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Patient, protect thyself

Mistakes happen even at top-tier hospitals. Consumers can do their part to help prevent them.

January 28, 2008|Jan Greene | Special to The Times

The numbers can be worrisome -- 1 out of 10 hospitalized patients picks up an infection or suffers some kind of mistake while in the hospital, statistics show. And the stories are frightening -- Dennis Quaid's newborn babies were given a huge overdose of a drug two months ago at a hospital with a top-notch reputation.

So what is a medical consumer to do? Should we all be afraid to go to the hospital?

It's not quite that bad, say experts in medical quality and error prevention; hospitals these days are being held to higher standards. But, they add, there's a long way to go on patient safety efforts. And consumers also have a role to play in keeping themselves safe -- asking questions, gaining a better understanding of how the healthcare system works, and more.

"There's an assumption that the providers should have all the information and you should just take at face value what the provider tells you," says Dr. Peter Angood, a trauma surgeon and vice president and chief patient safety officer for the Joint Commission, a national organization that accredits hospitals and other healthcare facilities. "One of the biggest things we can do in healthcare is to help patients understand that they need to be better consumers -- it's good to question, to ask for clarification and solicit second opinions as needed."

Here are some tips from organizations such as the Joint Commission and the federal Agency for Healthcare Research and Quality, which is charged with improving quality and safety of healthcare, on how to reduce the risk that you or a loved one will experience a medical error.


In the hospital

* Ask questions.

The best way to help your caregivers avoid mistakes is to talk to them. Many medical errors are related to medications -- getting the wrong drug or the wrong dose. A 2006 report by the Institute of Medicine on medical errors calculated, based on national data, that a hospital patient is subject to one medication error per day, on average. Medications most likely to be associated with errors, the report found, were insulin, morphine, potassium chloride, heparin and warfarin.

If you are in the hospital and being given a new drug or dose, ask the nurse what it is or why the dosage has been changed. If you don't know why you are getting a medication, ask why.

The hospital may have a bar-coding system for medications that is meant to double-check by computer the patient's name and drug dose against what the doctor ordered. (Currently, only 11% of California hospitals are fully using bar-coding technology for administering drugs, according to a January study by the nonprofit California HealthCare Foundation.)

If you have a bar code on your patient wristband, be sure it's checked every time. Even if there's no bar code, the caregiver should check your name.

* Vigilance is easier if you have someone else with you, particularly if you're having surgery or are too sick to keep track of your own care. Try to have a support person there when you get checked in, when the doctor visits (most likely in the morning), before any major procedures and upon checkout.

"People need to watch out for their family members," says Maribeth Shannon, director of the Market and Policy Monitor Program for the California HealthCare Foundation. "Often errors are caught because a family member says, 'That doesn't make sense to me.' "

If you are particularly concerned, have no one else to watch out for you or a relative and can afford it, consider hiring a patient advocate or private duty nurse to provide backup during key periods of a hospitalization. Some hospitals employ patient advocates to help sort out miscommunications. A registry of private-duty nurses available by the day may be available at your hospital. Private patient advocacy groups exist too. (Be warned: They can be pricey, and not all medical staff welcome involvement of a third party.)

Hospitals are becoming more open to support people in patient rooms and are even designing new hospitals with bigger rooms to accommodate more people, some even providing something to sleep on overnight.

* Keep close track of your medicines, including herbal or homeopathic remedies, supplements and over-the-counter drugs such as aspirin. And tell your caregivers what you're taking. Some of these substances can interact negatively with one another -- ginseng, for example, interferes with the blood-thinner warfarin; chondroitin may cause excessive bleeding during surgery. A study assessing data from 21,000 U.S. adults in 2002 found that more than two-thirds of people using a supplement and a prescription medication in the same year did not tell their doctor about the supplement.

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