Patient, protect thyself

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Patient, protect thyself

http://www.latimes.com/features/health/la-he-

patients28jan28,1,5485739.story?track=rss

Actor Dennis Quaid and his wife, , have newborn twins who

were given overdoses of a blood thinner at Cedars-Sinai Medical

Center last November. Mistakes happen even at top-tier hospitals.

Consumers need to help caregivers avoid mistakes.

By Jan Greene, Special to The Times

January 28, 2008

The numbers can be worrisome -- 1 out of 10 hospitalized patients

picks up an infection or suffers some kind of mistake while in the

hospital, statistics show. And the stories are frightening -- Dennis

Quaid's newborn babies were given a huge overdose of a drug two

months ago at a hospital with a top-notch reputation.

So what is a medical consumer to do? Should we all be afraid to go to

the hospital?

'It's never just one thing' that leads to serious error.

It's not quite that bad, say experts in medical quality and error

prevention; hospitals these days are being held to higher standards.

But, they add, there's a long way to go on patient safety efforts.

And consumers also have a role to play in keeping themselves safe --

asking questions, gaining a better understanding of how the

healthcare system works, and more.

" There's an assumption that the providers should have all the

information and you should just take at face value what the provider

tells you, " says Dr. Angood, a trauma surgeon and vice

president and chief patient safety officer for the Joint Commission,

a national organization that accredits hospitals and other healthcare

facilities. " One of the biggest things we can do in healthcare is to

help patients understand that they need to be better consumers --

it's good to question, to ask for clarification and solicit second

opinions as needed. "

Here are some tips from organizations such as the Joint Commission

and the federal Agency for Healthcare Research and Quality, which is

charged with improving quality and safety of healthcare, on how to

reduce the risk that you or a loved one will experience a medical

error.

In the hospital

* Ask questions.

The best way to help your caregivers avoid mistakes is to talk to

them. Many medical errors are related to medications -- getting the

wrong drug or the wrong dose. A 2006 report by the Institute of

Medicine on medical errors calculated, based on national data, that a

hospital patient is subject to one medication error per day, on

average. Medications most likely to be associated with errors, the

report found, were insulin, morphine, potassium chloride, heparin and

warfarin.

If you are in the hospital and being given a new drug or dose, ask

the nurse what it is or why the dosage has been changed. If you don't

know why you are getting a medication, ask why.

The hospital may have a bar-coding system for medications that is

meant to double-check by computer the patient's name and drug dose

against what the doctor ordered. (Currently, only 11% of California

hospitals are fully using bar-coding technology for administering

drugs, according to a January study by the nonprofit California

HealthCare Foundation.)

If you have a bar code on your patient wristband, be sure it's

checked every time. Even if there's no bar code, the caregiver should

check your name.

* Vigilance is easier if you have someone else with you, particularly

if you're having surgery or are too sick to keep track of your own

care. Try to have a support person there when you get checked in,

when the doctor visits (most likely in the morning), before any major

procedures and upon checkout.

" People need to watch out for their family members, " says Maribeth

, director of the Market and Policy Monitor Program for the

California HealthCare Foundation. " Often errors are caught because a

family member says, 'That doesn't make sense to me.' "

If you are particularly concerned, have no one else to watch out for

you or a relative and can afford it, consider hiring a patient

advocate or private duty nurse to provide backup during key periods

of a hospitalization. Some hospitals employ patient advocates to help

sort out miscommunications. A registry of private-duty nurses

available by the day may be available at your hospital. Private

patient advocacy groups exist too. (Be warned: They can be pricey,

and not all medical staff welcome involvement of a third party.)

Hospitals are becoming more open to support people in patient rooms

and are even designing new hospitals with bigger rooms to accommodate

more people, some even providing something to sleep on overnight.

* Keep close track of your medicines, including herbal or homeopathic

remedies, supplements and over-the-counter drugs such as aspirin. And

tell your caregivers what you're taking. Some of these substances can

interact negatively with one another -- ginseng, for example,

interferes with the blood-thinner warfarin; chondroitin may cause

excessive bleeding during surgery. A study assessing data from 21,000

U.S. adults in 2002 found that more than two-thirds of people using a

supplement and a prescription medication in the same year did not

tell their doctor about the supplement.

You can bring your current medications with you in a bag and have the

doctor, nurse or pharmacist who visits your hospital room upon

admission go over them and ensure that information about them is

included in your hospital record. You'll also want to be sure that a

medical professional gives you advice about how to start taking any

long-term medications again after hospitalization.

* Ask everyone who comes into your hospital room to wash their hands

or use antibacterial lotion. Along with medication mistakes, the

other complication most likely to occur from a hospital stay is

getting an infection. Hospitals are germ factories, and there are

some nasty, antibiotic-resistant bugs you really don't want to take

home with you.

Patients shouldn't feel uncomfortable about requesting that people

sanitize their hands -- many hospitals, in fact, put up posters

reminding them to do so. In a study reported in 2001, 39 patients at

a hospital in Oxford, England, agreed to ask all healthcare workers

who were going to touch them to wash their hands. The result: an

average 50% increase in hand-washing rates.

* If you're having surgery, ask your surgeon what measures are in

place at the hospital to prevent wrong-site surgery -- for example,

having the wrong limb operated on. One of the hospital mistakes that

gets the most attention, it is rare but does still happen despite a

lot of bad publicity. (The Joint Commission has collected 615 reports

of them since 1995.) Hospitals now commonly use some marking

technique, such as having the patient sign the area to be operated on

and repeatedly asking the patient which site is to go under the knife.