Patient Safety & Medication Management
Patient Safety depends on You
the numbers of
preventable death and injury due to medical error are staggering
World Health Organization:
1 in 10 patients
U. S. Institute of Medicine:
48,000-98,000 medical errors annually & $1.5 M spent on preventable adverse drug events
Johns Hopkins 2000 study:
225,000 patients die annually from medical error due to adverse events, unnecessary surgery, fatal infections, wrong drugs and equipment failure
Simple ways to stay safe in the hospital
Know what medications you should be taking and when
Take notes of communications with your medical team
Ask health care providers if they have washed their hands
Wash your hands frequently. Ask visitors to wash their hands
Use your call button and ask for help getting around, especially at night
Take your time when you get up from bed
Wear nonslip socks
Keep the bed rails up
Keep your glasses and other important items close at hand
Make sure the brake is on when getting in and out of a wheelchair
Let your medical team know of any changes in your condition: swelling, throbbing or cramping in your legs, shortness of breath, or dizziness
Preventable patient harm is the third leading cause of death in the United States, exceeded only by heart disease and cancer. The publicity that erupted after numerous studies showing the scope of this problem got the attention of government oversight agencies as well as medical organizations and individual patients. Yet, even after becoming laser-focused on resolving this pervasive issue and spending millions of dollars, the reality is these preventable adverse events continue to occur!
The belief that the responsibility for patient safety lies solely in the hands of providers is prevalent among many of us. We typically think of patient safety as adverse events that could have been avoided: infections from less than sterile instruments, surgical cases where foreign objects are left at the operative site, hospital-borne super-bugs that once unleashed are nearly impossible to control, much less eradicate. It’s somewhat easier to blame “them,” “the system” or “your insurance carrier” than take responsibility for patient safety ourselves. And yet, the onus of patient safety does rest firmly on our shoulders as well. We are the ones who need to get the follow up lab tests and take our prescribed medicine within the parameters that provide the environment to allow them to work properly.
medication compliance
As one physician says, “Physicians can’t ensure good health outcomes in non-compliant patients.” You have to take the medication, to get the positive effect. And yet, if you consider these two examples it seems many of us haven't gotten that message:
In the field of osteoporosis research, there are 54 million Americans (male and female) who have low bone mass (osteopenia or osteoporosis); yet of those treated, 60% stop their treatment within the first year of a five-year drug regimen;
In 2016, The Center for Disease Control (CDC) studied 18 million Medicare Part D enrollees who had two or more anti-hypertensive prescriptions filled in 2014. More than 25% of these patients were not compliant with their drug regimen. These are drugs aimed at preventing stroke and heart attacks, by all accounts disease states that we can easily understand and hope to prevent.
While everyone needs to be careful about taking medications, older adults need to be even more careful because not only do they often take more medicines, but they may react differently to them. Two of the biggest problems people have with medicines are reactions from mixing two or more medications, which is called drug interactions. or getting to much of one medicine, called a drug overdose. With older adults their bodies typically absorb food and drugs more slowly and thus it may take longer for a drug to start working and the drug may stay in their body longer. To ensure our safety through compliance with our medication regimens, it is essential that we truly understand the ramifications of continuing our drug protocols. Should problems result or should we choose to discontinue treatment, we must be willing to communicate with our provider and seek alternative treatment options. It is also important to tell your provider about all the drugs, vitamins, herbs and other pills you take including both prescription drugs as well as over-the- counter ones. If you have more than one provider, it is important to be sure they each know what the others are prescribing.
Hospital Stay
As a patient there are several important things you can do to safeguard your health during a hospital stay. Two examples are providing thorough health records when you are admitted and having a reliable advocate with you.
Organizing your health care information and making sure it gets into your medical record when you are admitted to the hospital is an important step toward safety. It is vital your medical team know as much as they can about you, including your family history, past procedures / surgeries, current medications and supplements, allergies and any legal paperwork, such as an Advance Directive.
Similarly, with a serious illness, having a trusted friend or family member who stays by your side and can advocate for you is also a good safety precaution. Before your procedure, this person can: take notes; help you ask important questions about your condition, treatment/surgery, anesthesia, what you can expect when you awake, how they will manage your pain and how you can avoid infections. Right after your surgery or medical procedure, chances are you may feel too tired to be on top of things and will require a great deal of sleep and rest to heal. While you are focused on your recovery, your advocate can help you follow your post treatment plan, ensure you are taking your medications and help you find your voice in communicating with your medical team. At discharge, they can be sure you are given clear instructions, know what to expect during your recovery period and who to call if questions or a problem arise.
Communication is at the foundation of ensuring your safety. Never be timid about asking questions or asking for clarification. If you have any hesitations at all about the way you feel, experience any unexpected changes, or are concerned about hygiene, the quality of your care or your safety, speak up. Remember ultimately you are in charge.
Infections
Although there certainly has been progress made on hospital safety, the threat of serious infections remains a key concern for the medical community and patients alike. According to the Centers for
Disease Control and Prevention (CDC), health care associated infections account for approximately 99,000 deaths per year. Accordingly, the CDC has developed the following list of 10 things you can do to protect yourself and your loved ones:
1. Speak up. Talk to your doctor about any questions or worries. Ask what they’re doing to protect you.
2. Keep hands clean. Make sure everyone, including friends and family, clean their hands before touching you. If you don’t see someone clean their hands, ask them to do so.
3. Ask each day if your IV, central line catheter or urinary catheter is necessary. Leaving a catheter in place too long increases the chance of infection. Let someone know immediately if the area around the central line or IV becomes sore or red, or if the bandage falls off or looks wet or dirty.
4. Prepare for surgery. Let your doctor know about any medical problems you have. Ask your doctor how surgical site infections are prevented.
5. Ask your healthcare provider, “Will there be a new needle, new syringe and a new vial for this procedure or injection?” A needle or syringe should never be reused on more than one patient.
6. Get Smart about antibiotics. Antibiotics only treat bacterial infections – they don’t work for viruses like those that cause colds and flu. Ask your health care provider if there are steps you can take to feel better without using antibiotics. If an antibiotic is prescribed, make sure to take it exactly as your health care provider tells you and do not skip doses.
7. Watch out for deadly diarrhea (aka Clostridium difficile). Tell your doctor if you have three or more diarrhea episodes in 24 hours, especially if you’ve been taking an antibiotic.
8. Know the signs and symptoms of infection. Some skin infections, such as MRSA, appear as redness, pain, or drainage at an IV catheter site or surgery site and come with a fever.
9. Get Vaccinated. Getting yourself, family, friends, and caregivers vaccinated against the flu and other infections prevents spread of disease.
10. Cover your mouth and nose. When you sneeze or cough, germs can travel 3 feet or more. Use a tissue to avoid spreading germs with your hands.