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!
Friday, May 15, 2015
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!
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