All Entries Tagged With: "Patient involvement"

Visitation rights and restrictions

I wanted to share with you an opportunity to learn more about patient visitation rights and restrictions because who can and cannot visit a patient while he or she is in the hospital has changed in recent years.

Heavily covered in national news, new federal mandates give patients more authority and autonomy to decide who may visit them as they try to recover. To align with these mandates, The Joint Commission updated two Elements of Performance (EP) under its Patient Rights (RI) chapter. These changes were announced July 13, 2011, and were retroactively effective as of July 1, 2011.

Both changes were made under standard RI.01.01.01, which states that the hospital must promote, respect, and promote patient rights. EP 1 requires hospitals to have written policies on patient rights, and a new note for hospitals that use Joint Commission accreditation for deemed status, says the EP now requires hospitals address in those policies visitation rights procedures, such as restrictions or limitations (including those clinically necessary).

It’s safe to say that any hospital that either accidentally or purposely infringes on those rights is going to end up big trouble. And it’s not just implementing policy–educating patients to be empowered to know their rights, including their rights regarding visitation, is critical. It also enhances patient experience and satisfaction, another area laying heavy on the minds of quality professionals these days as reimbursement is now partially tied to HCAHPS scores.

Wouldn’t it be nice to have a patient safety expert and veteran guide you through this change? To help you do your job in ensuring your organization is compliant with federal and Joint Commission standards? Join Barbara Balik, RN, MS, EdD, senior faculty at the Institute for Healthcare Improvement (IHI), principal of Common Fire Healthcare Consulting, and a member of the National Patient Safety Foundation Board of Governors, for a January 26 webcast to learn what must be done.

Challenging the ‘business as usual’ patient interaction

Catherine Hinz, our monthly columnist for Patient Safety Monitor Journal,  often brings new thoughts and ideas to those in quality and patient safety, and so I thought you may find this interesting.

Challenging the ‘business as usual’ patient interaction

I was recently out to a business lunch and had an amazing server who clearly delighted in the work she was doing. When a colleague complimented her service excellence, she replied, “I think of each table as a new experience.” She went on to describe her good fortune to work in an environment that appreciates her extroverted style.

I’ve been thinking about this woman’s positive ­attitude, but more so her philosophy and outlook about the work she does. Instead of viewing her job as routine, she engaged herself in her work with attentiveness and passion. It made me wonder how often our caregiving and leadership teams challenge the status quo of how routine care is delivered-not only for the sake of service excellence, but also for that of patient safety.

Let’s take the medication administration process as an example. The process typically starts by obtaining the medications from the pharmacy or a dispensing cabinet, doing the prep work, and, depending on available technology, taking steps to scan the medication barcodes and reconcile physician orders. The nurse will then administer the medications, hopefully coupled with an explanation of possible side effects to the patient and their loved ones. As it stands today, this practice seems to me to be one-sided and anything but engaging.

As health reform introduces new rewards and penalties for service excellence, especially for interactions surrounding medication delivery, does this particular routine process and others like it provide a golden ­opportunity for redesign? I believe it does. Perhaps we would be inspired to do things differently if we asked ourselves questions such as, “If Walt Disney had to administer a medication, how would he do it?” (In fact, Disney is capitalizing on its universal success and offering service excellence programming tailored for healthcare professionals through the Disney Institute.) Or maybe, “If Richard Branson, visionary chairman of Virgin Group, was inserting an IV, how would he engage the patient?” He certainly has changed the flying ­experience for consumers through unique aircraft and travel experience strategies. Or even, “What if WalMart® or Nordstrom’s had stations for medications, what would they look like?”

Read more.

Hinz currently works at PatientSafe Solutions, Inc. Previously, she served as the patient lead at HealthEast Care System in St. Paul, MN, worked for seven years as an ED health unit coordinator, and has completed a patient safety internship with the Agency for Healthcare Research and Quality.

Blog spotlight: Doc becomes patient

How can you make patient experience better? Well, one physician became a patient and got a better understanding of how patient experience is affected by bedside manner. Granted, I doubt becoming a patient was a planned-out strategy of his, but it’s an interesting post about what it’s truly like to be a patient.

“Doctor D” blogs often about the physician-patient relationship. Recently, however, he broke his leg in multiple places, becoming a patient himself. He learns some interesting lessons, including some about pain management (it ain’t easy) and bedside manners (some docs just don’t have it).

Most interestingly, however, is Doctor D doesn’t seem to have any plan to change his own habits after his experience:

As a physician, it was a bit eye opening to experience how inconsistent and imperfect our best pain medicines are. Managing the pain of a fellow human being is about as frustrating a situation as an MD can experience. I doubt my prescribing patterns will change much, but I do have a deeper appreciation for how hard it is to correctly wield the double-edged sword of pain medicines.

Does appreciation matter? Will it be lost in a few short months, maybe even weeks? Is pain management hopeless? Do some physicians lack a bedside manner they will never be able to learn, ever? Should the patient adjust to these circumstances, or should healthcare providers change their ways, and if so, how? This physician went through the experience himself and although might have a better idea of what patients go through, doesn’t seem to think actual practices need change.

Post your thoughts.

Letting patients call a rapid response

Many hospitals have rapid response team providers can use if they feel quick intervention is needed for the patient. But St. Joseph Hospital in Orange, California, lets patients and/or families call a rapid response team. Though many feared Condition H, as the hospital calls it—the “H” stands for help, would become overused with families abusing it with non-emergencies, the hospital says the code is rarely used, and usually for good reason. The program was launched in March, 2008 and is often used because of lack of communication, reports Today’s Hospitalist. But staff members at the hospital say that it is used to put attention on real problems, not as a call light. Patients and families treat it like a 911 phone call.

Most hospitals have a rapid response, but I wonder, how many hospitals allow patients and families to use it? Does your hospital use it? Do you think most hospitals will hop on board?

Joint Commission tailors “Speak Up” campaign

In late July, The Joint Commission released an update to its popular “Speak Up” campaign, specifically targeting patient falls. The Speak Up campaign has been in existence since 2002 and its main purpose is to encourage patients to become more involved in their own care. Many organizations use the free, downloadable forms on The Joint Commission’s website regarding “Speak Up” to help inform their patients that they can participate in their care.

The latest iteration of the campaign involves preventing patient falls. It’s widely acknowledged that falls are the cause of many minor and major injuries, as well as death. Data from the Centers for Disease Control and Prevention show that falls are the number one reason that elderly patients are admitted to the hospital.

“Falls can cause serious to life-threatening injuries; however, there are steps people can take at home or in a health care facility to reduce their risk of falling,” says Mark R. Chassin, MD, MPP, MPH, president of The Joint Commission. “We want people to be aware of these simple yet important precautions and avoid preventable injuries,” says Mark R. Chassin, MD, MPP, MPH, president of The Joint Commission.

The Joint Commission’s new campaign includes action items to help people reduce their own risk of suffering a fall. Two of these include taking extra precautions in the hospital or in a nursing home and making small changes at home to prevent falls.

To learn more, visit The Joint Commission’s website.

I wrote about another version of the Speak Up campaign almost a year ago. At that time, The Joint Commission had released a campaign encouraging parents to become involved in preventing medical errors in their childrens’ care. Do you think these various versions are useful to hospitals? Do you think the latest “Speak Up” campaign, regarding patient falls, will be something your facility promotes?

Patient navigators a growing field in healthcare

Patient navigators may be coming soon to your hospital—if your hospital doesn’t already use them. Patient navigators are staff members whose jobs consist of helping patients find their way through the confusing world of medical tests, procedures, inpatient stays, and discharges, reports The Philadelphia Inquirer. Programs across the country are sprouting up, and although not every one uses the term “navigator,” the intent is the same: Help sick, anxious patients better understand and utilize the healthcare system.

Many cancer centers are employing patient navigators, reports the Inquirer, because cancer care is so unique. However, some hospitals also use navigators more in the disease management role, for patients with chronic diseases like diabetes. The idea is not a new one—case managers have been helping patients in this role for years, but now more facilities are embracing the role as healthcare remains a complex system.

To read more about patient navigators, click here to find the full Philadelphia Inquirer story.

Has your hospital employed patient navigators? Have you found that they help increase patient safety and patient satisfaction?

An illustration of patient-centered care

The Boston Globe has a column today about a patient’s positive experience with the healthcare system, and it struck me as one I wanted to share with Patient Safety Monitor Blog readers. The patient was going in for hip surgery and although she had her share of ups and downs (a headache as the result of spinal anesthesia, an allergic reaction to morphine) she felt that she had been taken good care of throughout the process, including a case manager calling once the operation was scheduled simply to be sure the patient’s home was set up in a way that would be conducive to her needs after surgery. Many caring healthcare professionals helped her through the stages of surgery and she valued the attention given by her care team.

I don’t want to take away from the column’s account, so you can read the full version here.

Sometimes its easy to focus on the negative–the never events, near misses, communication problems, etc.–in the realm of patient safety. I liked that this account focused on the positive, which is something that I think anyone who works in healthcare needs to be reminded of from time to time.

President Obama asks HHS to ensure patients have the right to receive visitors

Last week President Obama issued a memorandum to Kathleen Sebelius, the secretary of Health and Human Services, asking her to make it mandatory that all hospitals that participate in Medicare or Medicaid allow patients the right to have any visitors (regardless of relationship) they want while under their care. Specifically, the memorandum states that hospitals cannot deny visitation privileges based on race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. Of course, if it is medically necessary to restrict visitors, hospitals should continue to do so.

Although this is a broad list, gay, lesbian, bisexual, and transgendered patients will be the main beneficiaries of this resolution, because they are often barred from seeing lifelong partners during times of sickness, as many are not legally married to their partners. I think this is a necessary step in ensuring equality of healthcare.  Coincidentally, The Joint Commission hosted a Webcast last week about their forthcoming standards concerning patient-provider communication and this same standard is a part of their new requirements. Why? Because they have found that to keep patients’ best interests at heart, hospitals should allow for visitation by anyone allowed by the patient. Patients are often going through high stress during hospital stays, and allowing them to receive the support of their closest friends and relatives helps alleviate that.

The memorandum also asks that hospitals respect that patients’ advance directives and that they respect the wishes of patients who have placed their powers of attorney with a close relative or friend.

You can read the full memorandum here. Will this be a major policy change at your facility?  Do you think there will be some  push back at any level?

Tips for creating a patient advisory committee

I wrote an article for an upcoming issue of Briefings on Patient Safety about how to create and sustain patient advisory boards/committees. As part of that article, I put together the following succinct points to help readers focus on defined ways to create effective advisory boards:

• Scope the project: Make sure you have a detailed idea of what the patient advisory committee is there to address, whether that is one specific topic (e.g., medication safety) or a process that involves general patient safety practices (e.g., like discharge)
• Recruit the right patients on board: It might even be necessary to conduct one-on-one interviews to determine whether a patient is the right choice to serve on an advisory board. He or she may not be right for the board based on the topic, his or her experience, or demographic
• Clearly outline board members’ responsibilities: If patients serving on an advisory board are unaware of the time commitment, energy required, and that they are going to be asked their opinions on how to improve patient care in front of hospital staff members, they may feel uncomfortable and/or may not be a valuable board member who will provide feedback.
• Set up an orientation: Many people serving on an advisory board—whether they are from the community or work at the hospital—will be doing so for the first time. Allowing everyone to get to know each other before they get down to discussing improving patient care will make future conversations more comfortable.

Do you have any points you could list that have made your patient advisory boards successful?

AHRQ says that more patients are leaving against medical advice

More news from the AHRQ–this time, however, patients may be acting as a threat to themselves. An August report from the Healthcare Cost and Utilization Project says that between 1997 and 2007, the number of patients who left the hospital against medical advice rose 39%. Although the 368,000 people who did leave against medical advice represent only 1.2% of all hospital patients, the readmission rate for these patients is significantly higher than for the rest of the patient population—not to mention these patients immediately put themselves at high medical risk.

Patients leave against medical advice for many reasons. The report makes it clear that it’s necessary to get to the bottom of why patients might leave against medical advice, because that holds the key to making sure they complete their hospital stays in the future. Often the reasons may be related to external factors, like financial obligations or family emergencies versus perception of poor treatment, but it’s important to address these external factors as well in order to provide the safest care.

Have you had any experience with patients who left against medical advice? How have you addressed this issue as a medical staff?