Tag Archives: patient safety

Be Very, Very Scared! What You Don’t Know CAN Kill You…

Hospital Associated Infections: “C. Diff”

Posted by: Deborah Caputo Rosen

What do Harvard Magazine and AARP: The Magazine have in common? In the past five months both have published articles about “Superbugs”. “Superbugs” are those microorganisms that have developed resistance to commonly- used antimicrobial medications. “Superbugs” are dangerous and difficult to treat.

The Centers for Disease Control and Prevention (CDC) has been in the news providing guidance on the prevention and science of Ebola infection. But Ebola, although terrifying to many, has sickened only a handful of Americans, and only one person has died in this country of Ebola.

Scarier than Ebola is that on any given day about 1 in 25 hospitalized patients has at least one healthcare-associated infection (HAI). In 2011 there were 722,000 HAIs in hospitals. About 75,000 people died from these infections¹.

What does this mean? It means that people are admitted into hospitals without infections but develop an infection during their hospital stay.

Some of the types of infections patients and healthcare workers need to be vigilant about include: catheter-associated urinary tract infections, central-line associated bloodstream infections, ventilator-associated pneumonia, surgical site infections and hospital-onset Clostridium difficile infections (CDI or “C. diff” infection).

Why do patients acquire infections in the hospital? Let’s use C. diff as our example. In 2012, 107,700 cases of C. diff were reported in acute care hospitals². Often, these cases are preventable.

C. diff is the most common cause for infectious diarrhea in hospitals. Long-term care (LTC) facilities may be at even greater risk. In 2003, 2% of patients discharged to long-term care carried a diagnosis of C. diff infection.

There are people who carry C. diff without symptoms. These bacteria produce spores that are shed in feces. The spores can persist for 5 months on hard surfaces that have not been adequately cleaned. They are transferred on the hands of healthcare workers and are not adequately removed with alcohol-based hand rubs. Alcohol-based rubs do not kill the spores. Using them alone, without soap and water washing, merely spreads spores around on the hands but does not completely remove them.

C. diff spores are dormant in the colon until the normal bacterial environment is disrupted. The usual culprit is an antibiotic. Antibiotics can kill harmless C. diff spores. When that happens, C. diff transforms into a form that inflames and damages the colon, causing colitis of varying severity.
C. diff requires both exposure to antimicrobial agents and new acquisition of the organism. This occurs by transferring fecal spores to the mouth, usually by touching contaminated surfaces. Symptoms begin soon after infection; with watery diarrhea 3 or more times per day, cramping pain and tenderness, and fever. If unrecognized and untreated, the symptoms worsen.

The mortality rate for CDI varies. Some patients may recover without therapy other than discontinuation of antibiotics. That is the appropriate first step. Although it may seem counter- intuitive, additional antimicrobial agents are usually prescribed. Elderly patients who are frail and who do not respond to the first or second medications frequently used to treat the infection and supportive therapy for dehydration may become seriously ill, with a mortality rate as high as 25%.³

CDI recurs at least once in 50% of people, either because the first infection was incompletely treated or because of a new exposure. Highest risk groups include the elderly, those taking antibiotics and those with long and/or frequent hospitalizations. Virtually every antibiotic can increase the risk. The risk of acquiring the infection increases with time and can be as high as 40% with prolonged hospitalization. This is due to exposure to healthcare workers’ hands as they care for infected patients, touch contaminated surfaces and experience failures of correct hand washing technique.

Breaking the cycle requires proper hand hygiene, environmental decontamination and a hospital program of antibiotic use monitoring (“antibiotic stewardship”).

Know, Ask, Speak

Wilson-Stronks advises all patients and their care companions to keep in mind the Wilson-Stronks patient safety mantra of “Know-Ask-Speak” to decrease risk of healthcare acquired infections, including C. difficile. When you or a patient you love enters the hospital….

Know:

  • What C. diff is.
  • What the symptoms are.
  • How it is transmitted.
  • How to properly wash your own hands and when to do so.
  • Whether you/the patient has been taking or is now being given antibiotics.
  • Whether you/the patient has had a long or recurrent hospital or LTC stay.
  • If you/the patient is older than 60 years, has had a compromised immune symptom, or recent gastrointestinal surgery.

Ask:

  • Why antibiotics are being prescribed?
  • Whether and what tests will guide antibiotic selection?
  • Whether the symptoms could be C. diff?
  • How the C. diff will be treated?
  • If your room has a patient with C. diff in it?
  • Whether disposable equipment can be used?

Speak:

  • Request that providers wash their hands with soap and water in front of you, reminding them that alcohol rubs do not kill C. diff spores.
  • Learn how equipment, including BP cuffs, portable commodes and rectal thermometers are disinfected.
  • Learn how surfaces, including floors, bedrails, bedside tables, call buttons and bathrooms are cleaned.
  • Tell your nurse and doctor if you have cramping pain or watery diarrhea, especially if you are taking an antibiotic.
  • If you become infected with C. diff: learn if you will be in a private room or with another patient with C. diff, if contact isolation precautions will be observed, if visitors should follow such precautions.
  • Learn what the likelihood of recurrence is and how to reach help if you have symptoms after discharge.

¹/hai/eip/antibilotic-use_techinfo.html

²/hai/progress-report/index/html

³Cohen S, Gerding N, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31(5):431-455.

 

Healthcare Horrors!

This Halloween we are launching the first in a series of blog posts about something really SCARY – Healthcare.

HEALTHCARE HORRORS!!

You may be surprised to learn that medical errors are the 3rd leading cause of death in the United States surpassed only by cardiovascular disease and cancer.
Hospitals can be scarier than any house of horror. It is estimated that more than 130,000 errors occur each month in the nation’s hospitals. Each month!!!

Deaths due to medical errors have increased to about 210,000-440,000 per year.
Some of the most common medical errors—and this is scary–

  • Medication errors-
  • Infections
  • Falls
  • Wrong site surgery
  • Misdiagnosis
  • Failure to identify the correct patient — Care provided to the wrong person

Unlike cardiovascular disease and cancer, there are few public campaigns aimed at preventing the occurrence of medical errors. Efforts to reduce medical errors are leaving out the most important stakeholders: PATIENTS!

Wilson-Stronks is changing how medical errors are being prevented. Learn more on our Advocacy Page and our Advocacy Blog.

Putting Patients in Patient Safety

It is time for us to become smarter about our healthcare! Many medical errors are preventable, and patients are a key element to creating systems of care to minimize error and improve safety.

A few tips for protecting yourself and those you care about:

  • Don’t go alone! Just as we don’t allow children to trick-or-treat alone, anyone receiving healthcare is by definition vulnerable and should have a care companion/support person with them. Learn more
  • Wash away the scary bugs! Make sure that all caregivers including your physician wash their hands before they touch you. Who knows what monster they were treating before they arrived to care for you! Learn more
  • Don’t be afraid to ask! If something doesn’t make sense, ask. Healthcare is complicated and confusing. Bring a list of questions and paper and pen to write down notes about your care. Learn more

Learn More: Our Patient Advocacy Program Continue reading

Have Soapbox; Will Travel

By Amy Wilson-Stronks

Last month I delivered the keynote address at the American Medical Association’s Fall 2014 Commission to End Health Care Disparities Meeting. I was flattered to be asked to speak to a room of accomplished healthcare professionals who are leading efforts to improve healthcare by addressing healthcare disparities. I envisioned this as an opportunity to share some observations made during the years that I have been working toward the same goal/directing efforts in the same direction.

Specifically, I saw this unassuming audience as an opportunity to get on my soapbox, a position I find myself on with increasing frequency as I continue to work in healthcare. The title of my talk was Putting Patients in Patient Safety: Lessons Learned.

When tasked with delivering the keynote, I was told to “ ‘ignite’ the audience; give them something provocative to consider, something that will keep them awake during this dinner time presentation”. Since the focus of this group is the reduction of health disparities with the ultimate goal of eliminating disparate care, I believed I could deliver.

Why? Because fundamentally, our current systems are so flawed that none of us will EVER be able to eliminate disparities for any vulnerable or underserved group. I envisioned this message: Give up, we are wasting our time!

No, that was not my opening line. But beneath my remarks, that sentiment muttered like a mantra; it was the gist of my talk, whether articulated or not.

Why am I so negative? Several reasons. And, yes, these are points I shared with my esteemed colleagues.

There is no such thing as racism, sexism, (Insert any “ism”) .
“Not in my backyard,” “We treat everybody the same.” It would be short sighted and inaccurate to blame healthcare organizations for racial, ethnic, and other healthcare disparities. However, since health care is received at healthcare organizations, they necessarily are essential to the solution. Yet, many do not believe that they are culpable, nor do they think it is a problem that they need to address as a priority.

If our care organizations are not interested in evaluating the care they provide to various population groups that have been identified at the national level as suffering from health and healthcare disparities, then how will we recognize when we are doing things right? I have found that many healthcare organization leaders are not aware what is happening across their organization during patient-provider interfaces. They may set expectations that all patients are treated with dignity and respect, but they aren’t told, nor do they observe the Emergency Department staff comment, “Oh no! Not another Ebonics. I wish my shift would end already!” They don’t realize how unconscious and conscious bias can create a chasm between providers and patients from different racial and ethnic groups. And the bias isn’t only between providers and patients, but also among employee groups, as one HR professional once confided to me when asked about the lack of racial diversity in his organization,

“You know, the blacks (employees) really need to get over (themselves); Slavery was over a hundred years ago.”

Yeah, I guess we all need to get over it. But that won’t eliminate disparities.

Meaningful Use isn’t Meaningful
Meaningful Use is designed to establish a degree of data accessibility across the healthcare system to support care transitions, improve data access and communication, and improve systems for monitoring and evaluating quality by introducing uniformity and compatibility. This makes sense. And it is necessary for us to really understand how healthcare disparities present, what causes them, what removes/improves them, etc.

Unfortunately, the data necessary for us to address healthcare disparities are rarely captured, and if captured, they are rarely accurate.
“Only Press Ganey Data Matter”
“We have the data field right here.”

We need to incite collective action to incentivize the vendors of Electronic Health/Medical Record (EH/MR) systems to create adaptable programs for the collection of data on patient race, ethnicity, and preferred language. To the AMA, NMA, NHMA, AHA, and all others working to improve healthcare and advance equity– please join us on our soapbox.

If we still can’t get this right after more than 10 years, how are we ever going to effectively collect data on sexual orientation and gender identity?

Our Systems of Care Aren’t Designed by Patients
“If you listen to your patients CAREFULLY they will give you the diagnosis; if you listen a bit longer they will give you the treatment”

“Only physicians are capable of judging what is or is not good medical practice. Patients and hospital personnel may learn to recognize good practice but only the physician can accurately evaluate its quality.”-Explanatory Supplement to the 1965 Joint Commission Hospital Standards.

“Well, when I am in their room and they are all talking in another language I feel uncomfortable. I feel as if they are talking about me. I don’t like that.”

“Although my doctor knew all about me, each encounter with new people—with blood draws, ultrasound, breast x-ray, etc.—had the basic anxiety of the procedure and layered on to that, the possibility of homophobia and having to watch out for myself” ¹

If patients cannot communicate with their caregivers, then caregivers can’t do their job.

Unfortunately, many things complicate communication, such as trust, fear of hospitals, cultural beliefs and practices, conscious and unconscious bias as well as basic human assumptions. Healthcare professionals must involve the patient in every aspect of their care and not make any assumptions.

This drives the work we do at Wilson-Stronks. We want to Improve Healthcare. And we know that the only way to do so is to work collaboratively and act collectively. This collaboration and collective action must involve our patients. We were honored to be asked to share some of our experiences “in the world” with the AMA Commission to End Health Care Disparities.

¹ Margolies L, Scout NFN. LGBT Patient-Centered Outcomes: Cancer Survivors Teach Us How To Improve Care for All. April 2013.

Note: All other quotes are reflections of my thoughts from information that others have shared with me.

Advocating for Change: Improving Healthcare

Posted by Amy Wilson-Stronks

I am fortunate to have a very wide, robust, multi-disciplinary, diverse network of colleagues and friends with expertise in many areas related directly and indirectly to healthcare. I have had many conversations with my network about our healthcare system, and unashamedly, I find myself frustrated with how healthcare is delivered. I am stunned at the lack of sincere focus on the patient.

Sure, “patient engagement,” “population health,” “patient experience,” and “patient satisfaction” cover the pages of healthcare trade publications. But as I work with healthcare organizations, I see that sincere attention to the needs, beliefs, and expectations of the patients, families, and communities receiving care is relatively rare.

I know that there are many reasons for the lack of awareness, and but the issue does not exist because healthcare providers don’t care about their patients. However, competing priorities, the complexity of payment systems, staffing challenges, and the burden of documentation and electronic record systems limits the time that direct care staff and clinicians have to communicate effectively with patients and family members in order to sincerely understand the patient.

Historically, Wilson-Stronks has engaged clients by collaborating with healthcare organizations to help them create systems that support effective patient-provider communication and understanding. Unfortunately, effective communication is an area of quality and safety improvement and risk reduction that is not always viewed as a priority. We are left to wonder, “Well then, WHAT? What CAN we do to improve healthcare?”

A conversation last summer finally made things click. Ilene Corina, a grass-roots patient safety advocate and trainer, responded to my laments regarding patient provider-communication with this comment,

“That’s why I work with patients. (Decision-makers) don’t really know what is happening at the bedside. They sit behind their desks and hold meetings. And when they are on the units, it’s a show in their honor; unlikely the day-to-day reality faced by most direct care staff, clinicians, and patients.”

Ilene helped me (finally) understand how Wilson-Stronks can have a more meaningful impact: Working to empower the people who are at the patient’s bedside–the family caregiver; the healthcare proxy; the support person. I don’t know why it took me so long to get it, but my conversations with Ilene inspire our launch of the Wilson-Stronks Improving Healthcare Advocacy Program: Putting Patients in Patient Safety.

Many people who read this blog may have had personal experiences that made them aware of the gaps in the healthcare system. Some people may know about the gaps from the experiences of a friend or family member. Others may be familiar with issues because they are among the direct care staff trying to find the time and resources to sincerely understand their patients. Many of you have shared your stories with me, as I have shared my own.

But FINALLY I get it, and now Wilson-Stronks is ready to act: the only way to really improve healthcare is by taking our care into our own hands and educating and empowering those around us who have less medical and health literacy than we do.

I hope I can share some great success stories with you soon. Please know that the power of your stories can have a positive influence, and I thank you all for sharing to help the rest of us better understand what it is like to be in the hospital gown and sitting at the bedside of our loved one.