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!
Monday, September 7, 2015
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.
Friday, June 12, 2015
The Patient Advocate as a Witness
A Reader Shares Her Experience in the Hospital
A reader who purchased my Smart Patients, Safe Patients book left a review with some honest feedback that I very much appreciated. I am posting her review here without her permission, since I don't have a way to contact her. I assume she won't mind, since her review is public. Here is what the reader, Jean, wrote:
I think the book has good ideas but it's not is Emphatic enough about how dangerous hospitals are. Personally, I was dropped in bed by a technician and a nurse came to my aid when I was in the hospital. But my nurse covered up the accident. The nurse never reported the accident in the daily notes. I told subsequent nurses and the resident on Saturday and Sunday morning but when I confronted the hospital there's just an empty spot in my medical notes – so this book guides you to say that when nurses change shifts they should discuss in front of you your care. But A patient's medical needs go further than that. A patient needs a witness to virtually everything that goes on in a hospital. Nurses and technicians lie for each other – nurses technicians and doctors cover up each other's mistakes and the only way A patient is protected is to have a witness. This information is glaringly missing from the book.
I completely agree with Jean that the patient's medical needs go further than having the nurses do report at the bedside, and I did attempt to convey that message. I can understand the desire for a stronger message after the experience Jean shared.
By Sharing Experiences, We Can All Benefit
I think of this blog as a dynamic book, and it is one that we can all create together. If you have had an experience and have learned something as a patient that might help others, I would be most happy for you to share it here. I only ask that you do so in a manner that is respectful and helpful to others and not as an opportunity to bash or demean anyone.
About Jean's Experience
I'm sorry Jean had a bad experience when she was a patient, and I hope no one else has that kind of experience. I would like to share what should have happened in Jean's case based on the information she gave.
Jean was dropped by a technician. Either the technician or the nurse was required to complete an incident report, which would go to the manager of the floor where the event occurred. The nurse should have notified Jean's physician about the event. If there was any question of injury, the physician should have ordered an appropriate follow up test, such as an x-ray to check for fractures. The physician notification should have been documented in Jean's chart. The nurse should have also written a nurse's note or possibly completed an event form, depending on the type of documentation used. Jean doesn't say why she confronted the hospital, so I'm unclear if she wanted a copy of the documentation for legal purposes or simply wanted to make sure the event had been documented. It's entirely possible that an incident report was filed, because those are separate from the chart.
What Would I Do in This Case?
If I was dropped by a technician, and I had any concern that I might have suffered an injury, I would verify with the nurse that an incident report was filed and the physician was notified. I would request that she ask the physician to obtain an order for an x-ray of whatever part of my body I felt might have been injured. Even if there was no injury, I would still ask if an incident report was filed. The purpose of the incident report is to give the manager an opportunity investigate the event, find out exactly what happened, and do whatever can be done to prevent another event. In addition, I would ask the nurse if he or she documented the event in my chart, and I would ask to be shown the documentation. I would also tell the nurse, "Please don't feel that I don't trust you. This is simply my practice and it is what makes me comfortable."
I do want to add that in all my years of working in the hospital, I personally have never known caregivers to cover up for each other when a mistake was made, although I don't doubt that it happens on rare occasions.
Questions and Stories are Always Welcome
I love questions, and I love for people to share their stories when they feel comfortable doing do! If you have had an experience as a patient in the hospital and don't quite understand something that happened or simply want to know how to make it a better experience next time, I would love to help if I can. Questions asked and answered can benefit everyone.
A reader who purchased my Smart Patients, Safe Patients book left a review with some honest feedback that I very much appreciated. I am posting her review here without her permission, since I don't have a way to contact her. I assume she won't mind, since her review is public. Here is what the reader, Jean, wrote:
I think the book has good ideas but it's not is Emphatic enough about how dangerous hospitals are. Personally, I was dropped in bed by a technician and a nurse came to my aid when I was in the hospital. But my nurse covered up the accident. The nurse never reported the accident in the daily notes. I told subsequent nurses and the resident on Saturday and Sunday morning but when I confronted the hospital there's just an empty spot in my medical notes – so this book guides you to say that when nurses change shifts they should discuss in front of you your care. But A patient's medical needs go further than that. A patient needs a witness to virtually everything that goes on in a hospital. Nurses and technicians lie for each other – nurses technicians and doctors cover up each other's mistakes and the only way A patient is protected is to have a witness. This information is glaringly missing from the book.
I completely agree with Jean that the patient's medical needs go further than having the nurses do report at the bedside, and I did attempt to convey that message. I can understand the desire for a stronger message after the experience Jean shared.
By Sharing Experiences, We Can All Benefit
I think of this blog as a dynamic book, and it is one that we can all create together. If you have had an experience and have learned something as a patient that might help others, I would be most happy for you to share it here. I only ask that you do so in a manner that is respectful and helpful to others and not as an opportunity to bash or demean anyone.
About Jean's Experience
I'm sorry Jean had a bad experience when she was a patient, and I hope no one else has that kind of experience. I would like to share what should have happened in Jean's case based on the information she gave.
Jean was dropped by a technician. Either the technician or the nurse was required to complete an incident report, which would go to the manager of the floor where the event occurred. The nurse should have notified Jean's physician about the event. If there was any question of injury, the physician should have ordered an appropriate follow up test, such as an x-ray to check for fractures. The physician notification should have been documented in Jean's chart. The nurse should have also written a nurse's note or possibly completed an event form, depending on the type of documentation used. Jean doesn't say why she confronted the hospital, so I'm unclear if she wanted a copy of the documentation for legal purposes or simply wanted to make sure the event had been documented. It's entirely possible that an incident report was filed, because those are separate from the chart.
What Would I Do in This Case?
If I was dropped by a technician, and I had any concern that I might have suffered an injury, I would verify with the nurse that an incident report was filed and the physician was notified. I would request that she ask the physician to obtain an order for an x-ray of whatever part of my body I felt might have been injured. Even if there was no injury, I would still ask if an incident report was filed. The purpose of the incident report is to give the manager an opportunity investigate the event, find out exactly what happened, and do whatever can be done to prevent another event. In addition, I would ask the nurse if he or she documented the event in my chart, and I would ask to be shown the documentation. I would also tell the nurse, "Please don't feel that I don't trust you. This is simply my practice and it is what makes me comfortable."
I do want to add that in all my years of working in the hospital, I personally have never known caregivers to cover up for each other when a mistake was made, although I don't doubt that it happens on rare occasions.
Questions and Stories are Always Welcome
I love questions, and I love for people to share their stories when they feel comfortable doing do! If you have had an experience as a patient in the hospital and don't quite understand something that happened or simply want to know how to make it a better experience next time, I would love to help if I can. Questions asked and answered can benefit everyone.
Thursday, June 11, 2015
Students and New Graduate Nurses
Allowing Students to Care For You
You may wonder if it is safe to have a student care for you. The answer is yes, as long as the student, their preceptor nurse, and their clinical instructor are observing the patient when necessary and communicating frequently with the student. There may be certain tasks the student should not attempt on some patients. For example, if you have found in the past that getting an IV in you is a monumental task, then it is appropriate to kindly tell the student that you require someone with a great deal of experience. The student will be grateful for your honesty! If you need an NG tube threaded through your nose, and this task has been difficult for nurses in the past, a student should not be the one to attempt the NG insertion. The same is true of any task that has been proven to require a highly skilled nurse in the past.
What Students Can Do
Students are generally allowed to do a head-to-toe assessment of you, administer medication under the watchful eye of an experienced nurse or their instructor, and perform dressing changes, IV starts, urinary bladder insertion, and numerous other tasks. The students are expected to communicate any and all pertinent information to the nurse who is supervising them as well as to their instructor. If your blood pressure is high, for example, the student should communicate that information to the your primary nurse and to their instructor. In some respects, you are even more safe due to the watchful eyes of your primary nurse, the student, and the student's instructor. Also, students tend to be very attentive, and that's always a nice thing. Students usually care for only one or two patients, so it's a great time to ask for the back massage that nurses rarely have time to offer these days.
How Patients Can Help Students Learn and Grow
Patients can be a great help to students who are learning how to be great nurses. If you give the student positive feedback when deserved and also make tactful suggestions when appropriate, the students can learn a great deal. Students spend more time than ever in simulation with mannequins, and we sometimes fear the art of nursing is being overshadowed by the science of nursing. Both aspects of patient care are vitally important, and the patient can help students fine tune the art of nursing in a way that benefits both the student and the patient.
If I were a patient being cared for by a student, I would ask the student at the beginning of the shift, "Would you like me to give you honest feedback during the time you care for me?" Almost certainly the student will respond with an enthusiastic "YES!" Here are some things I would suggest to a student caring for me:
You may wonder if it is safe to have a student care for you. The answer is yes, as long as the student, their preceptor nurse, and their clinical instructor are observing the patient when necessary and communicating frequently with the student. There may be certain tasks the student should not attempt on some patients. For example, if you have found in the past that getting an IV in you is a monumental task, then it is appropriate to kindly tell the student that you require someone with a great deal of experience. The student will be grateful for your honesty! If you need an NG tube threaded through your nose, and this task has been difficult for nurses in the past, a student should not be the one to attempt the NG insertion. The same is true of any task that has been proven to require a highly skilled nurse in the past.
What Students Can Do
Students are generally allowed to do a head-to-toe assessment of you, administer medication under the watchful eye of an experienced nurse or their instructor, and perform dressing changes, IV starts, urinary bladder insertion, and numerous other tasks. The students are expected to communicate any and all pertinent information to the nurse who is supervising them as well as to their instructor. If your blood pressure is high, for example, the student should communicate that information to the your primary nurse and to their instructor. In some respects, you are even more safe due to the watchful eyes of your primary nurse, the student, and the student's instructor. Also, students tend to be very attentive, and that's always a nice thing. Students usually care for only one or two patients, so it's a great time to ask for the back massage that nurses rarely have time to offer these days.
How Patients Can Help Students Learn and Grow
Patients can be a great help to students who are learning how to be great nurses. If you give the student positive feedback when deserved and also make tactful suggestions when appropriate, the students can learn a great deal. Students spend more time than ever in simulation with mannequins, and we sometimes fear the art of nursing is being overshadowed by the science of nursing. Both aspects of patient care are vitally important, and the patient can help students fine tune the art of nursing in a way that benefits both the student and the patient.
If I were a patient being cared for by a student, I would ask the student at the beginning of the shift, "Would you like me to give you honest feedback during the time you care for me?" Almost certainly the student will respond with an enthusiastic "YES!" Here are some things I would suggest to a student caring for me:
- I would suggest that the student always ask patients, "What are the three most important things to you while you are a patient in the hospital?" I would then ask the student if he or she would like me to share my three most important things with him or her.
- I might give the student the following feedback if it is applicable: "I've noticed that sometimes when you come in the room, you are very focused on the task at hand, and I think you forget to look at me. I feel more connected to you when you make a point of looking me in the eye."
- When I have been a visitor to a patient in the hospital, I always appreciate it very much when the nurses acknowledge my presence. I would suggest to the student that he or she should do the same with family members or visitor, if I've noticed it hasn't yet become a habit.
- There is often a hand sanitizer dispenser outside each patient's room. I would tell my student that I like to actually see my nurses sanitize or wash their hands inside my room, and it would be great if they would be willing to do that for their patients.
There are many things a patient can teach a student, and if the student is willing to learn from the patient, it can be a beneficial experience for everyone, including the student's future patients! (By the way, patients can also learn from students, and all students should be teaching their patients!)
New Graduate Nurses
New graduate nurses, or "new grads," generally have a lengthy orientation period under the guidance and leadership of an experience nurse called a preceptor. As with students, I recommend that new graduates not be expected to perform tasks that require extra skill and experience, such as starting an IV on a patient whose past experience with IV starts has been very bad.
New grads need to be observed the first two or three times they perform a new task. I feel it is appropriate to ask your new grad how many times they have performed a certain task if you have any concern about the difficulty or complexity of the task in question. It is also acceptable to request that the preceptor be present if it will help you feel more comfortable. New grads need to get experience, and they can be safe practitioners from the very start as long as they are following protocol and demonstrating safe habits. If you notice any unsafe practices, bring it to the new grad's attention in a tactful way, and let them know you understand there is a lot to remember in the beginning.
Receiving care from a student or a new grad can be a good experience as long as communication between all parties is open, honest, and helpful for everyone.
Wednesday, June 10, 2015
For Patients Who are Very Difficult IV Sticks
No Need to Become a Human Pin Cushion!
Some of you may have had the experience of being a patient in the hospital and getting poked so many times that you felt like a human pin cushion. I don't need you tell you it is not a fun experience! What can you do to avoid multiple attempts at starting an IV, when you know from experience that it is futile? There are several things you can do!
Vein Finders
Ask if the hospital has an ultrasound machine or "Vein Finder" made specifically for finding deep veins. If the hospital has such equipment, insist that the nurses use it.
Hospital Policy
Hospitals have policies that dictate how many times each nurse can attempt to start an IV. The policy likely limits it to two or three attempts at the most. Don't allow the same nurse to keep poking you over and over again without success.
Ask For the Most Talented IV Starter
Ask for the best IV starter available. Many nurses have a talent or gift for starting difficult IVs, and it's perfectly ok to ask for that person if you know from experience that special skill is required in your case.
Requesting a PICC Line
Perhaps in past hospitalizations you have always ended up with a PICC line or other central line because you are such a difficult IV stick, and maybe when a nurse does get an IV in you, it doesn't last for any length of time. If that is the case, you should share that information with the first nurse who sees you in the ER and with the doctor as well. The problem is that in the beginning, the urgency of your need may require immediate IV access, and it takes time to get a PICC (Peripherally Inserted Central Catheter) line in. Also, in the beginning, it is usually unknown as to how long you will be in the hospital. A picc line is used for extended stays or longer term antibiotic administration. They are costly, time consuming to insert, and not appropriate for a very short stay. That said, the doctor may know early on that your stay will likely not be a short one, and in that case, you or your advocate should ask for a PICC line if you are still an almost impossible "stick."
When You Meet Resistance
Patients sometimes feel they meet with resistance even after telling horror story after horror story about dozens of IV sticks, blown veins, and massive bruises on their arms from countless IV starts or attempts. Some patients have found that these numerous sticks have left them with painful areas that take weeks or even months to heal. One patient had difficulty using her thumb for months after an especially painful IV stick in her thumb after she had asked the nurse not to try to put an IV in that particular place. The patient explained that it had been used before and had created problems in the past. When it seems you are not being heard, you always have the option of asking to speak to a manager.
Document Your Experience
I hope you don't have another bad experience, but if you do, document the experience with detailed facts that include exactly how many IV sticks you received, when you received them, how long your IV sites lasted before they had to be changed, and how many sticks each nurse attempted. Finally, I suggest you take a photograph of any bruises or other signs of the numerous sticks you endured. Print out the photo and be prepared to take it and your written documentation to the hospital the next time you have to go. Show the photo and documentation to the caregivers, or have an advocate do it for you. The physician and nurses will likely take the situation more seriously if they can see and read what you have endured during previous hospitalizations.
Finally, Be Patient When Patience is Required
Your safety is the most important consideration, and sometimes the need for IV access is so urgent that there simply is no time to wait for equipment, locate someone skilled in starting a PICC line, or make any other special arrangements. Someone has to get an IV in you and FAST! When that is the case, you may end up with an IV in your neck, if no other site is feasible. Once the crisis has passed, then you or your advocate can begin to work with the caregivers to make plans to avoid numerous unnecessary IV starts or attempts for the remainder of your stay in the hospital.
I hope these suggestions help, and I hope you never have to endure the human pin cushion experience again!
Some of you may have had the experience of being a patient in the hospital and getting poked so many times that you felt like a human pin cushion. I don't need you tell you it is not a fun experience! What can you do to avoid multiple attempts at starting an IV, when you know from experience that it is futile? There are several things you can do!
Vein Finders
Ask if the hospital has an ultrasound machine or "Vein Finder" made specifically for finding deep veins. If the hospital has such equipment, insist that the nurses use it.
Hospital Policy
Hospitals have policies that dictate how many times each nurse can attempt to start an IV. The policy likely limits it to two or three attempts at the most. Don't allow the same nurse to keep poking you over and over again without success.
Ask For the Most Talented IV Starter
Ask for the best IV starter available. Many nurses have a talent or gift for starting difficult IVs, and it's perfectly ok to ask for that person if you know from experience that special skill is required in your case.
Requesting a PICC Line
Perhaps in past hospitalizations you have always ended up with a PICC line or other central line because you are such a difficult IV stick, and maybe when a nurse does get an IV in you, it doesn't last for any length of time. If that is the case, you should share that information with the first nurse who sees you in the ER and with the doctor as well. The problem is that in the beginning, the urgency of your need may require immediate IV access, and it takes time to get a PICC (Peripherally Inserted Central Catheter) line in. Also, in the beginning, it is usually unknown as to how long you will be in the hospital. A picc line is used for extended stays or longer term antibiotic administration. They are costly, time consuming to insert, and not appropriate for a very short stay. That said, the doctor may know early on that your stay will likely not be a short one, and in that case, you or your advocate should ask for a PICC line if you are still an almost impossible "stick."
When You Meet Resistance
Patients sometimes feel they meet with resistance even after telling horror story after horror story about dozens of IV sticks, blown veins, and massive bruises on their arms from countless IV starts or attempts. Some patients have found that these numerous sticks have left them with painful areas that take weeks or even months to heal. One patient had difficulty using her thumb for months after an especially painful IV stick in her thumb after she had asked the nurse not to try to put an IV in that particular place. The patient explained that it had been used before and had created problems in the past. When it seems you are not being heard, you always have the option of asking to speak to a manager.
Document Your Experience
I hope you don't have another bad experience, but if you do, document the experience with detailed facts that include exactly how many IV sticks you received, when you received them, how long your IV sites lasted before they had to be changed, and how many sticks each nurse attempted. Finally, I suggest you take a photograph of any bruises or other signs of the numerous sticks you endured. Print out the photo and be prepared to take it and your written documentation to the hospital the next time you have to go. Show the photo and documentation to the caregivers, or have an advocate do it for you. The physician and nurses will likely take the situation more seriously if they can see and read what you have endured during previous hospitalizations.
Finally, Be Patient When Patience is Required
Your safety is the most important consideration, and sometimes the need for IV access is so urgent that there simply is no time to wait for equipment, locate someone skilled in starting a PICC line, or make any other special arrangements. Someone has to get an IV in you and FAST! When that is the case, you may end up with an IV in your neck, if no other site is feasible. Once the crisis has passed, then you or your advocate can begin to work with the caregivers to make plans to avoid numerous unnecessary IV starts or attempts for the remainder of your stay in the hospital.
I hope these suggestions help, and I hope you never have to endure the human pin cushion experience again!
Friday, June 5, 2015
Headaches in the Hospital
Headaches: a variety of causes and a variety of treatments
For some reason this morning I feel inclined to say a few words about headaches in the hospital. Over the years, I have seen many patients dealing with headaches in the hospital. A patient might come to the hospital because of a severe headache, and it can be very serious. Other times, a headache is one of several symptoms related to a high blood sugar level, infection, or other condition. Treatment for headaches vary depending somewhat on the cause. Treatment might be as simply as starting hydrating IV fluids and insulin for high blood sugar, and range to narcotics for a headache caused by meningitis. But there is one type of headache that I often see treated in a manner that I consider to be overly aggressive, and that is the headache I want to talk about here.
The NPO Headache - otherwise known as caffeine withdrawal
When patient are admitted to the hospital, they are often made NPO, which means they aren't allowed to have anything to drink or drink - "nothing by mouth" we say. Patient who are used to drinking coffee first thing in the morning, or tea throughout the day, or Coke, Pepsi, Mountain Dew, or other drinks that contain caffeine are likely going to experience caffeine withdrawal, which usually incudes a throbbing headache. Some patients who don't necessarily drink anything that contains caffeine, might also have a headache from sugar withdrawal.
Treating a caffeine-withdrawal headache
If a patient has a headache in the hospital, they might want to ask themselves if it could simply be a caffeine-withdrawal headache. I have seen patients receive IV morphine or oral narcotics for such headaches, when Ibuprofen or Tylenol would likely be effective. Those headaches can be pretty painful, but fortunately, they don't last more than a day or so. If someone is going into the hospital for surgery, it would be a good idea to go off the caffeine before surgery and avoid the withdrawal headache. There is a way I have found to prevent them, and it has worked well for me.
Preventing a caffeine-withdrawal headache
NOTE: I am certainly not a medical doctor, so I can only say that the process I follow is safe for me.
For some reason this morning I feel inclined to say a few words about headaches in the hospital. Over the years, I have seen many patients dealing with headaches in the hospital. A patient might come to the hospital because of a severe headache, and it can be very serious. Other times, a headache is one of several symptoms related to a high blood sugar level, infection, or other condition. Treatment for headaches vary depending somewhat on the cause. Treatment might be as simply as starting hydrating IV fluids and insulin for high blood sugar, and range to narcotics for a headache caused by meningitis. But there is one type of headache that I often see treated in a manner that I consider to be overly aggressive, and that is the headache I want to talk about here.
The NPO Headache - otherwise known as caffeine withdrawal
When patient are admitted to the hospital, they are often made NPO, which means they aren't allowed to have anything to drink or drink - "nothing by mouth" we say. Patient who are used to drinking coffee first thing in the morning, or tea throughout the day, or Coke, Pepsi, Mountain Dew, or other drinks that contain caffeine are likely going to experience caffeine withdrawal, which usually incudes a throbbing headache. Some patients who don't necessarily drink anything that contains caffeine, might also have a headache from sugar withdrawal.
Treating a caffeine-withdrawal headache
If a patient has a headache in the hospital, they might want to ask themselves if it could simply be a caffeine-withdrawal headache. I have seen patients receive IV morphine or oral narcotics for such headaches, when Ibuprofen or Tylenol would likely be effective. Those headaches can be pretty painful, but fortunately, they don't last more than a day or so. If someone is going into the hospital for surgery, it would be a good idea to go off the caffeine before surgery and avoid the withdrawal headache. There is a way I have found to prevent them, and it has worked well for me.
Preventing a caffeine-withdrawal headache
- On the first no-caffeine day, drink more water than usual to help flush your system
- That night, before you go to bed, take two Ibuprofen (200mg. each) (I happen to prefer Ibuprofen over Tylenol, but it's just a personal preference)
- Upon waking the next morning, take two more Ibuprofen
- If you start to feel even a hint of a headache as the day progresses, take two more Ibuprofen
NOTE: I am certainly not a medical doctor, so I can only say that the process I follow is safe for me.
Friday, May 15, 2015
A Note to Nurses: Safe Medication Administration - A Beautiful Sight!
Busy, stressed, and hanging by a thread
I know how busy you are! I recall working at the bedside years ago and what it was like. I was the charge nurse at the time caring for a load of five patients (six patients on some days) and covering the LPN's six patients. I clearly remember one particular day, which was the straw that nearly broke this overwhelmed nurse's back. I stood in front of the nurses' station with five people standing around me asking for assistance. I looked at all of them and suddenly knew I was about a hair's breadth away from losing my mind!
Good habits can save the day
I'm convinced that good habits can literally save us and our patients. On those days when we seem to be extinguishing fires everywhere, our good habits can prevent us from cutting corners. They can help us remain safe AND efficient in the midst of crises or the everyday demands we face.
I've seen busy (ok, harried) nurses walk into a patient's room and hang an antibiotic without saying anything more than "I've got your antibiotic here." Then they silently hang the little bag and leave the room. There's a better way, and it takes only a matter of seconds.
Smart, Safe, and Picture Perfect
I recently witnessed a beautiful sight. I was teaching a patient, and the nurse came into the room and excused the interruption. She scanned the patient's wrist band with the scanner and made sure she had the right patient. She told the patient she had her antibiotic, and she said the name of the medication and why she was receiving it. She showed the patient the bag with the label, so the patient could see the name and the dose. She reminded her that she had received the antibiotic the day before. She told the patient, "If you feel any swelling or tenderness at the IV site, be sure to call me right away. Also, if you feel anything else unusual after I start the medication, please call me." I don't think it even took 15 seconds to communicate this information to the patient. The nurse was incredibly professional, thorough, considerate, informative, and efficient. It was truly beautiful.
The Real World
When I graduated from nursing school, I remember hearing these words, "There's what we learn in school, and then there's the real world." Dear nurses, and especially new grads, I'm here to tell you that what we learned in school is what we should be practicing in the real world. It was taught to us because if we practice what we were taught, it will help keep everyone safe from unnecessary errors.
I challenge all nurses to take a look at your habits and see how far you have drifted from what we were taught. Perhaps you haven't drifted at all, and if that is the case, I applaud you! I know your job is even more difficult that mine was when I was at the bedside. All the more reason to take every possible safety precaution and make them habit. I promise, you'll never regret it.
I'm pulling for you, my brothers and sisters!
I know how busy you are! I recall working at the bedside years ago and what it was like. I was the charge nurse at the time caring for a load of five patients (six patients on some days) and covering the LPN's six patients. I clearly remember one particular day, which was the straw that nearly broke this overwhelmed nurse's back. I stood in front of the nurses' station with five people standing around me asking for assistance. I looked at all of them and suddenly knew I was about a hair's breadth away from losing my mind!
Good habits can save the day
I'm convinced that good habits can literally save us and our patients. On those days when we seem to be extinguishing fires everywhere, our good habits can prevent us from cutting corners. They can help us remain safe AND efficient in the midst of crises or the everyday demands we face.
I've seen busy (ok, harried) nurses walk into a patient's room and hang an antibiotic without saying anything more than "I've got your antibiotic here." Then they silently hang the little bag and leave the room. There's a better way, and it takes only a matter of seconds.
Smart, Safe, and Picture Perfect
I recently witnessed a beautiful sight. I was teaching a patient, and the nurse came into the room and excused the interruption. She scanned the patient's wrist band with the scanner and made sure she had the right patient. She told the patient she had her antibiotic, and she said the name of the medication and why she was receiving it. She showed the patient the bag with the label, so the patient could see the name and the dose. She reminded her that she had received the antibiotic the day before. She told the patient, "If you feel any swelling or tenderness at the IV site, be sure to call me right away. Also, if you feel anything else unusual after I start the medication, please call me." I don't think it even took 15 seconds to communicate this information to the patient. The nurse was incredibly professional, thorough, considerate, informative, and efficient. It was truly beautiful.
The Real World
When I graduated from nursing school, I remember hearing these words, "There's what we learn in school, and then there's the real world." Dear nurses, and especially new grads, I'm here to tell you that what we learned in school is what we should be practicing in the real world. It was taught to us because if we practice what we were taught, it will help keep everyone safe from unnecessary errors.
I challenge all nurses to take a look at your habits and see how far you have drifted from what we were taught. Perhaps you haven't drifted at all, and if that is the case, I applaud you! I know your job is even more difficult that mine was when I was at the bedside. All the more reason to take every possible safety precaution and make them habit. I promise, you'll never regret it.
I'm pulling for you, my brothers and sisters!
Tuesday, May 12, 2015
Avoiding a Medication Error AFTER a Hospital Discharge
A Serious Prescription Mistake
Here is an example of a medication error that occurred after leaving the hospital and how you can help prevent such errors:
A patient was discharged from the hospital with a prescription to inject a rapid acting insulin three times a day before meals. The prescription was for 9 units. It was clearly typed out, and abbreviations were not used in order to avoid a mistake. The patient took the prescription to his pharmacy, and for some reason, the label created by the patient's pharmacy instructed the patient to inject 90 units of insulin before each meal! The patient injected the insulin as instructed by the pharmacist, and his blood sugar fell to a dangerously low level. The patient became non-responsive. Paramedics were called, and he was taken to the hospital where his blood sugar was stabilized. The mistake could have been deadly, but thankfully the patient survived with no permanent deficits.
How Can You Avoid Such an Error?
It is very important to know the following information about your medication after you are discharged from the hospital:
Here is an example of a medication error that occurred after leaving the hospital and how you can help prevent such errors:
A patient was discharged from the hospital with a prescription to inject a rapid acting insulin three times a day before meals. The prescription was for 9 units. It was clearly typed out, and abbreviations were not used in order to avoid a mistake. The patient took the prescription to his pharmacy, and for some reason, the label created by the patient's pharmacy instructed the patient to inject 90 units of insulin before each meal! The patient injected the insulin as instructed by the pharmacist, and his blood sugar fell to a dangerously low level. The patient became non-responsive. Paramedics were called, and he was taken to the hospital where his blood sugar was stabilized. The mistake could have been deadly, but thankfully the patient survived with no permanent deficits.
How Can You Avoid Such an Error?
- Take your hospital discharge paperwork with you when you fill prescriptions at the pharmacy.
- When the pharmacist gives you your medication, compare the dose and the instructions on the medication label with the medication dose and instructions found on your discharge form.
- If there is any discrepancy between what was ordered by the hospital physician and what Pharmacy gives you, don't accept the medication until there is a clear explanation for the difference or until the mistake is corrected, if a mistake was made.
It is very important to know the following information about your medication after you are discharged from the hospital:
- Why are you taking the medication?
- What dose will you be taking?
- When is the next dose due?
- How should the medication be taken? (With or without food etc.)
- How long are you to take the medication? For a week, a month, forever?
- If you are sent home on sliding scale insulin, make sure the sliding scale is printed out for you in its entirety and that you understand it completely.
Sunday, May 10, 2015
Every Patient Should Ask Questions!
What Questions Do You Have?
As I full-time diabetes educator, I spend all my time teaching patients in the hospital. At the beginning of my teaching sessions, I often ask if the patient has any burning questions. I would estimate that 99.9% of the time patients say, "No, not really." Their answer is not based on the fact that they already know everything about diabetes. I often teach patients who have had diabetes for 5, 10, 15, and even 20 years or more who are lacking in a knowledge of the basics of diabetes physiology and management. I believe the reason why patients don't have any questions, is because they don't know what they don't know, and they simply don't know what to ask.
Questions to Ask About a New Diagnosis
As I mentioned before, I have often found that patients who have had diabetes for literally decades have never been properly educated. The same is likely true of many diseases and conditions. Busy nurses and physicians often assume that patients who have had diabetes for years have received at least basic diabetes self-management education, for example. It isn't wise for caregivers to make that assumption. It is also not wise for patients to assume their nurses are going to teach them everything they need to know! That's why questions are so important.
A Case in Point - Mrs. A
Mrs. A was admitted to the hospital with cellulitis of her right foot. She was diagnosed with diabetes 9 years earlier, and she had been checking her blood sugar three times a day faithfully, just as her physician had advised so long ago when she was first diagnosed. I was asked to see Mrs. A., and one of the things I asked her was What are your blood sugar targets? In other words, when you check your blood sugar, what numbers do you hope to see? Mrs. A. hesitated just a moment before she answered I don't know!
The purpose of checking one's blood sugar is to get feedback. The numbers on the glucose meter let patients know if their diet and activity choices and their medication are having a positive impact on their blood sugar. Unless patients knows their targets and whether the numbers they are seeing are acceptable or not, checking blood sugar is a waste of time. Of course, patients should write down the numbers they see and take their log with them to their doctor visits, but they should not rely completely on their doctor for feedback every few months. They have a tool in their hand that can give them feedback every day! So what question didn't get asked or answered? What numbers should I be looking for when I check my blood sugar?
Nurses Love Questions!
I'll tell you why nurses love questions. It helps them educate you, the patient! Also, when you ask questions, it hints that you are motivated to take good care of yourself, and nurses love it when patients are fully engaged in that way. Finally, nurses truly want to make a difference in their patients' lives, and giving answers that help patients is very rewarding for the nurse.
When You Really Aren't Sure What Questions to Ask
If you are absolutely stumped and just don't know what to ask, because you have no idea what you need to know, then I suggest two things: 1) ask some friends or family members what questions they think you should ask. 2) Tell the nurse, At this point, I don't know what questions to ask. Can you please tell me everything you would want to know if you were in my place?
Be Persistent
If a nurse or physician tells you that someone is going to come and teach you about your new diagnosis, make sure there is follow through. In some hospitals, certain specialists, such as the diabetes educator, do not work on weekends. If you are going to be discharged on the weekend, and the person who is supposed to come to your room to teach you about your diagnosis is not available, make sure the nurses provide you with education. There should be videos available and printed material. And speaking of printed material, it is highly unlikely that you will remember everything you are taught, so please ask for printed material that you can refer back to when needed.
A Smart Patient is a Patient Who Asks Questions
Not only do your caregivers want you to be safe in the hospital, they also want you to be safe once you go home. So please be sure to ask lots of questions so you know exactly what to do at home to prevent a readmission. And if you have more questions once you get home, call your own primary care physician and ask even more questions! The more questions you ask, the more knowledge you acquire. SMART!
As I full-time diabetes educator, I spend all my time teaching patients in the hospital. At the beginning of my teaching sessions, I often ask if the patient has any burning questions. I would estimate that 99.9% of the time patients say, "No, not really." Their answer is not based on the fact that they already know everything about diabetes. I often teach patients who have had diabetes for 5, 10, 15, and even 20 years or more who are lacking in a knowledge of the basics of diabetes physiology and management. I believe the reason why patients don't have any questions, is because they don't know what they don't know, and they simply don't know what to ask.
Questions to Ask About a New Diagnosis
Let's pretend that you have a new diagnosis of diabetes, for example. Wouldn't you like answers to the following questions? (Note: Most of the questions below are appropriate for almost any new diagnosis.)
- What type diabetes do I have?
- What caused this?
- How is this going to change my life?
- Can you help me understand what is happening with my body and why my blood sugar goes up when I eat the same thing that has no impact on someone who doesn't have diabetes?
- Is diabetes inherited? Are my children at greater risk for getting it?
- Is there something that can be done to prevent other family members from getting it?
- What complications can there be from diabetes, and how can I prevent them?
- What lifestyle changes can help me manage diabetes as well as possible?
- When should I call the doctor?
- What side effects are possible from the medication I'm going to be taking?
- When should I take my medication?
- Will I be going home on insulin? If so, can I practice giving it with you watching me?
- Are there some classes available or good books or other resources to help me?
- Can a dietician come and talk to me about my diet?
- What is the expected course of diabetes? Will it shorten my life?
- Is diabetes curable?
- How often should I check my blood sugar, and when should I check it?
- What numbers should I be aiming for?
As I mentioned before, I have often found that patients who have had diabetes for literally decades have never been properly educated. The same is likely true of many diseases and conditions. Busy nurses and physicians often assume that patients who have had diabetes for years have received at least basic diabetes self-management education, for example. It isn't wise for caregivers to make that assumption. It is also not wise for patients to assume their nurses are going to teach them everything they need to know! That's why questions are so important.
A Case in Point - Mrs. A
Mrs. A was admitted to the hospital with cellulitis of her right foot. She was diagnosed with diabetes 9 years earlier, and she had been checking her blood sugar three times a day faithfully, just as her physician had advised so long ago when she was first diagnosed. I was asked to see Mrs. A., and one of the things I asked her was What are your blood sugar targets? In other words, when you check your blood sugar, what numbers do you hope to see? Mrs. A. hesitated just a moment before she answered I don't know!
The purpose of checking one's blood sugar is to get feedback. The numbers on the glucose meter let patients know if their diet and activity choices and their medication are having a positive impact on their blood sugar. Unless patients knows their targets and whether the numbers they are seeing are acceptable or not, checking blood sugar is a waste of time. Of course, patients should write down the numbers they see and take their log with them to their doctor visits, but they should not rely completely on their doctor for feedback every few months. They have a tool in their hand that can give them feedback every day! So what question didn't get asked or answered? What numbers should I be looking for when I check my blood sugar?
Nurses Love Questions!
I'll tell you why nurses love questions. It helps them educate you, the patient! Also, when you ask questions, it hints that you are motivated to take good care of yourself, and nurses love it when patients are fully engaged in that way. Finally, nurses truly want to make a difference in their patients' lives, and giving answers that help patients is very rewarding for the nurse.
When You Really Aren't Sure What Questions to Ask
If you are absolutely stumped and just don't know what to ask, because you have no idea what you need to know, then I suggest two things: 1) ask some friends or family members what questions they think you should ask. 2) Tell the nurse, At this point, I don't know what questions to ask. Can you please tell me everything you would want to know if you were in my place?
Be Persistent
If a nurse or physician tells you that someone is going to come and teach you about your new diagnosis, make sure there is follow through. In some hospitals, certain specialists, such as the diabetes educator, do not work on weekends. If you are going to be discharged on the weekend, and the person who is supposed to come to your room to teach you about your diagnosis is not available, make sure the nurses provide you with education. There should be videos available and printed material. And speaking of printed material, it is highly unlikely that you will remember everything you are taught, so please ask for printed material that you can refer back to when needed.
A Smart Patient is a Patient Who Asks Questions
Not only do your caregivers want you to be safe in the hospital, they also want you to be safe once you go home. So please be sure to ask lots of questions so you know exactly what to do at home to prevent a readmission. And if you have more questions once you get home, call your own primary care physician and ask even more questions! The more questions you ask, the more knowledge you acquire. SMART!
Wednesday, May 6, 2015
What I Know About Nurses
There are some people we will always remember
Today is Nurses' Day, and in honor of the wonderful nurses I have known over the years, I want to share my thoughts about a group of men and women who I consider to be indispensable in this world.
There are some people we will always remember. I'll never forget my grade school teachers. I can still name off every one of them. I'll never forget some of the patients I've cared for in years past. And I will always, always remember certain nurses.
They were there when I needed them
I still remember the nurse who cared for me when I was five years old and had an emergency appendectomy. This was in the 1950's, and my nurse was the only black nurse on the unit. She was a large woman with a great sense of humor and a laugh that told me I didn't need to worry about anything. (It's hard to be scared when you're laughing.) She acted like I was her favorite patient, and I'm sure the other children felt they were her favorite, also. I'll always remember her bustling about making sure we had ice cream and such.
I remember the nurse who cared for me when my baby was stillborn at full term. She wrapped my broken heart in a blanket of love, and I will always be grateful to her.
I had wonderful nurses when I gave birth to five other children and when I had my gall bladder removed. My husband had great nurses when he was hospitalized, and I have witnessed outstanding nurses give excellent care to other members of my family and to my friends.
Nurses want to give safe, excellent care
Every nurse I know, without exception, wants to give excellent care. They want to spend more time with their patients. They want to teach them, keep them informed, and even pamper them at times. Nursing and patient care has become very complex due to the constancy of change, but that is a topic for another time. For now, I simply want to honor the fact that nurses genuinely care about their patients well-being at all times.
Thank you
I want to thank all the nurses who have cared for me, my family, and my friends over the years. I want to recognize my nurse friends who have set a wonderful example of professionalism and compassionate caring and who have influenced my own practice. I appreciate you, and partly because of you, I'm proud to be a nurse.
Today is Nurses' Day, and in honor of the wonderful nurses I have known over the years, I want to share my thoughts about a group of men and women who I consider to be indispensable in this world.
There are some people we will always remember. I'll never forget my grade school teachers. I can still name off every one of them. I'll never forget some of the patients I've cared for in years past. And I will always, always remember certain nurses.
They were there when I needed them
I still remember the nurse who cared for me when I was five years old and had an emergency appendectomy. This was in the 1950's, and my nurse was the only black nurse on the unit. She was a large woman with a great sense of humor and a laugh that told me I didn't need to worry about anything. (It's hard to be scared when you're laughing.) She acted like I was her favorite patient, and I'm sure the other children felt they were her favorite, also. I'll always remember her bustling about making sure we had ice cream and such.
I remember the nurse who cared for me when my baby was stillborn at full term. She wrapped my broken heart in a blanket of love, and I will always be grateful to her.
I had wonderful nurses when I gave birth to five other children and when I had my gall bladder removed. My husband had great nurses when he was hospitalized, and I have witnessed outstanding nurses give excellent care to other members of my family and to my friends.
Nurses want to give safe, excellent care
Every nurse I know, without exception, wants to give excellent care. They want to spend more time with their patients. They want to teach them, keep them informed, and even pamper them at times. Nursing and patient care has become very complex due to the constancy of change, but that is a topic for another time. For now, I simply want to honor the fact that nurses genuinely care about their patients well-being at all times.
Thank you
I want to thank all the nurses who have cared for me, my family, and my friends over the years. I want to recognize my nurse friends who have set a wonderful example of professionalism and compassionate caring and who have influenced my own practice. I appreciate you, and partly because of you, I'm proud to be a nurse.
Monday, May 4, 2015
Speak Up!
You Have a Right to SPEAK UP!
The Joint Commission, an important regulatory agency that accredits hospitals, has come up with a program to teach patients that it smart to speak up when they observe unsafe habits or behaviors in the healthcare setting. Pamphlets are available at the Joint Commission website to help patients know what they should expect from their caregivers and how to communicate when those expectations are not being met.
Speaking Up Can Save a Life
As anyone can easily imagine, hospitals are full of infectious organisms, and they can be spread from patient to patient if caregivers are not diligent about wearing Personal Protective Equipment or they fail to wash or sanitize their hands properly. Patients and visitor should never hesitate to remind their caregivers to wash their hands before touching the patient and to wear gloves when doing any kind of treatment, such as starting an IV or changing a dressing. Patients can die from hospital-acquired infections, and it is simply not necessary.
Learn More about WHEN to Speak UP
Smart Patients, Safe Patients was written specifically to educate patients so they know what is safe behavior and what is not. It teaches patients and patient advocates when to speak up, who to speak to, and how to get their message across effectively.
There is No Need to Be Afraid
When I wrote Smart Patients, Safe Patients, I was concerned that I would frighten patients. Truly there is no need to be frightened. Nurses and physicians are among the most caring, dedicated individuals on the planet. They went into the medicine because they enjoy caring for people. You can be certain they want to provide safe care. As I wrote in the book, medical professionals are human, and they get busy and flustered like most human beings. So while there is no need to be afraid, there IS a need for you to speak up when you observe a caregiver who needs a reminder to be safe.
Safety Measures Abound in the Hospital Setting
There are entire teams in the hospital whose main focus is on patient safety. Every hospital could likely produce a long list of their safety programs and initiatives. Even so, errors continue to be made from time to time. My feeling is that an important missing component in the fight against hospital medical errors is patient education and patient participation. Gone are the days when the patient left all decisions up to the nurse or physician. It is time for patients to take their rightful place as an important member of their own healthcare team and SPEAK UP!
We Are Here to Help You
The more questions you ask, the more educated you will become. Most nurses and doctors enjoy teaching their patients, and they welcome questions. If you have any questions that I might be able to answer, don't hesitate to ask me! You can email your question to safepatients@cox.net or you can post it here for others to view. As your nurses and doctors, we are here for you. And we are glad you are an active part of the team!
The Joint Commission, an important regulatory agency that accredits hospitals, has come up with a program to teach patients that it smart to speak up when they observe unsafe habits or behaviors in the healthcare setting. Pamphlets are available at the Joint Commission website to help patients know what they should expect from their caregivers and how to communicate when those expectations are not being met.
Speaking Up Can Save a Life
As anyone can easily imagine, hospitals are full of infectious organisms, and they can be spread from patient to patient if caregivers are not diligent about wearing Personal Protective Equipment or they fail to wash or sanitize their hands properly. Patients and visitor should never hesitate to remind their caregivers to wash their hands before touching the patient and to wear gloves when doing any kind of treatment, such as starting an IV or changing a dressing. Patients can die from hospital-acquired infections, and it is simply not necessary.
Learn More about WHEN to Speak UP
Smart Patients, Safe Patients was written specifically to educate patients so they know what is safe behavior and what is not. It teaches patients and patient advocates when to speak up, who to speak to, and how to get their message across effectively.
There is No Need to Be Afraid
When I wrote Smart Patients, Safe Patients, I was concerned that I would frighten patients. Truly there is no need to be frightened. Nurses and physicians are among the most caring, dedicated individuals on the planet. They went into the medicine because they enjoy caring for people. You can be certain they want to provide safe care. As I wrote in the book, medical professionals are human, and they get busy and flustered like most human beings. So while there is no need to be afraid, there IS a need for you to speak up when you observe a caregiver who needs a reminder to be safe.
Safety Measures Abound in the Hospital Setting
There are entire teams in the hospital whose main focus is on patient safety. Every hospital could likely produce a long list of their safety programs and initiatives. Even so, errors continue to be made from time to time. My feeling is that an important missing component in the fight against hospital medical errors is patient education and patient participation. Gone are the days when the patient left all decisions up to the nurse or physician. It is time for patients to take their rightful place as an important member of their own healthcare team and SPEAK UP!
We Are Here to Help You
The more questions you ask, the more educated you will become. Most nurses and doctors enjoy teaching their patients, and they welcome questions. If you have any questions that I might be able to answer, don't hesitate to ask me! You can email your question to safepatients@cox.net or you can post it here for others to view. As your nurses and doctors, we are here for you. And we are glad you are an active part of the team!
Wednesday, April 29, 2015
Please Listen to Me
The Car Accident
Back in the 1990's, Oscar (not his real name) got in a car with a friend who had been drinking but insisted on driving. The driver's cousin sat in the back seat. Oscar's friend started driving down the road, weaving back and forth. The cousin begged him to stop the car and let him drive. His pleas only made the driver angry, and his driving became more erratic. Suddenly the car spun and flipped, turning over and over. When the car landed, Oscar and the driver were seriously injured. The cousin was mostly unhurt, and he ran for help.
Paramedics arrived quickly and assessed the victims' injuries. A collar was placed around Oscar's neck, and he was told to hold his head very still. He was air-lifted to the nearest Emergency Room. An ER physician examined Oscar and noted that while Oscar had no feeling below his waist and could not move his legs, he was still able to move his arms. The physician told Oscar, "Don't let anyone touch that collar around your neck! It needs to stay on, and you must not move your head!"
The Tragedy That Never Had to Happen
Oscar was admitted to the hospital, and it wasn't long before another physician was asked to evaluate the extent of Oscar's spinal injury. Oscar was still able to move both of his arms, and the physician again reiterated to Oscar that he must not move his head. The neck collar had to stay in place.
After the physician left, a nurse entered Oscar's room and told him she needed to remove the neck collar so she could clean the large amount of dried blood on Oscar's head, neck, and chest. Oscar told her she that the doctor said the collar was not to be removed. The nurse said, "It will be fine. I'll be careful." Again, Oscar repeated that the doctor said the collar was absolutely NOT to come off. The nurse ignored Oscar's warning and removed the collar. Then she turned Oscar's head side to side so she could clean the blood from the back of his head. Oscar screamed in pain. He tried to reach up to stop the nurse, but nothing happened. Oscar could no longer move his arms.
Refusing Treatment
If you are a patient, and you feel a particular treatment or action on the nurse's or physician's part may not be in your best interest and perhaps may even be harmful, you have a right to refuse treatment. In Oscar's case, he could have told the nurse, "I am officially refusing to allow you to touch me. Do not touch me, and get me your supervisor immediately."
Nurses are taught in nursing school to listen to their patients. They are taught that patients have the right to refuse treatment. Forcing treatment of any kind on a patient is unethical and completely unacceptable. Most nurses listen to their patients and would never force anything on a patient, even if they disagree with the patient's decision.
As a patient, your responsibility is to ask questions that will help you to be a well-informed decision maker. Until you have all the information you need, you may refuse treatment at any time. It's your right.
Back in the 1990's, Oscar (not his real name) got in a car with a friend who had been drinking but insisted on driving. The driver's cousin sat in the back seat. Oscar's friend started driving down the road, weaving back and forth. The cousin begged him to stop the car and let him drive. His pleas only made the driver angry, and his driving became more erratic. Suddenly the car spun and flipped, turning over and over. When the car landed, Oscar and the driver were seriously injured. The cousin was mostly unhurt, and he ran for help.
Paramedics arrived quickly and assessed the victims' injuries. A collar was placed around Oscar's neck, and he was told to hold his head very still. He was air-lifted to the nearest Emergency Room. An ER physician examined Oscar and noted that while Oscar had no feeling below his waist and could not move his legs, he was still able to move his arms. The physician told Oscar, "Don't let anyone touch that collar around your neck! It needs to stay on, and you must not move your head!"
The Tragedy That Never Had to Happen
Oscar was admitted to the hospital, and it wasn't long before another physician was asked to evaluate the extent of Oscar's spinal injury. Oscar was still able to move both of his arms, and the physician again reiterated to Oscar that he must not move his head. The neck collar had to stay in place.
After the physician left, a nurse entered Oscar's room and told him she needed to remove the neck collar so she could clean the large amount of dried blood on Oscar's head, neck, and chest. Oscar told her she that the doctor said the collar was not to be removed. The nurse said, "It will be fine. I'll be careful." Again, Oscar repeated that the doctor said the collar was absolutely NOT to come off. The nurse ignored Oscar's warning and removed the collar. Then she turned Oscar's head side to side so she could clean the blood from the back of his head. Oscar screamed in pain. He tried to reach up to stop the nurse, but nothing happened. Oscar could no longer move his arms.
Refusing Treatment
If you are a patient, and you feel a particular treatment or action on the nurse's or physician's part may not be in your best interest and perhaps may even be harmful, you have a right to refuse treatment. In Oscar's case, he could have told the nurse, "I am officially refusing to allow you to touch me. Do not touch me, and get me your supervisor immediately."
Nurses are taught in nursing school to listen to their patients. They are taught that patients have the right to refuse treatment. Forcing treatment of any kind on a patient is unethical and completely unacceptable. Most nurses listen to their patients and would never force anything on a patient, even if they disagree with the patient's decision.
As a patient, your responsibility is to ask questions that will help you to be a well-informed decision maker. Until you have all the information you need, you may refuse treatment at any time. It's your right.
Thursday, April 23, 2015
Members of the Same Team
Imagine a team of invested individuals sitting around the boardroom table discussing issues that are vital to the health of the organization. The CEO sits at the head of the table, because he or she has the final say in all matters. The CEO is smart and has hand picked the other individuals sitting around the table, each one an expert and indispensable resource. Together the team discusses challenges, options, interventions, and desired outcomes.
No member of the team is more important than another. The team works as one competent entity, working in sync with all available information. While members rely on the specialized expertise of each member of the team, it is well understood that the CEO must be kept fully informed, because the CEO is the ultimate expert on the organization as a whole.
Now imagine the same scenario with the patient as the CEO of the organization, the organization representing the totality of the CEO's own health and well being. Around the table sit registered nurses, nursing assistants, physicians from various areas of specialty, as well as a dietician, a pharmacist and other experts. Meetings regarding the CEO's health and well-being take place in his or her presence. The CEO is educated by the experts in order to facilitate intelligent, informed decision making. At the same time, the CEO, who has been with the organization since its inception, educates the experts to enable them to do a thorough, accurate, and effective assessment of the organization and its needs.
The message here should be clear. Patients and health care professionals are on the same team. The professionals are educated and experienced and bring important expertise to the table. The patient is also an expert in his or her own right and also brings important information to the table.
The healthcare team is just that...a TEAM. Therefore, as we discuss patient safety in the hospital and related healthcare issues, there is no need for blog that speaks to patients and excludes healthcare professionals. Likewise, there is no need for a blog that speaks to healthcare professionals and excludes patients.
Working together, team members are not segregated based on education, titles, or annual income. The team, with the CEO at the head of the table, can preserve the health and vitality of the organization. Ultimately everyone wins.
No member of the team is more important than another. The team works as one competent entity, working in sync with all available information. While members rely on the specialized expertise of each member of the team, it is well understood that the CEO must be kept fully informed, because the CEO is the ultimate expert on the organization as a whole.
Now imagine the same scenario with the patient as the CEO of the organization, the organization representing the totality of the CEO's own health and well being. Around the table sit registered nurses, nursing assistants, physicians from various areas of specialty, as well as a dietician, a pharmacist and other experts. Meetings regarding the CEO's health and well-being take place in his or her presence. The CEO is educated by the experts in order to facilitate intelligent, informed decision making. At the same time, the CEO, who has been with the organization since its inception, educates the experts to enable them to do a thorough, accurate, and effective assessment of the organization and its needs.
The message here should be clear. Patients and health care professionals are on the same team. The professionals are educated and experienced and bring important expertise to the table. The patient is also an expert in his or her own right and also brings important information to the table.
The healthcare team is just that...a TEAM. Therefore, as we discuss patient safety in the hospital and related healthcare issues, there is no need for blog that speaks to patients and excludes healthcare professionals. Likewise, there is no need for a blog that speaks to healthcare professionals and excludes patients.
Working together, team members are not segregated based on education, titles, or annual income. The team, with the CEO at the head of the table, can preserve the health and vitality of the organization. Ultimately everyone wins.
Wednesday, April 22, 2015
Know Your Numbers!
To say the patient is an important member of his or her own healthcare team is so intuitive and basic that it hardly seems worth reiterating. Nevertheless, when it comes to being included and informed of certain important pieces of information, it seems that patients are often left in the dark.
How many times have you gone to your doctor, and a medical assistant has taken your blood pressure, your temperature, and perhaps your heart rate? How many times has the medical assistant left you without sharing the numbers with you? In my experience, it is rare for that information to be shared with me unless I ask, "What is my blood pressure? What is my heart rate? My temperature?"
I've observed the same thing with patients in the hospital. A nursing assistant checks vital signs (blood pressure, temp, heart rate, and sometimes oxygen saturation level) or possibly does a finger stick to check blood sugar and then leaves the room without sharing the information with the patient. Patients not only have a right to that information, but it is important that patients are taught and understand normal values and where their numbers are in relationship to "normal."
It almost seems to be the norm to withhold vital sign numbers from the patient, although I don't believe it is done on purpose. I wonder if some caregivers assume the patients either don't care to know or wouldn't understand the numbers if the numbers were shared with them. This is where the Smart Patient comes in.
If the person taking your vital signs doesn't immediately share the numbers with you, ask for them. If you don't understand what the numbers mean, don't ask the nursing assistant. The nursing assistant is not expected or truly qualified to teach you about your vital signs. The next time your nurse comes to see you, ask your nurse what the normal range is and how your numbers compare, unless you already know and understand.
If I were a patient in the hospital, assuming I was well enough to advocate for myself, I would tell my nurses and nursing assistants from the very start, "I like to know everything. Be sure to tell me my numbers when you take my vital signs and anything else you are allowed to tell me! The more I know, the happier I am." I would probably need to say the same thing to every new caregiver, but it would be worth the effort.
The more you know and understand, the more effective you can be as the most important member of your health care team!
How many times have you gone to your doctor, and a medical assistant has taken your blood pressure, your temperature, and perhaps your heart rate? How many times has the medical assistant left you without sharing the numbers with you? In my experience, it is rare for that information to be shared with me unless I ask, "What is my blood pressure? What is my heart rate? My temperature?"
I've observed the same thing with patients in the hospital. A nursing assistant checks vital signs (blood pressure, temp, heart rate, and sometimes oxygen saturation level) or possibly does a finger stick to check blood sugar and then leaves the room without sharing the information with the patient. Patients not only have a right to that information, but it is important that patients are taught and understand normal values and where their numbers are in relationship to "normal."
It almost seems to be the norm to withhold vital sign numbers from the patient, although I don't believe it is done on purpose. I wonder if some caregivers assume the patients either don't care to know or wouldn't understand the numbers if the numbers were shared with them. This is where the Smart Patient comes in.
If the person taking your vital signs doesn't immediately share the numbers with you, ask for them. If you don't understand what the numbers mean, don't ask the nursing assistant. The nursing assistant is not expected or truly qualified to teach you about your vital signs. The next time your nurse comes to see you, ask your nurse what the normal range is and how your numbers compare, unless you already know and understand.
If I were a patient in the hospital, assuming I was well enough to advocate for myself, I would tell my nurses and nursing assistants from the very start, "I like to know everything. Be sure to tell me my numbers when you take my vital signs and anything else you are allowed to tell me! The more I know, the happier I am." I would probably need to say the same thing to every new caregiver, but it would be worth the effort.
The more you know and understand, the more effective you can be as the most important member of your health care team!
Tuesday, April 21, 2015
Smart Patients, Safe Patients book coming soon!
Having practiced as a registered nurse in the hospital setting for over 20 years, and having seen patient care from the perspectives of bedside nurse, manager, and nurse educator, I have been blessed with a unique perspective of hospital patient care. I also have a passion for patient safety and feel it is important for patients to be given the knowledge they need to be well-informed members of their own healthcare team.
While administrators, physicians, and nurses work hard to eliminate errors, mistakes are still made from time to time. Fortunately, when the patient is an active member of the team, or when an advocate is acting on the patient's behalf, the risk for error goes down significantly.
The purpose of this blog is to continue where the book Smart Patients, Safe Patients leaves off and to provide education in the hope that with the patient's or patient advocate's help, hospital errors will continue to decline.
This site is under construction, as is the book, and both the book and this site will be finished and available by the end of May at the very latest. Please add this site to your favorites, and come back and visit soon. In the meantime, if you have any questions or concerns, please feel free to drop me a note at parchuleta1@gmail.
While administrators, physicians, and nurses work hard to eliminate errors, mistakes are still made from time to time. Fortunately, when the patient is an active member of the team, or when an advocate is acting on the patient's behalf, the risk for error goes down significantly.
The purpose of this blog is to continue where the book Smart Patients, Safe Patients leaves off and to provide education in the hope that with the patient's or patient advocate's help, hospital errors will continue to decline.
This site is under construction, as is the book, and both the book and this site will be finished and available by the end of May at the very latest. Please add this site to your favorites, and come back and visit soon. In the meantime, if you have any questions or concerns, please feel free to drop me a note at parchuleta1@gmail.
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