By Roberta Carson, President, Zaggo, Inc.
Hospitals are where we go when we’re sick and in need of medical care. We hope, of course, that we’ll get better and then return to our lives. Hospitals can also be very risky environments where patients can be exposed to dangerous pathogens, develop an infection, or fall victim to a medical error. Knowledge is power and especially powerful when it comes to healthcare. Knowing what to look for and how to minimize the risk of error, can help make your family member’s stay as safe and comfortable as possible.
Here are some common issues and advice on steps you can take to better protect your loved one.
1. Patient Misidentification
Patient misidentification can cause patients serious harm, and in rare situations, death. No one wants their loved ones to get the wrong medication, treatment or procedure.
What should you do?
Make sure the information on the patient’s wrist band is accurate AND is checked before every medication or procedure. Again, it is very helpful to have a friend or family member stay with the patient as much as possible. If a healthcare professional wants to administer unfamiliar medications or perform an unexpected procedure, speak up.
2. Exposure to Pathogens
Infections acquired in healthcare settings are common and can be dangerous. In high-income countries like the U.S., approximately 30% of patients in Intensive Care Units (ICUs) are affected by at least one healthcare acquired infection.
Hospitals contain sick people and sick people contain germs. Unfortunately, germs (also referred to as pathogens), like C. diff and MRSA, can get transferred from one patient to another in a variety of ways. Germs can be transmitted through the air – when a patient coughs or sneezes the particles can travel by air and settle on another patient or surfaces which another patient (or guest) then touches. Germs can also be transmitted by medical staff. For example, a doctor or other health professional who doesn’t adequately wash his/her hands between patients can spread germs. Hard surfaces (e.g. bed rails, door knobs, tray tables) that are not properly cleaned and disinfected on a regular basis pose risks to all who come in contact with them. It turns out that even the floors are covered in dangerous germs.
What should you do?
• Treat all items in a hospital room as if they have been contaminated. Regularly wipe down hard surfaces with wipes containing bleach, including items that fall on the floor.
• If you haven’t observed it firsthand, ask all medical staff to wash their hands and/or put on a new pair of sterile gloves before touching the patient. Don’t be bashful.
• If possible, ask for a private room to reduce the chance of contamination from a sick roommate.
3. Risk of Infection from Medical Devices
Patients can develop infections from improperly sterilized needles, catheters and other tools, as well as from medical staff handling these devices with dirty hands.
What should you do?
• Insist all medical staff wash their hands and/or put on new gloves before handling a clean/new tool. Same for when handling these items that are already in use on the patient (e.g. ventilator tubes, catheters).
• Every day, ask if catheters, ventilators and other tubes can be removed. The longer they are in use, the higher the risk of infection.
4. Improper Medication Administration
Medications are a common treatment in hospitals, with the average patient taking 10 different medications, many of which look alike or have similar sounding names. Additionally, it is easy for busy staff members to give patients the wrong medications or make an error in dosage. The Institute of Medicine estimates the average hospitalized patient experiences at least one medication error each day! This IOM report also states there are 1.5 million preventable adverse drug interactions each year in US hospitals and long-term care facilities. These medication errors can lead to serious health consequences and even death.
What should you do?
Pay close attention to medication! Keep a written list of all prescribed medications and over the counter medications that should be given to the patient. Before any drug is given, ask the staffer to confirm the name and dosage of each medication. If you, or the patient, see an unfamiliar medication, ask what it is before it’s administered. Although this may seem like a burdensome, unnecessary step, the risks and likelihood of taking a wrong medication is too high to be ignored.
5. Missed bedside alarms
Bedside alarms alert medical staff when the patient’s condition is deteriorating and needs attention, such as a drastic change in blood pressure or respiration rates, or when there is a failure of life saving mechanical equipment such as ventilators. Of course, these alarms only work if a nurse (or other staff) responds in a timely, appropriate manner. When nurses and other medical staff do not recognize and respond to bedside alarms, the consequences can be serious, including serious patient harm or death.
A Boston Globe investigation found that between January 2005 and June 2010 more than 200 hospital patients in the U.S. died because of issues with on patient monitors. Missing alarms can also cause a worsening of the patient’s condition.
What should you do?
Until improvements are made in the design and use of these alarms, a family member or other attentive adult stay with a patient in the hospital at all times. If an urgent alarm sounds, a family member should seek help from a nurse immediately by finding a nurse in the hall or at the nurse’s station.
In order to minimize the risk of missed alarms, James Keller of the ECRI Institute recommends that patients and families — especially families of critically ill patients — speak with the medical staff to learn the following:
• What monitors are being used and why
• What the different alarms sound like for each piece of equipment
• Which alarms are urgent and demand immediate attention
While there are many risks, knowing what to look for and what risks to be most mindful of will help you minimize the risk of error and help make your loved one’s stay as safe and comfortable as possible.
