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.
Wednesday, April 29, 2015
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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