alarms as well as motion alarms, which alert staff if someone is trying to get out of bed, are in use. Low beds or Vail “enclosed bed systems” may be employed. Physical and chemical restraints are still being used as well. * Many facilities are working to move to a “restraint-free” environment as restraints have not been proven to reduce falls.

Simple care strategies should also include:

  • non-skid footwear
  • improved lighting
  • minimize clutter near the patient’s bed
  • frequent patient checks

We all know that accidents do happen. However, be sure that the hospital staff has a program in place to minimize the risk of a fall. Use the following “Action Plan” with all hospitalized patients.

FALL PREVENTION ACTION PLAN

Patient safety is an ongoing responsibility for all hospital staff. Families can also play an important part in creating a safe hospital environment. The following guidelines will help ensure maximum safety of your loved ones.

  • 1. Request a copy of the hospital’s Fall Prevention Policy and Procedure.
  • 2. Review the policy and procedure to determine if a safe plan is in place.
  • 3. If restraints are indicated, request a copy of the hospital’s Restraint Policy and Procedure.
    • Restraints, if used correctly, can be a part of a hospital’s safety plan. However, restraint use can also pose their own safety risk. Be sure they are monitored as outlined in the Restraint Policy.
  • 4. Patients are to be assessed continuously to evaluate their safety risk. Studies have reported that between 16% and 52% of patients may experience more than one fall during their hospitalization. Be alert for changes in condition that warrant a change to their Fall Prevention Action Plan.
  • 5. Depending on the nature on an individuals care needs, a 24hour sitter may be the only option to ensure safety. Hospital staff should assess for this high level of monitoring.
  • Effective fall prevention requires the involvement of all hospital staff. Gentle reminders may be helpful if they are not following safety guidelines. If this approach does not work, request to see someone in authority to ensure the safety of your loved one. Hospital stays are difficult enough without the added burden of a serious fall. Being attuned to these issues will decrease the likelihood of ever hearing “thud”.

    Article Usage and Reprint Information: Articles may be reprinted in their entirety or in part without permission as long as proper credit is given; “by Brent C. Aleshire MSW, www.TheHealthCareSystem.com, Copyright 2006.”

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