Making health care safer, that’s what we all want. Medical mistakes contribute to unnecessary deaths each year, many of these during a hospital stay. To improve patient safety, the healthcare community has attempted to identify hazards and solutions that work to reduce patient harm. Here are some measures that the medical community has said should be STRONGLY encouraged for adoption NOW. Make sure you and your family members are being taken care of as you are the best watchdogs.
1. Pre-operative checklists: I would advise a family member go to the pre-op room with you; when the nurses and doctors come in, you can make sure the allergies and medications they have listed for you jive with the truth.
2. Hand hygiene: Everyone who comes in and out of the room should wash their hands with soap and water OR use the hand sanitizer provided right outside the hospital room. For sure.
3. Barriers: Barrier precautions means gowns, gloves, and masks must be used to prevent health-care associated infections: Methicillin Resistant Staph Aureus aka MRSA, clostridium difficile, Vancomycin resistant enterococcus (VRE.) If you see the gowns and gloves on the outside of the door with a sign you make sure everyone is changing on their way in and out.
4. Urinary catheters: These are sometimes left in too long and represent another common source of hospital acquired infection. Make sure a urinary catheter is still needed if you have one in. Catheter reminders, stop orders, and nurse-initiated removal protocols exist in most hospitals now.
5. No clots please: Improving prophylaxis (prevention medications and measures) for venous clots (deep venous thrombo-embolism or DVT) include blood thinners (Lovenox, heparin) or the leg squeezers. If your family member is immobilized they need this.
6. Falls: I can’t tell you how many folks in the hospital get up to use the restroom, woozy on pain meds, and fall and break a hip. Interventions to reduce falls include bedside signs, wrist band alerts, footwear advice, and scheduled or supervised toileting.
7. Wounds and skin breakdown: Interventions to reduce pressure ulcers are a big deal and will prevent this well-known complication of “bed sores” or “pressure ulcers.” “Skin champions” and wound care teams exist in every hospital so make sure your loved ones wound/cut/tear is well taken care of.
8. Medication errors: Unintended changes to patient medication regimens occur in 67% of patients admitted to the hospital. EEK! This means we forget a medication that you were on at home or add one you that you weren’t taking. Many of these mistakes don’t hurt the patient, but some do. Medication reconciliation is the formal process of identifying and correcting medication discrepancies; you can help by asking; “what is this new pill I’m taking” when you don’t recognize it, or “where are my routine medications”, if you notice you aren’t getting it.
9. Central lines: Many of you know these are larger IVs (in the groin or neck, or sometimes in the arm called a PICC line) and are a common source of hospital acquired infection. Watch for how they are cared for: Checklists nurses and doctors go through to prevent central-line associated bloodstream infections are a big deal. Many hospitals also started using ultrasound (real time) at the bedside for placement of these large intravenous lines.
10. Bad handwriting: Computerized physician order entry is the way to go here, to help nurses and pharmacists avoid having to interpret bad physician handwriting and thinking “Magnesium Sulfate” is “Morphine Sulfate.” You get the picture, dangerous stuff.
- Dr. O
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