Two weeks ago I was riding my bike in my neighborhood, and in an attempt to avoid being hit by a car that was backing out of a driveway, I rode my bike from the street up onto the sidewalk. In so doing, I had to squeeze past a dumpster that was halfway on the sidewalk in my path. The space between the dumpster and a rocky yard was too narrow, and I somehow rammed my little finger into the dumpster and broke it at the base of the lowest joint. I nearly fell off the bike but was able to stay upright in spite of an extremely painful left hand!
By the time I got home, the little finger on my left hand was already swelling, and the pain was unrelenting. I decided it was best to go to Urgent Care, and I was waiting outside when their doors opened.
After filling out some paperwork about my insurance, I was eventually led back into the bowels of the Urgent Care where my vital signs were taken. I was then escorted to a small exam room to wait for the physician's assistant. No physician was in the facility that day. The PA came in, looked at my finger, and told me I would be taken to X-ray shortly. At no time did he or anyone else ask me how the injury was incurred and when it happened. No one asked me to rate or describe my pain.
When the x-ray results were obtained, I was told to see an orthopedist and was given a printed copy of the x-ray results along with a CD of the x-ray image to take to the doctor. For some reason, neither my primary care physician nor the hand specialist I eventually saw were able to download the images on the CD.
It wasn't until after I left the urgent care that I read the history written by the PA. According to the history, the accident had occurred the previous day when I supposedly fell. In reality, it had happened that very morning, and there had been no fall. The PA wrote that my pain was severe (though it was mild and intermittent by that time) and he described it using several inaccurate adjectives. In short, the history was a complete fabrication.
In my book, I encourage the patient to ask the nurse to either read the medical history contained in the patient's chart or provide a printed copy so the patient can check it for accuracy. An inaccurate history can result in a misguided focus, inappropriate or unnecessary treatment, and influence future visits to the physician or hospital. An inaccurate history can even adversely affect potential litigation in some cases.
I failed to take my own advice to read the history before leaving the facility, but I hope that you will take my advice and remember to make sure your medical history, as recorded in your permanent chart, tells the true and accurate story of you!
Tuesday, July 16, 2019
Thursday, September 22, 2016
Feeling Safe, Feeling Grateful
When the World Fell off it Axis
My sister, Patsy, and I escaped the Phoenix heat one Thursday and drove 4.5 hours north to visit our father in the tiny town of St. Johns, Arizona. Our dad is just three months shy of turning 91 years old, and he is still as sharp as ever. The weather in St. Johns was a welcome 78 degrees with clouds and occasional sprinkles of rain, which always lifts my spirits. The three of us were sitting in the living room; Daddy in one recliner, Patsy in another recliner, and I was sitting on the couch feeling peaceful and content. My iPad was sitting next to me on the couch, and I picked it up to check out something online. Suddenly I had a sense that something terrible was about to happen. Seconds later the world fell off its axis and began to move about in a dance of madness. My heart rate shot up and so did my blood pressure to the extent that I instantly experienced a headache. It was a terrifying experience.
Slow, Deep Breaths
As a nurse, I tried every trick I know to slow my heart rate. I breathed in deeply and breathed out slowly through pursed lips. I tried gently massaging the sides of my neck (the carotid arteries.) I did the valsalva movement - bearing down as though I was trying to have a bowel movement. My heart rate finally started to slow down, but the world still seemed unstable. I was a little dizzy when I tried to walk, but just when I thought the worst had passed, it started again - the fast heart rate, elevated blood pressure, headache. I asked Patsy and my dad to drive me to the fire station. In St. Johns, I could get to the paramedics faster than they could get to me. At the fire station, a paramedic did an EKG and assured me it was normal. My blood pressure was still high, so we waited until it began to come down. We discussed my options, and I decided to go back to the house, take it easy, and hope for the best. The remainder of Friday passed without incident, and the three of us drove back to Phoenix the following day, Saturday. I was feeling cautiously hopeful and thought that perhaps I had simply experienced a bizarre reaction to the change in altitude in St. Johns, and anticipated that all would be well. I was not to be so fortunate.
The Nightmare that is Vertigo
Sunday morning I woke up before daylight. I didn't need to open my eyes to know that something was wrong. When I did open my eyes, the room wouldn't hold still. Adrenaline again flooded my bloodstream, and my heart rate and blood pressure shot up. This time I was determined to ride it out and quietly worked on relaxing and slowing my heart rate without waking up my sleeping husband. I was able to remain calm, but I couldn't make the dizziness go away. At one point, I got out of bed and walked to the bathroom holding on to chairs, a table, the wall, and other sturdy objects along the way. Then I walked back to bed, again holding on to things to keep from falling. Once in bed, I tried resting, but I felt as though I was being tossed about on an angry sea, and the feeling was intolerable. I finally woke my husband and told him I needed to go to the emergency room. I was afraid my blood pressure would reach a truly dangerous level, and I needed help sooner than later. My husband threw on some clothes, and helped me down the stairs and into the car. Finally, we were going to get me some help.
A Safe Place
As we drove to the hospital, I felt as though I was holding my breath and just hanging on. At the same time, I knew I would begin to relax once we reached the hospital. We were going to Banner Estrella Medical Center (BEMC), a hospital where I had previously worked for over 10 years. I knew the caliber of doctors and nurses there, and I knew they would take good care of me. At one point during the drive, I was struck by the irony of having written a book about staying safe in the hospital setting, when all I wanted at that moment was to be in the hospital where I knew I would feel safe! I'm happy to say that I was not disappointed for even a moment.
A Nurse, a Doctor and Answers to Prayers
Earlier that Sunday morning, when I woke up feeling like I was in a death spin, the only thing I could do besides take slow deep breaths was to pray, pray, and pray some more. I prayed for comfort, for heavenly assistance, and for relief from the misery I was feeling. My prayers were answered in the BEMC emergency room in the best possible ways!
I waited in the triage area for just minutes before I was taken to the back and placed in a bed. The nurse who cared for me was Mauricio, a nurse I have known for many years. He is an amazing nurse, and I couldn't have handpicked a better one. Dr. Parise, who cared for me, remembered me from years before when I had gone to the ER with a back injury. Both Mauricio and Dr. Parise did everything right. They took great pains to keep me well informed and to ensure my comfort. Dr. Parise sat at my bedside and answered endless questions as though I were the only patient in the ER. He explained that I had vertigo and went into great detail about the construction of the inner ear and the "calcium ball" that was causing my problem. He described the exercises that would help the dizziness until the "ball" dissolved on its own.
After doing lab work and giving me IV fluids and medication for the vertigo, I was released to go home and rest. Less than three hours had passed from the time I entered the ED to the time I arrived back home.
Feeling Grateful
I've been hospitalized during different decades of my life for a variety of reasons, starting at age five with an emergency appendectomy. In every case, I received flawless care from excellent nurses and doctors. I felt their compassion and their genuine desire to help me get well. I still remember certain nurses who cared for me, and I will be forever grateful for them.
Feeling Safe
I have always felt safe in the *hospital, but I have an advantage. I know when red flags are waving and something isn't quite right. I want everyone to have that same advantage. We can't all go to nursing or medical school and spend years working in a hospital; but we can share what we know with each other, and that is exactly why I wrote the Smart Patients, Safe Patients book. I want everyone to feel as safe in the hospital as I feel and to BE as safe as I know we can all be. When the world falls off its axis, it's a great feeling to know there is a hospital nearby and excellent caregivers to safely make things right again.
*I don't count my chin surgery as a hospital stay. It was done in an outpatient surgical center in a completely different environment.
My sister, Patsy, and I escaped the Phoenix heat one Thursday and drove 4.5 hours north to visit our father in the tiny town of St. Johns, Arizona. Our dad is just three months shy of turning 91 years old, and he is still as sharp as ever. The weather in St. Johns was a welcome 78 degrees with clouds and occasional sprinkles of rain, which always lifts my spirits. The three of us were sitting in the living room; Daddy in one recliner, Patsy in another recliner, and I was sitting on the couch feeling peaceful and content. My iPad was sitting next to me on the couch, and I picked it up to check out something online. Suddenly I had a sense that something terrible was about to happen. Seconds later the world fell off its axis and began to move about in a dance of madness. My heart rate shot up and so did my blood pressure to the extent that I instantly experienced a headache. It was a terrifying experience.
Slow, Deep Breaths
As a nurse, I tried every trick I know to slow my heart rate. I breathed in deeply and breathed out slowly through pursed lips. I tried gently massaging the sides of my neck (the carotid arteries.) I did the valsalva movement - bearing down as though I was trying to have a bowel movement. My heart rate finally started to slow down, but the world still seemed unstable. I was a little dizzy when I tried to walk, but just when I thought the worst had passed, it started again - the fast heart rate, elevated blood pressure, headache. I asked Patsy and my dad to drive me to the fire station. In St. Johns, I could get to the paramedics faster than they could get to me. At the fire station, a paramedic did an EKG and assured me it was normal. My blood pressure was still high, so we waited until it began to come down. We discussed my options, and I decided to go back to the house, take it easy, and hope for the best. The remainder of Friday passed without incident, and the three of us drove back to Phoenix the following day, Saturday. I was feeling cautiously hopeful and thought that perhaps I had simply experienced a bizarre reaction to the change in altitude in St. Johns, and anticipated that all would be well. I was not to be so fortunate.
The Nightmare that is Vertigo
Sunday morning I woke up before daylight. I didn't need to open my eyes to know that something was wrong. When I did open my eyes, the room wouldn't hold still. Adrenaline again flooded my bloodstream, and my heart rate and blood pressure shot up. This time I was determined to ride it out and quietly worked on relaxing and slowing my heart rate without waking up my sleeping husband. I was able to remain calm, but I couldn't make the dizziness go away. At one point, I got out of bed and walked to the bathroom holding on to chairs, a table, the wall, and other sturdy objects along the way. Then I walked back to bed, again holding on to things to keep from falling. Once in bed, I tried resting, but I felt as though I was being tossed about on an angry sea, and the feeling was intolerable. I finally woke my husband and told him I needed to go to the emergency room. I was afraid my blood pressure would reach a truly dangerous level, and I needed help sooner than later. My husband threw on some clothes, and helped me down the stairs and into the car. Finally, we were going to get me some help.
A Safe Place
As we drove to the hospital, I felt as though I was holding my breath and just hanging on. At the same time, I knew I would begin to relax once we reached the hospital. We were going to Banner Estrella Medical Center (BEMC), a hospital where I had previously worked for over 10 years. I knew the caliber of doctors and nurses there, and I knew they would take good care of me. At one point during the drive, I was struck by the irony of having written a book about staying safe in the hospital setting, when all I wanted at that moment was to be in the hospital where I knew I would feel safe! I'm happy to say that I was not disappointed for even a moment.
A Nurse, a Doctor and Answers to Prayers
Earlier that Sunday morning, when I woke up feeling like I was in a death spin, the only thing I could do besides take slow deep breaths was to pray, pray, and pray some more. I prayed for comfort, for heavenly assistance, and for relief from the misery I was feeling. My prayers were answered in the BEMC emergency room in the best possible ways!
I waited in the triage area for just minutes before I was taken to the back and placed in a bed. The nurse who cared for me was Mauricio, a nurse I have known for many years. He is an amazing nurse, and I couldn't have handpicked a better one. Dr. Parise, who cared for me, remembered me from years before when I had gone to the ER with a back injury. Both Mauricio and Dr. Parise did everything right. They took great pains to keep me well informed and to ensure my comfort. Dr. Parise sat at my bedside and answered endless questions as though I were the only patient in the ER. He explained that I had vertigo and went into great detail about the construction of the inner ear and the "calcium ball" that was causing my problem. He described the exercises that would help the dizziness until the "ball" dissolved on its own.
After doing lab work and giving me IV fluids and medication for the vertigo, I was released to go home and rest. Less than three hours had passed from the time I entered the ED to the time I arrived back home.
Feeling Grateful
I've been hospitalized during different decades of my life for a variety of reasons, starting at age five with an emergency appendectomy. In every case, I received flawless care from excellent nurses and doctors. I felt their compassion and their genuine desire to help me get well. I still remember certain nurses who cared for me, and I will be forever grateful for them.
Feeling Safe
I have always felt safe in the *hospital, but I have an advantage. I know when red flags are waving and something isn't quite right. I want everyone to have that same advantage. We can't all go to nursing or medical school and spend years working in a hospital; but we can share what we know with each other, and that is exactly why I wrote the Smart Patients, Safe Patients book. I want everyone to feel as safe in the hospital as I feel and to BE as safe as I know we can all be. When the world falls off its axis, it's a great feeling to know there is a hospital nearby and excellent caregivers to safely make things right again.
*I don't count my chin surgery as a hospital stay. It was done in an outpatient surgical center in a completely different environment.
Saturday, August 13, 2016
The Nurse as Patient Advocate
I had a terrible experience a number of years ago that I want to share in order to make an important point. I don't want my experience to frighten you, so please understand that what happened to me happens very rarely.
Uneasy in the Doctor's Office
I was in need of some corrective surgery for a problem with my chin, and a plastic surgeon was recommended to me. At the time, I was not a nurse, and my trust in medical professionals was solid across the board. It never occurred to me during my younger, naïve years that medical professionals could be anything but perfect. I went to the plastic surgeon, and he examined the problem to see if it could be corrected. When I asked him if he had done the procedure very many times in the past, he bragged that he had a reputation for doing especially good work. There wasn't really anything wrong with what he said, but something inside me felt uneasy. I quickly brushed it off and told him I wanted to go ahead with the surgery.
Like a Bolt of Electricity
The day of the surgery came, and my husband drove me to the outpatient surgical center. I signed a consent after the procedure was explained to me, I was prepped and put on a gurney to await the surgeon. Soon I was rolled into the surgery room, and I was given anesthesia through my IV. In retrospect, I recall there was no anesthesiologist present. There was a nurse assisting the surgeon and no one else. After I was given sedation through the IV, I fell asleep. The surgeon made an incision, and shortly after that the nightmare began.
I remember being aware of what the surgeon was doing. I remember being in great pain. I was unable to open my eyes or move any part of my body, including my lips. I was unable to tell the surgeon, "Wait! I'm not asleep, and this hurts!" At some point, I heard the nurse say, "Doctor, I don't think she is completely under. Do you want to give her some more sedation?" The surgeon said it wasn't necessary and kept working. Then he did something to my chin that made me feel as though a bolt of lightening had struck me in the chin and traveled through my body. The pain was excruciating.
After the Trauma
I don't recall seeing the surgeon again after the paralytic anesthesia wore off, but I did tell the nurse what had happened. She said she could tell I was in pain. A few weeks later I went back to the surgeon's office to have bandages removed. The work he had done on my chin left me with a crooked chin. When I mentioned it to him, he blamed it on my facial structure, though my chin hadn't been crooked before the surgery. He was rough when he examined me, and although he had been only slightly interested in me as a person when I first met him, any small amount of warmth exhibited previously had evaporated. He removed the bandages, told me "Don't do any crazy aerobics," and sent me home.
Evidently this surgeon was suffering from personal problems. Several weeks lately he drove himself to the desert and committed suicide.
The Nurse as Advocate
The nurse who assisted the surgeon tried to get him to address the problem she observed during my surgery. She tried to be my advocate. In that case, there was nothing more she could do at the time. She couldn't leave my side to phone an administrator or complain to anyone higher up the chain of command. I don't know if she filed an incident report later or not. I hope she did, simply because part of her job is to be the advocate for all patients, including future ones she has not yet met. If a nurse is aware of unsafe practices on the part of any medical professional, that nurse needs to do something about it and report the problem to someone in authority.
If you are admitted to a hospital, I encourage you to let your nurse know that you are counting on him or her to be your advocate. Nurses are taught that one of our most important roles is that of patient advocate, and a gentle reminder won't hurt his or her feelings a bit. Sometimes we nurses need to be reminded, especially on crazy busy days. No matter what else is happening, you, the patient, need to come first. Your safety and comfort is our highest priority, and acting as your advocate is an honor and privilege. Please don't hesitate to share concerns with us and allow us to put your mind at ease, and stand up for you when necessary.
If I Could Do it Over Again
I'm wiser now than when I had that surgery years ago. Now I go to the Medical Board of Examiners and look up any doctor I plan to see in order to check for complaints or board action. I also check Health Grades to see what other patients think of the physician. And if I ever have to go to the hospital, I will talk to my nurses and let them know how important their advocacy is to me. I'll let them know I'm counting on them to keep me comfortable and safe and to run interference for me if necessary. Trust me, I know nurses, and fortunately I know we can count on them to be the advocates we need. (But a little reminder won't hurt.)
Uneasy in the Doctor's Office
I was in need of some corrective surgery for a problem with my chin, and a plastic surgeon was recommended to me. At the time, I was not a nurse, and my trust in medical professionals was solid across the board. It never occurred to me during my younger, naïve years that medical professionals could be anything but perfect. I went to the plastic surgeon, and he examined the problem to see if it could be corrected. When I asked him if he had done the procedure very many times in the past, he bragged that he had a reputation for doing especially good work. There wasn't really anything wrong with what he said, but something inside me felt uneasy. I quickly brushed it off and told him I wanted to go ahead with the surgery.
Like a Bolt of Electricity
The day of the surgery came, and my husband drove me to the outpatient surgical center. I signed a consent after the procedure was explained to me, I was prepped and put on a gurney to await the surgeon. Soon I was rolled into the surgery room, and I was given anesthesia through my IV. In retrospect, I recall there was no anesthesiologist present. There was a nurse assisting the surgeon and no one else. After I was given sedation through the IV, I fell asleep. The surgeon made an incision, and shortly after that the nightmare began.
I remember being aware of what the surgeon was doing. I remember being in great pain. I was unable to open my eyes or move any part of my body, including my lips. I was unable to tell the surgeon, "Wait! I'm not asleep, and this hurts!" At some point, I heard the nurse say, "Doctor, I don't think she is completely under. Do you want to give her some more sedation?" The surgeon said it wasn't necessary and kept working. Then he did something to my chin that made me feel as though a bolt of lightening had struck me in the chin and traveled through my body. The pain was excruciating.
After the Trauma
I don't recall seeing the surgeon again after the paralytic anesthesia wore off, but I did tell the nurse what had happened. She said she could tell I was in pain. A few weeks later I went back to the surgeon's office to have bandages removed. The work he had done on my chin left me with a crooked chin. When I mentioned it to him, he blamed it on my facial structure, though my chin hadn't been crooked before the surgery. He was rough when he examined me, and although he had been only slightly interested in me as a person when I first met him, any small amount of warmth exhibited previously had evaporated. He removed the bandages, told me "Don't do any crazy aerobics," and sent me home.
Evidently this surgeon was suffering from personal problems. Several weeks lately he drove himself to the desert and committed suicide.
The Nurse as Advocate
The nurse who assisted the surgeon tried to get him to address the problem she observed during my surgery. She tried to be my advocate. In that case, there was nothing more she could do at the time. She couldn't leave my side to phone an administrator or complain to anyone higher up the chain of command. I don't know if she filed an incident report later or not. I hope she did, simply because part of her job is to be the advocate for all patients, including future ones she has not yet met. If a nurse is aware of unsafe practices on the part of any medical professional, that nurse needs to do something about it and report the problem to someone in authority.
If you are admitted to a hospital, I encourage you to let your nurse know that you are counting on him or her to be your advocate. Nurses are taught that one of our most important roles is that of patient advocate, and a gentle reminder won't hurt his or her feelings a bit. Sometimes we nurses need to be reminded, especially on crazy busy days. No matter what else is happening, you, the patient, need to come first. Your safety and comfort is our highest priority, and acting as your advocate is an honor and privilege. Please don't hesitate to share concerns with us and allow us to put your mind at ease, and stand up for you when necessary.
If I Could Do it Over Again
I'm wiser now than when I had that surgery years ago. Now I go to the Medical Board of Examiners and look up any doctor I plan to see in order to check for complaints or board action. I also check Health Grades to see what other patients think of the physician. And if I ever have to go to the hospital, I will talk to my nurses and let them know how important their advocacy is to me. I'll let them know I'm counting on them to keep me comfortable and safe and to run interference for me if necessary. Trust me, I know nurses, and fortunately I know we can count on them to be the advocates we need. (But a little reminder won't hurt.)
Friday, March 11, 2016
Let Hospital Experts Help You Get Smarter!
Patients often assume their caregivers have told them everything they need to know about their illness or condition and what the patient needs to do to properly manage the condition in the future. Caregivers often assume some other caregiver has already told patients everything they need to know. Such assumptions can leave patients without important information and lead caregivers to mistakenly label patients non-compliant! (A label I detest, by the way!)
I cannot count the number of patients with diabetes who have lived with high blood sugar levels for many years because they've never been given the knowledge or tools to achieve good diabetes self-management. One patient, for example, told me he took his long-acting insulin only when his blood sugar was high. I explained to the patient that if his blood sugar was not high, it was because he took his long-acting insulin! No one had ever asked him how he took his insulin, so he didn't realize he was doing it wrong. (By the way, long-acting insulin that is taken once a day should be taken at the same time every day, and the amount should remain the same day after day regardless of the blood sugar level, unless the physician changes the daily dose.)
When I ask patients how they treat low blood sugar, they often describe to me a treatment that is far from ideal. For example, some patients treat low blood sugar with peanut butter. When blood sugar is low (below 70) it must be treated with a FAST-acting carbohydrate. That means a food that contains no protein or fat to slow down digestion. Peanut butter is mostly fat and protein, so it is a poor choice when quick action is needed. However, once the blood sugar is recovered and is above 70, peanut butter makes a great snack to help stabilize blood sugar. The point here is that patients often don't know what they don't know. They don't know they are doing something that either hampers their blood sugar management or might even be downright dangerous.
So what is the solution? If you are in the hospital, take advantage of the experts! If you have conditions such as diabetes, kidney disease, chronic digestive problems or morbid obesity, ask to see a dietician. You can describe your diet to that expert and ask if what you are doing is the optimal approach. If you have diabetes, ask to see a certified diabetes educator. Not every hospital has one, but if your hospital has a diabetes educator, you can describe your self-management routine to that expert and make sure you are doing the right thing and that you haven't created any inappropriate habits due to lack of information or a misunderstanding. If you have had a heart attack, ask to speak to a cardiac rehab nurse. Other experts in the hospital include the physical therapist, occupational therapist, speech therapist, pharmacist, and social worker. There is no charge for their services, and they can answer your questions and teach you what you need to know to carry on safely at home after discharge.
As I mentioned earlier, patients often don't know what they don't know. A good approach is to simply ask your nurse and other experts, "What do I need to know about this illness/condition/disease? How can I best care for myself and avoid a return trip to the emergency room?" Caregivers love to answer questions, and they enjoy teaching patients, so don't be stingy with your questions! Let your caregivers, and especially the experts, help you get smarter so you can be safer!
I cannot count the number of patients with diabetes who have lived with high blood sugar levels for many years because they've never been given the knowledge or tools to achieve good diabetes self-management. One patient, for example, told me he took his long-acting insulin only when his blood sugar was high. I explained to the patient that if his blood sugar was not high, it was because he took his long-acting insulin! No one had ever asked him how he took his insulin, so he didn't realize he was doing it wrong. (By the way, long-acting insulin that is taken once a day should be taken at the same time every day, and the amount should remain the same day after day regardless of the blood sugar level, unless the physician changes the daily dose.)
When I ask patients how they treat low blood sugar, they often describe to me a treatment that is far from ideal. For example, some patients treat low blood sugar with peanut butter. When blood sugar is low (below 70) it must be treated with a FAST-acting carbohydrate. That means a food that contains no protein or fat to slow down digestion. Peanut butter is mostly fat and protein, so it is a poor choice when quick action is needed. However, once the blood sugar is recovered and is above 70, peanut butter makes a great snack to help stabilize blood sugar. The point here is that patients often don't know what they don't know. They don't know they are doing something that either hampers their blood sugar management or might even be downright dangerous.
So what is the solution? If you are in the hospital, take advantage of the experts! If you have conditions such as diabetes, kidney disease, chronic digestive problems or morbid obesity, ask to see a dietician. You can describe your diet to that expert and ask if what you are doing is the optimal approach. If you have diabetes, ask to see a certified diabetes educator. Not every hospital has one, but if your hospital has a diabetes educator, you can describe your self-management routine to that expert and make sure you are doing the right thing and that you haven't created any inappropriate habits due to lack of information or a misunderstanding. If you have had a heart attack, ask to speak to a cardiac rehab nurse. Other experts in the hospital include the physical therapist, occupational therapist, speech therapist, pharmacist, and social worker. There is no charge for their services, and they can answer your questions and teach you what you need to know to carry on safely at home after discharge.
As I mentioned earlier, patients often don't know what they don't know. A good approach is to simply ask your nurse and other experts, "What do I need to know about this illness/condition/disease? How can I best care for myself and avoid a return trip to the emergency room?" Caregivers love to answer questions, and they enjoy teaching patients, so don't be stingy with your questions! Let your caregivers, and especially the experts, help you get smarter so you can be safer!
Monday, September 7, 2015
The Importance of a Positive Patient Identification
Middle of the Night Blood Draws
A phlebotomist (some patients call them vampires, my husband being one of those patients) comes into your hospital room in the middle of the night, flips a switch on the wall, and floods your room in light. Coming out of a deep sleep, you are momentarily blinded and wonder what is so important that my sleep must be so rudely interrupted? Oh no. Another person coming to take blood. More needle sticks.
An Inconvenience that Ultimately Benefits the Patient
You already feel like the most popular pin cushion in town. This is not fun at all. I don't know of anyone who enjoys having their blood drawn, especially in the middle of the night. The reason this task is done at such a miserable hour is because the personnel drawing the blood have many patients to see, and lab work should ideally be resulted and in the chart by the time physicians start to round. It's one of those unpleasant necessities that ultimately benefits the patient.
But Are You the Right Patient?
It may be necessary to draw blood in the middle of the night, but it is imperative that the blood being drawn is taken from the right patient! Imagine a physician coming into your room early in the morning to share the news that you have cancer or diabetes or perhaps your hemoglobin is so low that you need a blood transfusion. And imagine finding out later that those lab results came from another patient's blood! This is an error that can and does happen, though hopefully it happens rarely. (Most phlebotomists are meticulous about doing a positive patient identification.) It should never happen at all, because the very first thing the phlebotomist must do once before ever drawing your blood is to ask for your name and birthdate. Comparing the information you give with the information on the order will ensure that the blood is being drawn from the correct patient.
No ID, No Blood!
If you or a friend or family member is ever a patient in the hospital, do not allow the phlebotomist to draw blood until he or she asks you for a name and birthdate. Watch to make sure they are looking at an order or the lab label to verify that they have the correct patient. If the phlebotomist fails to make a positive patient identification, simply ask him or her "What is the name and birthdate of the patient you are supposed to be drawing blood from? Can I see the label please?" When I get my blood drawn in the lab, the phlebotomist always shows me the label and asks me to verify its accuracy.
Don't Let it Happen to You
I'm aware of a recent case where a phlebotomist drew a patient's blood and then checked the label. He said to the patient, "Oh you're the wrong patient," and threw the vials of blood in the sharps container. It was a potentially dangerous situation, and it created discomfort for the patient and blood being drawn unnecessarily. Don't let this happen to you!
A phlebotomist (some patients call them vampires, my husband being one of those patients) comes into your hospital room in the middle of the night, flips a switch on the wall, and floods your room in light. Coming out of a deep sleep, you are momentarily blinded and wonder what is so important that my sleep must be so rudely interrupted? Oh no. Another person coming to take blood. More needle sticks.
An Inconvenience that Ultimately Benefits the Patient
You already feel like the most popular pin cushion in town. This is not fun at all. I don't know of anyone who enjoys having their blood drawn, especially in the middle of the night. The reason this task is done at such a miserable hour is because the personnel drawing the blood have many patients to see, and lab work should ideally be resulted and in the chart by the time physicians start to round. It's one of those unpleasant necessities that ultimately benefits the patient.
But Are You the Right Patient?
It may be necessary to draw blood in the middle of the night, but it is imperative that the blood being drawn is taken from the right patient! Imagine a physician coming into your room early in the morning to share the news that you have cancer or diabetes or perhaps your hemoglobin is so low that you need a blood transfusion. And imagine finding out later that those lab results came from another patient's blood! This is an error that can and does happen, though hopefully it happens rarely. (Most phlebotomists are meticulous about doing a positive patient identification.) It should never happen at all, because the very first thing the phlebotomist must do once before ever drawing your blood is to ask for your name and birthdate. Comparing the information you give with the information on the order will ensure that the blood is being drawn from the correct patient.
No ID, No Blood!
If you or a friend or family member is ever a patient in the hospital, do not allow the phlebotomist to draw blood until he or she asks you for a name and birthdate. Watch to make sure they are looking at an order or the lab label to verify that they have the correct patient. If the phlebotomist fails to make a positive patient identification, simply ask him or her "What is the name and birthdate of the patient you are supposed to be drawing blood from? Can I see the label please?" When I get my blood drawn in the lab, the phlebotomist always shows me the label and asks me to verify its accuracy.
Don't Let it Happen to You
I'm aware of a recent case where a phlebotomist drew a patient's blood and then checked the label. He said to the patient, "Oh you're the wrong patient," and threw the vials of blood in the sharps container. It was a potentially dangerous situation, and it created discomfort for the patient and blood being drawn unnecessarily. Don't let this happen to you!
Thursday, July 2, 2015
Informed Consent
Signing a Consent for Surgery or a Procedure
If you are asked to sign a consent for surgery or other procedure, make sure the surgeon or the person who will be doing the procedure has done the following:
Questions? Just ask!
If you are asked to sign a consent for surgery or other procedure, make sure the surgeon or the person who will be doing the procedure has done the following:
- Explained why the procedure is necessary and what it should accomplish.
- Has explained all the risks and benefits.
- Has given you a chance to ask questions and has answered questions to your satisfaction.
Questions? Just ask!
Thursday, June 18, 2015
Insulin Safety
Different Types of Insulin
I always feel some concern when a patient goes home from the hospital with orders to add insulin to his or her blood sugar management routine. Insulin is a powerful hormone, and used safely, it is an excellent way to manage blood sugar and prevent the complications that diabetes can sometimes cause. However, I fear that too many patients go home from the hospital without a clear understanding and respect for insulin and how to use it properly. The first thing to understand is that there are different types of insulin. In this post I will cover only long-acting and rapid-acting insulin and describe the most common insulin regimens.
Long-Acting or Basal Insulin
Lantus and Levemir are two brands of long-acting insulin. Long-acting insulin lasts up to 24 hours, and it is usually taken once a day. Sometimes it is taken twice a day, in the morning and in the evening. The important things to know about this type of insulin is that it must be taken at the same time every day, and it cannot be mixed with other types of insulin in the same syringe. Long-acting insulin provides a slow, even background dose of insulin, and it has little or no peak, so there is less risk of low blood sugar events, although low blood sugar is a possible side effect. This insulin should be taken faithfully even if the blood sugar is in the normal range. This insulin takes hours to start working, so it is not used to correct a blood sugar that is currently too high.
Rapid-Acting Insulin
Humalog, Novolog, and Apidra are all different brands of rapid-acting insulin. They start to work in 10-15 minutes, peak in about 2 hours, and they are gone from the body in about 4 hours. Rapid-acting insulin is used to correct a blood sugar that is currently too high, and it is also often used to cover food that you are about to eat in order to prevent a large spike in blood sugar after your meal.
Post-Hospital Insulin Orders
Not all patients who go home on insulin are given the same orders, and your physician may order a different insulin routine than your Aunt Susie or your neighbor Sam was given by their physicians. Your physician may order any of the following:
The types of insulin described above are quite expensive, and if you do not have insurance, your physician may order a less expensive insulin that has a different start time, peak, and duration time. If that is the case, it is important to ask your nurse for clear instructions before you leave the hospital.
Important things to know
If you are to give yourself both a mealtime or nutrition dose and a correction dose of a rapid-acting insulin, you can add the two doses together in the same syringe to avoid two injections. Just remember that no other insulin can be combined with a long-acting insulin the same syringe. If the correction dose is ordered to be given four times a day at meals and at bedtime if needed, then you will give yourself a correction dose at bedtime only if your blood sugar is high and the correction dose is needed. Always check your blood sugar before injecting insulin. Write down the time, your blood sugar, and the insulin dose in a log book so you can look for trends and also so you can take the logbook to your doctor appointment.
Recognizing and Treating Low Blood Sugar
When you check your blood sugar before meals, it should be higher than 70. If it is lower than 70, it is too low and must be treated before you eat your meal. Low blood sugar is treated with about 15 grams of a fast-acting simple carbohydrate. In other words, the treatment should be something that is almost pure sugar and can digest quickly. Some examples are half a cup of juice or regular soda, a small handful of jelly beans or other sugary candy that does not contain fat, or a cup of fat-free or low fat milk. After eating or drinking the carbohydrate, wait 15 minutes and recheck your blood sugar. If it is still below 70, eat or drink some more. If your blood sugar does not come up after two treatments, continue to eat or drink more carbohydrate and also call your physician. If the blood sugar was below 50, eat or drink double the amount of carbohydrates. Once the blood sugar is higher than 70, eat your meal. If it isn't mealtime, eat a snack that contains fat, such as peanut butter and crackers, which will help stabilize blood sugar. Right after eating, I recommend checking your blood sugar again. If it is at least 90, you might give yourself half the mealtime dose of insulin when you finish eating. Do NOT give yourself a correction dose, also, even if blood sugar is now high. Half the mealtime dose may be sufficient. Check with your physician to make sure he or she wants you to take half the mealtime dose after you have eaten.
The signs of low blood sugar may include:
Don't Assume Anything When it Comes to Insulin
Please don't guess or assume anything about your insulin, when to take it, how much to take, or anything else. If you are unsure of anything related to your insulin or insulin routine, always call your physician for clarification. If you can't reach your physician, you might try calling your pharmacist for general insulin questions. But make sure you get accurate answers from a professional!
If you have any questions, feel free to post them here. I'm happy to try to help you.
I always feel some concern when a patient goes home from the hospital with orders to add insulin to his or her blood sugar management routine. Insulin is a powerful hormone, and used safely, it is an excellent way to manage blood sugar and prevent the complications that diabetes can sometimes cause. However, I fear that too many patients go home from the hospital without a clear understanding and respect for insulin and how to use it properly. The first thing to understand is that there are different types of insulin. In this post I will cover only long-acting and rapid-acting insulin and describe the most common insulin regimens.
Long-Acting or Basal Insulin
Lantus and Levemir are two brands of long-acting insulin. Long-acting insulin lasts up to 24 hours, and it is usually taken once a day. Sometimes it is taken twice a day, in the morning and in the evening. The important things to know about this type of insulin is that it must be taken at the same time every day, and it cannot be mixed with other types of insulin in the same syringe. Long-acting insulin provides a slow, even background dose of insulin, and it has little or no peak, so there is less risk of low blood sugar events, although low blood sugar is a possible side effect. This insulin should be taken faithfully even if the blood sugar is in the normal range. This insulin takes hours to start working, so it is not used to correct a blood sugar that is currently too high.
Rapid-Acting Insulin
Humalog, Novolog, and Apidra are all different brands of rapid-acting insulin. They start to work in 10-15 minutes, peak in about 2 hours, and they are gone from the body in about 4 hours. Rapid-acting insulin is used to correct a blood sugar that is currently too high, and it is also often used to cover food that you are about to eat in order to prevent a large spike in blood sugar after your meal.
Post-Hospital Insulin Orders
Not all patients who go home on insulin are given the same orders, and your physician may order a different insulin routine than your Aunt Susie or your neighbor Sam was given by their physicians. Your physician may order any of the following:
- Long-acting insulin only (Lantus or Levemir) once or twice a day
- Long-acting AND rapid-acting (Humalog, Novolog, or Apidra) with a set dose (mealtime or nutrition dose) of rapid-acting insulin before each meal. Again, the purpose is to cover food that is about to be eaten.
- Long-acting and rapid-acting insulin with a rapid-acting insulin correction dose in the form of a sliding scale. If you are sent home on this order, you MUST have the sliding scale detailed out for you. For example, the order may say something like "If blood sugar is 151 to 200, inject 1 unit of Humalog. If blood sugar is 201 to 250, inject 2 units of Humalog and so on." This is just an example, and the actual sliding scale may differ. The important thing is that you cannot guess how much insulin to give yourself. You must have a detailed order.
- Long-acting insulin AND a set mealtime dose AND correction dose of a rapid-acting insulin
The types of insulin described above are quite expensive, and if you do not have insurance, your physician may order a less expensive insulin that has a different start time, peak, and duration time. If that is the case, it is important to ask your nurse for clear instructions before you leave the hospital.
Important things to know
If you are to give yourself both a mealtime or nutrition dose and a correction dose of a rapid-acting insulin, you can add the two doses together in the same syringe to avoid two injections. Just remember that no other insulin can be combined with a long-acting insulin the same syringe. If the correction dose is ordered to be given four times a day at meals and at bedtime if needed, then you will give yourself a correction dose at bedtime only if your blood sugar is high and the correction dose is needed. Always check your blood sugar before injecting insulin. Write down the time, your blood sugar, and the insulin dose in a log book so you can look for trends and also so you can take the logbook to your doctor appointment.
Recognizing and Treating Low Blood Sugar
When you check your blood sugar before meals, it should be higher than 70. If it is lower than 70, it is too low and must be treated before you eat your meal. Low blood sugar is treated with about 15 grams of a fast-acting simple carbohydrate. In other words, the treatment should be something that is almost pure sugar and can digest quickly. Some examples are half a cup of juice or regular soda, a small handful of jelly beans or other sugary candy that does not contain fat, or a cup of fat-free or low fat milk. After eating or drinking the carbohydrate, wait 15 minutes and recheck your blood sugar. If it is still below 70, eat or drink some more. If your blood sugar does not come up after two treatments, continue to eat or drink more carbohydrate and also call your physician. If the blood sugar was below 50, eat or drink double the amount of carbohydrates. Once the blood sugar is higher than 70, eat your meal. If it isn't mealtime, eat a snack that contains fat, such as peanut butter and crackers, which will help stabilize blood sugar. Right after eating, I recommend checking your blood sugar again. If it is at least 90, you might give yourself half the mealtime dose of insulin when you finish eating. Do NOT give yourself a correction dose, also, even if blood sugar is now high. Half the mealtime dose may be sufficient. Check with your physician to make sure he or she wants you to take half the mealtime dose after you have eaten.
The signs of low blood sugar may include:
- Tremors
- Clammy sweat
- Blurred vision
- Headache
- Dizziness
- Confusion
- Weakness
- Lethargy
- Racing heart
Don't Assume Anything When it Comes to Insulin
Please don't guess or assume anything about your insulin, when to take it, how much to take, or anything else. If you are unsure of anything related to your insulin or insulin routine, always call your physician for clarification. If you can't reach your physician, you might try calling your pharmacist for general insulin questions. But make sure you get accurate answers from a professional!
If you have any questions, feel free to post them here. I'm happy to try to help you.
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