What Every Hospital Patient Should Think About

hospital patientAccording to a recent study in the British Medical Journal by Dr. Martin Makary of Johns Hopkins University School of Medicine, the third most prevalent cause of death for Americans (topped only by heart disease and cancer) is medical error.  Indeed, it is estimated that preventable medical errors cause in excess of 400,000 deaths annually in the United States.  In addition to these fatal medical errors, it is estimated that 10,000 preventable serious medical complications occur per day in the U.S.  Fortunately, a little planning and active participation during your hospital stay can go a long way to ensuring that you receive the best possible care and have a speedy recovery.

As patient safety advocates in the field of law for over three decades, we at Decof, Decof & Barry offer the following tips to help avoid medical complications:

1. Keep an up-to-date list of basic medical information such as your medications and dosages, any diseases or medical conditions you have (including food and drug allergies) and the names and telephone numbers for all your physicians and medical providers. Make sure you keep this list somewhere safe and easily accessible by you or your loved ones.  The Institute for Safe Medication Practices has a helpful sample form that you can download here.

2. For planned hospitalizations do just that…make a plan. Investigate various hospitals’ ratings and complication rates especially infection rates by accessing these links:  Consumer Reports and Medicare.  To the extent possible, choose the hospital where the procedure is done.  Schedule surgeries early in the week to avoid weekend or holiday staffing issues.

Talk to your doctor about what medications you will need to start or stop prior to the procedure or what pre-admission testing or screenings, such as MRSA or heart attack/stroke risk, you should undergo.  Ask what will happen during your admission, about how long it will last, and who will be caring for you.  If a surgical procedure is planned, ask what other physicians will be taking part and what specific parts of the procedure they will be doing.  Talk with your physician about what a successful outcome means to you.

3. During your hospital stay be an advocate for yourself or ask someone to be an advocate for you.

  • Make sure your wrist band has your name spelled properly and contains any drug allergies you have. Also, make sure the hospital staff checks it prior to administering any medications or performing any tests.
  • Ask hospital staff to introduce themselves and find out if they are a nurse or doctor. If it is a doctor, ask if he/she is an  intern or resident and inquire into their specialty.
  • Ask lots of questions.
    • Who will be in charge of or coordinating your care?
    • Ask daily about whether catheters or IV’s are still needed as they significantly increase the risk of infection after being in place for 2-3 days.
    • Ask what medications you are taking, why they are being prescribed and in what doses. If something does not make sense or sound right, say something.  If you are placed on heartburn medication, ask if it is really needed because these medications can increase the risk of intestinal infections and pneumonia.
    • Ask about tests prior to undergoing them and make sure you understand why they have been ordered.
    • Ask about discharge timing, so you have time to plan properly.
  • Anyone who touches you should wash their hands with soap and water or antibacterial hand sanitizer before doing so. Have your own bottle of hand sanitizer and a container of bleach wipes (for bedrails, tray tables, etc.) bedside for staff and visitors.  Make sure you use them, too.
  • Avoid wrong-sided surgery by marking correct surgical sites yourself or having the surgeon do so, and mark the other side with a clear indication that it is not the correct site.
  • Take notes and speak up. Write down tests that are done, vitals, visits by nurses/doctors.  Each day, ask your physician how you are doing, what the plan is for the day, what your goal is for that day and write it down —  an example of this type of “care journal” used by Christ Hospital can be found here, and for another free alternative click here.

It is OK to ask questions, voice concerns and to expect answers.  If you don’t get answers, ask to speak with the physician who is in charge of your care or the hospital’s patient advocate.

4. As your discharge approaches, ask to see a discharge planner so that appropriate home services can be arranged. Hospital and insurance companies have strong financial incentives to discharge patients as soon as possible.  Make your own decision regarding whether you feel ready to go home.  If you do not feel ready, ask your doctor to extend your stay.  If he/she is not able to do so ask about appealing to the discharge planner, the patient advocate, or a state board.

5. Stay vigilant upon discharge.

  • When you are ready to go home, ask for clear written instructions on what you should or should not be doing at home.
  • Report any signs of infections or negative changes to your system, such as fever, loss or decrease in urinary function or increasing pain.
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