How to Not Die in the Hospital

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    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.

    How to Not Die in the Hospital

    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.
    Last edit by Joe V on Oct 20
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    16 Comments

  3. by   Susie2310
    Thank you for your article on this important topic.

    From our experience, we have found it very necessary and helpful to have a family member present when one is hospitalized to advocate for one's needs with the hospital staff as necessary, ask questions about the plan of care, and be ready to talk to the doctor/s when they make rounds.

    We have also found it very helpful to have a copy of Advance Directives with us, and a list of medical problems in order to answer medical history questions.

    My family member also found out how very important it is to have the call bell within reach in bed and to know how to use it to call for help if needed when they became short of breath after surgery and had to call for help. Fortunately they had the call bell right beside them and knew how to use it.
  4. by   RuthBryan
    I really appreciate you for writing beautifully on such an important topic.
  5. by   Michelle Rhodes
    Thank you Beth for the great insight. I look forward to sharing with others as this is a must needed topic that deserves further discussion.
  6. by   Nurse Beth
    Quote from RuthBryan
    I really appreciate you for writing beautifully on such an important topic.
    Thank you kindly
  7. by   Nurse Beth
    Quote from Michelle Rhodes
    Thank you Beth for the great insight. I look forward to sharing with others as this is a must needed topic that deserves further discussion.
    Thank you!
  8. by   Nurse Beth
    Quote from Susie2310
    Thank you for your article on this important topic.

    From our experience, we have found it very necessary and helpful to have a family member present when one is hospitalized to advocate for one's needs with the hospital staff as necessary, ask questions about the plan of care, and be ready to talk to the doctor/s when they make rounds.

    We have also found it very helpful to have a copy of Advance Directives with us, and a list of medical problems in order to answer medical history questions.

    My family member also found out how very important it is to have the call bell within reach in bed and to know how to use it to call for help if needed when they became short of breath after surgery and had to call for help. Fortunately they had the call bell right beside them and knew how to use it.
    Those are such helpful tips, esp the list of questions for the doctor
  9. by   booradley
    This is great, a lot of these tips apply to friends and families too. It makes a huge different if visitors etc are on board with getting people mobile. I have had people decline to walk with me because they have visitors but it's great when the visitors say no let's go, I can come too! I would also definitely agree having a family member by your bedside is helpful, but also to try and limit the number of visitors. People don't realise how exhausting it is having your grandkids brothers cousins neighbours all around until everyone leaves and they are so tired they are barely awake for dinner. That's no good for anyone!
  10. by   KatieMI
    I would add a few things. Some of them might sound blunt but...

    - learn who is who and who is doing what. If you feel a new and significant pain, for one example, pain, immediately ask for your NURSE. Passing information through secretary/CENA/etc. takes time.

    - thou mustn't tell lies... seriously. For example, if you take 4 pain pills a day but tell that you only take "some", or smoke 2 ppd but afraid to say it so that you won't be treated like an addict, everything that happen is you going into withdrawal. It won't feel good, and it won't help anyone, you including.
    Believe me, there is no many things you can surprise anyone in health care. Relax and TELL THE TRUTH.

    - if you need help, ask for it. If you don't (and you KNOW it), go ahead and do it as long as it is safe. I am not telling about programming IV pump; I am telling about wiping yourself after visiting restroom.

    - do not think you come in a healthcare facility to get anything except what you came there for in the first place. It is not a resort, an entertainment center, spa or restaurant, whatever is said otherwise. If you do, the staff will eventually start to softly avoid communicating with you, and it will be truly the worst thing ever that could happen with you in a hospital. It will bring more risks than pretty much anything else. So, make staff LIKING to work with you, and you greatly improve yoyr chances to get outta there alive and better than before.



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  11. by   KatieMI
    Re. family members in the role of "advocates":

    where I work, it is encountered pretty often. In 95+% of cases it is more than one person permanently camping in the room, sometimes charged with family chores like babysitting, granny watching (other granny, not a patient, for whom the staff may be asked to provide care as well), online shopping and, for one case, pet care. Everything this person usually does is writing everything he/she sees down in form of utter nonsense, like "Nurse A came at x PM. Had tired face, gave me attitude when I just asked her for some iced tea with lemon, changed some blue tube on some machine and said that Mother doin' fine" and/or attempt filming it all and streaming it online for the whole family to enjoy. They bring zero benefits for anyone, and much trouble for everyone INCLUDING the patient.

    On the other hand, a few times families employed private duty RN to come for a few hours a day to keep patient' company as well as to meet doctors, get plans, etc. In those cases, the nurses were of tremendous help both for personnel and family just because they knew what you were doing. Even SNF "caregivers" (whose medical knowledge is very limited but who really know patient and can do some limited body care) are more useful as "advocates" than nit-picking family members.

    Take home fact: only one case when family member can play a role of "advocate" and be good at it is when the said family member has at least some sort of medical knowledge/is teacheable, knows his limits, able to hold himself within limits of civil behavior at all times AND knows the patient well enough to be able to make some serious decision. In all other cases, the worst case scenario is going to happen early or later - that being the staff not seeking contact/softly avoiding/rotating care for the patient.
  12. by   Pythinia
    I've seen patients bow and squeak to nurses, humble themselves actually because of their vulnerability in sickness hoping by this action, they will be treated with kindness and humanity.
  13. by   cocoa_puff
    Also, how not to die in the hospital: Die at home. I plan to dig my own grave, lie in it, and then die. As my life-force leaves me, it will activate a cascade that will cause the dirt to cover the grave and effectively bury me.
  14. by   SmilingBluEyes
    Well-done, excellent article, Beth.

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