The Health Care Spectator March 2013. Volume 1, Issue 1
Your ultimate resource for patient safety, wisdom & empowerment Essentials of Patient Safety Week 2013: March 3-9
Patients Share True Stories of Horrific Medical Experiences
Manage Your Medication Safely!
Also Inside: Gluten, What’s the Big Deal?
Editor-in-Chief: Anita Haridat, MS Executive Editor: Vikas Girdhar, MA
THE HEALTH SPECTATOR, 2013. All rights reserved. This magazine is not intended to provide medical advice on personal health conditions or replace recommendations made by health professionals. The opinions expressed by contributors and sources quoted in articles are not necessarily those of the staff.
First Edition Exclusive: About Us Editor-in-Chief: Anita Haridat is an avid patient safety advocate and has worked with organizations such as PULSE of New York, North Shore LIJ and Cold Spring Hills Nursing Home. She has her master’s degree in clinical nutrition and focused primarily on the well-being of those in geriatric care. She has a plethora of publications in sources such as Newsday and Our USA Magazine and she is pursuing her PhD in health care/business administration, which will be completed in 2014. By creating the Health Care Spectator, Anita is striving to make initiatives regarding the improvement of quality for patients one step at a time.
Executive Editor: Vikas Girdhar is a journalist with a plethora of experience in a wide variety of areas including politics, sports, entertainment and health care. Before completing his master’s degree in journalism, Vikas focused on diabetic intervention for his Capstone which was presented and defended in front of a panel of judges. He has a special interest in science and medical writing that will be a positive factor for the Health Care Spectator.
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March 2013
Letter from the Editor Welcome to the Health Care Spectator! What if people lived healthier lives, practiced preventive medicine, and took precautions against illness and disease? Maintaining a framework for good health and wellbeing is one of the most precious things that individuals have, yet our health care system can be the one that puts us at great risk. Collectively, we recognize that there are problems with the system and we want to see them solved, but it is up to use to take the first steps towards improvement. With patient safety week coming up, The Health Care Spectator strives to provide readers with a resource about the importance of advocacy and overall wellness. We will aim to be a driving force for public awareness and patient empowerment, especially through the use of real life stories. Those stories tell the tales of unfortunate cases dealing with misdiagnoses, incorrect amputations, medication errors, and similar reports of medical errors, most of which were preventable. I welcome the challenge of serving a large community and participating in such a dynamic and challenging field of health care. What if abandoning unnecessary procedures saved thousands of dollars, which then allowed a hospital to treat other patients needing care? What if every person was guaranteed care and that care was high quality? I would like to find answers for these questions during my career as an administrative health care professional and doctoral student. Enjoy our first edition! Anita Haridat, MS
Contents REAL LIFE MEDICAL ERROR STORIES 4 Awake. Is this Really Happening to Me? 12 Beware of Wrong Sided Surgeries
18 Is this Really What I need to Have Done?
PATIENT ADVOCACY 9 Be Your Own Patient Advocate 14 Manage your Medication Safely
NUTRITION CORNER 20 Gluten. What’s the Big Deal? 11 Eat Smart: Shake the Habit
THE SPECTATOR BOOK CORNER 22 The Patient’s Checklist: 10 Simple Hospital Checklists to Keep you Safe, Sane & Organized
Save Yourself for the Future: Report Medical Errors
As I was browsing through the hundreds of stories received about patient harm and medical errors, I was reminded of the troubling truth, yet again. Most individuals who suffer from a mistake while undergoing medical care do not file any type of complaint with the health care system. Unfortunately, one of the major reasons is simply due to the fact that they were unaware that they were a victim of a medical error in the first place. This is a troubling problem for patients and providers alike, but it has to be known that if there are no complaints made, the health system’s flaws can remain hidden. Essentially, if they are not corrected, they will most likely be repeated. Unfortunately, there are staggering estimates of the number of people harmed while undergoing medical treatment. A review of medical records by the U.S. Health and Human Services Department’s inspector general found that in a single month, one in 7 Medicare patients were harmed in the hospital. That is equivalent to 134,000 people!
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According to Dr. Julia Hallisy, President of the Empowered Patient Coalition , “You can’t really improve what you don’t measure.” How are health care systems supposed to focus on their improvement efforts for the protection of their patients if they can’t measure what has been happening in the first place? Patients and their families have the ability to make changes for their own safety in the future. Report each error, no matter how small you think it may be. It has the potential to make a huge difference!
FOR COMPLAINTS ABOUT CARE: Adult Care and Assisted Living Complaints - 1-866-893-6772 Home Care and Hospice Complaints - 1-800-628-5972 Hospital Patient Care Complaints - 1-800-804-5447 Hospital and Diagnostic and Treatment Center Complaints - 1800-804-5447 Laboratory Complaints - 1-800-682-6056 Medicaid Fraud Hotline - 1-877-87FRAUD Managed Care Complaints - 1-800-206-8125 Nursing Home Patient Care Complaints - 1-888-201-4563 Professional Medical Conduct Complaints - 1-800-663-6114 The Joint Commission (800) 994-6610
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REAL LIFE STORY
"My toes wouldn't move. My whole body was completely paralyzed. I had no way to let them know I could hear everything. I felt the doctor’s hand on my abdomen and I thought oh no, they're getting ready to cut into my stomach.“ This sounds like something straight out of a horror movie, but these are words from Emily Cook, a patient who described how she was awake during surgery. Emily was undergoing a procedure in order to get an ovary tumor removed, but she remembers going to sleep and eventually waking up to the burning pain of being sliced open. She was unable to move or speak and worst of all, she was trapped in her own body. Being awake and aware of one’s surroundings during a surgical procedure is a phenomenon known as anesthesia awareness. Emily, a registered nurse, says she had never heard of it until it happened to her. Victims have called it their worst nightmare. They may remember sounds or conversations in the operating room or they may have excruciating pain. Typically, they wake up feeling paralyzed, without having the ability to respond. It's like being alive, but inside a corpse. To be clear, anesthesia is very safe, and awareness incidents are usually rare. It has been found that out of the 30 million cases in which anesthesia is used, anesthetic awareness happens in about 1 or 2 cases out of every 1,000, according to the American Society of Anesthesiologists.
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According to the advocacy group Anesthesia Awareness, researchers believe that anesthesia awareness is under-reported by 50 percent to 100 percent of the official numbers. Whenever this occurrence does happen, the impact can be extremely traumatic. According to the organization, approximately 50 percent of awareness victims suffer from post-traumatic stress disorder. Going into surgery is definitely a scary risk, but there are certain things that can help reduce the risk of experiencing anesthesia awareness.
Here are some important points that should be addressed with a physician before going under the knife: Operating room brain monitors: Are they available in your facility? Weight: Your body mass index (BMI) or amount of body fat is a factor. Anecdotally, women and slimmer patients report more awareness. Age: The older you are, the less anesthesia you typically need. Medications/herbal supplements: Any medications including herbal supplements can have a big effect on the anesthesia.
Type of surgery: Some surgeries are more susceptible to awareness including cardiac and obstetric operations as well as acute trauma surgery.
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Back Pain? Pay Close Attention If you spend more than 5 hours of leisure time per day sitting, turn off the television and move around! According to the American Journal of Epidemiology, there is a 34% increase in your risk of death within a 14 year period. If you find yourself slumping over a computer for long periods of time, it can throw off the natural alignment of your back so much that it may even lead to pain. Here are tips on how to reduce this:
Rise to the occasion: At home or at work, rest your computer at on a stack of books or magazines so the screen is at eye level. This reduces long periods of looking down and slumping forward. Take Breaks: About every 30 minutes, shrug your shoulders up and down and gently roll your head from side to side. Utilizing these motions and switching positions helps to keep stiffness away. Drink Water: Water lubricates the joints and discs in your back, making them much less likely to ache in during a short period of time and in the long run.
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Be Your Own Patient Safety Advocate The facts are clear: medical errors cause detrimental harm to patients more often than we would like. Each year, there are multitudes of patients that lose their life or become inadvertently injured during a healthcare process. This is why it is absolutely essential to be your own patient safety advocate. The first step is to understand the magnitude of the problem and then devise effective intervention strategies. When people take an active role in their care, research shows that satisfaction rates tend to be higher. Without a doubt, communication is crucial to effective healthcare. Many times, patients are afraid to speak up and this can cause a great deal of miscommunication. Essentially, there is a simple mnemonic that can make a difference when dealing with your own health care. It’s as easy as A-B-C!
A. Ask Questions: Ideally, doctors and other providers should communicate on a level that matches the patient’s knowledge, but of course this is not always a realistic expectation. Understandably, there are occasional lapses in communication, but it is absolutely important for you to stop and ask if something is unclear. More often than not, they will stop and explain anything that may need clearing up.
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B. Be Prepared If there are issues to address with your provider, make sure that everything is covered within that scheduled session. Sometimes, it is possible to remember important questions/concerns after your visit, which can then be a hassle because you may not have all of the proper information that you need. It is helpful to make a list prior to your appointment in order to lay important issues out on the table. C. Communicate Concerns and Desires Proper communication means asserting yourself in order to get maximum benefits of your health care. Do not be afraid to speak up if you have a problem with the care or if there is an issue that you want your provider to consider. Often, financial concerns may come up as well and many are hesitant to bring this topic up. Remember- an actively involved patient knows what to expect from their doctor. Beyond that, people's expectations vary greatly. The kind of relationship that you want to have with a doctor may depend not only on your personal preferences, but also the reason why you need medical care.
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Nutrition Corner
Even if you are not that person who mounds salt on your food, your diet still has the possibility of being dangerously high in sodium. Earlier this year, the FDA announced that it would reconsider its stance on how much sodium can safely be allowed in packaged foods- this includes restaurant meals. According to the chief of clinical dietetics at the Mayo Clinic Food & Nutrition Center, “salt is a silent threat.” Many times, people are simply unaware that they are just consuming way too much salt. While we need sodium for proper nerve and muscle function, too much has serious consequences including an increased risk of osteoporosis, gastric ulcers and high blood pressure. Kicking the tendency of consuming plenty of salt may be tougher than you think. The substance may be habit forming and research has found that salty tastes actually activate pleasure receptors in the brain. In studies that were done with lab rats, a sodium deficiency was linked to a key symptom of depression. Now for the empowering news: since salt is typically an acquired taste, you can fend off the habit yourself. In order to discover where sodium is hidden, you need to rely on your eyes as well as your tongue, but unfortunately not all culprits are as obvious as a glistening carton of French fries. Essentially, it is important to read nutrition labels. If products have labels that say “reduced sodium”, this can mean food has as little as 25 fewer milligrams than the original, so look for “low sodium” instead. These have no more than 140 milligrams per serving! One of the best and easiest ways to cut back on salt is to eat fewer processed foods. Aim to make three quarters of your diet whole foods and cook them at home if you can in order to control the salt level.
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Delicious Low Sodium Snack Apple Cartwheels Prep: 20 minutes + chilling Yield: 24 Servings
Ingredients 1/4 cup peanut butter 1-1/2 teaspoons honey 1/2 cup miniature semisweet chocolate chips
2 tablespoons raisins 4 medium unpeeled Red Delicious apples, cored Directions In a small bowl, combine peanut butter and honey; fold in chocolate chips and raisins. Fill centers of apples with peanut butter mixture; refrigerate for at least 1 hour. Cut into 1/4-in. rings. Yield: about 2 dozen.
Nutritional Facts 1 apple ring equals 50 calories, 3 g fat (1 g saturated fat), 0 cholesterol, 13 mg sodium, 7 g carbohydrate, 1 g fiber, 1 g protein.
REAL LIFE STORY
Beware of Wrong-Sided Surgeries Early one morning in Portland, Oregon, Dale Matlock and Tasha Gaul took their three year old son, Jesse to the hospital for a routine eye surgery. It was supposed to be a standard procedure dealing with the correction of a lazy eye. Jesse and his parents were even told that they would be able to go home the same day since the entire session would only take a few hours. The surgery was indeed quick and simple; however it was done on the wrong eye. The surgeon, Dr. S Goodman exited the operating room and immediately spoke to the parents. She said that she lost her sense of direction and by the time she realized that she was operating on the wrong eye, the surgery was almost finished. There was realization in the mistake, but the truth is- this is serious, preventable and it should NEVER happen. According to a 2010 study looking at the frequency of surgical errors in the United States, each year there could be as many as 2,700 mistakes where a surgery is performed on the wrong body part or the wrong patient. That's about seven per day. Efforts to prevent these types of surgical errors have gotten better over the past decade, but there is still room for constant improvement. Even the best doctors make mistakes, but when dealing with people’s lives, it is simply not tolerable. Although it has been a year since Jesse Matlock’s surgery, there is still a lag in the “good” eye even though correctable procedures have been done.
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According to a spokesperson for the American Academy of Ophthalmology, it is possible for eye surgeons to become disoriented since they are accustomed to examining a patient from in seated position -- a different angle from the operating table. Ophthalmologists are aware of this, which is why they typically take preoperative protocol very seriously. Here is a helpful tip to prevent wrong sided surgery before you or a loved one goes under the knife! Be slightly aggressive. Say your name and the exact procedure that you are getting done prior to surgery. Whether you are speaking to the doctor, nurse or anesthesiologist, make sure that everyone involved in your care knows who you are. * Source: CNN Health
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The numbers are simply outrageous: Every year 1.5 million people are sickened or severely injured by medication mistakes, and 100,000 may pass away. Yet, most of those deaths are preventable. How can we stop this? It is essential to take precaution and protect ourselves and our loved ones by utilizing simple techniques. Here are medication mistakes researchers say are most likely to kill or cause serious harm and how they can be prevented:
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Confusing Medications with Similar Names It can happen to anyone: Maybe the physician’s handwriting is illegible or the wrong drug is pulled from the pharmacy shelves. According to the national Medication Error Reporting Program, most pharmacies stock medications in alphabetical order, so it is possible to have drugs with similar names right next to each other, which makes it even more likely for someone to grab the wrong one. Confusion caused by similar drug names accounts for up to 25 percent of all reported errors and the Institute of Safe Medication Practice lists pages of confused pairs in a recently published document.
How to Avoid This
When you get a new prescription, ask your doctor to write down a LEGIBLE name, dosage and what it is used for. If the prescription states depression but is meant for stomach acid, that should be a red flag for the pharmacist. When you're picking up a prescription at the pharmacy, check the label to make sure the name of the drug (brand or generic), dosage, and directions for use are the same as those on the prescription. (If you don't have the prescription yourself because the doctor sent it in directly, ask the pharmacist to compare the label with what the doctor sent).
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Taking the Wrong Dosage Medications are prescribed in a variety of units of measure that are usually notated using abbreviations or symbols. Unfortunately this offers opportunities for disaster. All it takes is a misplaced decimal point and 1.0 mg becomes 10 mg, a tenfold dosing error that could cause a fatal overdose.
How to Avoid This
Make sure that your doctor's writing is legible on the original prescription. If you can't read the dosage indicated chances are the pharmacist might have difficulty as well. When you pick up the prescription from the pharmacy, ask the pharmacist to check the dosage to make sure it's within the range that's typical for that medication. At home, keep a medication chart and write down the proper dosage for each medication that you take throughout the day.
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Dangerous Interactions with Food According to the Institute of Medicine, it has been found that the most dangerous culprit in this situation is grapefruit juice. This fruit has unique properties when it comes to inactivating or over activating medications. Grapefruit juice inhibits a crucial enzyme that normally functions to break down many drugs, such as anti-seizure drugs and statins used to lower cholesterol. The result? The overloaded liver can't metabolize the medication, resulting in an overdose, with possible fatal consequences. Other less serious interactions to be aware of include coffee and iron. Coffee plays a role in inhibiting absorption. Physicians say they frequently see coffee drinkers who take their iron in the morning with breakfast, yet their anemia doesn't go away because the iron is not absorbed.
How to Avoid This
When you get a new prescription, ask your physician or a pharmacist whether you should take it with food or without food. ALWAYS ask if there are any particular dietary issues to watch out for.
REAL LIFE STORY
Is This Really What I Need to Have Done? The moment Kerry Higuera starting bleeding during the first three months of her pregnancy, she feared that there was going to be a miscarriage. She decided to head to the emergency room in order to take precautionary measures. However, Higuera says that she will regret that decision for the rest of her life.
Higuera arrived at a hospital in Glendale, Arizona and was placed in a room where she was told to wait for a nurse. Soon after, a nurse arrived and said, “Kerry?” Higuera said “yes” and the nurse said that she was going to take a walk down the hallway into the CT scan room. Higuera then blatantly asked, “Is this really what I need to have done?” and the nurse insisted that it was doctor’s orders to have a scan of her abdomen. After the scan, the nurse led Higuera back to a room to wait for the doctor. "I was so scared. I told my husband, I'm sure I've had a miscarriage. I'm sure the doctor is going to come and tell us we lost the baby," stated Kerry. However, that wasn't what happened at all.
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REAL LIFE STORY
After about half an hour, Higuera says the emergency room physician, two radiologists and a representative from the hospital's human resources department came into her room. "I started to cry and asked if I'd miscarried, and they said no, I was still pregnant. My husband and I said, 'Oh, that's great!'" she remembers. However, they then told the Higueras that there was something else that they needed to know. "They said, 'We made a mistake; we did something we shouldn't have done. There's another patient here named Kerry, and you two are the same age. We mixed you up. She was supposed to have the CT scan, not you.' “ While there have been limited studies done on the potential harms of performing a CT scan to a pregnant woman's abdomen and how it may affect the fetus, experts say that a fetus exposed to radiation can, in some cases, develop physical and mental growth problems. In general, CAT scans are not recommended during pregnancy unless the benefits of the CAT scan clearly outweigh the potential risk. In statement e-mailed to CNN, senior director for public relations and online services at the involved hospital wrote, "Ms. Higuera is represented by legal counsel in this matter and it appears to be moving towards litigation. *Source: CNN Health
Gluten free diets seem to be all the rage these days and they are looked at as a “cure-all� for everything. Before you hop on the bandwagon, read this: Just 10 years ago, hardly anyone knew what the word gluten even meant, let alone how to avoid it. Now, gluten free eating continues to trend and even high profile celebrities such as Victoria Beckham and Gwyneth Paltrow have been linked to this type of lifestyle. It is said that a diet with limited or no gluten allows for increased energy and reduced bloating. Before we validate these thoughts, let’s figure out what the substance actually is. Gluten is a protein that is found in the grains wheat, barley and rye. Most of us unknowingly are huge fans of it because it gives our favorite foods that extra kick. It makes pizza dough stretchy, gives bread a spongy texture and it is even used to thicken sauces/soups. With regard to medical science, gluten-free eating plays a huge role because it helps a legitimate health problem. For people with a chronic digestive disorder known as celiac disease, gluten is considered a malicious invader. The substance develops an adverse immune response and plays a role in damaging parts of the small intestine which prevents the organ from absorbing foods that are healthy for the body. In turn, it causes gastrointestinal distress and nutritional deficiencies. When left untreated, it can even lead to intestinal cancer as well as complications such as infertility and osteoporosis.
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What is the hype? Since there has been an increase in diagnosed celiac cases, the promotion of “gluten-free” foods have sky rocketed as well. There is even a promotion of “healthier diets” if one chooses a gluten free lifestyle. While there is relief for those with celiac disease, this does not mean that a gluten free diet will work in all cases. Gluten free dining can seriously limit the number of foods that you can eat and with fewer choices, you are less likely to over eat. It may help you lose weight for the time being, but it is very likely that the weight will be put back on if the diet is not adhered to. This is true of many diets! There is also the misconception that “gluten-free” means fat free or calorie free. Without the use of gluten to bind food together, food manufacturers often use more fat and sugar in order to make the sugar more palatable. Check this out: a serving of regular pretzels has about 110 calories and just one gram of fat. Swap them for gluten free pretzels and you could get 140 calories and 6 grams of fat. Do you see the irony there? It’s important to know that “gluten –free” does not necessarily equal “healthy”, especially when people get rid of vitamin enriched and whole grain foods from their diets and replace them with gluten free brownies. Research suggests that those who forgo gluten may be more likely to miss out on important nutrients such as iron, B vitamins and fiber. If you do decide to go down this route, focus on fruits, vegetables, lean protein and dairy. Remember- moderation is the key!
The Spectator Book Corner
The Patient’s Checklist: 10 Simple Hospital Checklists to Keep you Safe, Sane & Organized By: Elizabeth Bailey
For anyone who has been a patient or a visitor at a hospital, more often than not, there are moments of confusion and chaos. By the time you learn the routines and the rules, with any luck you're recovered and on your way out the door. Within the unique notebook-esque appearance of this book, Elizabeth Bailey provides patients and caregivers a sense of calm through a potential hospital storm. Her synthesis of useful information into straightforward checklists is the perfect antidote for the often confusing, chaotic, and overwhelming patient experience. The checklists in Bailey's book include templates for patients on managing hospital medications, including a master medication list that describes every drug being taken, the frequency, dosage, prescribing doctor's name, special instructions and more, as well as a daily medication log where patients can keep track of every pill, injection and IV drip they're given each day. True to her word, she offers simple steps to keep us safe, sane, and organized within our healthcare journey. Through the utilization of real life stories and scenarios, Elizabeth Bailey has put together a masterpiece that could potentially save your life.
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of New York: Persons United Limiting Substandards and Errors in Health Care PULSE of NY leads the nation in grassroots patient safety education and encourages culture changes to enable patient participation to reduce unplanned outcomes costing the economy as much as $29 billion a year. Since 1997 PULSE of NY has been working with patients and families who have experienced a medical injury. Through PULSE support groups, community outreach and education, patients and their family members share experiences and for the first time have a place to talk about the outcomes that changed their lives forever.
Whether you have recently been diagnosed with a life changing medical condition, or are about to become a patient in today’s health care system, or are a medical professional in need of medical treatment, or want to help a friend or family member as they go through the health care system, we can help you take steps to help ensure safe, quality care.
Our priority at PULSE is the patient and your needs. Let us help you make informed choices. For more information about PULSE visit www.PULSEAmerica.org
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THE HEALTH SPECTATOR, 2013. All rights reserved. This magazine is not intended to provide medical advice on personal health conditions or replace recommendations made by health professionals. The opinions expressed by contributors and sources quoted in articles are not necessarily those of the staff.