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Patient Safety

Patient Safety. What does it truly mean? Why are so many errors being made by doctors and hospitals? What is the solution and how can we be facing such an epidemic of mishaps in our medical care? After all, aren’t we the greatest nation in the world with the best hospitals and doctors available? These and other questions haunt us all.

Recently I wrote about my personal experience with a loved one. I will not mention the name of the hospital or the doctors because I know that what happened at Hospital A, happens at Hospital B.  Near misses in hospitals happen each day.  I saw countless errors being made that if I was not there to serve as a patient safety advocate (someone with a little knowledge that was not afraid to speak up), the errors could have been tragic.  For example, a radiology tech that didn’t bother to realize that the patient couldn’t sit up in her bed due to the nature of her condition was about to raise the head of the bed until I screamed “STOP,” do you know why you are taking this x-ray?  Answer from the tech – No, I was just told to do a bedside x-ray!  A failure to start anticoagulation blood thinning prophylaxis on this patient who had been immobile and was at risk of developing blood clots until I questioned the doctor’s orders and the response was,” you are right, an order for blood thinners should have been started. An attitude by the attending and his team that the patient safety advocate was a troublemaker when all I was trying to do was to protect my loved one and get answers. Come on, people. Get real. These are life and death decisions being made in a haphazard manner.

What I realized is that it is fashionable to talk about patient safety, but on a day-to-day basis, it is business as usual. Doctors make rounds with their residents and the patient is a teaching tool. Orders are written and often delayed. Thankfully, patient advocates that understand medicine are there to protect their family and friends, but those without help are at the mercy of our broken health system.

Radiologists that don’t communicate in a timely manner the results of x-rays or overlook technical issues that might influence treatment options are inexcusable. Doctors that don’t follow-up on test results or assume that the patient is stable are inexcusable. Patients are left wondering what in the world is going on and why is this happening to them.  And we can never forget those alarms on monitors that beep or I.V. infusion pumps that get occluded and patients are left anxious and uncertain what is going on. Think about when a patient presses the call button for help and is made to feel like he/she is imposing on the  receptionist that couldn’t be nastier and says she will send someone in (and the patient waits and waits). Come on people, show some respect and compassion for the patient and try being understanding and empathetic. It works.

What I have learned is that there are simple rules that need to be followed to keep patients safe.  (1) A doctor should pay attention to what is different about his patient, rather than only those things that are similar to other patients; (2) A doctor should pay attention to new symptoms that arise; (3) A doctor should not ignore symptoms that are inconsistent with his/her original diagnosis; and (4) It is always better to be safe than sorry when it comes to caring for the life of your patient!

Hopefully these oversights do not result in harm. But, no one should be made to feel like they are bothering their doctor or nurse when they are in the hospital. These near misses we all experience can lead to death. The solution is that doctors and nurses must realize that each patient is a human being and deserves to understand their medical issues and their options. Doctors and nurses need to explain and to get informed consent from patients before assuming that they know better than the patient what should be done with their bodies. Discharging a patient without proper instructions or without a clear understanding about their illness can be deadly.

Doctors and nurses need to focus and pay attention to what really matters – Patient Safety.  Any mental slip or lapse can result in the wrong medicine being given resulting in a fatal allergic reaction, or a delay in responding to a change in clinical condition that could lead to serious consequences. The list goes on and on and on.

All patient harm should be eliminated. Patients shouldn’t go into the hospital to get well and suffer injury or harm because of a lack of communication between team members. Patient safety should be the #1 goal of healthcare. In the meantime, if you or a loved one is in the hospital, make sure you know to speak up and question anything that doesn’t seem right or is unclear to you or the patient. If there is a substantial change in your family member’s condition, insist that you get answers. Your life or the life of your loved one could be compromised if you don’t.

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By David Kulwicki|2022-02-17T23:24:59+00:00April 18th, 2014|Patient Safety|Comments Off on Patient Safety

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