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Patient Advocacy — a Complete 360
Dodging your responsibility as a patient advocate for you or your family member could have devastating results.
As a health care professional on the front lines of the health care system, I understand exactly 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 always be proactive in their health care.
As a media broadcaster, I always encourage the listeners to speak up and ask questions. In my “outro” I usually sign off with something like, “Thanks everyone for listening, stay safe and as always be in charge of your health, speak up and ask questions. Have a great week. I’m Barbara Ficarra for Health in 30. See you next week.” In fact, one of the tag lines for Healthin30.com is Always Speak. Ask. Know! ™
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. It’s your body and you have a right to know. Pay attention to the care you are receiving. Make sure you’re getting the right treatments and medications by the right health care professionals. Don’t assume anything. Educate yourself about your diagnosis, the medical tests you are undergoing, and your treatment plan. Ask a trusted family member or friend to be your advocate. Know what medications you take and why you take them. Medication errors are the most common health care mistakes. Use a hospital, clinic, surgery center, or other type of health care organization that has undergone a rigorous on-site evaluation against established state-of-the-art quality and safety standards, such as that provided by The Joint Commission. Participate in all decisions about your treatment. You are the center of the health care team.”
As a consumer of health care, and as an advocate for family members, I understand how imperative it is to be involved in the health care process. I understand how critical communication is between the staff, patient and their family members.
Communication between patients and health care professionals is critical for positive patient outcomes. Communication is imperative for patient safety and good quality patient care. Any breakdown in communication will result in a breakdown of quality patient care, and the results can be devastating.
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.
Now with that said, taking charge of one’s health — asking questions and speaking up — sounds really easy, and in theory, yes; absolutely, and without a doubt it is. After all, this is my mantra. This is what JCAHO encourages. This is definitely what is imperative for great health care.
But what happens when “speaking up” isn’t looked upon so enthusiastically by staff? What happens when the staff — both nurses and physicians — view the patient or family member as “difficult” because they ask so many questions? What happens when questions go unanswered, what happens when information one is trying to obtain is not so easily accessible?
My role suddenly changed when I became the outsider looking in. In February of last year an elderly family member was admitted to the hospital for heart disease. Complications set in and I suddenly found that I became the one asking questions. Although my family member was alert and oriented, being in the hospital was a frightening and overwhelming experience and she needed the assistance of a trusted family member by her side to speak on her behalf.
I became the family member; the patient advocate. I became the one asking questions. No longer was I in control. I was the “visitor,” “the family member.” I was in a strange environment, and in an unfamiliar hospital. I was out of my realm of all things professional. Suddenly, I was at the mercy of a health care system.
I was just a “family member,” “just a visitor,” “just a stranger,” and “just a patient advocate.” My mantra, “Always Speak. Ask. Know!” played over and over again in my mind, and it’s a good thing because this process of being a patient advocate was exhausting. Trying to obtain information was almost an impossible feat; trying to find out why the safety of my family member was compromised was like trying to climb Mt. Everest; a struggle to say the least. Information did not flow easily between the staff and the “patient advocate.” How did this hospital have a breakdown in communication that left my family member’s safety compromised?
Although the sequences of events have been overwhelmingly frustrating and exhausting, I continued to be on the outside looking in. I continued to be the patient advocate. I continued to ask questions. I continued to make sure that this hospital was doing everything in its power so the safety of my family member was not compromised again. I continued to Speak Up.™ I continued to “Always Speak. Ask. Know! ™
I will continue to sign-off the Health in 30™ radio show by always encouraging the listeners to take charge of their health, to speak up and ask questions. It’s simply a matter of life and death, and it doesn’t matter if you are a health professional or not; never underestimate your concerns, always be proactive and never assume. Always communicate in a proper manner. Voice your concerns and get your message across by being respectful. Speak to someone the way in which you would like to be spoken to. You don’t need to bully staff; communicate in a proper manner. Always take charge of your health, speak up and ask questions. Thankfully, my hospital experience as an “outsider looking in” turned out OK; exhausting, but OK.
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Leaving the Emergency Room
It’s great to be discharged, but be sure to follow instructions!
Have you ever been a patient in an emergency department? If your visit to the ED didn’t require an admission, that’s good news. After being told by the ED doctor that you could go home and armed you with discharge instructions, you most likely want to high tail it out of there as fast as you can.
Wait! Not so fast. It’s really vital that you do not leave the ED until you are absolutely clear about the discharge instructions. Understanding and following discharge instructions is critical for your well-being. The bad news is that complications can arise if you do not understand your diagnosis and discharge instructions.
According to the American College of Emergency Physicians (ACEP), it was reported in a recent study that 78% of patients do not fully understand discharge instructions they receive in the emergency department, and sadly the majority of patients do not understand what the doctors told them.
Emergency departments are chaotic and can be frightening and overwhelming. In the very fast paced and frenzied ED environment understanding information can be difficult. The communication process can be impeded in a setting that often seems confusing and unruly.
As a registered nurse who has been on both sides of the ED, as an administrative head nurse and as a family member, here are some simple tips:
1. Always speak up and ask questions. If you do not understand anything that is being told to you by your doctor or nurse, let them know! By speaking up and asking questions, you’ll know what to expect when you leave the ED. Don’t ever feel intimidated to ask questions.
2. When the discharge instructions are handed to you, make sure you review your instructions with your doctor or nurse. Go over each and every step. Repeat back the information.
3. If you need to write down information that will help you decipher what the doctor or nurse tells you, than do so.
4. 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.
5. If possible, it’s always a good idea to have a family member or trusted friend with you since they may be able to comprehend and understand instructions more clearly. As a patient, you may still be feeling overwhelmed by the whole ED process. Having someone with you can help ease the overpowering environment.
6. Be patient. Even though you are eager to go home and you want to be discharged as quickly as possible, please be aware that you are in an ED and your doctor or nurse may suddenly need to see an incoming, critically ill patient.
7. Despite the crazed atmosphere of the ED, the professional staff of doctors and nurses are concerned for your well-being and they are there to provide the best quality care for you.
8. If you do not feel your needs are met, you can always ask to speak to the nurse manager or during evenings, nights, weekends and holidays (depending on the hospital) you can ask to speak to an administrative head nurse or nursing supervisor.
9. Staffing issues and overcrowding are always concerns in an ED, but your care is very important. Remember to always take charge of your health and speak up and ask questions.
10. It’s important for you to speak up, and not only about your health, but the nation’s health. Emergency departments across the nation are in dire straits and they need you to speak up for them so you’ll be able to continue to receive the care you deserve. ACEP makes it easy for you to make your voice heard. Take action now!
If you find yourself in need of emergency treatment and you head to the nearest ER, remember these tips and don’t for to take “action now.”
(Barbara Ficarra is a registered nurse, executive producer & host of a Health in 30® a live radio show, founder of Healthin30.com and award-winning journalist. Barbara can be reached at B.Ficarra@Healthin30.com.)
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NURSES & DOCTORS TOGETHER FOR THE GOOD OF THE PATIENTS
What were the biggest challenges you faced as a patient in the hospital? If you could change anything about your hospital experience what would it be? Were there enough nurses and doctors on staff to care for you especially at night and on weekends? Was there a team effort between nurses and doctors?Did you know that medical mistakes do happen in hospitals?
Medical mistakes unfortunately do happen in hospitals and shockingly, 238,337 patients died from potentially preventable medical errors during 2004 through 2006, according to HealthGrades’ fifth annual Patient Safety in American Hospitals Study.
Hospitals have an increase in the number of errors on nights and weekends, and hospitals are fully aware of the existing problems. Are hospitals putting the lives of patients at risk if they knowingly are aware that these problems exist and they do not attempt to correct these conditions? Fortunately, hospitals have gotten the message that action is needed to keep patients safe and (alive).
In a recent article in The Wall Street Journal titled“Hospitals Move To Reduce Risk Of Night Shift” by Laura Landro, the focus is on hiring “nocturnists” to help relieve this crisis of substandard care on weekends and nights. However I find this a bit disconcerting since this article paints a picture of hospitals that function typically with doctors and the solution to this crisis is additional nocturnists. What about the nurses?
Anyone who has listened to me on the Health in 30™ radio show knows hospitals cannot exist with only doctors or only nurses, but instead it is a team effort of both doctors and nurses working together for the good of the patients.
Ronald M. Davis, MD, writes about the importance of the team approach, and credits nurses for their outstanding care.
According to Laura Landro: “Of course, with rising medical costs and a shortage of nurses and doctors, hospital will never be a fully staffed on nights and weekends as they are during weekdays.” She is right on target with that statement. Then she writes, “Indeed, hospitals do quiet down at night, when patients sleep, support staff go home and a skeleton crew mans many units. But that’s also the time when dangerous delays in care can occur for patients.” Let’s stop here for a moment. During my nursing career I’ve rotated to the night shift many times and I can see how the assumption can be made that since it is night, patients sleep and it is quiet. Let me emphasize that this is simply not the situation. It is not quiet and for the most part patients do not sleep, and even if patients are sleeping that doesn’t mean they are not cared for; assessments and treatments continue regardless of this. It is true that support staff goes home and there are skeleton crews; and with the shortage of both doctors and nurses mistakes can happen.
Both doctors are nurses are needed in hospitals. Nurses are responsible for the well-being of their patients around-the-clock, and just because it is night doesn’t mean continuous care stops. Nurses are committed to provide quality patient care. Nurses assess, plan, implement and evaluate their patients. They continuously observe patients and teach patients, nurses consult with doctors and other members of the health care team, and not only do they provide physical care, they are a pillar in providing emotional care. The constant eyes of nurses are needed to keep patients safe on a 24/7 basis. With the current nursing shortage perhaps this article could have delved into this area a little more rather than focusing solely on nocturnists as the solution.
The idea of hiring nocturnists makes sense, but the major piece to this maze of chaos is to focus on nurses as well. Even if hospitals get up to par with hiring enough nocturnists, with the shortage of nurses, who’s going to be there to provide care to these patients? Who’s going to question and carry out orders, provide treatments and offer support? Who’s going to man the units? Are hospitals failing?
A shattered system has hope of renewal and vitality. Patients’ safety does not need to be compromised. A culture of denial cannot be prevalent; if a system is failing, it needs to be fixed. It is unacceptable to endanger the lives of patients. There is a system in need of more staff; both physicians and nurses, now it is a matter for the folks in charge to make this happen.
Readers, what has your experience been like? Have you been a patient in a hospital or the family member of a loved one? Do you feel your treatment and care can be carried out solely by physicians? Do you feel a team effort is needed to provide you with the best care and treatment? Describe your experiences. Were your needs met right away? How would you describe the physicians who cared for you? How would you describe the nurses who cared for you? Are you always proactive in your health care? Do you speak up and ask questions if you do not understand something? Do you feel intimidated to ask questions?
Barbara Ficarra is a registered nurse, executive producer & host of a Health in 30™ a live radio show, founder of Healthin30.com and award-winning journalist. Barbara can be reached at B.Ficarra@Healthin30.com.
HYPERLINKS TO UNDERLINED WORDS ABOVE:
Patient Safety in American Hospitals Study - http://www.healthgrades.com/
article - http://online.wsj.com/article/the_informed_patient.html
nocturnists - http://en.wikipedia.org/wiki/Nocturnist
radio show - www.healthin30.com
team approach - http://www.ama-assn.org/ama/pub/category/18621.html
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Trusting the Experts for Accurate Health Information
Have we educated the public to recognize heart attack symptoms?
Hollywood is hot for drama, and when it comes to portraying a person having a heart attack it can be misleading. Gasping, struggling for a breath, holding the chest as if it is about to explode or clenching an arm tightly all make for great dramatic TV. But the reality is that sometimes the signs of a heart attack are so subtle the person experiencing an attack may ignore it, or may not realize that discomfort in the jaw, neck or back can signal a heart attack.
According to a report in the CDC’s Morbidity and Mortality Weekly Report, February 22, 2008, it is estimated that approximately 920,000 people had a heart attack in 2005. It is critical for treatment to begin immediately because it is reported that half of the cardiac deaths occur within one hour on onset “before patients reach a hospital.” Recognizing the warning signs of a heart attack and calling 911 immediately are crucial.
The following questions were asked in the survey and a total of 71,994 people responded. “Do you think pain or discomfort in the jaw, neck, or back are symptoms of a heart attack?" "Do you think feeling weak, lightheaded or faint are symptoms of a heart attack?" "Do you think chest pain or discomfort are symptoms of a heart attack?" "Do you think pain or discomfort in the arms or shoulder are symptoms of a heart attack?" "Do you think shortness of breath is a symptom of a heart attack?"
Here’s how the results played out: Only 48% of the respondents were aware that pain or discomfort in the jaw, neck, or back are symptoms of a heart attack; only 62% of the respondents were aware that feeling weak, lightheaded or faint are symptoms of a heart attack; 92% of the respondents were aware that chest pain or discomfort are symptoms of a heart attack; 85% of the respondents felt that pain or discomfort in the arms or shoulder are symptoms of a heart attack; 93% of the respondents were aware that shortness of breath is a symptom of a heart attack; and shockingly, only 86% of the respondents would call 911 if someone was having a heart attack or stroke.
The most disconcerting portion of this report is that only 86% of the respondents would call 911 if someone was having a heart attack or stroke. Why only 86%? If these respondents knew someone was in need of emergency treatment, why would so few folks call 911? Why wouldn’t 100% of the respondents? What’s holding them back?
Not surprisingly, the majority of the respondents were aware that chest pain or discomfort and shortness of breath are symptoms of a heart attack. After all, this is the classic Hollywood example. Is “Hollywood” the prime health educator? Is the general public receiving vital health information from “Hollywood?” Feeling weak, lightheaded or faint and feeling discomfort or pain in the jaw, neck or back are all indicators of a heart attack, but these symptoms are not as dramatic as the person struggling for breath, grabbing the chest and falling to the floor.
The bottom line from this report is that not everyone is on the same page when it comes to understanding the warning signs of heart attack and knowing whether to call 911. The study reveals that there is a disparity between race, gender, educational status, and the state in which one lives when it comes to understanding the warning signs of a heart attack.
As a registered nurse and broadcast journalist, I find it quite shocking that the level of knowledge among the general public is lacking. After all, heart disease is the number one killer of Americans today, so why is the knowledge of Americans so limited? Are we doing a poor job in educating the public? Do we need more specific targeting of the population? Do we need more public service announcements and more campaigns? How do we increase public awareness? What will it take to educate the public? Should Hollywood be part of the campaign?
To sum up, we definitely need to be doing a better job in educating the public. Not only is it the responsibility of the media to provide accurate information, but health care professionals in masses need to focus on prevention and accurately provide health information to the public. While Hollywood loves dramatization, we need the information to be accurate.
Public awareness must focus on the RED FLAGS (Warning Signs) of a heart attack, emphasizing that subtle chest discomfort is as serious as an excruciating pain in the chest, and recognizing that feeling faint, weak or lightheaded is just as vital. It’s critical that folks understand that even with the most subtle symptom — whether it’s a slight chest discomfort or a pain in the jaw, neck or back — they must immediately call 911.
(Barbara Ficarra is a registered nurse, journalist, executive producer & host of the radio show “Health in 30™,” and founder of Healthin30.com. She can be reached at b.ficarra@healthin30.com. Opinions expressed by Health Commentary guest bloggers do not necessarily represent the views of Health Commentary.)
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Medical Mall Madness?
Be careful about having procedures done while out shopping
Before heading out to the mall you may want to do a little research first. Who knows, you may end up coming home with not only new designer shoes and the hottest dress but — oh, yeah — a plumper face and smoother thighs as a part of your shopping spree.
In The New York Times’ Business Section, January 13, 2008, writer Janet Morrissey reports on a new trend in “Having a Little Work Done (at the Mall).” Morrissey interviews Andrew Rudnick, of SleekMedSpa.
Anyone offering answers to those seeking the fountain of youth may find themselves with a multi-million dollar business. Turning back the clock and looking as young as you feel are only a couple of the hopes for slowing down the aging process.
Morrissey writes, “Mr. Rudnick estimates that 50 percent of his company’s mall clients are walk-ins…”
Okay, people, as a health care professional and advocate of prevention, step on the brakes, stop the presses, and backspace! Did I just write “50 percent?” Yes, that’s what the article states — 50 percent of clients are walk-ins. Here is where concern number-one arises. If 50 percent of clients are walk-ins, I suspect that these consumers have not researched in any way what they are about to embark upon.
I suspect that these consumers are like the shoppers in the supermarket; the ones that impulse buy. You know who they are — heck we’re probably all (or mostly all) guilty of it at one time or another. Shoppers who know exactly what they want to purchase – even when armed with a shopping list — may spot specials and perfectly displayed items. Before they know it, the shopping cart is filled with things they didn’t need.
So are these mall shoppers, impulse shoppers? Are they the ones who fill their cart with unnecessary items? I’m not saying trying to capture youth is unnecessary; what I am saying is how can someone so matter-of-factly opt for treatments that could potentially put them in harm’s way without doing any research?
I don’t think anyone would purchase a car without first doing a little research, so why anyone would let someone probe and inject into body areas without doing any bit of homework first?
Here is where concern number-two comes into play. Who’s doing the probing and injecting? Who’s shooting the Botox? Who’s using the laser? Who’s inserting the syringe for the Mesotherapy?
Doctors? Nurses? What is the doctor’s specialty? What is the nurse’s specialty? What are their credentials? Is the doctor a specialist in dermatology or plastic surgery? Is the nurse a nurse practitioner who specializes in the same? What’s the training? How many hours of training? Is the training the same for doctors and nurses? Once they’re certified, how often is there re-certification? Who should be doing the injecting?
Who regulates these spas? What if there’s an emergency? How is that handled? Who’s ultimately responsible for ensuring that the spa is safe?
Morrissey writes: “For its part, Sleek MedSpa says some of its outlets have onsite physicians while others doctors as medical directors offsite, and nurse practitioners and physician’s assistants who handle day-to-day treatments. If there were an emergency a nurse couldn’t handle, the nurse would call 911, Mr. Rudnick said. He added that no such emergency had ever arisen.” (I suspect a doctor would also call 911 if there was a critical situation where additional help was needed).
Isn’t prevention key? Isn’t prevention what all health professionals should be shouting from the roof tops? Although Mr. Rudnick says that an emergency has never arisen, what if one should? Well, he said 911 would be called, but what kind of emergency equipment is available in these decadent spas?
The concerns keep growing. Here is where concern number-three comes into play. Although these procedures are non-surgical, there are still risks involved. According to the official website for Botox®, it offers information regarding the safety of the product from drug interactions and potential side effects. “Serious heart problems and serious allergic reactions have been reported rarely. If you think you’re having an allergic reaction or other unusual symptoms, such as difficulty swallowing, speaking or breathing, call your doctor immediately. The most common side effects following injection include temporary eyelid droop and nausea. Localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection. Patients with certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects.”
It’s vital that as a consumer of health care you investigate and become fully informed of your choice.
According to The American Society of Plastic Surgeons (ASPS) more than 1.1 million people had Botox® injections in 2002, representing 15 percent of non-surgical cosmetic plastic surgery procedures. Fifty-four percent of all Botox® procedures were performed on people between the ages of 35-50.
So while we’re searching for a little something that erases lines and plumps up the face for that youthful glow; always do your homework first.
Fast and cheap isn’t always best. Make sure the health professionals are fully qualified. Make sure they are experts. Ask to see the credentials. Always speak up and ask questions. Make sure you are fully informed of the procedure and any potential risks. Make sure you understand them 100%. Make sure you take charge of your health, always speak up and ask questions. Remember, prevention begins with you. “Always Speak. Ask. Know™.”
And if the Mecca of the malls are Medspas, don’t be an impulse shopper. Be smart and do your homework first. Be the best that you can be, but always be a savvy health shopper. Learn the facts and choose the expert for you.
(Barbara Ficarra is a registered nurse, journalist and founder and executive producer of the radio show “Health in 30™.” She can be reached at b.ficarra@healthin30.com. Opinions expressed by Health Commentary guest bloggers do not necessarily represent the views of Health Commentary.)
