Improving Quality through Consumer Involvement

advocacy_word_cloudAs a Registered Nurse of 25 years I have always been humbled by the trust that patients give to us as health care providers. In particular the countless times patients accepted my care without question. This is a great honor and I am hopeful that I have never violated their trust and lowered their quality of care.
Why do I share this with you? Recently, personal experiences with the health care system have led me to reflect more on the importance of patient and family involvement in care and the impact this has on the quality of care provided. My experience has also prompted me to advocate through my blog to remind health care providers that each and everyone of us need to take the time to assure that all communication is clear, concise, and that patients and families have every tool necessary to understand what is happening and what the next steps are. I also want to advocate by providing consumers who read my blog with tools that will assist health care providers to consistently provide high quality care and reduce the possibility of potential errors in that care.
When we are ill and in need of hospitalization or medical and nursing care the last thing we want to worry about is whether or not we are safe in the care of others, let alone be involved in asking questions and actively seeking opportunity to learn more about what is happening to us in that moment. Our focus is on getting well and letting others “fix us” if they can. When we are feeling better or we are not so overwhelmed with what is happening to us, we can then engage, in the questioning and learning process. I have learned that at this point it is often to late. When we are well enough, it is time to be discharged and we are experiencing a whirlwind of information that seems comprehensible in the moment, but when we are gone and left to review our instructions alone or with family members, clarity waivers, inconsistencies in information are found, and many questions arise. At this point our health care providers are no longer so easily accessible. We may call for clarification, but we are led to an answering machine, or a message is taken, and return calls may or may not come.
So, how do we as consumers of health care take an active approach in our own care, or on behalf of a family member? How do we as consumers play an active role in assuring that quality is not in question and that we receive the care we deserve? Here are some suggestions:
1. Always Speak UP! I have found that the majority of patients and families are reluctant to speak up when something does not feel right or seem right. I have asked individuals why it is this way. Responses I receive range from “I am not the health care provider and they know more than I do” to “I don’t want to cause any conflicts that will change my care”. These thoughts are not uncommon but I would like to think as a health care professional that they are not reality. Health Care Providers, although educated for their role, are human too and have probability of making mistakes. If your care does not make sense or you have a feeling or thought that something is not right, Speak Up! I for one would welcome the opportunity to make a correction in the care I am providing or to reassure you and provide education. I do know other health care professionals would welcome the same.
2. Share everything you can! There is a recent commercial that shows a young woman seeking care for a specific problem, yet when she is being assessed by the primary care provider she does not openly communicate her symptoms. At the end of the commercial the young woman gains the courage to admit she was not being truthful and shares everything with her provider. Both she and the provider then begin to address and alleviate her problems.
Downplaying our symptoms for one reason or another is not uncommon. I believe that this comes as a result of fear, lack of trust, or our parental influence. This can be dangerous and our health care providers cannot help us properly alleviate or address our health issue or concern. I am not suggesting that we run to our primary care provider for every little ache or pain, but when we do seek treatment it is important that we are honest about our symptoms and our medical history.
3. Question, Question, Question! When I am in a classroom teaching nursing students I will often encourage them to question like a three year old. I want them to ask Why? Why? Why? I want them to be active in their learning and to seek out every possible answer and explanation. The same is true for consumers of health care. Before you visit your primary care provider make a list of all of your questions and assure they are answered to your satisfaction. Do not worry about whether you will irritate your practitioner with your questions and do not settle for explanations you do not understand or leave you with more questions. Ask until you are satisfied and you know everything that is happening to you. If your primary care provider or your health care provider becomes irritated with your questions or does not respond to you, it may be time to consider transferring your care. Most care providers I know welcome these questions and find it helpful. This will leave you both satisfied with the care you are receiving.
If you are needing hospitalization the same is true. Make your list if you have time to do so. If you do not have this time due to emergency and you are alert to ask questions, ask them as they arise. I cannot possibly list every question to ask in this blog, but I can get you started, and lead you to a valuable resource for more. A few great questions to ask a hospital when you or a loved one require hospitalization are:
a. How many registered nurses do you have per patient?
b. How often will I see a health care professional?
c. Will I share a room or receive a private room?
d. What is your infection rate?
e. What time do physicians and primary care providers make rounds?
f. Do you have a patient advocate available should I need one? (Advocates are available in many hospitals when families cannot be present or a patient does not have family).
g. What is your patient fall rate?
h. What is your medication error rate?
I. Is a member of my family allowed to stay with me in my room during my hospital stay to serve as my advocate?
Also, do not settle for answers that do not provide you with clear understanding. For example, when receiving the results of your laboratory work answers like “it is in normal range” or “it is a little high” or “it is a little low” do not provide us with a clear understanding. It is okay to seek more detail. For example, what is the normal range?
The Agency for Health Care Research and Quality found at https://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/10questions.html is also a great resource for questions consumers should ask to assist health care providers in the delivery of high quality low risk care. These questions include things like “what time is my test?”, “what type of preparation is required for my test?”, “what is this medication and what does it do?”, “what are the side effects?”, “what changes in my medication regimen are being made?” and more.
4. Keep an accurate medication list! This includes all prescribed, over the counter medications, and herbal or natural medications. Make sure this list is readily available when you need it. In today’s health care arena patients are visiting multiple providers as a result of specialization and even insurance provision. I have found through my own experiences that each provider may have a different list of what medications a patient is taking. I have also experienced transcription errors in the process of health care providers documenting medications. Having your list readily available for comparison and corrections will assist your providers in assuring the absence of potential medication errors.
5. Know your allergies and what type of reaction you experience! A great place to keep this information listed is on your medication list.
6. Make sure that when you leave a provider office or a hospital that you have an accurate and updated list of all medications and treatments. If you are being discharged from a hospital assure that the registered nurse provides you with the date and the time that the medications were last taken. Be clear on what was discontinued and what is continued or newly added. Medication errors after discharge are not uncommon and can cause significant harm. One 2014 health article found at https://www.reuters.com/article/us-medication-errors-health-literacy/medication-errors-may-be-common-after-hospital-discharge-idUSKBN0FN1SK20140718 identifies that “Overall, 20 to 30 percent of prescriptions are never filled, and 50 percent are not continued as prescribed, according to the U.S. Centers for Disease Control and Prevention.”
Once you have received the accurate and updated list, make your home corrections, dispose properly of your discontinued medications, and place the updated correct medication list where is easily accessible when you need it.
The health care environment can be overwhelming and frightening for many patients and families. Being armed with tools to assist you in the navigation of this environment and to provide you with control over the quality of care you are receiving can provide you with reassurance and decreased anxiety that is helpful in promoting a healthy outcome in the care you are receiving.
I am hopeful that you have enjoyed this weeks Talk Tuesday and have found at least one take-away or tool that can be of help to you today. If you are interested in learning more about me and the services I provide as a legal nurse consultant, trainer, and educator please take time to visit my website at https://upvisionconsulting.com/. If you would like to receive my blog updates please take time to leave your email on this page.
Talk Tuesday,

The Legal Nurse

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