From the Pittsburgh Post Gazette
Getting good care in the hospital requires vigilance
Tuesday, January 14, 2003
By Virginia Linn, Post-Gazette Staff Writer
In recent weeks, I've received more complaints than I can remember from exasperated family members trying to ensure good medical care for their loved ones. Not while they were at home, but in the hospital.
For many, it required 24/7 vigilance and repeated visits to the nursing stations to seek basic assistance such as janitorial services, water cups or a change of dirty linens that had been soiled for hours.
Here were some of the complaints:
A 90-year-old Squirrel Hill woman with a swallowing problem was given a "Nothing by mouth" order from her doctor, meaning she was to receive no liquids or food by mouth. But several times, cafeteria aides left food trays at her bedside. The practice continued despite complaints from her daughter.
One morning at 3, the daughter got a call at home from a hospital nurse with news her mother wasn't doing well. The nurse had been feeding her ice cream.
An 84-year-old woman on a fluctuating dose of the blood thinner Coumadin was admitted to the hospital with other medical problems. Her son said the nurses failed to follow her strict drug regimen and after she was released, she experienced related complications that landed her back in the hospital. While there, she went hours without water, despite repeated requests to the nurses, and often was left without for a bedpan.
The daughter of a 96-year-old Munhall patient was horrified at the condition of her mother's hospital room during a lengthy stay: On one day she found dirty latex gloves, toilet tissue and bloody bandage wrap on the floor and an overflowing garbage can. There were no paper towels in the room for more than two days and the bathroom often lacked hand soap (How was the medical staff washing their hands?). Staff administering drugs often failed to read medical charts, and had to be corrected by the daughter about the proper drugs and doses.
When her mother was in a critical care step-down unit, her care was entrusted to unsupervised nursing students for extended periods.
The daughter ultimately took her complaints to the Pennsylvania Department of Health, which conducted an unannounced investigation. In a letter to her, the health department said the investigators found no violations.
These are just a handful of complaints I've recently heard involving respected hospitals throughout the city. These complaints would take weeks of investigation and interviews to confirm, but the pattern of these concerns shows that something is not right. Are families just becoming more proactive or critical in their assessments of hospital care? Or is care deteriorating before our eyes?
Most hospitals have patient representatives who handle complaints, but families often find them ineffective.
Charles Inlander, president of the People's Medical Society, a consumer advocate group based in Allentown, Lehigh County, is not surprised about these complaints.
"When we started the organization in 1983, the No. 1 issue was hospital-related problems," he said. That hasn't changed. "The hospital is the most unsafe place you can be when you're sick. If you have to be there, you have to be assertive -- not obnoxious -- but assertive."
There are many things families can do to ensure the best care, he said. First, enter with the right attitude.
"You're not in custody, you are the patient. You are the customer. You have the right to have your questions answered, you have the right to prompt service, the right to information not easily made available, the right to complain and the right to ask for a different nurse or a different staff member. The law supports this in every case."
If possible, have someone with your loved one 24 hours a day. Patients often are too sick or intimidated to push for what they need.
As soon as you get to the hospital, make it clear that you'll be keeping a close watch on your loved one. Write down everything that happens -- the name of every person who comes in the room, what he or she does, the condition of the room, etc.
If a nurse doesn't answer a page promptly, call the hospital switchboard and ask to be connected to that floor's nurses station. They'll be sure to pick up that phone.
If your problems are not being addressed, call the hospital administrator. If a secretary tries to refer you to the patient representative, say "no", and insist on talking to the administrator.
"That gets you very quick action," Inlander said. "The hospital does everything it can do so you won't complain. It doesn't want problems."
But there's a flip side. The complaining relative becomes a pariah among hospital staff, said one daughter. "You're public enemy No. 1."
After her experience tending to her mother in the hospital, she said "you feel like you've been through a war."
You can find other strategies in the People's Medical Society book, "Take this Book to the Hospital With You: A Consumer Guide to Surviving Your Hospital Stay" by Inlander and Ed Weiner. It's available at local bookstores or Amazon
.com for $5.99.
As some Amazon reviewers learned, simply displaying the book on their hospital bedside table prompted staff to be more attentive.
Upon a patient's discharge, many hospitals distribute surveys so the patient can evaluate the stay. Take full advantage of this.
Bill Lieber, a travel agent who lives in Squirrel Hill, was admitted to a local hospital in late November for pneumonia.
After a five-hour wait in the emergency room, he was taken to his hospital room where there were two uncovered wastebaskets filled with Kleenex and dirty paper towels. They were never emptied during his three-day stay.
He needs a special breathing machine to sleep because of apnea, but staff didn't install it until after midnight -- hours after he normally would have been asleep.
And two requested urine samples went uncollected, each sitting by his bedside until the next day, and became too old to be tested.
"I sent it to everybody," he said about the hospital survey. "This was the worst experience I've ever had."
Jan 21, '03
Dear Ms. Linn,
I find it absolutely incredible that nurses are blamed for these conditions. Nurses are patient advocates. They have been warning the public about increasingly dangerous patient loads at hospitals for years; the public has largely been silent, the media unresponsive. The fact is, hospital management has caused the conditions you describe, trying to cut costs by cutting nursing staff, by understaffing units, by using unlicensed staff to do nursing tasks, and by failing to retain experienced nurses.
The result is that thousands of licensed nurses have left the bedside, and management cries, "We have a nursing shortage!"
No kidding, really?
And is the management which caused these problems planning to retain nurses by paying them a decent wage, by hiring and staffing in sufficient numbers to promote patient safety, or encouraging retention of experienced bedside nurses? Oh no. Now they're going to recruit nurses from overseas. They're going to lower the standards for licensing for them, so that they'll be able to work in the US, and they're going to pay them less.
So now you can add to your list of complaints the fact that patients will additionally have to deal with cultural differences and language barriers. Staffing ratios will stay the same. Conditions won't change.
The media needs to realize that the nurse is not the bad guy here; management caused these problems. Only a public outcry and media coverage will prompt management to change it.
PS It would also be a big help if you folks in the media would not call Patient Care Techs, Unit Secretaries, Respiratory Therapists, housekeepers, and other such ancillary staff, "Nurse." Because they aren't. And chances are that most of the patients in the scenarios you describe weren't dealing with RNs or LPNs. (A couple of your scenarios were not even nursing issues, by the way, they were housekeeping issues. Again, root cause is poor management, not bad nurses.) Why do we all look alike? So patients will think that they have a large staff of nurses caring for them. Management just loves that.
Please take the time to get educated about who the nurse is and what the nurse does. Nursing is hard enough without having to take the fall for everyone else's mistakes.
Last edit by Sleepyeyes on Jan 21, '03
Jan 21, '03
Awesome responses guys!!!
Last edit by EmeraldNYL on Jan 22, '03