How to Not Die in the Hospital

Medical errors are a leading cause of death for patients in hospitals. The better informed you are, the higher are your chances of avoiding harm. Nurses General Nursing Article

Tragically, many people die from medical errors every year in hospitals.

It's hard to know how many. "Medical error"is never listed as a cause of death on death certificates. But according to Johns Hopkins Hospital patient safety experts in a report published in 2016 in the BMJ (formerly the British Medical Journal), medical errors are the third leading cause of death, causing more than 250,000 deaths per year. In order of prevalence, here are the leading causes of death in the US:

  • Heart disease
  • Cancer
  • Medical errors
  • Respiratory disease

Note: Not all doctors agree with the study results, saying the study did not differentiate complications from medical mistakes. For example, a pulmonary embolism following surgery is a known complication, whereas amputating a wrong limb is an error. Still, the article brought the subject into the spotlight. Medical errors include failing to diagnose, such as sepsis, failure to rescue, surgical mistakes, medication errors, and more.

Sometimes even Nurses Make Fatal Errors.

Hospitals are dangerous places. But there are things you can do proactively to reduce your risk for harm.

Family Member

You need to have a family member or friend with you. Patients with family present at the bedside receive more attention than those without. This is my observation and seems to follow human nature. It holds staff more accountable even when it is not a conscious effort.

Identify a spokesperson to speak with the doctors and communicate to the rest of the family. The spokesperson should avoid calling the nurse at the beginning of their shift- give them time and you'll be better received as well as get better information.

Personalize Yourself

For a longer hospitalization, put pictures on the wall or bedside table. It makes you a parent or a sibling. A person with stories. An animal lover or a guy who fishes. Not just another patient in a faded gown.

Get to know the caregivers by name and be appreciative. It goes a long way.

Speak Up

Ask health care workers, including doctors, if they have washed their hands. Healthcare workers go from patient to patient and not all are conscientious about handwashing.

Using an alcohol-based gel is considered the same as washing with soap and water in most cases (unless they have been exposed to Clostridium difficile (C Diff).

Informed consent

You have a right to informed consent for all invasive procedures. Informed consent is provided by the provider.

Informed consent is the provider explaining the risks and benefits so you can make an informed choice. There are risks to everything, including taking an aspirin!

Don't assume doctors and nurses know best or are infallible. It's your body. Surgeons may see something as a surgical problem, while medical doctors see a medical problem. Some doctors are aggressive in treatment while others are conservative. Listen carefully to the risks and benefits.

A pulmonologist once recommended my husband have an invasive and painful procedure (pleurodesis) to keep his lung inflated. His cardiologist barged in and dismissed the notion with a wave of his hand. "Ridiculous! You'll be fine without it." He was right.

Hand Hygiene

Wash your hands. Keep a packet of hand wipes close by and do not eat or drink anything without first using them. Picture invisible spores of bacteria clinging to high touch areas such as your bed rails and overbed table.

Many serious diseases are contracted by hand to mouth transmission (actually fecal-oral transmission) such as Clostridium difficile (C. diff) spores. Avoid touching your eyes, nose and mouth -you may unknowingly infect yourself.

Get Up

Mobilize. Get out of bed. When you are in bed, natural processes slow down. For example, in bed, blood pools in the vessels. Clots form in pooled blood.

Blood clots can be life-threatening. You will most likely be provided intermittent pneumatic compression devices to improve leg circulation. But the best prevention is to get out of bed.. When in bed, flex your feet and make foot circles.

Staying in bed puts you at higher risk for pressure ulcers, lung problems...you name it. Sitting up on the side of the bed is better than laying in bed. Sitting up in a chair is better than sitting up on the side of the bed. Walking is better than sitting and getting out of the hospital is the best way to avoid complications.

Falls

Wear slip-resistant socks when out of bed and always ask for help when needed. Poor lighting, an unfamiliar environment, and the effects of medications can all put you at increased risk of falls.

Infections

Get your urinary catheter out. Catheters are a portal of entry for bugs. Ask your nurse if your catheter is still needed, and what is the plan for it to be removed. The standard is for urinary catheters to be removed 1-2 days post-op to help prevent catheter-associated urinary tract infections (CAUTI).

Likewise, central lines, including PICC lines, are a source of infection and should be evaluated for necessity daily.

Medications

Keep an updated list of your medications with you so your doctor can reconcile your hospital medications with your home medications.

When a nurse administers a medication that is new to you, you should be informed what the medication is, and the reason for taking it. If you are a nurse, be sure and read 6 Essential Tips for Avoiding Medication Errors

I hope these tips help next time you or a loved one is in the hospital. What other tips do you have to add?

Nurse Beth

Leading Causes of Death. CDC. Accessed February 2017 FastStats - Leading Causes of Death

Makary, M. A., & Daniel, M. (2016). Medical error-the third leading cause of death in the US. Bmj, 353, i2139.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Well-done, excellent article, Beth.

Specializes in SICU, trauma, neuro.

I'm a bit confused why this is directed at a nursing forum? I mean most (if not all) of your advice itself is sound, but generally we play a huge part in preventing deaths the hospital...I mean pts are under nursing care 24/7.

But since we're on topic and non-nurses could be reading this, I have another suggestion: do not come in with guns blazing, as an advocate ready to protect your loved one from our mistakes. An adversarial relationship benefits nobody. We are not adversaries: we are on the same team, dedicated to helping your family member get well. We will listen to your concerns, and we can 1) either reassure you that you don't need to worry -- and why you don't need to worry -- or 2) recognize that you are right, and that your concern is now our concern, and begin working on a solution.

A simple example that comes to mind: last year I had one of those patients with THAT family -- so I was told. Shortly after beginning my shift, the pt's wife said she didn't think his NGT was working (it was hooked up to wall suction). I said something like "Oh? I can take a look...what makes you think it's not working?" She pointed to a small clump of gastric output and said "That hasn't moved all day." After verifying that the suction was on and all connections sealed, I flushed the tube with a little water. Turns out the tube had been clogged. She had been in the room with him all day, and noticed something a busy nurse might not have. I mean I mark my canister q 2 hrs, but sometimes there is no output even with a patent tube. I might not notice that yeah, those gastric contents in the proximal 12.45 inches of tubing is identical to a few hours ago.

Now for the family who grills me incessantly and writes down every single thing I do, down to number of strokes with the mouth swab or minutes since they last saw me, to the point that I'm falling behind on patient care -- including my other patient.... Guess what? I will probably be doing my best to avoid you, or at least tune you out. I am human and don't like to feel hostility while dring to do my job any more than you do. Not to mention I am not interested in staying late or skipping my break simply because you took too long to interrogate me. An adversarial relationship is bad for patient care.

Specializes in ICU, LTACH, Internal Medicine.
I'm a bit confused why this is directed at a nursing forum? I mean most (if not all) of your advice itself is sound, but generally we play a huge part in preventing deaths the hospital...I mean pts are under nursing care 24/7.

Because of this is one of the ways to look inside a lay person's brain and see what they might perceive as important things - and to guide them to care for things which are REALLY important.

The problem is that the articles like original one produce effect of "holding onto that very straw". 90+% lay people do not have analytical skills developed enough to prioritize their own needs, leave alone complex medical processes. So, they develop something they think they still control, and grip onto it to the death. I saw family which insisted that the whole team went and washed their hands for designated 20 sec in a single faucet when patient was in fresh arrest, and after someone just physically pushed them away and jumped on the chest to start compressions, they complained to no end. Or a family which counted two-hours turns with a sport watch (so each turn must start at, say, 08.58.00 and end 09.00.00).

I see that sometimes family might notice something that otherwise coud fall through a crack but for 1 case like that there are literally hundreds of those who literally make nurse's day a living hell and not at the least add to either quality of care or safety. In addition, most of such families are not appreciative of teaching or just objective reality.

What we can do as nurses is to 1). introduce reality early, so the patient and family knew what to expect (IMHO, it is not OK promice something to be done "in a few minutes" when I know it will take at least half an hour); 2) stop these customer service oriented lies, including "he's doin' great" when things are in fact turning south, and 3). teach them what is important. For one example, I teach making a card with all the meds, allergies, etc., and update it as needed. It is more reliable tool than any EMR system.

Because of this is one of the ways to look inside a lay person's brain and see what they might perceive as important things - and to guide them to care for things which are REALLY important.

The problem is that the articles like original one produce effect of "holding onto that very straw". 90+% lay people do not have analytical skills developed enough to prioritize their own needs, leave alone complex medical processes. So, they develop something they think they still control, and grip onto it to the death. I saw family which insisted that the whole team went and washed their hands for designated 20 sec in a single faucet when patient was in fresh arrest, and after someone just physically pushed them away and jumped on the chest to start compressions, they complained to no end. Or a family which counted two-hours turns with a sport watch (so each turn must start at, say, 08.58.00 and end 09.00.00).

I see that sometimes family might notice something that otherwise coud fall through a crack but for 1 case like that there are literally hundreds of those who literally make nurse's day a living hell and not at the least add to either quality of care or safety. In addition, most of such families are not appreciative of teaching or just objective reality.

What we can do as nurses is to 1). introduce reality early, so the patient and family knew what to expect (IMHO, it is not OK promice something to be done "in a few minutes" when I know it will take at least half an hour); 2) stop these customer service oriented lies, including "he's doin' great" when things are in fact turning south, and 3). teach them what is important. For one example, I teach making a card with all the meds, allergies, etc., and update it as needed. It is more reliable tool than any EMR system.

Unfortunately, posts such as this that complain about family members in a very negative way (not the purpose of the thread) do nothing to gain family members confidence in nurses. Then nurses wonder why family members take notes about the care they are providing, or ask more questions than they like, etc. The OP was written for the benefit of patients and family members.

After I read the posts that berated family members, as a nurse I simply felt even more need to be at my sick relative's bedside when they are hospitalized to help protect them from medical and nursing errors/bad attitudes etc. I agree with the OP that it is wise to have a family member at the bedside for the reasons she, I, and others mentioned. Of course family members should behave reasonably, but it is absolutely not necessary to be a health care practitioner oneself in order to be of great help to one's sick relative (as mentioned in your earlier post) - that is a ridiculous stipulation. Multiple studies show that it is very beneficial both for patients and family members for family members to be in attendance at the bedside, and this has shown to improve patient safety.

It is very counterproductive to state publicly that 90% of lay people have such a lack of analytical skills that they cannot prioritize their own needs let alone medical processes - that is simply a stupid, offensive comment. You come across as a nurse with a negative attitude/grudge towards family members. The OP's post was written to help patients and family members not for nurses to complain about them. Why not start your own thread?

Specializes in ICU, LTACH, Internal Medicine.

It is very counterproductive to state publicly that 90% of lay people have such a lack of analytical skills that they cannot prioritize their own needs let alone medical processes - that is simply a stupid, offensive comment. You come across as a nurse with a negative attitude/grudge towards family members. The OP's post was written to help patients and family members not for nurses to complain about them. Why not start your own thread?

It is not a "stupid, offensive comment". It is a sad fact.

Numeracy and the Affordable Care Act: Opportunities and Challenges - Health Literacy and Numeracy - NCBI Bookshelf

8.6% uninsured Americans are "proficient" in numeracy. Being "proficient" not means being an applied math professor; it means solving everyday "advanced" problems like understanding percentiles of risk and benefits of a flu shot.

Another thing to consider:

Literacy Project Foundation - Statistics

How do you expect people who do not understand numericals and cannot read a communuty-college level book to analyze their health condition and make informed decisions? As you can see, the majority of American population is just like that.

To state facts is never counterproductive. Counterproductive action is to hide from facts that are difficult or unpleasant for you and look another way instead of realizing what you are dealing with and trying to solve the problem. Just to remind you, Florence Nightingale herself did not lamented much about poor and unfortunate who were dying in squalor; she, in fact, was quite a good statistitian for her time, and that were numbers she put before the Lords of Admiralty to support her plea.

And, yes, if you will be in the room of your relative I care for, I welcome you with my open hands. Because I am sure that you will behave RESPONSIBLY and make others do the same. You won't try to pour prune juice in PEG tube of your relative with acute bowel obstruction because "it is an excellent laxative and will clean things right up", and then write somewhere that I "gave you attitude" because, not wishing to lie, I responded to 100500th question of "is he fine now?" with honest "no, not yet - but he is not worse and seems to go to the right direction".

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