HOW TO BE A SAFE PATIENT
For Patients: How to Receive Safe Care
Proper Hand Hygiene is Job One
The medical industry has come to find that truly superior health care comes in part, from a harmonious team effort between proficient caregivers and educated patients who become partners in their
own medical care.
Here’s some more valuable information you need and practical advice you can use before and during your next medical procedure or hospital stay.
INSIST ON COMPULSIVE HAND HYGIENE
Poor hand hygiene compliance among care staff as well as visitors can kill you.
When receiving any sort of invasive medical care or when you are a patient in a hospital, insist that everyone who touches you or even enters your room washes or sanitizes their hands in front of you.
ASK ABOUT SPECIALTY HOSPITALS
When discussing a potential procedure, ask your doctor which hospital has a good reputation for giving the best care and having the most successful results for your condition or diagnosis.
Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their specific condition.
Hand Hygiene Saves Lives Video
Urinary Catheter Safety Video
Proper Hand Hygiene Video
New research shows that patients can have a role in promoting hand hygiene among doctors and nurses.
New hand hygiene video empowers patients to remind hospital caregivers to clean their hands, a strategy that is critical in the fight to prevent infections.
RECRUIT A “CARE ADVOCATE”
While many people are
taken ill instantly and find
themselves in emergency situations, many others
have the opportunity to recruit an advocate to assist in the hospital or during the time of their scheduled medical procedure.
While it is important to be respectful of any healthcare institution’s rules and regulations, many times it is perfectly allowable for a family member or close friend to be present much of the time of the hospital stay.
Your advocate will help stay on top of issues important to you when you are unable to oversee your own care or are asleep; important issues like making sure caregivers are ALWAYS washing their hands before touching you and smaller things like needing another pillow or getting a blanket.
HAVE YOUR IMPORTANT PAPERWORK IN ORDER
Advance care planning like Living Wills and Durable Powers of Attorney for Health Care are important papers to have in place should something unexpected happen.
In the event that an unforeseen situation arises, you will want your wishes followed and with good planning, won’t have to rely on the “best guesses” of your relatives as to how your care should proceed.
Safe Care Campaign offers a free, downloadable brochure with TIPS to help you prevent infections as you receive medical care.
(Click on left image)
You can download the forms for your specific state for free at the Caring Connections website, a program of the National Hospice and Palliative Care Organization (NHPCO). Connections is a national consumer engagement initiative to improve care at the end of life, supported by a grant from The Robert Wood Johnson Foundation.
PREVENTING MEDICATION ERRORS
Medication errors can occur in hospitals and surgical facilities, sometimes with grave consequences. However, hospitals and health providers are working to improve medication safety.
There’s much you can do to help avoid mistakes happening with your medications or with doses being missed.
Be sure to tell care staff which medications, if any, you are allergic to. Make sure they make a note of it (them) on your chart.
When a nurse or doctor brings you a new medicine, ask what it is for, who prescribed it, how often you’ll get it, and what its side effects are.
Read the name on any bag of IV fluid or medication you receive, or ask someone else to read it.
Make sure that the care provider checks your ID bracelet or asks your name before giving you medication.
If you don’t receive your medicine when you think you are supposed to, tell a nurse.
Don’t be afraid to tell a nurse or doctor if you think you are about to be given the wrong drug.
Tell your nurse right away if you have a bad reaction or don’t feel well after receiving medicine.
PREVENTING WRONG SITE SURGERY
Prior to a surgical procedure, make certain the care staff identifies you with the correct FIRST and LAST name and that they tell you what type of surgery is about to be performed.
Ask to have the surgical site marked with a permanent marker and 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.
DISCUSS THE ADMINISTRATION OF PRE-INCISIONAL ANTIBIOTICS WITH YOUR SURGEON
It has been reported that up to 40 percent of surgical cases requiring preoperative antibiotics did not receive them preoperatively.
Pre-incisional antibiotic infiltration 30 minutes to an hour prior to receiving your initial surgical incision is a standard safety measure for prevention of surgical-site infections.
Ask your doctor if you need one prior to your scheduled upcoming surgical procedure.
CHLORHEXIDINE GLUCONATE (CHG)
If you’ll be having an invasive procedure or surgery, tell your doctor that you are concerned about health care-acquired bacterial infections and ask if using a surgical soap or antiseptic cleanser prior to your procedure would be a safeguard you could incorporate into your personal plan for safe care.
Chlorhexidine Gluconate (the active ingredient in the solution) destroys bacteria, which helps prevent infections during and after surgery. It is usually available without a prescription at your local pharmacy. If not, they’ll be happy to order it for you.
Catheters are long, thin, flexible plastic tubes inserted into your body to deliver or remove fluids.
You may need to be catheterized during your hospitalization and because they break the skin barrier or enter through a body opening, it is possible for them to allow infections to enter your body.
Catheters that are coated with antibiotics, antiseptics or chlorhexidine - silver sulfadiazine may reduce the risk of infection during prolonged use. The CDC website says that, “Use of a commercially available chlorhexidine - impregnated
sponge dressing at the insertion site of central venous and arterial catheters led to a threefold reduction in catheter-related bloodstream infections in a recent prospective, randomized study." Ask if those are appropriate for you.
When inserting a short - term venous catheter in the hand or forearm, health care workers should cleanse their hands with soap or hand sanitizer, wear gloves and use an antiseptic on your skin where the catheter will enter. Catheters in a vein in your hand or arm should be replaced every three to four days to reduce risk of infection.
This isn't necessary for central venous catheters. If you're receiving a central venous catheter - which is placed in a large vein in your neck, chest or groin to end up in a large vein in your chest or heart - health care workers should also wear masks and gowns and use a sterile drape. This is because you are at greater risk of infection with this type of catheter than with the type that is inserted into a vein in your hand or arm.
ASK YOUR CAREGIVERS TO WIPE OFF THEIR STETHOSCOPES
Ask that your doctor to swipe the flat part of his / her stethoscope (the part that touches your body) with an alcohol wipe prior to using it to touch you.
This part of the instrument is often contaminated with pathogens and is sometimes casually carried by doctors from room to room, patient to patient.
CLIP INSTEAD OF SHAVE
Prior to surgery, have caregivers clip, rather than shave any surgical site with a razor. A razor may inadvertently create tiny nicks in the skin, creating easy access for harmful, potentially deadly bacteria to be introduced into the newly vulnerable area.
More than 30 years of scientific evidence has demonstrated that shaving surgical sites before operations actually increases the risk of sometimes
Several organizations ranging from the Institute for Healthcare Improvement (IHI) to the National Patient Safety Foundation have taken up the issue and hope to ban the razor from the operating room once and for all.
In 1971, the American Journal of Surgery published research indicating that unseen razor injuries released bacteria into the surgical site. Several other studies conducted during the 1970s reached similar conclusions. And in 1981, physicians in Alberta, Canada, published the results of a 10-year study of surgical site infections that showed having patients shower with antimicrobial agents before surgery and not shaving the surgical site reduced clean wound infection rates.
PREVENTING BEDSORES (aka Pressure Ulcers / Decubitus Ulcers)
Bedsores are ulcers that occur on areas of the skin that are under pressure from lying in bed, sitting in a wheelchair, and/or wearing a cast for a prolonged period of time. Bed sores can occur when a person is bedridden, unconscious, unable to sense pain, or immobile.
A bed sore develops when blood supply to the skin is cut off for more than two to three hours. As the skin dies, the bed sore first starts as a red, painful area, which eventually turns purple. Left untreated, the skin can break open and become infected. A bedsore can become deep, extending into the muscle. Once a bed sore develops, it is often very slow to heal. Bed sores often occur in the buttocks area (on the sacrum or iliac crest), or on the heels of the feet. They are much easier to prevent than to treat so prevention is job one. If you do develop these ulcers, keeping them from becoming infected is crucial to your overall recovery.
Change your position frequently and consistently. Avoid lying directly on your hipbones. Keep your knees and ankles from touching. Use small pillows or pads but avoid placing a support directly behind your knee - it can severely restrict blood flow. Use a pressure-reducing mattress or bed if possible.
Daily skin inspections for pressure sores are an integral part of prevention; inspect your skin thoroughly at least once a day; a family member or caregiver can help if you're not able to do it yourself.
If you're confined to bed, pay special attention to your hips, spine and lower back, shoulder blades, elbows and heels. If you see skin damage or any sign of infection such as drainage from a sore, a foul odor, and increased tenderness, redness and warmth in the surrounding skin, get medical help immediately.
Your body usually functions best at its normal temperature (98.6°F). This is true during most kinds of surgery, too. Keeping your body at its normal temperature during your surgical experience can help prevent infections.
Today, there are several ways to keep surgical patients at normal body temperature. One of the most common and effective methods is “forced-air” warming. Warm air flows through forced-air warming blankets and gowns that can be used before, during and after surgery.
There are more than 100 scientific papers on the importance of maintaining normal body temperature and the benefits of forced - air warming. Ask your surgeon about ways he/she plans to maintain your body temperature before, during and after surgery.
POSTOPERATIVE MONITORING OF BLOOD SUGAR
Discuss with your doctor the well - documented link between uncontrolled glucose levels and an increased risk of infection.
High blood glucose levels compromise the immune system and leave patients vulnerable to infections. Conversely, controlling blood glucose for patients has been shown to reduce infections and death.
IHI says, “Hyperglycemia encourages the development and spread of infection. Testing of blood sugar, especially in diabetic patients, allows staff to control the levels in the patient’s body after surgery.”
NOTIFY NURSE OF DISCOMFORT, REDNESS OR SWELLING
Avoid unnecessary complications whenever possible.
Potential infections are nothing to scoff at.
Here are some things to keep in mind during your hospital stay:
Safe care dictates that an IV should be changed every 3 days or so to control the risk of infection at the site. The main complications with catheters are tissue trauma and infection. After 48 hours of catheterization, most catheters are colonized with bacteria, thus leading to possible bacteria and its complications.
If, while hospitalized, you think you notice any signs of infection like discomfort, redness or swelling, notify hospital staff at once. Rather than ignore a potential problem, it’s better to ask and err on the side of caution!
PREVENTING POTENTIAL FALLS
Each year in the United States, thousands of patients are injured in accidental falls during their hospital stays. While this may not seem like much of a likelihood, patients, attempting to get out of an unfamiliar high-situated hospital bed, on medication that can make them dizzy and other circumstances, can all lead to potentially dangerous accidents.
In the hospitalized elderly, a seemingly benign overnight procedure can instantly turn into a worse one carrying with it a more extended stay if they fall and break a hip or worse. When receiving care as a patient, stay in bed when on medication that make you dizzy and when ambulatory, wear non-skid shoes or slippers. If you normally need to use a cane or walker, do so, even if that nearby robe, book or bathroom is just feet from your bed.
SOLEMN PARTNERSHIP OF CARE
Your care plan is a special partnership between you and your caregivers. When you don’t understand something, ASK. It’s the only way you can begin to get an answer.
In situations where you are unclear, ask questions like: “What does that mean?”, “What are the choices?”, “What is reasonable for me to expect?”, “Is this typical or out of the ordinary?”, “Is this an emergency?”.
Trust your instincts. If something feels wrong, it just might be; in these situations it is perfectly acceptable to voice your concern if you feel an internal “red flag”.
It’s no secret that sometimes doctors are rushed. So that he / she will give you their full attention - preface your conversation by telling the doctor you need just need 2 minutes to talk - then talk from a list you’ve made beforehand if possible.
If you are confused about the direction of your care, ask more questions until you are satisfied. If you remain unsatisfied, tell your doctor you’d like to pursue a 2nd opinion. If your concern has to do with care that you’re receiving from the hospital, ask to speak to the head nurse or the hospital’s patient representative. If you still need help, ask to speak to an Administrator.
Overall advice: Try to stay calm; becoming upset is unproductive. Accept the help and moral support of friends and well-wishers. Call upon God, your inner spiritual strength or rely on outside resources like a minister, priest or rabbi. Try to remain positive. Be kind. Breathe.
For more comprehensive information
on patient safety and preventing medical errors,
PATIENT SAFETY PARTNERSHIP