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 ~

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.

Tip #8 For The Best Hospital Care: Be Nice ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Today we continue our series on how to get the best hospital care--this post is pretty much common sense but you would be surprised at how easy it is to have The Golden Rule disappear out the window in crisis.  The purpose of this series however is for you to learn how to get the BEST hospital care, and if I didn't mention this than I would be remiss in achieving this goal.  


Please be nice is the FIRST & strongest piece of advice I gave my hospitalized family member AND all other members of my family.  So they were nice and things went a lot better (nurses gave quick assistance with a smile & physicians spent longer time in the room).  Take this advice to heart--if you do nothing else, follow this tip!


Tip #8:  Be Nice:  One of my Mom's best friends always said: "You catch more flies with honey than with vinegar."  This REALLY applies in the hospital setting.  I realize that when your are sick you don't feel much like "making nice" and when you are worried about your family you "just want answers." But the reality of the situation is that medical personnel are just that--people! 

Every person wants to be treated with courtesy and you WILL get better & more responsive care if you are kind to the nurses/physicians/techs/cleaning persons/administrative assistants/social workers/dietary staff.  

I know (from being on the patient side of things) that some staff members don't return the favor & this may not seem fair.  To be honest, I had to sometimes ACTIVELY tell myself not to snap at people last week as I sat with my sick family member.  I kept reminding myself of the following key point:  most staff members are not actively trying to be rude--they are stressed, they are understaffed & they are trying to please a lot of different people at once.  By surprising them by being nice, they will look forward to coming into your room--this translates into more attentive care.

With regards to the nursing staff & techs--one last thought.  Please remember not to treat them like they are your servant & remember that you are not their only patient.  Don't "speak down to them."  If you need something within your own reach & you are well enough than get it (*without doing anything you were told NOT to do by the nurse/doc*), than do it for yourself. 

• Please don't be like a patient I saw the other night who had the staff running in and out of the room trying to please her requests.  The evening culminated in her asking me to comb her hair & get her skin cream for her even though both items were on the tray in front of her & she was more than capable to do so herself.  I had to sit down & talk to her about the importance of bundling her requests & asking only for things that she cannot do herself so the staff could do their job for all the other patients on the floor.  After the explanation she seemed to understand & the staff enjoyed caring for her much more!  

That said, there are limits to this suggestion. If you believe that someone is actually actively being harmful to your or your family members than ABSOLUTELY you should stop them firmly & ask to talk to the nurse manager or patient care advocate immediately.  If its an issue with a doctor you can "ask for a second opinion."  Just no matter how angry you are, take a deep breath & ask nicely--things will get fixed a lot faster.

Coming Up Next Time on Medical System Tuesday: 

• Tip #9 For The Best Hospital Care:  Pay Attention ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Coming Up This Week:

• BOOK REVIEW:  "29 Gifts!"
• SuperImmunity for Kids ~Part 2~!
• Practical Stuff:  Kitchen Tools That Help & Products I Like!!

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.

Tip #6: Know the Role That Each Person Plays In The Hospital Team (quick cheat sheet) ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Who are all those people working in the hospital & what do they do?? 

Continuing our journey into the foreign land of the hospital, lets meet the team...

• Nurse:  Your tour guide.  Responsible for your day to day care. Manages meds, personal care, intake & output & executes doctors orders.  Eases patient's anxiety and deals with overwhelmed (and often emotional, highly stressed) families. Have the most comprehensive view of the patient's condition & can usually make or break a patient's progress.  Their insights are extremely valuable.  Most are very intelligent, highly educated or experienced and have the patient's best interests at heart. Some are not and do not (but I've found these folks to be few & far between).  There are a lot of different kinds of nurses:  RN, LPN (LVN), APN(NP)) and I'll devote a guest post to my husband (THE HAPPY NURSE) to explain all of these sub-types and specialties but on the floor you will usually see either RN's or LPNs/LVNs. A good medical team always takes nurses' assessments into account with great weight when making any patient care decisions.  I do not recommend being rude to your nurse.  Please treat them with the respect they deserve.  Frequently understaffed.

• Tech:  Your helping hand.  Responsible for a long laundry list of tasks including: recording vitals, running EKG's, assisting nurses in complex tasks (i.e. wound care, etc), helping you to the restroom, helping with your grooming/bathing/dressing & managing your transfers (moving from the chair to the bed, etc) so you won't fall.  Also many times get stuck running patient's errands.  Be very nice to them.  They are not your servants. Also frequently understaffed.

• Social Worker:  Your tour management company.  Responsible for coordinating your admission and discharge.  Arranges home services, equipment, transportation and plugs you into community, government resources.  Tracks down absent family members to assist with your care upon discharge & obtain data on your advanced directives, insurance, etc if you are unable to do so.  Manages the majority of communications with your family as a whole.  Directs "family meetings" about end-of-life issues & your care plan.  Overworked, underpaid and usually extremely nice people.

• Physical Therapist (PT):  Your Coach.  The key to your physical independence.  Their job is to help you walk again, get you strong, and push you to become as independent as possible. They are experts in the appropriate exercises for each specific surgery, illness or injury.  They generally tailor your program to return to or exceed your pre-hospital activity level upon discharge or after home/outpatient care.  They focus primarily on training the lower body and OT usually focusses on the upper body, but there is overlap. These people are extremely nice and motivated.  I have yet to meet a PT (or OT for that matter) that I don't like.

• Occupational Therapist (OT): Your ADL guru.  In rehab, the term "ADLs" refers to "Activities of Daily Living" and OT's are the experts in these.  Eating, bathing, dressing and toileting are the basics, but their skills range to helping physically replicate your daily routine (i.e. cooking, laundry, etc) to allow you to function as independently as possible at home.  They are extremely innovative in providing you with adaptive devices that can allow you to function independently--from splints to "reachers."  Once again, nicest people ever!

• Speech-Language Pathologists: Your Translator. Most of you will not meet these therapists but if you have trouble swallowing, speaking or processing language (like after a stroke), these people will be your best friend.  They are exceptionally well-trained and patient.  They do things ranging from the extremely technical (modified barium swallows and FEES to determine the quality of your ability to swallow) to the physical (speech & swallow exercises).  They also do cognitive assessments in patients with suspected dementia or brain injury.  Once again, like all the other therapists--I have found them to be VERY kind.

• Nurse Pracitioners & Physician's Assistants:  Your Doctor's Point Person.  Depending on what state you are in, responsibilities & level of independence of NP's and PA's varies.  Detailing the differences between each & their training is going to have to be a future independent post as it is very complicated to describe each one's scope of practice.  For your purpose's know that they are the DIRECT line to your doctor.  They often have more experience than the doctor they work with and can offer you very important information.  They will manage your day to day care in the hospital if the doc doesn't have any residents (and sometimes even when the doc does!). If they are a surgeon's PA or NP they are often in the OR with the Doc assisting in the surgery as well.

• Doctors: Your Team Leader:  I'm going to devote a whole post this week to doctors.  For now know that the different categories of doctors include:
• Attendings
• Fellows
• Residents
• Interns
• Medical Students

• Dietician:  Your secret weapon. Obviously I'm a huge fan of anyone whose job revolves around helping my patients become nutritionally healthy.  The dietician does nutritional assessments, makes recommendations to the team on how to nutritionally optimize your ability to heal and can intercede on your behalf to improve your meal choices & content.  Once again, very nice, very smart people.

Other people you will see who are not involved in DIRECT clinical patient care include:

• Administrative Assistant for the Unit (also known as the Unit Secretary depending on the hospital):  This person has a crazy intense job.  They answer phones & patient call lights & communicate needs to nursing staff.  They organize all the massive paperwork in everyone's charts.  In hospitals without electronic medical records, they enter all the orders.  They administratively admit & discharge patients--serving as a hub for coordinating all the services on the floor--from housekeeping to transport to maintenance.  I'm sure I've missed a bunch of stuff but you get the gist.    
• Housekeepers:  Big job, small time frame.  These folks have to clean and sanitize rooms between patients (very time-pressured turn around) AND make sure patient rooms are kept hygienic.  They deal with contaminated trash & are responsible for managing all that laundry you see everywhere! A key role in minimizing hospital infectious diseases. Without them, all those MRSA and VRE patient rooms would spread disease from one patient to another. A lot of work, very underappreciated.
• Dietary Staff:  manage your food--from ordering to delivering.  You see these folks three times a day and often their sunny moods (or lack thereof) really sets the tone for the day.  They have to keep food hot through long distances and make sure that each patient gets the right food (key--we don't want the kosher patient eating pork, etc!).  A busy job!

{NOTE:  I know the above descriptions do not NEARLY capture the full extent of the responsibilities in each position!  I just tried to hit the highlights!!}

Next Time on Medical System Tuesdays (new feature on the blog):

• Tip #7:  Know Your Doctors: A Short Guide to Hierarchy! ~ More Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Coming Up THIS Week!

• SuperImmunity Foods for KIDS (Calling All PARENTS!)
• RECIPES & Ideas: Snacks!  YUMMY & Portable Plant-Based Snack Food--all sugar-free, gluten-free & without adding oil or fat!!

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.

Tip #5: What is the Hospital Routine? (Insider Tips on How to Get the BEST Medical Care in the Hospital)

Being in the hospital is literally like moving to a foreign country.  People eat & sleep at different times. There are all these people wandering around but you don't who they are or what they do.  A lot of the time it feels like everyone is speaking a foreign language.


Tips #5 & #6 are your travel guide:  


Tip #5:  Know the hospital routine:

• Nurses & Techs usually change shift at 7 am & 7 pm.  If you want ANYTHING (especially pain medication) ask for it BEFORE 6pm or 6am.  Do not expect to have any response to requests between 6:45pm-8pm or 6:45am-8am unless it is an emergency & you are seriously ill.  Family members & patients:  do not ask to talk to a nurse during this time frame.  Why? They are giving report to the next nurse or tech.  If you want the next nurse to have ALL the important details about your family member or yourself than you should allow them to transfer care uninterrupted.  Your care on the next shift will be better!

• Social Workers:  they usually work 8am to 4/5pm & are INCREDIBLY busy & overworked.  Most ones I know end up staying after the time they are supposed to leave.  If you want to meet with them, don't ask to do so after 3pm.  Ask early & it will happen.  Ask late & you may have to wait until the next day.

• Physical & Occupational Therapists:  they usually work 7am-4pm.  They usually see their last patient at 3pm.  You will not be able to talk to them after this time & You probably won't ever have therapy after 3pm.  

• Dietary Staff & the Kitchen:  They bring trays to patients at Breakfast (usually 6am-8am); Lunch (usually 11am-1pm) & Dinner (usually 5pm-6:30pm).  If you want snacks in between meals you will need to talk to the Dietician or the Nurse.  On the floor they usually have a few sodas, crackers, applesauce/pudding & juices.  Don't expect a big spread in between meals.

• Doctors:  We usually sign-out our patients around 5pm to the person covering for the night.  This does not mean we leave then--I regularly work past 6pm--but what it does mean is that if you ask for your doctor after 5pm you usually won't get them (you will get the night person).  Ask before 4pm if it is urgent that you see them that afternoon.  But as noted above, if you have further questions that aren't answered in the a.m. rounds & are very important to be answered that day, ask the doctor in the morning if they have time to come back in the afternoon before they leave

Next time:  Tip #6:  Know the Role That Each Person Plays In The Hospital Team ((Who ARE These Different People Taking Care of You & What DO They Do??!!))

Coming Up AFTER Thanksgiving:

• SuperImmunity Foods for KIDS (Calling All PARENTS!)
• RECIPES & Ideas: Snacks!  YUMMY & Portable Plant-Based Snack Food--all sugar-free, gluten-free & without adding oil or fat!!

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.

When You Have a Family Member in the Hospital You Start to Realize How Much It Helps to Know How To Navigate the Hospital World!!

Its been a stressful week for me and I'm glad that I pre-wrote & scheduled my posts for this week because I would have had to take a blogging hiatus!  I have a close family member in the hospital and they are getting better but I've become acutely aware how hard it is to navigate the system as a non-medical person!  


Sometimes I felt like I was translating a foreign language when explaining to my family what was going on.  This is not because my family is not intelligent--they are, extraordinarily so in my opinion:-)--but the medical world & the outside world are SO far apart sometimes!!!  


I've realized this before (& I'm sure my doc/nurse/etc readers will agree that we are aware there is some translation needed from medical lingo to layperson speak) but every time I'm on the other side of the fence (coming from the patient's side as opposed to the doctor's side) I wonder how people without medical family members figure out what is going on!!!????


I had already planned a post for this week on "Getting the Best Medical Care: Tips for Patients" (ironic, huh!) but I think I'm going to need to expand that post into two separate posts:  one for inpatient/hospital care and one for outpatient care.   Keep your eye out.  I have to say that when these posts come out I'd really recommend emailing them to family & friends.  I think it can make a huge difference in your hospital & outpatient experiences to know how to the system works from a doc's perspective as well as know how to get the best out of your doctors, nurses, social workers, techs & therapists!!