Patient Safety Information

A Safer Experience

Patient Safety InformationPatients can ensure a safer experience with the health care system by being involved and informed about their treatment. By asking questions and following through on their clinician's treatment and instructions, patients can take part in the process and gain confidence in the system. Improving patient safety requires continuous learning and the constant communication of information between caregivers, organizations, and patients. Everyone has a role in patient safety, and everyone will benefit from its successes.

Nurse Anesthetist Study Reveals Possible Risks to Surgical Patients
who use Complementary/Alternative Medicines(CAM)
What Can You Do?
Be Involved in Your Health Care
Tips to Help Promote Patient Medication
Safety
Tips for patients to prevent wrong site

 

What can consumers do to make sure they have a safer experience with the health care system? The National Patient Safety Foundation (NPSF) suggests these steps to help make your health care experience safer:

Become a more informed health care consumer:

Keep track of your history

  • Write down your medical history including any medical conditions you have, illnesses, immunizations, allergies, hospitalizations, all medications and dietary supplements you're taking, and any reactions or sensitivities you've experienced. Medical History Form
  • Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the counter medicines, and dietary supplements such as vitamins and herbs.
  • Possible Risks to Surgical Patients who use Complementary/Alternative
  • Write down the names and phone numbers of your doctors, clinics, and pharmacies for quick and easy references.
  • When your doctor writes you a prescription, make sure you can read it.

Work with your doctor and other health care professionals as a team

  • Share your health history with your care team.
  • Share up-to-date information about your care with everyone who's treating you.
  • Make sure you understand the care and treatment you'll be receiving. Ask questions if you're not clear on your care.
  • Pay attention. If something doesn't seem right, call it to the attention of your doctor or health care professional.
  • Discuss any concerns about your safety with your health care team.
  • Expect your health care workers to introduce themselves when they enter your room and look for their identification badges.
  • Make sure your nurse or doctor confirms your identity, that is, checks your wristband or asks your name, before he or she administers any medication or treatment.

Involve a family member or friend in your care

  • If you're not able to observe or participate fully in your care, ask a family member or friend to assist. They can accompany you on appointments or stay with you, help you ask questions, understand care instructions and suggest your preferences.
  • Review consents for treatment with your family member or friend before you sign them and make sure you both understand exactly what you are agreeing to.
  • Make sure your family member or friend understands the type of care you will need when you get home. Your family member or friends should know what to look for if your condition is getting worse and whom to call for help.

Your Hospital Stay

  • If you have a choice, choose a hospital at which many patients have the procedure or surgery you need.
  • If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands.
  • Do not bring valuables.

Discharge

  • When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home.

Surgery

  • If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done.

Follow your doctor's directions

  • Be sure you receive all instructions in writing and that you read and
  • Take medications exactly as prescribed.
  • Use home medical equipment and supplies only as instructed.
  • Report anything unusual to your doctor.

Nurse Anesthetist Study Reveals Possible Risks to Surgical Patients who use Complementary/Alternative Medicines (CAM)

The American Association of Nurse Anesthetists (AANA) published a study reporting that patients who use complementary and alternative medicines within two weeks of surgery may experience adverse side effects.

The study, titled Use of Complementary and Alternative Medicines by Surgical Patients, appears in the February 2000 issue of the AANA Journal and evaluates the interaction of vitamins, herbs, dietary supplements and homeopathic medicines with anesthetics. Based on a survey of 500 elective surgical outpatients from the University of Colorado Health Sciences Center (UCHSC) in Denver, the study categorizes complementary and alternative medicines (CAM) according to their potential to cause "adverse effects" with drugs used during surgery. The study, which underscores the relationship between conventional and unconventional medicines, profiles patient use of CAM.

Of the 500 patients surveyed, more than half consumed one or more types of alternative medicines during a two-week period before surgery. Garlic and cranberry represented the most common herbal substances consumed followed by echinacea, gingko and ginseng, respectively. The vitamins most frequently taken included vitamin C, multivitamins and vitamin E. The survey also indicates that 220 patients took 31 types of dietary supplements including calcium, fish oil, magnesium or zinc.

More popular with women than men, the study found that some alternative medicines could increase bleeding and prolong coagulation during surgery. Twenty-seven percent of patients surveyed consumed vitamins, herbs and supplements that could increase the time it takes for blood to clot. Alternative medicines that may prolong coagulation include alfalfa, chamomile, some Chinese herbs, garlic, gingko, gava, licorice, vitamin E and fish oil.

Fifty-eight patients or 12 percent of survey respondents took herbs that could adversely impact blood pressure levels during surgery. Black cohosh, used to treat menopause, menstrual cramps and osteoporosis, can lower a patient's blood pressure. St. John's Wort, used to control depression, can raise blood pressure as well as cause confusion, agitation and drowsiness in surgical patients.

The study also links some herbs to heart irregularities and others to electrolyte imbalance. Ephedra, an herb used to treat coughing, asthma and weight loss, can trigger arrhythmia and high blood pressure while licorice, used to control coughing and soothe sore throats, can raise the risk of hypokalemia, a potassium deficiency that can cause arrhythmia. Herbal diuretics, which increase urine output, also can deplete potassium levels and cause electrolyte imbalance. Sedative herbs, like kava, can cause severe drowsiness when combined with the hypnotic drugs used during surgery.

Carol Norred, a Certified Registered Nurse Anesthetist (CRNA), researcher and Ph.D. student at the UCHSC Department of Anesthesiology and School of Nursing, believes that more scientific research is needed to safely integrate CAM into the management of surgical patients. Norred, who spearheaded Use of Complementary and Alternative Medicines by Surgical Patients, believes an open dialogue between patients and providers can prevent complications related to the use of unconventional medicines."Most patients who take alternative medicines never tell their providers about it. This can compromise a patient's safety if these medicines aggravate a health condition or interact poorly with the drugs used during surgery. As advocates of patient safety, we at the AANA advise patients to disclose information about CAM use prior to surgery," she says.

What Can You Do?

Be Involved in Your Health Care

  1. The single most important way you can help to prevent errors is to be an active member of your health care team. That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. Some specific tips, based on the latest scientific evidence about what works best, follow.
  2. Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs. At least once a year, bring all of your medicines and supplements with you to your doctor. "Brown bagging" your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date, which can help you get better quality care.
  3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines. This can help you avoid getting a medicine that can harm you.
  4. When your doctor writes you a prescription, make sure you can read it. If you can't read your doctor's handwriting, your pharmacist might not be able to either.
  5. Ask for information about your medicines in terms you can understand-both when your medicines are prescribed and when you receive them. Questions to Ask about Your Medicine:
    • What is medicine for?
    • How am I supposed to take it, and for how long?
    • What side effects are likely?
    • What do I do if they occur?
    • Is this medicine safe to take with other medicines or dietary supplements I am taking?
    • What food, drink, or activities
  6. When you pick up your medicine from the pharmacy, ask: Is this the medicine that my doctor prescribed? A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.
  7. If you have any questions about the directions on your medicine labels, ask. Medicine labels can be hard to understand. For example, ask if "four doses daily" means taking a dose every 6 hours around the clock or just during regular waking hours.
  8. Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you're not sure how to use it. Research shows that many people do not understand the right way to measure liquid medicines. For example, many use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people to measure the right dose. Being told how to use the devices helps even more.
  9. Ask for written information about the side effects your medicine could cause. If you know what might happen, you will be better prepared if it does-or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines could help patients recognize problem side effects and then give that information to their doctor or pharmacist.

Hospital Stays

  • If you have a choice, choose a hospital at which many patients have the procedure or surgery you need. Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.
  • If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands. Handwashing is an important way to prevent the spread of infections in hospitals. Yet, it is not done regularly or thoroughly enough. A recent study found that when patients checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.
  • When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home. This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors think their patients understand more than they really do about what they should or should not do when they return home.

Surgery

  • If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done. Doing surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. The American Academy of Orthopedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery.

Other Steps You Can Take

  1. Speak up if you have questions or concerns. You have a right to question anyone who is involved with your care.
  2. Make sure that someone, such as your personal doctor, is in charge of your care. This is especially important if you have many health problems or are in a hospital.
  3. Make sure that all health professionals involved in your care have important health information about you. Do not assume that everyone knows everything they need to.
  4. Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can't). Even if you think you don't need help now, you might need it later.
  5. Know that "more" is not always better. It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.
  6. If you have a test, don't assume that no news is good news. Ask about the results.
  7. Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources. For example, treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse (www.guideline.gov
  8. Ask your doctor if your treatment is based on the latest evidence.

Reference: AHRQ Publication No. 00-PO38, Current as of February 2000

TIPS TO HELP PROMOTE PATIENT MEDICATION SAFETY

During your stay, you can expect to receive the five rights:

  • To receive the right drug.
  • Given by the right route, (mouth, IM.IV, etc.)
  • The right dose.
  • At the right time.
  • To the right patient.

During your stay, we need you to participate by:

  • Tell the doctor/nurse about every medicine you take. (Prescription, Herbs, Over the Counter)
  • Make sure we know about any allergies/reactions to medicines you have taken.
  • Know the name of the medicine, what it is for & when you should be taking it.
  • Don't be afraid to tell the nurse or the doctor if you think you are about to receive the wrong medication.
  • Don't hesitate to tell the health care professional if you think he or she has confused you with another patient.
  • Speak up when you have concerns, questions or don't understand.
  • While you are in the hospital, you may take different medicines than you did before your hospitalization.
  • The time schedule for taking your medicines may be different then when you take your medicines at home.
  • When you are discharged, be sure to find out when you should resume taking your medicines at home.
  • Ask what you should do if you have an unexpected reaction to your medicines.

    The single most important way you can help to promote safe medication usage is to be an active member of your health team.
    That means taking part in every decision about your health care. Uninvolved and uninformed patients are less likely to accept the doctor's choice of treatment and less likely to do what they need to do to make the treatment work.

TIPS FOR PATIENTS TO PREVENT WRONG SITE SURGERY

  • You and your surgeon should agree on exactly what will be done during the operation.
  • Ask to have the surgical site marked with a permanent marker to be involved in marking the site. This means that the site cannot be easily overlooked or confused (for example, surgery on the right knee instead of the left knee).
  • Ask questions. You should speak up if you have concerns. It's okay to ask questions and expect answers that you understand.
  • Think of yourself as an active participant in the safety and quality of your health care. Studies show that patients who are actively involved in making decisions about their care are more likely to have good outcomes.
  • Insist that your surgery be done at an JCAHO-accredited facility. JCAHO accreditation is considered the "gold standard," meaning that the hospital or surgery center has undergone a rigorous on-site evaluation and is committed to national quality and safety standards.
  • Ask about the health care organization's experience in treating your type of illness. How frequently do they perform the procedure you need and what specialized care do they provide in helping patients get well?

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