Bedside Manner: Advocating for a Relative in the Hospital

[question everything]

OCTOBER 28, 2008

Bedside Manner: Advocating for a Relative in the Hospital
By MELINDA BECK
The WSJ

Don't go to the hospital alone, if you can possibly avoid it.

A friend of mine slipped on the sidewalk recently and broke her hip. She had surgery in one of the best hospitals in the country. But it was my friend's grown daughter who noticed that she was having an adverse reaction to a pain medication. And that her IV drip had pulled out of a vein and was pumping her arm full of fluid. And that the hot compresses to reduce the swelling in her arm had left blisters on her skin. And that the blood-sugar test she was about to be given was meant for her roommate instead.

Having someone with you in a hospital who is alert and asking questions can help stave off all kinds of potential problems, from mistaken identity to medication mixups to MRSA infections. An estimated 100,000 hospital patients die every year in the U.S. because of preventable errors. Many hospitals are under financial pressures to keep nursing staffs lean. A personal advocate can be a valuable resource. It doesn't have to be a relative -- and it can be more than one person -- as long as they know you and are willing to speak up.

(snip)

A growing number of hospitals are doing just that -- including unlimited visiting hours, letting family members accompany patients to procedures and even stay during emergencies. "We're drawing on the strength of the family. They're not out in the waiting room, wondering what's going on," says Pat Sodomka, senior vice president for Patient and Family-Centered Care at MCG Health Inc., which runs a 630-bed hospital in Augusta, Ga. Some hospitals now have nurses give change-of-shift reports at the bedside and encourage families to share observations.

(snip)

Initially, some staffers worried that family involvement would take up valuable time, but in the long run, it saves time because doctors have more information, says Ms. Chatman. After MCG Health's neuroscience unit became more family-centered, average length of stay dropped 50% because discharge planning went faster. Patient satisfaction rose, and nursing turnover dropped.

Still, it can be difficult for family members to know when to raise an alarm and how. Karen Aydt Curtiss, a market researcher in Lake Forest, Ill., often felt helpless while her 71-year-old father was recovering from a lung transplant in a big teaching hospital in 2005. He was faring well until he fell, hit his head and was made to lie flat until a neurologist could evaluate him. While he waited -- all weekend -- his new lungs filled up with fluid. He developed pneumonia, then a pulmonary embolism and had three MRSA infections. He died seven months after the transplant, having never left the hospital. "I wish I had grabbed the neurologist by the sleeve and dragged him to my father's room," says Ms. Curtiss, who is writing a book on how to help a loved one in the hospital, titled "Someone With You."


http://online.wsj.com/article/SB122514012478473347.html (subscription)

[man4allcats]

1. This is very important information.

And not only for hospital stays. If you think that's a risk, and it is, imagine what nursing home residents go through. Many of them die not because they're old but rather just because staffers fuck-up.

Wrong meds to the patient is a common error.

"A personal advocate can be a valuable resource. It doesn't have to be a relative -- and it can be more than one person -- as long as they know you and are willing to speak up." I would love to be able to convince family members of nursing home residents of this simple fact.

A growing number of hospitals are doing just that -- including unlimited visiting hours, letting family members accompany patients to procedures and even stay during emergencies. "We're drawing on the strength of the family. They're not out in the waiting room, wondering what's going on," says Pat Sodomka, senior vice president for Patient and Family-Centered Care at MCG Health Inc., which runs a 630-bed hospital in Augusta, Ga. Some hospitals now have nurses give change-of-shift reports at the bedside and encourage families to share observations.

Be there, and be ready to speak up!

Initially, some staffers worried that family involvement would take up valuable time, but in the long run, it saves time because doctors have more information, says Ms. Chatman. After MCG Health's neuroscience unit became more family-centered, average length of stay dropped 50% because discharge planning went faster. Patient satisfaction rose, and nursing turnover dropped.

Again, be there, and be ready to speak up!

Don't put a family member in a nursing and expect them to be well cared for if you're not there frequently! As with hospital stays, your presence is required for their safety.

I know. I've been there and done that.

[no_hypocrisy]

2. Have an attorney draft a living will and health care proxy for you.

These documents are invaluable to your safety, if not mortality.

A living will directs which care you accept and you refuse if you lack the capacity to communicate with your doctor and/or the hospital. Do you want to be sustained on IV until death, do you want "heroic measures" to save your life, or do you want to donate your organs if you are diagnosed as "brain dead"? This document leaves no decision to a third party. These are your wishes. The document is notarized and legally enforceable if need be.

A health care proxy is a document that appoints a person or persons to advocate on your behalf and the effect the living will if you lack the capacity to make your own medical decisions.

These documents are not meant solely for the elderly. They are necessary as one can find oneself in a situation you didn't expect.

Short story to make my point. My friend was diagnosed during an echocardiogram as having three arteries 99 percent blocked. He had to have emergency bypass surgery. His estranged wife worked in the hospital where he had the surgery. He had selected his sister (as opposed to his wife) to be his health care proxy which was a wise decision on his part as his wife was not engaged with his convalescence which included a severe bout of pneumonia. His sister insisted that he be examined and treated for this. The doctors missed all kinds of problems. His wife didn't question the doctors (partly because she was part of the hospital) but his sister advocated on his behalf until he received the appropriate medical attention. It made all the difference. This is an extreme story but it does show that without proper planning, things can spin out of control.

[99th_Monkey]

3. I just went through this with my Mom, who was hospitolized and then in a transitional care facility

Despite the fact she's 94, she got through it fine, but I have many reasons to believe her recovery was in no
small part due to the fact that me, my brother and my sister pulled shifts with her, and assisted with the interface
between my Mom and the doctors and nurses, especially since she's VERY hard of hearing ... I can barely count on
both hands the number of times our presence was vitally important to her getting the care shereally needed. Talking
it up & befriending the staff and nurses doesn't hurt either... it's not like they are "the enemy", it's mostly that
they're over worked & underpaid, tired, at the end of their shift thinking about picking up the kids instead of what
medication they're handing out, they have their own "issues", etc.

This is just one more indicator that our health care system is broken, and needs to be fixed pronto.
But, come to think of it, being with loved ones in such situations is probably ALWAYS a good idea,
regardless.

[Warpy]

4. I encouraged family members to stay

and so did most of my colleagues. It became increasingly necessary as staffing was cut to dangerous levels and patients were discharged early, leaving fewer and fewer nurses to care for sicker and sicker patients.

Even family members without a real clue could tell me, "Gramma just isn't right," and cause me to take a closer look. Most were a wonderful help to us and a wonderful comfort to the patient.

This isn't a new trend. It's become necessary in the environment created by sucking the maximum profit out of sickness.

[man4allcats]

5. Kicking

:kick:

[man4allcats]

6. Kicking

:kick:

[man4allcats]

7. Kicking

:kick: