Archive for May, 2010

Beyond Kleenex

May 20th, 2010

Several months ago I wrote about the scourge of nosocomial (still my favorite word) or hospital-acquired/healthcare associated infections (HAI) as one of the most important indicators to measure and monitor in an assessment of healthcare quality. HHS testified as much to Congress last month.
See Post: A Patient’s Quest for Quality in Healthcare
After spending many days in the hospital with my father, watching him beset by multiple tubes and catherers, noting the prophylactic antibiotics in his IV and the fact that his hospital staff was diligent about washing hands, the topic seems ripe for revisiting.
See Post: From DCpatient to CTcaregiver

It seemed timely that I was sent information on an initiative sponsored by Kimberly-Clark, the Not on My Watch Hospital Acquired Infection Prevention Campaign, that aims to reduce these infections. I’m sure with Medicare no longer paying for readmissions caused by preventable infections, many hospitals are keenly interested in information on how to reduce their infection rates. Most know Kimberly-Clark as the makers of Kleenex and other home icon products. I certainly didn’t realize they had a sophisticated healthcare division. (Disclosure/Non-disclosure: I am not compensated in any way for this post)

Some important facts to note:

    In a quality report to Congress in mid-April 2010, the Health and Human Services (HHS) department noted that “very little progress on eliminating hospital-acquired infections” has been made since the problems were brought to light more than a decade ago. In addition to the potentially fatal considerations for patients, this lack of progress in preventing infections could have financial ramifications for the hospitals as the new health care overhaul law comes to fruition over the next few years.”

    The Centers for Disease Control (CDC) of the U.S. Department of Health and Human Services notes that 5-10 percent of the patients admitted to acute care hospitals and long-term care facilities in the U.S. develop hospital-acquired infections, with an annual total of more than 1 million people. These infections are usually related to a procedure used to diagnosis or treat the patient’s initial injury or illness. A CDC report published in March-April 2007 estimated the number of U.S. deaths from healthcare associated infections in 2002 at 98,987.

    The CDC has estimated that about 36 percent of these infections are preventable through strict adherence to guidelines by healthcare workers when caring for patients. These infections can be extremely dangerous because they are occurring in people whose health is already compromised. HAI often leads to lengthening hospitalization, increasing the likelihood of readmission, and adding sizably to the cost of care per patient. Financially, HAIs represent an estimated annual impact of $6.7 billion to healthcare facilities.

    Two of the most important things that patients and caregivers can do are to ask about infection reduction practices in their hospital and insist that everyone washes their hands (from doctors to visitors).

    Not on My Watch HAI Resources: http://www.haiwatch.com/

    HHS Action Plan to reduce Healthcare Associated Infections: http://www.hhs.gov/ophs/initiatives/hai/research.html

From DCpatient to CTcaregiver

May 17th, 2010

While in NYC for business I received a call from my mother that my father had been admitted to the hospital. I raced home to Connecticut arriving at the hospital to find my father on a gurney in the hallway, pale and connected to oxygen and other tubing, waiting to be wheeled down to testing. I leaned over to kiss his cheek and let him know I was there.

So began my transition from DCpatient to CTcaregiver.

I’ve spent the bulk of the past two weeks trying to coordinate care for my father and support my mother as they struggled to understand and adapt to this health crisis and what it means moving forward. Now was the time to see if I could actually apply all the fancy patient advocacy talk and e-patientism to a situation closer to home.

1st Lesson: Being a caregiver is much harder than being a patient. You get no meds and never get to lie down.

2nd Lesson: Education is not Empowerment.
My parents are very smart people. My mother has a PhD and my father has 2 masters degrees. They are retired teachers – my father taught life science. Still the amount of detailed information on the myriad conditions that my father was battling and the pace and format at which this information was given was overwhelming. Also, information was also given without context. For example, in the huge package of information there was a list of the sodium levels of different foods. BFD. What was the recommended goal for how much sodium he should have each day? What should be the limits for sodium per serving he looks for on labels? My task was not to give them more information (although my husband and I were looking up drug information and clinical guidelines on our phones from the hospital room) but to give them tools to help them digest the information and apply it to their lives.

3rd Lesson: Fragmentation of the healthcare system can kill ya.
Now I knew this from my own experience, but since I have the ability to compensate for the gaps and uncoordination of medical care in my own situation, I did not truly appreciate the potential consequences of not getting it right. The most important and impactful things I did while I was with my parents was to get support services in place from the Visiting Nurses Service, schedule follow up appointments with all of their doctors, and to ensure that follow up testing was ordered, conducted, and shared in a timely fashion. My Dad is on coumadin for example, but the order for the INR (the test to see if his blood is being appropriately thinned to avoid clots but not too much) was not given, and then they expected him to travel to the office to have it drawn. IMHO all of this should have been done before discharge.

I could go on and I’m sure I’ll write about this more, but let me leave this post with . . .
Five Things Hospitals Can Do to Make it Easier for Caregivers, Reduce Readmissions, and Improve Patient Care:
1. Upon admission, prompt for ALL doctor’s names and ALL medication. Have a mechanism to alert all a patient’s doctors that the patient has been admitted. My Dad had eye drops that were counterindicated with his blood pressure meds and the ophthalmologist and cardiologist never knew of each other.
2. Proactively provide timely information and updates to family twice a day. (Luckily I knew enough to skulk around the nurses’ station well before posted visiting hours spotting anyone in a white coat or tie who handled my father’s chart to corner them into an update and plan for treatment. It shouldn’t be that hard.)
3. Conduct training. Don’t just give pamphlets before discharge. God bless my 70-something year old mother for figuring out how to wrangle my Dad’s oxygen tank and foley catheter into the car. Good luck trying to get my transplanted southern African-American parents to instantly transition to a low sodium, low fat, complex carb diet without significant intervention.
4. Schedule all follow up and have prescriptions ready upon discharge. The caregiver may not be able to leave the patient to pick up prescriptions and has too much on their hands to play round robins on the phone with multiple providers.
5. Finally, I’d like to request a 24 hour cafeteria. I appreciate the thought of the “Vending Café’”, but I’m never going to order a seafood salad sandwich from a vending machine and I don’t want to end up in the bed next to my Dad because I passed out from hypoglycemia. Caregivers need their strength to shoulder all the burdens laid there by the healthcare system.

National Family Caregivers Association http://www.nfcacares.org/

National Transitions of Care Coordination http://www.ntocc.org/