How to Help the Healthcare System Help You (Part 3 of 3)

We are finishing up the last section of a three-part series on how to develop a healthcare plan that works for you. We’ve included the steps of building relationships with your healthcare providers, gaining knowledge and health literacy about your health status, developing an effective system of communication and collaboration with those involved in your health plan, and the value of maintaining your own health record. Then we looked at what to do if you think you have been misdiagnosed and how to promote transparency when mistakes are made.

Part three of this series is about making our healthcare safer by looking at some of the prime areas, which may cause harm: drug blunders, infections, and poor discharge instructions and planning (all of which often lead to hospital readmissions). By helping the healthcare system help us, we can better attain our goal of making informed decisions that lead to an effective and safer plan of care. The outcome is worth the time and effort.
 
Reduce Drug Blunders with Safer Distribution and Administration
 
Drug errors lead to over 7,000 deaths annually in the U.S., and these errors increase healthcare costs and lengthen the hospital stays. It is a major area in need of repair (http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/ucm080629.htm). There are numerous contributors to medication errors:
 
Mishaps with Distribution and Usage

• Labeling, which is confusing
• Repackaging for dispensing purposes and resulting in errors
• Not prescribing the right drug in the right amount
• Not administering the right dose at the right time

• Poor communication with providers and patients
• Unclear instructions among providers and patients
• Poor techniques and poor training with medication use
• Ambiguous product names, which contribute to confusion
• Patient misuse, either intentional or due to misunderstanding

 
One of the major gaps with medications occurs with transition of care. When a patient moves from one department, facility, or care of service to another, there is increased potential for mistakes and oversights. The term is called medication reconciliation. Reasons for errors include miscommunication when multiple staff are involved, misreports at change of shift, and staff members working too quickly and under stressful conditions.

Other factors include the presence of multiple caregivers for one case, and people taking multiple drugs (sometimes 18-20 or more daily). Any of these factors can result in too many opportunities for things to fall through the cracks (AARP Bulletin, September 2016). Too often patients are confused about the correct administration of drugs, especially when medications and doses change. Patients sometimes stop their medications due to cost factors or side effects and fail to report this to their physicians. Although addressing provider errors and  improving patient education measures will help, a major solution for preventing drug blunders falls on the shoulders of the patient or advocate by simply knowing the list of drugs and questioning what type of drug is being given and why.
 
Infection Control
 
Infection is the Number 1 reason for patients to be readmitted to a hospital and sepsis is a major cause of death and serious morbidity. Despite the efforts to tackle this problem, we have a long way to go: 1 in 25 hospitalized patients (on any given day) is fighting an infection acquired in the hospital (called nosocomial infections) and 75,000 patients die each year according to the Centers for Disease Control (http://www.consumerreports.org/cro/health/hospital-acquired-infections/index.htm). Preventative measures are making a dent in reducing infections acquired by medical treatments (intravenous lines, foley catheters, surgical sites, etc.).

Infection Control and Sepsis Prevention Programs are in place in hospitals and healthcare facilities throughout the country. These programs include using antibiotics wisely, enforcing proper cleaning techniques for equipment, proper training in the utilization of equipment, staff training in appropriate processes, and implementing patient education and awareness measures. Be your own steward and find out what hospitals are doing well by checking the report cards  (http://www.consumerreports.org/health/doctors-hospitals/hospital-ratings.htm). One of the easiest and most effective measures you can do to improve infection control is to make sure your providers wash their hands. You can simply watch or ask your doctor and the staff if they washed their hands before administering your care.
 
Poor Discharge Instructions and Planning
 
When being discharged from a hospital, discharge instructions are critical in guiding the patient’s recovery and preventing readmissions back into the hospitals. Now the  government agency, the Centers for Medicare & Medicaid Services(CMS), is penalizing hospitals and other providers when their readmission rates are too high. Starting in 2009 studies revealed that 1 in 5 patients returned to hospitals within 30 days of discharge and 50% of hospitalized surgical patients were dead or rehospitalized within a year (AARP Bulletin, September 2016).  

Patients are leaving hospitals still in recovery mode with overwhelming healthcare needs and coordination of care requirements. This requires extensive planning and sometimes it is difficult to anticipate exactly what plans will be best for the patient. Other times, patients decline the plans. Any given patient might require rehabilitation, homecare, physical therapy, follow-up appointments with specialists, multiple medications and treatments, not to mention that they are returning to the routines of their everyday lives such as cooking, cleaning, caring for family members or sorting through the accumulated pile of mail and bills. Unlike vacation, patients are not well rested and rejuvenated. Research has also determined that patients leave the hospital sleep deprived, nutritionally deprived and with muscle atrophy since patients are not as active as they should be in hospitals. In addition to these challenging conditions, patients are not understanding their discharge instructions.

As mentioned in Part 1, it is known through qualitative reviews that almost 90 million Americans have only basic or below health literacy skills (http://healthcare411.ahrq.gov/column.aspx?id=373). Patients are simply confused by their discharge instructions or dismiss them because they do not understand why they need to follow the instructions. In addition to these challenges, many electronic medical records are poorly designed and result in discharge instructions that are unclear, not accurate or too long. Better discharge planning and instructions are two major challenges for improving patient safety.
 
In summary of this three-part series, you can take measures to “help the healthcare system help you.” Although it is certainly disturbing that, according to the Johns Hopkins Study released this year, 250,000 Americans die annually due to medical errors (http://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us), the deaths are preventable. The cause is not bad people, but rather bad systems (AARP Bulletin, September 2016).

By becoming informed and participating in your healthcare, you can have a tremendous impact on improving your own personal health as well as the nation’s. The outcome should be a plan of care that is customized for you and one that brings you a good quality of life.