(No – that’s not Dad in the photo – but this gentleman is quite representative!)
Last week I shared notes from my father’s hospital bedside as he began his recovery from back surgery. The majority of his hospital stay was safe and successful, although we continued to have big problems managing his pain throughout.
Dad was discharged to a skilled nursing center to convalesce and begin rehab. He’s well on the road to recovery. We have much to be thankful for.
As mentioned previously, my work does not typically include helping individual patients with their healthcare challenges. I write and speak on advocacy topics, but one-on-one is not how I spend my typical day… So this hospital experience with Dad was quite the eye opener.
And what I learned is that being a successful patient advocate means learning how to nail jello to a tree. (Just picture it….) And it raised my esteem even further (if that was possible!) of all of you who work side-by-side with patients every day.
I do not know how anyone gets out of a hospital alive without having an advocate by his or her side. OK, I don’t think it must always be a paid, private advocate who pitches in. A family member, or someone who knows about the necessary safety measures will be able to catch most of the smaller problems. But I learned that for those of us who are not experienced, it is impossible to anticipate the “saves” that professional advocates perform. And the magnitude of those “saves” is what is important. They can be life-saving.
Some examples of the ones I caught:
Last week I told you about one of the drug saves, and the catch-him-falling-out-of-the-chair save. There was no way that I could have anticipated either. I’m just not experienced enough.
I’ve written in my other blog about the sign I put up on the wall above the head of his bed. It caused a bit of controversy among the hospital staff. They took it down citing privacy issues. I replaced it, and promised to take on the Joint Commission if necessary.
Handwashing – without a pretty good backbone and some chutzpah to boot, it can be quite intimidating to insist on infection control. The first few days, the hospital personnel were not at all resistant to hygiene when I asked, but as time went on, they began to act offended. “We have the lowest infection rate in the area,” one said. “OK – good – let’s keep it that way,” I replied. At least a dozen different times they would arrive and put on gloves – and I would ask them to wash their hands or sanitize BEFORE they put on the gloves. Gloves protect only the provider and not the patient! I promise, I was polite and respectful each time but without being assertive, it’s easy to see how infections spread. Do they really not understand that?
Another “save” resulted after discharge. Dad’s primary came to see him and decided to take Dad off two drugs he’s been taking for a long time. Upon arrival in the Skilled Nursing Center (SNC) they wanted to give him those two drugs. I mentioned that his primary had taken them off the list – but the SNC’s list, from the hospital, still included both. I insisted they contact Dad’s primary to double check and sure enough, he was not supposed to be taking those drugs – but the primary had never reported that to the hospital, so the wrong instructions were sent. A discharge problem. Some of you have taught me how prevalent those discharge problems are. You are so right.
These are just a few examples of those frustrating and elusive details – those problems you can’t anticipate but for which you must be constantly vigilant. I shudder to think what I didn’t catch!
Yes – it’s clear to me that those of you who advocate for patients one-on-one are constantly challenged by unanticipated events. You constantly nail jello to a tree.
And for that I shall be forever in awe of you.
Trisha, I Have been going through this with my Mom for the past 6 weeks since she fell and broke her hip. Vigilance is the key, I am truly heartbroken for those patients, both at the hospital and at rehab centers that have no one to speak for them and/or look out for their well being, You have taught me so much. Thanks for all you do. Sincerely, Jean Gilcher
Trisha, I can so related to your recent expereince with your father as I just came back from a visit with some of my friends who I went to nursing school. One of them has been going through a tough time. In Feb, she began forgetting things. She was put on leave as a nurse and her husband (non-medical) is trying to find out what is wrong. No one from the insurance company has ‘identifed’ her as an out of the ordinary case…so she has not gotten a CM. She had had no treatment to date and is getting worse. I offered to be her advocate and am will f/u with her husband.
The experience taught me that the theory we talk about; patient and family centered care, care coordination really is theory and has not made it to the bedside. We talk about breaking down silo’s but silo’s are the norm in HC. Doctors don’t talk to each others, nurses don’t offer ideas (for the most part) for fear of getting into trouble for speaking out. The ‘system’ is dangerous. I feel sorry for people like my friend who trust the system, but are finding out first hand, that is fragemented, confusing and at times very selfish. The patient and the family are outsiders to this system…..
Bottom line…..when you enter the healthcare system – find an adovate – as they say, you would not represent yourself in a court of law…………….you need an advoate when you entere the healthcare system.