Preparing for Your Hospital Stay
Many hospitals in this country have safety records intolerable in any other industry. The statistics are alarming:
- More than 180,000 people die every year from hospital infections, injuries, and errors
- A Medicare patient has a one-in-four chance of experiencing injury, harm or death when admitted to a hospital
- Today alone, 493 people will die because of a preventable hospital error
Unfortunately, hospitals also have a poor track record of being direct and sharing information on their quality and safety with the public. Behind a wall of medical jargon, protocols and legal fears, patients like you are often left out of the loop. The Hospital Safety Score is designed to be the first consumer-friendly way of sharing safety data in an easy-to-use format. Each A, B, C, D, or F grade reflects how safe that hospital is for patients, and hospitals that receive an A grade have proven to do a better job at protecting you from harm. Please use our hospital locator tool to find the safest hospital near you. You deserve a hospital stay free from harm and error. However, even when seeking care for yourself or loved ones at an A hospital, it is important that you stay vigilant in monitoring your care. Be prepared and take precautions.
What you can do to prevent medication errors during a hospital stay
Reduce the chance for medication errors by being informed, alert, organized and aware. Be sure to:
- Bring all the medicines you are currently taking with you so that your healthcare team can review them. Do not forget over-the-counter medications, dietary supplements and herbal remedies.
- Know what the medicines given to you in the hospital look and taste like. If either is different when your nurse brings them to you, ask why. If you are not fully coherent, have a family member or friend do so for you.
- Know what ailments or conditions your medicines are treating. It is helpful to know both the clinical and consumer-oriented name for your condition(s).
- Some discomfort can be expected, but it is important to let someone know about an atypical response to medication, which could help flag a potential problem or error in your care.
- Make sure your nurse or medication administrator checks your hospital wristband before giving you medication. Your family members can also watch to ensure this happens.
- Share your medication list with a friend or family member every time it changes. Make sure the list is dated, as your list of medications may change often.
- Make sure you are not taking medications or dietary supplements from home without your healthcare team’s knowledge.
- Remember that some of the same drugs have different names, while some drugs have similar names but are different. Having a printed, legible list of your medications that includes generic and brand names is helpful in sorting this out.
Make sure care team members who bring medications to you are aware of any allergic reactions you have had to medicines in the past. Ensure your family members are aware of any drug allergies as well. Many of these suggestions to keep medication use safe in the hospital can also be helpful at home.
What hospitals do to minimize medication errors
Medication errors in hospitals are, unfortunately, quite common. However, your healthcare team and hospital staff take many precautions to minimize medication errors in the hospital. For example, hospitals are:
- Involving pharmacists in the care units who may participate in rounds with your care team. This is a good practice, as it brings their medication expertise to your bedside.
- Use a process called medication reconciliation to help keep track of changes in your medications while in the hospital. The process engages doctors, nurses, pharmacists and patients in comparing a patient’s current drug routine to any changes a physician makes when you are admitted, moved to another unit, or released from the hospital.
- Minimizing interruptions and noise that can affect the medication preparation and administration process.
- Building electronic medication administration systems to keep track of prescribed medications, minimize errors from hard-to-read handwriting, and more rapidly share information about changes in medications with all of your providers across the hospital.
- Redesigning medication storage systems within the pharmacy to prevent drugs that look alike or sound alike from being stored near one another, helping to lessen the possibility of a busy pharmacist accidentally selecting the wrong medication.
- Encouraging patients and their loved ones to speak up with any concerns about the medications they are receiving.
Medication safety improvement is a top priority for hospitals. You and your family can play a role in helping hospitals improve.
Preventing falls is important and can save lives
Falls in hospitals are a significant problem and patients of all ages are vulnerable to them, especially the elderly. Falls often happen when patients try getting out of bed to either go on a walk or go to the bathroom. If you need to get out of bed, you should:
- Let people know. Use your call button.
- Ask for assistance in getting to the bathroom.
- Ask for help if you want to move about your room or stroll hospital hallways.
- Wear non-slip socks or footwear that fit well.
- Lower the bed height and side rails. Don’t hesitate to ask for help.
- Talk to your healthcare team if your medicine makes you feel unsteady or dizzy. If you are sleepy, light-headed, sluggish or confused, ask about getting a different medication so you feel more like yourself.
Many hospitals have fall prevention programs, and some provide visual aids such as bracelets and stairs for patients at risk for falls. These tools can help alert everyone that you may have trouble with balance. Your family and other visitors should also learn how they help protect you from falls. Tips include:
- Keep the room tidy
- Keep medical equipment (i.e. IV poles) out of the path to the door or bathroom
- Keep the hospital bed low and wheels locked
- Keep personal items (i.e. glasses, books) and tools (i.e. call light and TV remote) within easy reach
- Keep the bathroom clean and ready for use
Talking with your doctor about medical errors
Talking to your doctor about medical errors—either general experience or with specific regard to your care—can be tricky. It is important to be sensitive yet assertive. From the perspective of the doctor-patient relationship, it is valuable to discuss the issue prior to beginning a course of care.
Questions about errors in general:
- Ask about errors your doctor may have made in the past
- Ask about the outcome
- Ask what was learned
Questions about errors in your care:
- Ask what happened; dig deeper to get an understanding of what really went wrong and why
- Ask what the doctors, nurses, and hospital are doing to keep the error from happening again
- If you are able, ask to participate in the investigation of the incident, and work with the team that develops solutions to keep it from happening again
- Expect an honest apology and if you can, accept it
Seek support together. Medically Induced Trauma Support Services (MITSS), (found at http://www.mitsstools.org/ ) is an organization founded to assist in healing the relationship between clinicians and patients who have experienced an error together. MITSS also provides insights to the public to prevent similar errors from happening.
Improving communications with your doctor to make care safer
Communication is challenging. When you are meeting with your physician, it is important to listen carefully to help make your care experience as safe as possible.
- Ask questions when you are unsure of what you are being told.
- Be as prepared as possible for the encounter. Before your visit, think about and write down any questions you may have.
- If you want to bring articles about safety issues related to your care, be selective. A librarian or patient advocate may be able to sort through them to ensure you are sharing the best pieces of information to discuss with your physician.
- Take notes if you can. If you cannot, designate this task to an advocate or family member.
Helping hospitalized family members is important
As a family member or loved one of a hospitalized patient, you are an integral member of the healthcare team. The more informed you are about their care, the better! There are several ways you can participate in order to be a contributing member of this team:
- Explain early on that you are there to help your family member and are part of the team caring for them.
- Be present for rounds, shift changes and any major conferences with the care team. If you are not invited, ask when these events are likely to happen. Remember that hospital care is not like factory work and schedules are not perfect – but team members may be able to align schedules if you communicate with them.
- Take notes for you and for your family member.
- When the patient is recovering from surgery, see if you can arrange to be there or have another loved one with them in the room overnight until their recovery advances.
- Arrange with other loved ones to tag team staying with the patient. If you are exhausted, you will not be as helpful as another, well rested family member or loved one. Let the care team know who will be there in your place, especially if the person is staying overnight.
- Visit the hospital library to get accurate, reliable information on the patient’s problem. A librarian can help point you to reputable websites for disease and treatment information, and provide you with reading materials you might not be able to get online. Your public library can help with this too.
What parents can do to help keep children safe in a hospital
Children, just like adults, are vulnerable when they are in the hospital. Protecting them from harm is an important role for a parent. Here are some ways you can participate in the care of your child:
- Understand what will happen in your child’s care is important. Knowing what is expected can help you provide an extra pair of eyes and ears.
- Take care to respect all safety signs and messages. Behaviors such as washing your hands, making sure a security door is shut, or not allowing children to run down the halls, can help protect patients from harm.
- Share concerns and remain an active participant in the healthcare team. There are effective ways to show concern and participate while not disrupting care processes. Inviting the staff to engage you as a partner is a good first step.
The Joint Commission (the organization that accredits hospitals) makes the following suggestions for helping keep your child safe during surgery:
- Ask that sleep medicines be given to your child at the hospital so the care team can observe how your child might react to these medications.
- Learn what you can about the surgeon and his/her experience with the type of surgery your child will have. Talk to the surgeon and others who will operate on your child. Find out how often they have done the surgery. This will help you build a relationship with him/her, and ideally make you feel informed and comfortable with his/her ability to perform the surgery.
- Be sure you know what part of your child’s body will be operated on. Ask the surgeon to “sign the site” of the operation while you are with your child. This will help everyone be clear of the correct area. The only mark should be on the part to be operated on.
- Ask to stay with your child until he/she falls asleep.