Quality, Patient Safety and Clinical Affairs
NJHA Institute for Quality and Patient Safety
For Consumers
Consumer Safety Brochure - It's Your Healthcare: Be Involved!
It's Your Healthcare: Be Involved!
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It's Your Healthcare: Be Involved!
Contents:
Introduction
Medical errors are among our country's leading causes of injury and death. The Institute of Medicine's 1999 report To Err is Human: Building A Safer Health System stated that anywhere from 44,000 to 98,000 deaths annually could have resulted from medical mistakes. A survey by The Commonwealth Fund, released in April 2002, showed that 22 percent of respondents reported that they or a family member had experienced a medical error of some kind.
Medical errors can occur anywhere in the healthcare system, and most of them result from a breakdown in communication between healthcare providers and patients. To that end, the New Jersey Hospital Association has prepared this informational brochure to help you become a more active participant in your own healthcare, taking part in every decision. The tips below have been compiled from a variety of sources, including the Agency for Healthcare Research and Quality and the Institute for Safe Medication Practices.
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Manage Your Medicines
- Make sure that all of your doctors know about everything you are taking. This includes prescriptions, over-the-counter medications and dietary or nutritional supplements such as vitamins and herbs. It's a good idea to put everything into a brown bag once a year and take it with you to an appointment so your doctor can review them. This is especially important if you are receiving care from several physicians who may not know what the other physicians are prescribing for you. Keep a list of the medicines you are taking and the phone numbers of your physician(s) in your wallet so that it is readily available at all times.
- Make sure your doctor knows about any allergies and adverse reactions you have had to medicines.
- Don't stop taking medicines or change dosages because of side effects without first consulting with your physician.
- When your doctor writes a prescription for you, ask that the purpose for the medication be included on the form, and make sure you can read the prescription. If you can't read it, your pharmacist might not be able to read it either.
- Ask your physician and your pharmacist to include both the generic as well as the trade name for the drug on the prescription bottle, and that no abbreviations be used in the directions for taking.
- Ask for information about your medicines in terms you can understand. It's OK to be curious!
- What is the medicine for?
- How will I know it is working?
- How am I supposed to take it?
- What are the side effects I should be aware of, and what do I do if I believe I am having any? Insist on getting this information in writing so that you can refer to it later if you have any problems.
- Do I take this before or after meals, with or without food? Are there any foods or activities I should avoid while taking this medicine?
- Is there a certain time when it is best to take this medicine?
- What happens if I forget to take it?
- How should I store this medicine?
It's a good idea to always use a single pharmacy for filling your prescriptions so that the pharmacist can double check for potential drug interactions. If the prescription is for a small child, know their weight and let the pharmacist know. When you pick up the medicine from the pharmacist, read the labels and make sure it is the right medicine for you and that you understand the instructions. If you are unsure of anything, have the pharmacist call your physician and verify the medicine and why you are taking it. Many medical errors are caused by the wrong medicine or the wrong dose.
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At The Hospital
If you get a choice of hospitals, do some research and choose one that has had a lot of experience treating patients with the same problem as yours. It is always a good idea when you are first entering the hospital to have a family member or friend with you who can act as a second pair of eyes and ears and as your advocate. Hospitalization and illness or pain can cause a lot of stress, and most people do not remember things they are told as well when they are under stress.
- Take all your medicines (prescription and over the counter) and dietary and nutritional supplements with you so that the doctors and nurses know what you have been taking.
- Check your armband to ensure the accuracy of your name, your doctor's name and your birthdate.
- If you are allergic to any medicines or foods, make sure you are given an armband that specifies these allergies. If you are allergic to some soaps or laundry detergents, let the staff know. If you have any history of allergy to latex, insist on a latex-free room.
- If English is not your primary language, or you are deaf, ask how the hospital will provide translation services for you and how you can access those services. In some instances it may be helpful to have a family member or friend with you at all times to translate.
- Make sure staff members wash their hands when coming into the room and giving you any medications or treatments, and again as they are leaving your room. All staff should be wearing gloves when they are involved in activities where they may come into contact with “body secretions.” For example, they will wear gloves when starting IVs, drawing blood, changing dressings, etc.
- If your doctor prescribes medicines for you to take while in the hospital, tell your doctor that you want to know the names of each medicine and the reasons you are taking them. Ask the same questions about side effects as you would if you were at home. When the nurses bring medicines for you to take (by mouth, by injection, or through an intravenous line), look at it, ask what it is for and insist that no medicine be given you without the person checking your armband. If you are unsure of anything, speak up and ask that your physician be contacted.
- If you are having pain, tell someone. Make sure your physician and the nurses know about it. Most hospitals use some form of a pain scale to rate pain and will ask you to score your pain before being given any medication for it and then score it again 15 to 30 minutes afterward. If you don't feel you are getting appropriate pain relief, speak up and let the staff know.
- Before any test or procedure is done, make sure your physician has discussed this with you and you have consented to it. Ask whether there are any special preparations for the test or procedure, and if there are any dyes or specific medicines that will be used. If you have drug allergies, make sure these are known to the testing department. Ask about the results of the tests or procedures. Don't assume that no news is good news.
- If you are having surgery, make sure you have discussed it with your physician and the surgeon, that you understand what to expect, and that you all agree. This is a good time to have a family member or friend or advocate meet with you and the physician(s) to make sure all of your questions have been answered. Many people have found that keeping a notebook close by to jot down questions and the staff's answers is helpful. If you have a question after you have spoken with the physician(s), don't hesitate to have the hospital staff contact the physician to answer it for you. If you are having surgery and there is a possibility of operating on the wrong site (for example, right and left arms, legs, breasts, etc.) ask that the sites be appropriately marked to avoid this rare, but entirely preventable, error.
- If your physician has ordered restrictions on physical activities during your hospitalization, make sure they are reviewed with you and your family and that you understand the rationale. Don't attempt an activity that your physician has restricted (for example, if you are to stay on strict bedrest do not decide you want to walk to the bathroom unsupervised). Your illness or surgery and the medicines you are on may make you a high risk for falling and causing injury to yourself. Make sure your call bell is within reach at all times so that it is available when you need it. Use siderails to help in turning and to prevent accidental falls, especially at night when you might get disoriented.
- If your medical condition requires that you be in some form of isolation, ask your physician to review the reasons for it and what it involves.
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When You're Discharged
In planning for your discharge, learn what your discharge needs will be and review what resources you have at home. This is usually done with a discharge planning nurse or social worker, but discuss this also with your physician. For some patients, especially those who live alone or without significant support systems going to a rehab or subacute facility for a short while may be advantageous. This can be especially important if you will need home health services for a long time and there is difficulty in arranging for them in a timely fashion. If you will need special equipment at home, find out who is responsible for arranging for it and its delivery, and whether your insurance company is paying for it.
Research has shown that at discharge time, many physicians think their patients understand more than they really do about what they should or should not do when they return home. Make sure you understand your discharge instructions. If you are going to be taking new medicines at home, along with the medicines you were taking before the hospitalization, review them all with your physician to ensure there aren't duplications or possible interactions. Make sure any new prescriptions can be filled once you get home (for example, you may get discharged late in the day and your pharmacy may be closed). Find out what options you have if that is going to be a problem. Get all of your discharge instructions in writing (make sure you can read them and review them before you leave the hospital so that any questions can be answered then).
Finally, learn as much as you can about any medical conditions you have and how you can help manage your own care by asking your physician and other healthcare professionals. There are many credible resources available to patients and their families today, and many are located in local libraries. Additionally, information is available on the Internet from the Agency for Healthcare Research and Quality
www.ahrq.gov and the Institute of Safe Medication Practices
www.ismp.org or A.A.R.P
www.aarp.org.
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