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A Nurse’s Tips To Stay Safe In The Hospital

hospitalA hospital can be extremely frightening and overwhelming.

Hospitals generally are loud, cold, and sterile mazes of chaos. Unfortunately medical errors happen and it’s estimated that nearly 100,000 people die of medical errors each year.

According to the CDC, “In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year.”

As a registered nurse on the front lines of the health care, I understand how important it is for patients and their families to take charge and be an advocate for their health.

In my role as an administrative head nurse, I always encourage patients and family members to  be proactive in their health care.  I am passionate about encouraging patients to be proactive and kudos to CNN, and Consumer Reports for recently addressing the issue of patient safety; and The Wall Street Journal for recently addressing the issue of parents being active to ensure their child’s safety in hospitals.

I’ve written on this topic before, I have been quoted in national magazines, talked about it on web/TV and I’ll continue to speak out regarding this critical topic.

While hospital safety may seem daunting, the good news is that you can be an empowered patient and help eliminate medical mistakes. 

My top tips to keep you safe in a hospital

Carry your medication list and personal medical history form with you

During your admission assessment, whether you were brought to the ER or directly admitted to the hospital, you will be asked multiple times by multiple staff for a list of your medications, past hospitalizations, if you have any allergies and emergency contact numbers.  Carry this personal medical history and medication form in your wallet at all times; in case of an emergency or for a scheduled hospital visit; you’ll be prepared.

(As an expert contributor to Real Simple Magazine, “In an Emergency,” this was my number one tip).

Believe you are empowered: Give yourself permission to be in charge, an engaged patient

Unless you know how to be assertive and believe that you are an empowered patient all the tips in the world won’t help. Treat your doctors and nurses as partners in your health care team.

Communicate in a non-threatening manner

Communication between patients and health care professionals are critical for positive patient outcomes. Communication is imperative for patient safety and good quality patient care. In a hospital, which is a very fast-paced environment, where seconds can mean the difference between life and death, it’s crucial that communication flows consistently and thoroughly between patients, their families and staff. Speaking up and communicating needs to be continuous.

The Joint Commission, otherwise known as JCAHO, launched a national campaign in 2002 to urge patients to become active in their health care to help prevent errors. Speak Up™ encourages patients to:

Speak up if you have questions or concerns, and if you don’t understand, ask again…

Any breakdown in communication can result in a breakdown of quality patient care, and the results can be devastating.  If you don’t understand something, ask for clarification.  If you need assistance, ask!

If you find that communication between you and your doctor or nurse is not flowing, and your questions are not being answered, or if you do not feel your needs are met, you ask to speak to the nurse manager. (On evenings, nights, weekends and holidays, it may be the administrative head nurse, assistant director of nursing or nursing supervisor who will help you address any issues.)

Germs are lurking throughout the hospital

Don’t assume that your doctor, nurse or anyone else that comes in contact with you just washed their hands. It’s okay to ask them if they’ve just washed their hands. After all hand washing is the single most effective way to stop the spread of infections.

Make sure your visitors wash their hands.  Washing your hands for 30 seconds with warm soapy water will do the trick.  If a sink isn’t nearby, alcohol based hand sanitizers work great.  In fact, some hospitals even make hand dispensers available not only by each patient’s room door, but inside each room.

Make sure you ask anyone that comes in contact with you if they have clean hands.  It’s okay to ask them if they’ve washed their hands.  It’s not rude, you’re not being obsessive–you are keeping yourself safe and alive.  You do not want any infections.

Bring a trusted family member with you

Ask a trusted family member or friend to be your patient advocate. The hospital environment can be very frightening and overwhelming and often answering simple questions can be difficult.

If you have an advocate with you they can speak up on your behalf and answer questions for you.  Make sure your advocate understands your plan of care and whether there is an advance directive. An advance directive will allow a designated person to make medical decisions for you in case you are unable to.

To print out an advance directive form, go to the American Academy of Family Physicians.

Know your medications

Understand the medications that are ordered for you in the hospital.  When the nurse administers your medication, make sure you understand what it is for and its potential side effects. Also, make sure your nurse identifies you as the correct patient before any medications are administered.

Before administering any medications the nurse should perform five checks:  Right Patient, Right Drug, Right Dose, Right Route, and Right Time.  If you believe you are about to receive the wrong medication let your nurse know immediately.

Going home? Not so fast!

When discharge instructions are handed to you, make sure to review them with your doctor or nurse.   In most cases, it will be your nurse.  Go over each step.  Repeat back the information.

If you need to write down information that will help you decipher what the doctor or nurse tells you, than do so.  If you are given prescriptions for medications, make sure you understand what you will be taking.  Be clear about how to take your prescription, when to take it, the dosage, and any side effects.  Also ask if it will interfere with any other medications that you may be taking.

*This blog post was originally published at Health in 30*

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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