Tuesday, December 13, 2011

Tip #9: PAY ATTENTION!! ~More Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Ok so today we are continuing our series on how to get the best medical care while you are in the hospital. This post does put bodily functions front and center but I can't tell you enough how important it is to be aware of the following items.  You can save your own life ten times over just by making sure these aspects of your care are properly managed.

For my new readers, look to the bottom of this post for links to Tips #1-8!:-)

Tip #9:  Pay Attention

As much as I hate to admit it--hospitals are dangerous places.  There are so many sick patients and so many opportunities for error.  If you know what to look for however, you really can prevent nearly ALL of these problems.

Ok, now here are the KEY things to pay attention to (I developed this list in consultation with my husband, the Happy Nurse, since he is an ICU nurse & therefore an expert in skin, bowl, bladder, eating, meds & mental status.  So now you have both the nursing and the physician perspective).:-)  This post is written as if YOU are the patient, but you can also apply this information if you are a family member or friend of a person in the hospital.  If the patient is too sick to "pay attention" than you as a family member can advocate as I suggest below & pay attention on their behalf.

Hand Washing:  You need to ask EVERY single person who walks in your room (staff, friends, family) to wash their hands or sanitize them with the alcohol gel.  This in an uncomfortable thing to do but it also is the MOST important thing you can do to protect yourself in the hospital.  Just say "Excuse me, if you don't mind, I didn't see you wash your hands.  Can you please clean them with the gel before coming in further?  Thank you!"  

Meds:  KNOW your meds (remember my "How to Make A Medical Info Sheet post: Tip #4: Know Yourself) and also know what meds you will be taking in the hospital--your inpatient medications may be very different than your home meds.  ASK FOR AN INPATIENT LIST OF YOUR MEDICATIONS WHEN YOU ARE ADMITTED AND KEEP THAT LIST NEXT TO YOUR HOSPITAL BED AT ALL TIMES.  As your nurse gives you your meds, she/he is required to tell you what she is giving you.  Cross check the names of EVERY med that the nurse gives you with your list.  If there is a new med, ask her/him to explain why it was added.  Sometimes you will find that the nurse may accidently have nearly given you the wrong meds.  Make sure the nurse manager knows but be compassionate to the nurse--unfortunately this happens all the time and sometimes its the pharmacy's fault!  Try NOT to refuse meds without letting the doctor know first.  Ask questions and advocate for yourself (like I suggested in Tip #1: Be A Teammate!) but remember--we have been in school/training for a minimum of 12-18 years + our years in independent practice.  Sometimes its good to trust that judgement (not always, but most of the time its a good idea). 

Skin: This is VERY important. EVERY day, your family member & nursing should:
-check ALL points of contact of your body with the bed & check skin from head to toe for dryness, rash, cuts, bruises, etc.  Many of these skin issues are normal (particularly bruising & dryness) but they should be documented.
-The Happy Nurse recommends checking specifically for ULCERS/SKIN BREAKDOWN in the following areas:  the back of the head, elbows, shoulder blades, buttocks & heels.  At the buttocks, check between the folds because many ulcers start at the sacrum.  Also, staff should daily check the genital region for any skin issues.  An ulcer is NEVER a normal finding and should be treated immediately that day.
-Send modesty out the window my friends, skin issues take FOREVER to heal and are very susceptible to infection.  Let them look!

Urine: Watch for dramatic decreases or increases in output, change in color from yellow shades to reds or browns.  Bring all of these to nursing & the physician's attention.  Dramatic increases may mean a Urinary Tract Infection is brewing or it could just be because you've gotten IV fluids!  Dramatic decreases are VERY serious--make sure they check your kidneys.  If you have a foley catheter in make sure you consistently ask your doctor if it can be removed.  The longer it stays in, the higher the risk of infection.  Sometimes it is necessary to keep the catheter in, but other times, doctors forget to discontinue them so ASK!

Stool:  Watch for absence of bowel movement, increase in bowel movement (particularly if very liquid), change in color to black, tarry or bloody.  If you are taking pain medicine of any kind, I put my patients on a bowel regimen of stool softeners & laxatives daily.  Ask your doctor if that is a good idea (there are contraindications).  If you haven't had a BM and are not passing gas and are having severe abdominal pain, this can be a medical emergency.  Tell your nurse immediately. If absent BM but still passing gas for more than 3 days--ask for aggressive bowel management (from both directions--oral meds & rectal meds) if its safe for you & insist on an enema if nothing by day 4.  If liquid, very frequent and FOUL smelling--ask to be tested for C. Difficile or other infection.  

Eating:  If you have "no appetite," force yourself to eat unless you want to stay in the hospital!!  This is particularly important for older patients!  If you just can't manage any food, ask for Ensure or Glucerna or another oral supplement.  If you simply don't like the food, get permission from your doctor to have your family bring you HEALTHY food with lots of green vegetables & also foods with iron in them if you are anemic.  Dark leafy greens are particularly good but make sure your doctor knows you are eating them if you are on Coumadin (warfarin) so they can adjust your Coumadin dose appropriately.  Never eat food from home without your doctor's explicit permission.  DRINK a lot of water & other fluids, unless you are on a "fluid restriction."  Ask your nurse before drinking a lot--if its ok, then drink b/c you will help with constipation and prevent dehydration.  Do NOT drink sodas!!!!!

Mental Status:  Sometimes in the hospital you may get confused at night and may act in bizarre ways.  You may not remember this in the morning.  Make sure to ask your nurse about this because delirium can actually be deadly.  It may be due to medications or infections.  If you are confused at all during the day or night--bring this up to your doctor on rounds (remember how rounds work, check my post: Tip #2: Be Concise & Organized).  Family members with older patients, make SURE to ask nursing about this and bring it up to the doctor--common causes of delirium include: infection (particularly urinary tract infections), disorientation due to lack of glasses/hearing aids, loss of day/night cycle (make sure that the hospital room is dark & quiet at night and bright during the day to orient you properly), medication side effects and cardiac issues.  Unless it is absolutely necessary according to the doc, ask the doc to stop or reduce the dose of any meds if they are producing this effect.

***CAVEAT--if you find any problems with your care, please point it out politely.  Please also bundle your requests into ONE conversation, like I discussed in this post: Tip #8: Be Nice.   You will DRIVE STAFF CRAZY and really make them massively annoyed if every time they come in the room they are being peppered with requests. This annoyance level WILL effect your care.  Mention it ONCE at the beginning of the nursing shift (Remember what I told you about the the nursing shift schedule Tip #5: The Hospital Routine).  I recommend you ask the nurse as follows:
"I'd like to make sure that I get my skin checked thoroughly today & I know you are super busy but when you have a moment today, could we also talk about how my bowel, bladder, eating & mental status is doing?"  
Pick a time during the day to remind the nurses to check all these things before the end of his/her shift if they haven't gotten back to you from your inital request.  Good reminder times:  1pm for day shift.  10pm for night shift. ***

OK!  I think that wraps it up for this medical system post!  Hope this was helpful to you!  Next time we finish this post series with Tip #10:  Try Not to Be Alone!

Here are the links to my previous posts on these subjects:

Tip #1: Be a Teammate & Tip #2: Be concise & organized: http://happyrehabdoc.blogspot.com/2011/11/how-to-get-best-medical-care-insider.html
Tip #3:  Key Questions to Ask Your Doctor: http://happyrehabdoc.blogspot.com/2011/11/tip-3-key-question-to-ask-doctor-in.html
Tip #4:  Know Yourself--How to Make a Medical Info Sheet:  http://happyrehabdoc.blogspot.com/2011/11/tip-4-key-things-you-need-to-know-about.html
Tip #5: Know the Hospital Routine: http://happyrehabdoc.blogspot.com/2011/11/tip-5-what-is-hospital-routine-part-4a.html
Tip #6:  Know the Role Everyone Plays in the Health Care Team: http://happyrehabdoc.blogspot.com/2011/11/tip-6-know-role-that-each-person-plays.html
Tip #7:  Know Your Doctors: http://happyrehabdoc.blogspot.com/2011/11/tip-7-know-your-doctors-short-guide-to.html
Tip #8:  Be Nice!  http://happyrehabdoc.blogspot.com/2011/12/tip-8-for-best-hospital-care-be-nice.html

Coming Up This Week:
  • BOOK REVIEW:  "29 Gifts!"
  • SuperImmunity for Kids ~Part 2~!
  • Practical Stuff:  Kitchen Tools That Help & Products I Like! (Gift Ideas?!)
Coming Up Next Time on Medical System Tuesday
  • Tip #10 For The Best Hospital Care:  Try Not to Be Alone! ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~
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