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Arming patients to partner in their care
Encourage patients to ask questions
Traditionally, patients have been cast in a passive role in their own health care. Now, "patient involvement" has become an oft-heard term in hospital regulations and discussion, with acknowledgement that patients themselves can play an integral role in their care. How does The Joint Commission promote encouraging patients to speak up?
There are two particular ways, says Paul Schyve, MD, senior vice president of The Joint Commission: National Patient Safety Goal #13 addresses patient involvement and the organization's "Speak Up" campaign. As far as complying with NPSG 13, which requires that "the hospital encourages patients and families to report concerns about safety," Schyve says hospital personnel must tell patients and their families how to do that. "Just to inform people about the method is not the same as encouraging it," he says. "I think it's important that it be told to the patient and the patient's family in a way that actually says, 'This is important. You can actually help us make use safer.'"
We're talking about more than patient rights, he says. It's something important and that must be actively encouraged and any concerns addressed must be taken seriously whether they are real or just imagined.
"While the idea is to fairly broadly identify ways to involve patients in their care and safety issues around the care, the specific requirements are first that patients be educated about how they can report their concerns," Schyve says. "Second is that, in particular, the patient be informed about what kind of inspection control measures are in place... A third thing is patients should also be told about what's being done to provide for their safety in surgery."
As part of its "Speak Up" campaign, The Joint Commission offers various brochures that can be downloaded from its site to encourage and educate patients on what they can, and should, ask about. Topics include avoiding mistakes during surgery, preventing errors with medication, and planning follow-up care
"I think making it part of the process to invite questions and invite the input makes a huge difference. So sort of building that into the scripts of patient interaction. 'What questions do you have? Is there anything you may be concerned about? Have I explained everything so that you understand?'" says David J. Shulkin, MD, president of Beth Israel Medical Center in New York City, who has written a book, Patients need to ask: Essential information every patient needs to know, to arm patients with information they should know to change their role from passive to active.
He says his goal in writing was to put himself inside the head of the patient. "This is not necessarily a new concept... But what I felt was really missing was having the specific information that patients needed to have when they came into the hospital. What types of questions, what types of issues should they really be alerted for, and what are the biggest vulnerabilities in hospitals?"
Quality improvement directors should be aware of the questions patients should ask to ensure safer care and encourage them to voice those questions. Shulkin says those include "the most obvious one," which is to teach patients that they have the right to ask every clinician who enters their room to wash their hands before an examination. Also, he says, "if you are going to be receiving blood, you should ask your nurses to do two separate identification checks to make sure the unit that is going to be given to you is the proper one." He tries to empower patients to ask nurses when they come to administer medicine what the medications are and what the dose is. For patients coming to the hospital for a surgical procedure, physicians should let the patient know about the processes and procedures they employ for the safety of the patient.
If a health care professional puts anything invasive in a patient's body — for instance, a central line — and he or she isn't wearing a mask, gown, and gloves, the patient should speak up, Shulkin says. Patients should know when prophylactic antibiotics should be given prior to surgery and prompt the clinicians if they are not given. Also, they should be aware of how long catheters should be left in and prompt caregivers if they are left in longer than that.
Schyve cites a study, "Rehospitalizations among Patients in the Medicare Fee-for-Service Program" in the April 2 issue of The New England Journal of Medicine that looked at the number of patients readmitted to the hospital within 30 days of discharge. "In the case of 50.2% of the patients who were rehospitalized within 30 days after a medical discharge to the community, there was no bill for a visit to a physician's office between the time of discharge and rehospitalization," the authors write.
"In order to help provide for safety for the patient, one of the things that we encourage patients to do while in the hospital is to really be active themselves in getting their discharge planning going and getting their questions answered about what's going to happen after they leave the hospital," Schyve says.
Patients not looking at performance measures
Schyve says studies that have looked at how much patients use the public data available on sites such as Hospital Compare indicate that only a small minority use that information to make choices about their care. Most patients still rely on friends' or physicians' recommendations or word of mouth. "So the data that are available, even when you can look at it and say, 'Gee, it looks like it's pretty easy to understand and could be useful,' it's clearly not used to the extent people hoped." But that could change, he adds, as more data are released and more sources tell consumers it's there for their use. "Secondly, I think with a generational change, those who are used to going easily to the internet to get information are more likely to look for that information. And that probably increases the likelihood they're going to use it."