Presentation covers ideas and tools to use to improve the safety of your care as an outpatient and an inpatient in the hospital

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Improving the Safety
of Your Healthcare
(being an educated patient, advocating for
yourself, safe and patient-centered care)
For Metro Maryland Ostomy Association
March 12, 2017
Noel E. Eldridge, MS
noel.eldridge@ahrq.hhs.gov
neldridge202@yahoo.com
301 427-1156
240 641-3714

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What is Patient Safety
Improvement Trying to Achieve?
 Our goal is to prevent harm to patients as
they receive medical care. For example…
 Adverse Drug Events (overdose, wrong drug,
drug interaction, etc.)
 Wrong or Mixed-up Procedure, Test, or X-ray
 Patient Falls and Wandering Patients
 Healthcare-acquired Infections
 Problems with Medical Devices –
Malfunctions or Accidental Misuse

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Books for Patients amazon.com
Take This Book to the Hospital With You:
A Consumer Guide to Surviving Your Hospital
Stay
(4.5 stars)
 by Charles B. Inlander
Buy this book with
How to Get Out of the Hospital Alive
(4.5 stars)
 by Sheldon P. Blau, Elaine Fantle Shimberg

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I’m not a doctor or a nurse
 Information here is based:
 On personal experiences
 Reading and learning about adverse
events in healthcare on my jobs over
the last 16 years
 Listening to lots of doctors and nurses
 New tools developed at the Agency for
Healthcare Research and Quality
• Where I work, but I haven’t worked on these tools

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Participating in Other Settings
 What do city bus passengers have to do?
 Get on the correct bus & pay the fare
 Follow basic bus rules – stay behind white
line, don’t talk to driver while bus is in motion,
don’t do anything crazy like leaning out of an
open window
 Keep track of where you are -- look out of the
window so you can ring bell at correct place to
get off
 Not like the extremes of being an airplane
passenger or driving your own car

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Patients Participating in Patient Safety
 Hospital inpatients shouldn’t have to do a lot.
Primary responsibility for inpatients is with
hospital and healthcare providers. Why?
 People are sick in the hospital – even sicker than they
used to be.
 Many sick people aren’t at their best mentally (I know
this firsthand).
 Sick people receiving healthcare shouldn’t have to be
vigilant about it. (my opinion)
 Participating as an outpatient in primary care
settings like doctors’ offices
 Maybe more potential for detailed involvement in
these settings than in hospitals

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What Patients Can Do (1)
 Before Surgery: Participate in informed
consent that is really informed and really
consent. (Think mortgage, not rental-car
agreement.)
 Ask your surgeon:
• Exactly what will you be doing?
• About how long will it take?
• What will happen after the surgery?
• How can I expect to feel during recovery?
• Tell the surgeon, anesthesiologist, and nurses
about any allergies, bad reaction to anesthesia,
and any medications you are taking.

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What Patients Can Do (2)
 Ask questions until you understand to
the extent that you care to understand.
 Try hard not be accusatory as you ask
questions, doctors and nurses intend to
help…and most of the time that’s what
will happen (or at least no harm).
 Pay attention to the extent possible.
 Willingly participate in safer systems –
e.g., don’t complain about being asked
your name 3 times by 3 different people.

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What Patients Can Do (3)
 Before an Office Visit: Make a written list
of symptoms, questions, etc., to review
during visit or interaction with clinician.
 Tell the doctor the truth about your
symptoms and history.
 Take your medicine or tell the doctor if
you stop.

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What Patients Can Do (4)
 Ask your doctor to provide you with a list of
the medications he/she has prescribed for you
– and keep it up to date. Add on any non-
prescription drugs that you take regularly
 When there’s a “better” choice – actually
choose the better specialist, hospital, health
plan, etc. But, one problem is defining better
• What’s better? more timely, nicer, smarter, more
up-to-date, safety-conscious, good listener, good
referrer, gentler, etc.?

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Special Ostomy Topics to Ask
About and Understand
 Hydration (drink more water than other people)
 Consider Potential for Blockages (carefully
consider what you eat – based on physician
advice and your own experience -- and chew!)
 Skin Care is Very Important
 Potential for Hernias or Abscesses
 Get Follow-ups as Recommended by your
Physician(s) or Nurses
 Ask if a Hospital has WOC Nurse(s)

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Official Agency Patient Safety
Advice for Patients
 Patient and Family Engagement has become a
major topic of interest in recent years
 Agency for Healthcare Research and Quality
Resources:
 https://www.ahrq.gov/patients-consumers/patient-
involvement/ask-your-doctor/index.html
• The 10 questions you should know
• Questions to ask before your appointment
• Questions to ask during your appointment
• Questions to ask after your appointment
• Build your own list of questions

13. The 10 Questions You Should Know
1. What is the test for?
2. How many times have
you done this procedure?
3. When will I get the
results?
4. Why do I need this
treatment?
5. Are there any
alternatives?
6. What are the possible
complications?
7. Which hospital is best for
my needs?
8. How do you spell the
name of that drug?
9. Are there any side
effects?
10. Will this medicine interact
with medicines that I'm
already taking?
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14. Before Your Appointment
 Prepare your questions
 Time is limited during doctor visits. Prepare
for your appointment by thinking about what
you want to do during your next visit. Do you
want to:
• Talk about a health problem?
• Get or change a medicine?
• Get medical tests?
• Talk about surgery or treatment options?
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15. During Your Appointment
 Things to ask and understand
 What is my diagnosis?
 What are my treatment options? What are the
benefits of each option? What are the side effects?
 Will I need a test? What is the test for? What will the
results tell me?
 What will the medicine you are prescribing do? How
do I take it? Are there any side effects?
 Why do I need surgery? Are there other ways to treat
my condition? How often do you perform this
surgery?
 Do I need to change my daily routine?
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16. After Your Appointment
 Times when you should follow up on your
care and call your doctor:
 If you experience any side effects or other problems
with your medicines.
 If your symptoms get worse after seeing the doctor.
 If you receive any new prescriptions or start taking
any over-the-counter medicines.
 To get results of any tests you’ve had. Do not assume
that no news is good news.
 To ask about test results you do not understand.
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17. New “Question Builder” web site
 Step 1: Choose the kind of appointment
you need.
 To talk about a health problem
 To get or change a medicine
 To get medical tests
 To talk about surgery
 See www.ahrq.gov/patients-
consumers/question-builder.html
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18. Medication List
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19. Patient Prep Card
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20. This whole set of my slides is on-
line on the Internet
 Go to www.slideshare.net and search for
Noel Eldridge
 Or go to:
www.slideshare.net/neldridge202/presentations
 Or go to: this specific presentation’s link
on the slideshare.net site:
https://www.slideshare.net/neldridge202/pr
esentation-for-metro-maryland-ostomy-
association-march-2017
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21. One more thing, if getting surgery… Ask about
“Enhanced Recovery After Surgery”
 ERAS is a clinical care pathway and approach to
surgical care that promotes the delivery of evidence-
based perioperative care and reduces variability. It’s
spreading now. Key elements of ERAS include:
 Patient and family engagement, including counseling
about expectations for surgery and recovery
 State-of-the-art analgesia (pain treatment), which
minimizes the use of narcotics and promotes multimodal
analgesia
 Early mobility (walking) and restoration of functional status
(activities of daily life)
 Avoidance of prolonged periods of fasting (especially
before surgery)
 Evidence-based best practices for preventing surgical site
infections, venous thromboembolism and catheter-
associated urinary tract infection prevention
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22. Thanks
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