Condition H

SharonH, RN · Jul 5, 2006

Oh and certainly I'm not saying that the parents do not have the right to expect quality medical care or the right to complain. Not at all. So please do not go there.

steelydanfan · Jul 5, 2006

I read this article, and I am still awed at the stupidity of the entire concept.

The solution lies in not having a "rescue team" but ensuring that the quality of care is so high; and that appropriate policies are in place, that such an idea would seem ludicrous.

This article is absurd in the beginning in that it takes the mothers impressions of events as factual, instead of being viewed as a layperson.

As nurses, we are trained to observe, assess, and plan for intervention. Every hospital in this country is required to have a chain of authority to which the RN can access if appropriate interventions are not forthcoming from the admitting MD.

Why would we think that oversight by untrained, emotionally involved laypersons is a SOLUTION?

All this contributes to is the idea that you as a RN are SO dumb that a patient's family has to turn to emergency personnel because YOU can't do the job you were hired for.

steelydanfan · Jul 5, 2006

I just reread the entire article. It would seem that the child was doing well until "a nurse" came in and gave the child "a shot", ostensibly of painkiller after the anestheiologist had written "no narcotics".

Again, my point is don't dumb down nurses by giving them the out of a rescue team, lets educate nurses to prevent tragedies by good asssement skills to ward off problems before they happen.

Works2xs · Jul 5, 2006

All this contributes to is the idea that you as a RN are SO dumb that a patient's family has to turn to emergency personnel because YOU can't do the job you were hired for.

All this says is that the patient comes first and that they are being empowered to take action when they are concerned instead of blindly trusting that everyone is providing the appropriate level of care.

In ANY disasterous outcome, there are a chain of events that result in the bad outcome. Study after study has been done to show that if any ONE of those links in the chain can be broken, the entire outcome can be avoided. It's because of this simple fact that organizations implement QA policies that enable the oversight individual to bypass the entire intermediate management staff and elevate their concerns to the highest levels of responsibility. (In the case of the "Condition H", that oversight person is designated as the parent/family member.) It has several levels of effect.

First, as the saying goes, crap rolls downhill. If the front line and middle management of a project, case, or whatever have so screwed the pooch that the top bosses have to become involved, the immediate problem gets addressed and the contributing factors get taken care of post haste. Top managment hates that sort of interruption. Folks lower on the food chain hate having their orifices kicked by their bosses. So the outcome is that the level of vigilance goes up in the lower ranks. The things that used to take time that people swore they didn't have, suddenly become important. And those things, usually closer to the heart of what they were SUPPOSED to be doing, get the focus they need.

And for those times when everything IS running by the books yet STILL goes afoul, there's a built-in safety valve. No policy is perfect. No procedure applicable to every combination and permutation of a set of circumstances. To assume that these mechanisms are capable of such a degree of perfection and to not include some means to raise a flag is the height of hubris. Clearly, when the number of people killed on our highways is exceeded by the number of people killed as a result of breakdown in medical policies, procedures, and implementations, the status quo just isn't good enough.

Is this "Code H" policy the way to go? Don't know. What might happen is that those doctors closest to the case might be pressured into doing outrageous things like taking the time to explain to parents/family members in sufficient detail so that they don't call a "Code H" unnecessarily. They might feel a bit more peer presssure to ensure the applicable dots are getting connected. Perhaps the chiefs of the dept's will apply a boot to any a-holes who seem to think that patients are only there to pad their personal income levels. Maybe hospitals will see that it might actually pay to reduce nurse patient ratios so nurses won't feel so damned rushed in order to handle their universally overburdened patient loads. I know it sounds wild, but the people we (the health care community as a whole, not just nurses) are actually supposed to be serving might actually have a better opportunity to go home at the end of the day.

This mom could have retreated into a well of self pity and depression - and nothing would have been moving toward change. She might have gotten really P.O'ed and sued everything that moved in that hospital - which would have caused the powers to dig in their heels and maintain that they were doing exactly what they needed to do and again, nothing would have changed. Instead, she chose to pursue a plan that just might make a difference.

Way to go, Mom.

Works2xs · Jul 5, 2006

I just reread the entire article. It would seem that the child was doing well until "a nurse" came in and gave the child "a shot", ostensibly of painkiller after the anestheiologist had written "no narcotics".
Again, my point is don't dumb down nurses by giving them the out of a rescue team, lets educate nurses to prevent tragedies by good asssement skills to ward off problems before they happen.

Not sure why you feel this is pointed directly at the nursing staff. The article also notes that the lead doc on the case figures the problem occurred some 12 hours prior to the administration of the methadone.

There were records to show the child was not keeping anything down. There was information showing no IV access was delivering fluids. There were records showing 14 diarrhea-filled diapers in a short period of time. The article doesn't really show it well, but the mom noticed something amiss and repeatedly pointed it out. Yet it didn't stop the process long enough for someone to stand back and take a holistic view of what was going on. Everyone was doing "their job" and trusted that everyone else was doing theirs. Yet, a kid still died as a result.

There was a whole team of people that were involved in this case, not just the nurses. Any one of them could have averted the outcome by doing just one thing differently than they did. I think the whole point of this "Code H" is to get some entity involved that can short circuit the path to another disaster.

Empress · Jul 5, 2006

Nurses and doctors are reasonably educated and well-trained, and they are still making mistakes. Many things can be done to help alleviate it, like better communication and patient ratios, but I don't understand why this is being met with resistence. It's just another tool to try to do the best for patients. Everything in a hospital is being done to the patient, they should have recourse to try to advocate for themselves in a meaningful way.

masstudent · Jul 5, 2006

I've worked at Shadyside since November, and as long as I've been there I've only ever heard one of these called overhead. I'm assuming that they are paged over the intercom just like Condition A's and C's. There is literature posted all around the hospital about this and you have to watch a video about Josie King during orientation. I am interested as to what the responce team does other than comforting loved ones.

Can you explain what a Condition X is (like Condition A or C?)? I am familiar with different types ofcodes and I understand what a condition H is.

My own opinion of a Condition H and having a team in place is that it seems like a good idea but isn't that what nurses and patient advocates are there for? I can see how people would be concerneed about it being over used and whether or not a team of people would need to be dedicated to solely responding to Condition H or have it in addition to their daily duties. I know my local hospital has a strong care management department that always has someone on call that a patient or family member can contact if they feel there needs are not being taken care of or heard. The majority if not all of the people in the Care Management Office are nurses. M

DaFreak71 · Aug 20, 2006

Well......yeah. It seems logical to me that if they wanted to put a lot of energy into being advocates for change, why not start with preventative measures? I'm funny like that, I think we should stop a problem before it starts. And safety in the home is a big issue; I think there should be a lot of attention aimed at education and prevention measures.

Down here on planet Earth, people aren't born with infinite wisdom...they make mistakes. Most preventative measures are discovered and bandied about as common sense only after a mistake or tragedy occurs. If we had the ability to forsee everything before it occured, we'd be perfect. :uhoh3:

Blee O'Myacin, BSN, RN · Aug 20, 2006

and goes running into the room to find a patient with a broken tv or needs a refill on a water pitcher even though the fluid restriction is constantly being reinforced, condition h will go right out the window.

will they be hiring an extra floor nurse for the "h team"? or is the charge nurse with a new grad orientee and an assignment of the sickest patients going to have to shoulder that responsibility too?

what happened to that baby is tragic and in no way do i mean to belittle the horrific experience that is losing a child.

blee

good day everyone - happy 4th :)
i had a question i wanted to put out there for opinions.
do any of the organizations you work for have a "condition h" procedure in place. for those of you who are unfamiliar with it (i was until very recently) i've pasted information below with the source link. if your hospital does have this procedure, how has it worked? is it effective? what are your opinions in general, even if your hospital does not have this in place. i look forward to the discussion. thanks :)
https://www.patientsafetygroup.org/uploads/projects/162/wallsigndraft2.doc
the story.
josie king was an 18 month little girl who died because of hospital errors in one of the best hospitals in our country. through the creation of a patient safety program, the king family's hope is to help prevent this from ever happening to another patient.
the josie king call "condition h" has been created here at upmc shadyside out of our desire to provide our patients and families an avenue to call for immediate help when they feel it is needed. josie's mother, sorrel king, has worked with upmc shadyside to design condition h. we are dedicated to making the hospital the safest place possible for patient care to happen.
condition h -- what does the h stand for? help -- "condition help" patients and families can call for help by initiating a "rapid response team". a rapid response team is made up of designated members of the hospital's healthcare team, including at least a doctor and nurse, who come to the patient's bedside in an emergency and manage the situation, much like an ambulance team does in the community.
the reasons for the condition h can be:
a report from a family member or visitor to a healthcare provider (i.e. nurses, physicians) of a serious noted change in the patient's condition that is not being addressed
an emergency situation where a noted change in the patient's condition is not being recognized by the caregiver or does not receive the attention deemed appropriate by the family.
if after speaking with a member of the healthcare team, confusion or conflict of what needs to be done for the patient is evident.
who will respond to a condition h? an internal medicine physician or nurse practitioner, the administrative nursing coordinator/supervisor. a floor nurse, and a patient relations coordinator, when in house.
we hope that you never need to call a condition h; however, this valuable resource for patients and families is another way that upmc shadyside hospital is partnering with patients and families to provide the highest quality and safestcare possible.

phil1968, ADN, BSN, LPN · Aug 20, 2006

It sounds like a knee-jerk reaction from the hospital in response to the tradgedy.

I wonder if anyone has seen a "code H", and how it went? I bet it will only take a few trivial responses to render the code as a pointless exercise when one is called.

I just cannot see how a mechanism for calling into question the judgement of nursing or medicine by laypersons is going to help. Would you want a "code H" to be called on your patient without your consent or knowledge? Would you want to be on the response team? Probably not. I know I wouldn't.

At the hospital I work at we have a similar team available to nursing any time called CAT - critical assesment team, and from my experience it works well. If there is good communication from patients and families, I just can't see a need for a rapid response team designed for non-medical folks to activate.

Phil

DaFreak71 · Aug 20, 2006

Could you imagine what life would be like if everyone else in society had the same attitude about condition H as some of the nurses who have posted on this thread?

The defendent wouldn't be able to appeal his conviction because it would be calling into question the integrity and expertise of the judge who presided over his case.

The restaurant patron wouldn't be able to complain to the manager if they were unhappy with their food because the Chef is a professional who should not have to answer to someone else.

The parent wouldn't be able to take their concerns with their children's school teachers to the principal because "how dare the parent question the authority and experience of the education professional"?

There are "appeal procedures" in nearly every realm of society that we take for granted as being there because it's our right to question the expertise and education/decisions of others. Why should this not be extended to the realm of healthcare?

In every one of the above examples, there have been disgruntled people who have undoubtedly "abused" the system. Just take a look at the criminal appeals courts. But would we be better off without them? No. We accept the fact that even though there is a possibility for the system to be abused, we would rather deal with that than to deny a person the opportunity to have their situations reviewed by an objective or uninvolved party.

Why should nursing get to be the exception? Remove the emotion out of the equation so that it's no longer about being offended at having your judgement questioned and what remains is a fair way for patients to be heard when they have concerns that aren't being dealt with to their satisfaction.

tencat · Aug 20, 2006

There's a fine line between respectfully bringing up a concern with a professional (Nurse, judge, teacher) and harrassing and belittling said professional on baseless grounds. Unfortunately the latter is what most often occurs with professions that are already deemed as less worthy of respect, such as teaching and nursing. In the case of this little girl there were some huge mistakes made. The system is at fault, not one individual. As long as a Code H system looks at the whole picture and is not there to point fingers at one individual, it could work. There also needs to be some criteria for taking action so that the idiot whose pillow didn't get fluffed on time doesn't get the right to call a Code H. In theory it's a good idea, but knowing that management/administration often likes to point fingers at individuals rather than address system wide problems, I'm dubious about how well the idea would work in practice.