Hospitalized Aging Parents: Avoiding the Accidental “Bad Things”

EACH YEAR, half-a-million injuries occur in the United States because of medication errors,” according to a 2009 U Magazine (UCLA health) article. 

We live in an imperfect world. The older we get the more we’re aware. With a better understanding of “best practices” are we better equipped to help hospitalized aging parents avoid accidental bad things because we know what to look for and thus, know what questions to ask? How can we know and ask pertinent questions if we’re clueless about it in the first place?

The following excerpted information from U Magazine’s 2009 article, “Do No Harm,” illuminates measures the UCLA hospital system began implementing to reduce the potential for accidental “bad things” (my words for the overarching concept). Having this knowledge helps us know what to look for. Hopefully our hospitals have implemented some of these measures so we and our aging parents can take advantage–now 4 years later.

For example: Hand hygiene, infection control. General hearsay is that we can “get things” in the hospital. Isn’t that a reason for the hand sanitizers and latex gloves within reach in every examining room and sanitizers in–or outside–every hospital room? But, for example, do we take advantage of this by checking that hands are washed or sanitized or fresh gloves are put on when a health care person comes into our parents’ hospital room?  The “Do No Harm” article empowers us in this regard.

We learn of a national effort to create a kind of safety net in medicine. A UCLA doctor is quoted as saying  “Our hospitals are very safe. But we can always do more.” UCLA, in particular, has embarked on an ambitious program to enhance patient safety that touches on a variety of areas, including controlling infections, eliminating medication errors, improving incident reporting, and enhancing surgical safety.

Medication errors:  To help prevent errors, UCLA Health System [now has]…a bar-coded medication-administration system. The rationale? Experts say adding bar codes to the drugs given to patients could substantially reduce the number of medication errors by applying an extra layer of oversight to every step in the delivery process. That said, do we check to make certain aging parents are getting the correct medications and dosages? Do we keep a list..even when they aren’t in the hospital?

A personal note: it would seem to make sense to make sure parents (especially when they’re not too “with it” for whatever reason), drink lots of water with pills. Mother (never a big water-drinker) didn’t do this during one hospitalization. Pills more or less collected in her throat someplace, causing bad irritation. Not a medication error –just no one was checking water consumption with pills.

Incident reporting: Visitors occasionally take tumbles in hallways; equipment sometimes malfunctions; and patients may have bad reactions to their medication.

To track such mishaps, hospitals in California must report any “adverse events” to the state’s Department of Health Services. UCLA has implemented a cutting-edge computerized reporting system that can be accessed from any computer terminal within the hospitals and affiliated clinics and by those involved in patient care, from physicians and nurses to respiratory therapists and housekeeping personnel.

This computerized system also has an event-reporting system to improve its own monitoring of the quality of care at its hospitals and clinics. This system eliminates the time-consuming paperwork to report “adverse events” and the necessity to deliver the report to a central office in a timely manner.

Says Tod Barry, quality director for Ronald Reagan UCLA Medical Center. “If people are comfortable in reporting, they’re more likely to report.

Read the article in its entirety: http://magazine.uclahealth.org/body.cfm?id=6&action=detail&ref=701 “Do No Harm” article

Related:
–February 2013  Hospitalization and the Importance of Family post.
http://www.uclahealth.org/site.cfm?id=837–Quality website links for everything  hospital-related throughout California and the USA
http://magazine.uclahealth.org/

 

 

Hospitals, Care Facilities: What We Don’t Want for Aging Parents–a true story Part 1

Can we know what’s happening when parents can’t advocate for themselves in hospitals and care facilities?

An upsetting last stage of life is precisely what we don’t want–for aging parents or anyone else. Several decades ago I spent a night as a patient in a non-private room at one of America’s best (and overcrowded that night) teaching hospitals. I took quick notes and shortly thereafter wrote this piece, long before aging parents were part of my life. It just surfaced when I unpacked the last box from our move. Hopefully things have changed, but have they? If not, how can we know? Are health care proxies the answer? Do our parents have them?

Not a sound was heard, yet the forms of her tiny legs agitating up and down under the white hospital sheets gave testimony to her distress. The medical resident, intently bending over her small body, tried yet another time to insert the IV needle into her vein.

Mrs. S, a stroke vicim in her 70’s, managed to wrest free of her IV. This was the second round of attempting to reintroduce it since the newly arrived nurse on the afternoon shift discovered it had come out.

“When did it come out?” she questioned. “Where could it have gone?” (It was  behind Mrs. S’s tiny body, under the covers.) Thus began the first in a series of attempts to insert the IV, with never a sound uttered by Mrs. S, who didn’t–or couldn’t–speak any more.  Only her legs betrayed her feelings.

Later that evening the medical resident’s cheery “How are you, Mrs. S?” (no answer) awakened me to another ordeal. He explained how she needed to swallow a tube because “you have to eat.” A discussion ensued between the resident and a nurse about the difficulty of her swallowing this particular tube. 

I sensed one felt if Mrs. S. didn”t want to, she shouldn’t have to. Nevertheless, I assume hospital policy or something required that attempt after attempt–with some intermittent choking (“that’s good, it will help your mucous”)–be made.

At one point the resident remarked: “Why are you looking so angrily at me? I’m only trying to help you.” I was beyond upsetI unravelled my own IV tubes, got out of bed, and pushed my IV pole as quickly as possible around the medical people, past Mrs. S, and out of the room.

I spotted an intern. “I think it’s morally reprehensible what they’re doing to Mrs. S,” I said. “She has to eat. It’s good to leave the room if it upsets you,” he responded.

Mrs. S. ultimately swallowed the tube but this did not end the attention paid her. Still later that evening another voice awakened me. “Mrs. S, I’m Dr. K. I know we’re doing lots of things that seem like we’re being mean to you, but we’re making it better for you.  I’m coming back to get some blood later and if you relax it will make it much easier. Close your eyes if you understand what I’m saying to you. Close them tight.”

Indeed blood was drawn (not easily) later and still not a sound was uttered; yet everyone seemed aware of Mrs. S’s silent resistance and suffering. Just before her 11 o’clock shift ended the nurse came in to check her patients. “Mrs. S. has managed to get her tube out again,” she stated. “Maybe she’s trying to tell us something, I responded. “I’m sure she is,” the nurse replied.

I wondered about her family. I became acquainted with them late the next afternoon–unavoidable eavesdropping through the curtain that separated our beds.

…………Continued and concluded tomorrow.