Kelly is a nurse practitioner, patient advocate, and a type 1 diabetic who empathizes with patients living with a chronic disease.
Going to a hospital, you may think that everything is now in the hands of the doctors and nurses taking care of you, but they are only human, and humans make mistakes. It could be an oversight, miscommunication, or simply a clerical error.
GetI'll discuss the following ways you can prevent complications and errors from occurring so that you can get the quality care you deserve.
- Get a Patient Advocate
- Know Your Medications
- Educate Yourself
- Don't Google It
- Raise Concerns
- Pay Attention to Little Details
- Maintain Good Hygiene to Prevent Infections
- Rest and Recover
- Discuss What to Do Once You Leave
- Ask About Any Restrictions
1. Get a Patient Advocate
Every patient needs an advocate in the hospital, whether it's their spouse, significant other, child, or even a bedside nurse for those who do not have family. A patient advocate is crucial when it comes to identifying lack in communication between the healthcare providers and the patient, alerting nursing staff to a new or worsening issue, and expressing concern when they feel something is wrong with the patient, even if they can't describe it.
When you're designating your advocate, please choose only one and make sure this is well-known to your healthcare provider and nursing staff. Having a clearly chosen advocate (or medical durable power of attorney) will improve communication between you and your healthcare team.
Also, make sure your advocate clearly understands your wishes in regards to end of life matters—regardless of the reason you're admitted to the hospital. The last thing you need is a group of opinionated family members attempting to make very different decisions regarding your care—especially if your life is on the line.
Each state should have their own MOST (Medical Orders for Scope of Treatment) form. For example, here's Colorado's MOST form. This one-page form allows a patient to clearly state their wishes in regards to key life-sustaining treatments including: CPR, general scope of treatment, antibiotics, artificial nutrition, and hydration. I strongly recommend having this formed filled out and signed before signing into the hospital.
2. Know Your Medications
Knowledge of your medications is crucial to surviving in the hospital. Not only should you know what medications you take at home, you should know why you take them. And if you really want to impress your healthcare providers, you will bring an up-to-date list of your medications when you come to the hospital. Some patients prefer to leave this up to their spouse or advocate, but if you have the cognitive capacity to learn about your medications, you should not avoid it at all costs.
First, medication errors happen, and nurses have to accept this fact. Unfortunately, some of these errors can have dire consequences that can possibly be avoided if the patient is made aware of the medications they receive. Patients should not be afraid to ask what medication they are receiving and why. Every. Single. Time.
Nurses are oftentimes rushed, and with a long-term patient, all the pills can get piled in one medicine cup, and down it goes without a question asked. And then it happens: the patient either gets the wrong medication or the wrong dose. Or maybe a medication was supposed to be held for a low blood pressure that day.
Side effects may or may not happen, but when they do it is cause for concern and who gets blamed? The nurse, of course, as it is their responsibility. The nurse not only feels guilty for the error, but gets disciplined and potentially loses their job. On the other hand, the patient may become ill or possibly die from the error. There was a recent case where an RN took her own life because of a fatal medication error she made, but that is a story for another article.
What Can You Do As a Patient?
How can you help prevent such medication errors as a patient in the hospital? Always be aware of the medication you're receiving and the reason (or diagnosis) you're taking it. This is also a time for self-education that the nurse or pharmacist can provide upon request. If you're being asked to take a mysterious medication that cannot be explained, you are allowed to refuse it.
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You should discuss the following points with your healthcare team:
- How long do you need to be on the medication?
- What side effects should you be aware of?
- Are there any routine labs or monitoring required for the medication?
- Are there activity restrictions? (e.g. no driving while taking a narcotic)
- Are there food/drink interactions?
- Are you allergic to it?
- What's the cost if you will be discharged with the medication?
Remember, medication knowledge will be up to you after you leave the hospital!
3. Educate Yourself
Oftentimes, I hear patients (and their families) tell me they don't know why they are in the hospital. Granted, they may have had an extended stay and various relocations from the ICU, step-down, and other nursing units, but I am still dumbfounded when I hear that question.
You may hear your doctor ask you, "Tell me why you're here?" One would hope that if you answer incorrectly, the doctor would inform you of your stay. However, there are exceptions to that rule, so here are some recommendations to fully understand your hospital stay. Grab a piece of paper and write this down:
- Admitting diagnosis: This is why you were admitted to the hospital. You may have gained 10 more diagnoses along the way, but this is why you were admitted in the first place. Now, when the doctor asks you why you're here, this should be your answer.
- What else is wrong with me? This is where you get to list your other diagnoses. These can be pre-existing (chronic) or new (acute) issues. Your healthcare provider should be able to tell you how severe these are, the treatment and any follow-up or specialist care you need. If you can't remember, write it all down.
- What medications am I taking and why? This is a good time to educate yourself on any new medications, potential side effects, and if you'll be expected to manage them once you go home (such as insulin for a diabetic patient).
4. Don't Google It
For the love of... nurses and healthcare providers. Do not Google it. If you want education on any of your diagnoses, please ask your nurse or healthcare provider for legitimate resources. The last thing you need is to read someone's horror story or rant on a forum.
Despite popular belief, medical professionals are not trying to confuse you with medical jargon. We want our patients to be educated and knowledgeable of their disease or ailment. But if you tell us you "saw something online" we may roll our eyes—at least at first.
5. Raise Concerns
Nurses call it a "gut feeling." Family members often tell me, "There's just something wrong." Patients will say, "I just don't feel right."
Many times, this is the calm before the storm. Lab tests will be normal, vitals will be stable, and the patient will look fine to the untrained eye. But, something is wrong. This is the time to evaluate the chain of events preceding this moment. Has there been a new medication? Has the patient developed a new symptom? Have labs and vitals been reviewed extensively for abnormal trends?
This is the time to ask questions—to request repeat lab tests and/or a follow-up exam by the provider. Healthcare providers have learned to accept this fact and have created the Rapid Response Team. This team can be activated by the nursing staff when a patient's condition is deteriorating, but not necessarily life-threatening. A team of critical care physicians and nurses will rapidly arrive to a patient's bedside to evaluate a patient's status and try to prevent life-threatening respiratory or cardiac arrest.
Don't be hesitant in asking questions. Always let your healthcare team know what's going on with you. This will help them take the necessary actions to prevent complications.
6. Pay Attention to Little Details
Keep track of your stay. Were you intubated and placed on a ventilator? Are you suffering from any complications from these interventions? Do you have symptoms that persist from this necessary intervention, such as difficulty swallowing or talking due to recent intubation, or maybe a blood clot related to a central intravenous line? What can be done to treat these complications, and when can you expect them to improve? These are the questions you should be asking your physician before you leave the hospital.
Another important finding during hospitalizations are "incidental findings." Incidental findings are diagnoses that are discovered during imaging, laboratory draws, or physical examination. Some of these incidental findings can be quite significant, such as suspicious nodules or a low blood count that require follow-ups after hospital discharge.
While hospitalized, make sure to inquire about any incidental findings discovered during your stay. Such things can be missed or forgotten, and can become life-threatening if not addressed. For example, a patient with a lung nodule may fail to follow up and later discovers they have advanced stage lung cancer with a poor prognosis.
Again, don't be afraid to ask questions. Always request for your full medical records before your leave the hospital.
7. Maintain Good Hygiene to Prevent Infections
Wash, wash, and wash your hands. Do not put your purse on the floor. Do not let your children or grandchildren sit and play on the floor. The hospital is gross, and its germs are not trained to stay within the walls.
Do not be afraid to ask your nurse or physician to wash their hands before they approach you with a friendly handshake. Tell your friends and families with mild colds or viral illnesses to stay away until you've completely recovered from your own illness. Also remember that the shorter the hospital stay, the less likely you'll get contaminated by one of the super-bugs that can live among its walls.
So, use that incentive spirometer, walk the halls despite the pain, and when the doctor says it's time to discharge, run as quickly as you can back home.
8. Rest and Recover
While some patients need to be constantly reminded to take deep breaths, get up, and walk around during their stay, other patients need to be reminded to slow down. A lawyer shouldn't be going over documents while on pain medications. Nor should a construction worker be lifting things while healing from a neck fracture. The physical and mental demand of healing from any illness is quite demanding, and even a sedentary office worker may find it exhausting if they return to work too soon.
Now is the time to consider short-term disability plans, if provided by your employer, or investing money into a savings account reserved for medical emergencies. A strong back-up plan will decrease the amount of stress that follows an unexpected hospitalization.
9. Discuss What to Do Once You Leave
Follow-up recommendations should be made clearly prior to discharge day. Which specialists should you follow up with? Is there any imaging or lab work that needs to be done? Have you seen a physical, occupational, or speech therapist during your stay? Do they recommend ongoing therapy once you go home? What medications will you need? Do you require any education about these medications? Where can you get them once you leave hospital?
For example, narcotic medications are minimally prescribed at discharge due to tight DEA regulations and the opioid epidemic. Because of this, many primary care physicians are no longer prescribing them and defer to the specialist that ordered them in the first place. So if you have suffered a devastating and painful injury, clearly discuss the pain management plan before discharge, and know who you will be following up with once you leave the hospital.
10. Ask About Any Restrictions
So, you've figured out why you're in the hospital. Now it's time to find out what you can and cannot do once you leave. Driving, returning to work or school, and exercising are the most common concerns.
There are multiple reasons for driving restrictions no driving: risk of seizure, stroke, brain injury; taking narcotics or other medications; orthopedic restrictions; and others. A patient with driving restrictions should ask when they can start driving again, if they require clearance from a specialist (such as a neurologist for a patient with a seizure disorder), or if they should first attend and graduate from a driving school (in the case of a patient recovering from a stroke).
Knowing your restrictions will help you heal safely and prevent further injury to yourself or others.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2018 Kelly Wagner
Cecil Kenmill from Osaka, Japan on November 13, 2018:
This is amazing! Thank you! The hospital isn't a hotel. There are so many moving parts that everyone needs to be alert. The patient is part of the team, probably the most important.