After hearing the perspectives of patients, providers and leaders from Indigenous communities on how they perceive safety and what solutions are/ can be implemented, we will leave the session with at least one practical idea for engaging all patients, families and/or the public in improving patient safety.
Consumer Attitudes About Comparative EffectivenessMSL
Evidence as an essential—but insufficient—ingredient for medical decision-making. Presentation to the National Comparative Effectiveness Summit by Chuck Alston, SVP and Director of Public Affairs at MSLGROUP Washington, DC on September 16, 2013.
After hearing the perspectives of patients, providers and leaders from Indigenous communities on how they perceive safety and what solutions are/ can be implemented, we will leave the session with at least one practical idea for engaging all patients, families and/or the public in improving patient safety.
Consumer Attitudes About Comparative EffectivenessMSL
Evidence as an essential—but insufficient—ingredient for medical decision-making. Presentation to the National Comparative Effectiveness Summit by Chuck Alston, SVP and Director of Public Affairs at MSLGROUP Washington, DC on September 16, 2013.
Va Health Literacy Research Presentationguest169e62f
What is the Impact of Low VA Patient Literacy on VA Diabetes Patient Educational Initiatives?
Department of Veterans Affairs Medical Center, North Chicago, IL USA
Jim Warren
National Institute for Health Innovation (NIHI)
The University of Auckland
The presentation was accompanied by this video:
http://www.youtube.com/watch?v=jbvmGqmIxXY
M. Chris Gibbons - Health IT and Healthcare DisparitiesPlain Talk 2015
"Health IT and Healthcare Disparities" was presented at the Center for Health Literacy Conference 2011: Plain Talk in Complex Times by M. Chris Gibbons, MD, MPH, Associate Director, Johns Hopkins Urban Health Institute.
Description: This presenter will discuss the use of technology and consumer health information to improve healthcare disparities.
Patient Focus within Healthcare CongressesPYA, P.C.
As the doctor-patient relationship evolves, the terms “patient activation and engagement” are cropping up more frequently in healthcare circles, including the International Pharmaceutical Congress Advisory Association (IPCAA) Conference in Philadelphia. PYA Principal Kent Bottles, MD, who is also chief medical officer of PYA Analytics, presented “Patient Focus within Healthcare Congresses.”
The goal of this webinar is to help hospice and healthcare professionals understand the history, philosophy and practice of hospice care and palliative care, including common myths and misconceptions, common diagnoses for hospice referrals, identification of hospice-eligible patients, reimbursement for hospice services, and the benefits of advance care planning and early referrals.
The Rise of Chronic Illness & Healthcare's Failed Value PropositionNick Gaudiosi
Using my personal health journey as a backdrop, this presentation looks at the healthcare economy and the intersection of medicine and wellness. I am not a clinician, but a healthcare marketer and executive with insights about how to build a category leading brand in the health & wellness economy. Building a leading health and wellness brand has a lot to do with authenticity. The next few slides are about my personal journey – and my authenticity in the health and wellness space – as a patient, consumer, caregiver, executive and innovator. Part I takes a brief look at the Rise of Chronic Illness and Healthcare's Failed Value Proposition. In Parts II. - IV, we explore how American's have extreme difficulty attaining wellness and why the cards are stacked against healthcare providers. Then we look at the business of wellness and the patient of the future.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Va Health Literacy Research Presentationguest169e62f
What is the Impact of Low VA Patient Literacy on VA Diabetes Patient Educational Initiatives?
Department of Veterans Affairs Medical Center, North Chicago, IL USA
Jim Warren
National Institute for Health Innovation (NIHI)
The University of Auckland
The presentation was accompanied by this video:
http://www.youtube.com/watch?v=jbvmGqmIxXY
M. Chris Gibbons - Health IT and Healthcare DisparitiesPlain Talk 2015
"Health IT and Healthcare Disparities" was presented at the Center for Health Literacy Conference 2011: Plain Talk in Complex Times by M. Chris Gibbons, MD, MPH, Associate Director, Johns Hopkins Urban Health Institute.
Description: This presenter will discuss the use of technology and consumer health information to improve healthcare disparities.
Patient Focus within Healthcare CongressesPYA, P.C.
As the doctor-patient relationship evolves, the terms “patient activation and engagement” are cropping up more frequently in healthcare circles, including the International Pharmaceutical Congress Advisory Association (IPCAA) Conference in Philadelphia. PYA Principal Kent Bottles, MD, who is also chief medical officer of PYA Analytics, presented “Patient Focus within Healthcare Congresses.”
The goal of this webinar is to help hospice and healthcare professionals understand the history, philosophy and practice of hospice care and palliative care, including common myths and misconceptions, common diagnoses for hospice referrals, identification of hospice-eligible patients, reimbursement for hospice services, and the benefits of advance care planning and early referrals.
The Rise of Chronic Illness & Healthcare's Failed Value PropositionNick Gaudiosi
Using my personal health journey as a backdrop, this presentation looks at the healthcare economy and the intersection of medicine and wellness. I am not a clinician, but a healthcare marketer and executive with insights about how to build a category leading brand in the health & wellness economy. Building a leading health and wellness brand has a lot to do with authenticity. The next few slides are about my personal journey – and my authenticity in the health and wellness space – as a patient, consumer, caregiver, executive and innovator. Part I takes a brief look at the Rise of Chronic Illness and Healthcare's Failed Value Proposition. In Parts II. - IV, we explore how American's have extreme difficulty attaining wellness and why the cards are stacked against healthcare providers. Then we look at the business of wellness and the patient of the future.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Patient Directed Care; Why it’s important and what does it really mean?Spectrum Health System
Understanding the importance of effective patient centered communication for patient engagement and improved health outcomes. Will discuss the importance of patient directed care and its relationship to the quadruple aim. Will discuss the barriers and a framework for conversations that are critical to patient directed care and cultural competency.
Join international leader in Palliative Medicine, Dr. Cleary, as he discusses a variety of unique issues faced by late stage colorectal cancer patients, including the integration of palliative care, end of life planning, keeping hope alive, and more.
Psychological and Behavioral Implications in Older Adults with CancerSpectrum Health System
Through Case Presentation and Dydactics, participants will gain an understanding of the psychological and behavioral impact cancer has on older adults.
Narrative medicine as a tool to detect the burden of illness: an application to myelofibrosis. Progetto realizzato da ISTUD per Novartis. Presentazione di Maria Giulia Marini.
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Presented at Kansas City University of Osteopathic Medicine 10/27/15 in Lecture Series in Bioethics. See live presentation here: https://www.youtube.com/watch?v=Dr3g3PeVKeo
Similar to Sherri Loeb - "The Impossible Dream": Safe, High-Quality, High-Reliability and Patient-Centered Care (20)
Jon Rubin & Katherine Spivey - User-Useful Government Websites: Intersection ...Plain Talk 2015
Presented by Jonathan Rubin, MA, & Katherine Spivey, MA, on March 13, 2015 at the fifth Center for Health Literacy Conference: Plain Talk in Complex Times.
Claire Foley & Tracy Torchetti - Editing Health Information for a Limited Eng...Plain Talk 2015
Presented by Claire Foley, MA, & Tracy Torchetti, MA, on March 12, 2015 at the fifth Center for Health Literacy Conference: Plain Talk in Complex Times.
Anthony Roberts Jr. & Meico Whitlock - Using Twitter Town Halls as a Tool to ...Plain Talk 2015
Presented by Anthony Roberts Jr., MS, & Meico Whitlock, MS, on March 12, 2015 at the fifth Center for Health Literacy Conference: Plain Talk in Complex Times.
Daniel Patrick Forrester - Reflection in an age of immediacyPlain Talk 2015
Presented by Daniel Patrick Forrester, MBA, on September 26, 2013 at the fourth annual Center for Health Literacy Conference: Plain Talk in Complex Times.
Christopher Tashjian - How technology is changing rural medicine: Fact, not t...Plain Talk 2015
Presented by Christopher Tashjian, MD, FAAFP, on September 27, 2013 at the fourth annual Center for Health Literacy Conference: Plain Talk in Complex Times.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
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CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
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Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
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The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Sherri Loeb - "The Impossible Dream": Safe, High-Quality, High-Reliability and Patient-Centered Care
1. “The Impossible Dream”
Safe, High Quality, and Patient
Centered Care…
Our Perspective On A Broken
Healthcare System
1
Sherri T. Loeb, RN, BSN
sherriloeb@gmail.com
Copyright: 2013: Sherri T. Loeb RN, BSN !
3. Jerod’s Health Care Journey.....
• Routine physical in August 2011, was asymptomatic and felt in perfect
health; only complaint – minor low back pain
• PSA at the end of 2009 – 1.29 Normal value is 0-6.5 depending on age and
race
• PSA in 2011 – 535
• Biopsy: Gleason 8 (4+4) (positive 3 of 12 core samples)
• Stage IV prostate cancer at diagnosis with significant bone metastases
3Copyright: 2013: Sherri T. Loeb RN, BSN & Jerod M. Loeb, PhD.
4. A Tale of Two Cities
• August 2011 – December 2011
• Treated locally with std of care tx – failed initial therapy after a
little over 3 months of treatment
• Next option – std of care – “what insurance would cover” – No
talk about additional options, or clinical trials besides double
blind. Nothing geared specifically towards aggressive case.
• Fall 2011 - Diagnostic clinical trial NIH
• December 2011-January 2013 - Entered clinical trial after
failing1st line tx. Self referral to MD Anderson Cancer Center
in Houston Texas.
• January 2013 – Metastasis to liver and bone marrow, DIC,
Tx with two IV chemo agents and returned to almost full
functional status. IV combo not available locally.
4
5. A Tale of Two Cities
• June 2013- October 2013 “Magic” Chemo stops
working
• New chemo agent started – again not std of care locally
but showing promise at MD Anderson
• August 2013 – Liver mets and DIC return - one last
chemo suggestion –
• October 2013 Hospice care
• Passed away October 9, 2013
5
7. 7
Local Hospitalization -
July 2013
• Missing vital signs
• No patient assessment
• Bypassing of CPOE alarm system
(audible and visible)
• No communication among
caregiver(s) and patient/family
members or physician to physician
• Lack of hand hygiene/Pt. ID
• Absence of Shared decision-making
Picc line experience
Copyright: 2013: Sherri T. Loeb RN, BSN & Jerod M. Loeb, PhD.
• 100% Hand Washing
• Phenomenal Communication – White
boards in ED and Inpatient Rooms
• Bedside Handoff Report between RN’s
• Patient Centered Compassionate Care
• Shared Decision Making
• Patient and Family Engagement
• Team Approach
• Excellent Transitions in Care
• Patient Safety Key in all areas of care
First Hospitalization in
Houston Cancer Center –
January 2013
8. Surviving A Health Care Crisis Requires Having
An
Relative/Friend With You At All Times
• Even health care professionals become
deaf, dumb and blind when in crisis mode
about their own health
• Navigation of the health care system
requires a map, a guide, and an
extraordinary amount of skill and stamina
– even for those who work in the system
• And that is before you have to deal with
insurers
88!
Copyright: 2013: Sherri T. Loeb RN, BSN & Jerod M. Loeb, PhD.
9. We Have Seen The Best Of Health Care And The
Worst Of Health Care….
• Drugs that work and then stop working
• Physicians who prescribe drugs that should not be
prescribed together
• Dispensing errors; failures to accurately reconcile
medications
• The interesting phenomenon of being hurt in order to be
helped
• Unanticipated drug-drug interactions
• Forgetting to be told the results of significantly abnormal
laboratory results
• Almost never being given good news without the
inevitable "but" that all cancer patients can associate
with
• An association with several oncologists who care and are
extraordinary role models - and some who are not
99!
Copyright: 2013: Sherri T. Loeb RN, BSN & Jerod M. Loeb, PhD.
10. Communication Failures Are The Rule
And Not The Exception
• Literacy levels are low…..and health
literacy levels are even lower
• Communication failures at transitions of
care are nearly ubiquitous…..and harm
patients every day
• These failures occur between physicians
and physicians, physicians and nurses,
nurses and nurses, and between all types
of caregivers and patients
1010!
Copyright: 2013: Sherri T. Loeb RN, BSN & Jerod M. Loeb, PhD.
11. 11
• With increased attention on transitions of care in light
of the recent scrutiny of duty hours, consultations and
other interphysician interactions, such as handoffs, are
becoming increasingly important. As modern medicine
increases in complexity, the skill of communicating
with medical colleagues throughout the continuum of
care becomes more challenging.
I’m Clear, You’re Clear, We’re All Clear: Improving
Consultation Communication Skills in
Undergraduate Medical Education
Academic Medicine, June 2013 - Volume 88 - Issue 6 p 753-758 Kessler,
Chad S. MD, MHPE; Chan, Teresa MD; Loeb, Jennifer M.; Malka, S. Terez MD
14. 14
The Reality......!
“I have the distinct feeling that the
patient in America is becoming invisible.
She is unseen and unheard....I gently
insist that we go to the bedside, but that
is often a place where the team is no
longer at ease. I realize what has
happened: the patient in the bed is
merely an icon for the real patient in the
computer.” A. M. Nussbaum, MD!
A Piece of My Mind!
JAMA!
July 17, 2013!
15. 15
Shared decision making is an approach where
clinicians and patients communicate together using
the best available evidence when faced with the task
of making decisions, where patients are supported
to deliberate about the possible attributes and
consequences of options, to arrive at informed ...
http://en.wikipedia.org/wiki/Shared_decision_making
16. …But Is It Truly Accepted And
Practiced??
The Value of Sharing Treatment Decision Making with Patients –
Expecting Too Much?
• Ethical responsibility of clinicians to facilitate patient involvement in
treatment decision
• More engaged patients are more informed
• Objectives of SDM are to fully inform patients and their families about
treatment options including risk and benefits and patient values and
preferences
• Does not support its potential to reduce overtreatment and costs.
• Clinicians are not adequately trained to facilitate SDM, especially eliciting
patient values and preferences for treatment.
16
JAMA October 16, 2013 Page 1559!
Corresponding Author: Stephen J. Katz MD, MPH!
!
JAMA VIEWPOINT
19. 19
“I think there is a
revolution coming. In the
past, patients were
expected to be obedient
and compliant.”
Harlan M.
Krumholz, MD, SM
Yale School of
Public Health
July 2013
20.
21. Patient and Family
Engagement
A set of beliefs and behaviors by patients, family
members, and health professionals and a set of
organizational policies, procedures and interventions
that ensure both the inclusion of patients and families
as central members of the healthcare team and active
partnerships with providers and provider organizations.
Benjamin K. Chu, M.D. Chair of the AHA’s Board of Trustees
21
22. “What I’ve learned from my odyssey thus
far…
We need to listen to the real voice of the
patient. What he/she is thinking/feeling/or
believing. I gave them lip service. I know
that now…I didn’t know that then.”
From John M. Eisenberg Honorary Lifetime Achievement
Award in Patient Safety and Quality - 2011
22Copyright Jerod M. Loeb, PhD April 2012
23.
• You treat a disease, you win, you lose. You treat a person, I
guarantee you, you’ll win, no matter what the outcome.
• Our job is improving the quality of life, not just delaying
death.
• We need to start treating the patient as well as the disease.
• You actually are a doctor and admitted it, you’d say, “I don’t
cure a huge percentage, I don’t have a 50 percent cure rate…
(but) I can have a 100 percent compassion rate.”
Hunter “Patch” Adams MD 1998
23
24. Patient Expectations 100%
of Time
• To be always told the truth.
• To have things explained to me fully and clearly.
• To receive an explanation and apology if things go wrong.
-Jim Conway, IHI presentation
25. Patient Expectations 100%
of Time
• To be listened to, taken seriously, and respected as a
care partner.
• To have my family/caregivers treated the same.
• To participate in decision-making at the level I choose.
-Jim Conway, IHI presentation
27. 27
Patient-centered care supports active
involvement of patients and their families in
the design of new care models and in
decision-making about individual options for
treatment. The IOM (Institute of Medicine)
defines patient-centered care as: "Providing
care that is respectful of and responsive to
individual patient preferences, needs, and
values, and ensuring that patient values guide
all clinical decisions."
Donald Berwick MD, MPA!
28. • Words can never express the gratitude of a terrified
parent when such kindness is shown … when we feel
seen, and that we matter. Think about it: as hospital
patients, a parade of people you do not know have
license to pierce and cut your skin, waken you out of
your sleep, expose your body, move your things out
of your reach, or refer to you as “the knee
replacement in 305.”
PAT MASTORS PATIENT | AUGUST 5, 2013
The gratitude of a terrified
patient when kindness is shown
29. 29
Reasonable
Expectations
That
Patients
Who
Are
Seriously
Ill
Deserve
To
Have
Ful>illed:
•
To
have
one’s
pain
and
other
physical
symptoms
regularly
assessed
and
competently
treated.
•
To
have
adequate
information
about
one’s
condition
and
treatments,
in
clear
and
simple
terms.
•
To
have
care
coordinated
between
visits
and
among
physicians
and
health
programs
involved
in
one’s
care.
•
To
have
crises
prevented
when
possible
and
have
clear
plans
for
managing
emergencies
in
place.
•
To
have
enough
nurses
and
aides
on
staff
in
hospitals
and
nursing
homes
to
provide
safe
and
high
quality
care
•
To
have
one’s
family
supported
in
giving
care,
in
their
own
strain
and,
eventually
,
in
their
grief.
Ira Byock MD!
The Best Care
Possible!
30. Making Individual Health Care Decisions
Can Be Hard – Even With Good Evidence
And Even For Someone In The Field For
Many Years
Technical Quality Is Important -
But So Too Is Patient Experience Of
Care
3030!
Copyright: 2013: Sherri T. Loeb RN, BSN & Jerod M. Loeb, PhD.
31. Every hospital should have a plaque
in the physicians’ and students’
entrances:
There are some patients whom we
cannot help; there are none whom
we cannot harm
31
Stanford University medical professor Arthur Bloomfield
34. 34
• Outpatient medication errors
• Lack of medication reconciliation leading
to missing of medications
• Medications that remain forever on
medication lists
• Wrong indication for medications
• Pharmacy/pharmacist attitudes
Med Rec and Med Errors!
Copyright: 2013: Sherri T. Loeb RN, BSN & Jerod M. Loeb, PhD.
35. 35
Ben Kolb
Died, Age 7
Medication Error
Errors Waiting To Happen
Jerod M. Loeb, PhD, January 2013!
36. 36
Our Most Recent Medication Error
Copyright: 2013: Sherri T. Loeb RN, BSN & Jerod M. Loeb, PhD.
37. 37
One Of My Medication Errors
Copyright: 2013: Sherri T. Loeb RN, BSN & Jerod M. Loeb, PhD.
45. 45
FINDINGS: No intracranial hemorrhage. Mild patchy areas of
low-attenuation in the periventricular and subcortical white matter
bilaterally. Small area of encephalomalacia in the right high
convexity parietal lobe cortex A small area of right anterior
frontal lobe encephalomalacia. The rest of the brain
demonstrates preserved gray-white differentiation. No
hydrocephalus or midline shift."
"
Basal cisterns are patent. Visual is paranasal sinuses and
mastoid air cells are clear"
"
"
IMPRESSION: Intracranial bleed. Encephalomalacia in the
right cerebral hemisphere with patchy areas of low-attenuation in
the white matter, which are nonspecific. These may represent
ischemic degenerative changes of the brain, although would be
extremely early for patient's stated age of 35. Please correlate
with history of diabetes, hypertension, or sickle cell disease. If
there is suspicion for acute infarction, further evaluation by brain
MRI is recommended.."
How/Why Do Things
Like This Happen?!
November 2012
47. Choose Your Disease Carefully, But Choose Your
Health Care Provider Even More Carefully
• Not all physicians or hospitals have the same
expertise
• Ratings (hospital and physician), while ubiquitous, are
often irrelevant, and many times, just wrong
• Access to innovative care depends on innovative
caregivers with innovative knowledge and awareness
• Patient’s values and desires matter, especially when
the evidence runs out as it often does in cancer
• Interdisciplinary vs. multidisciplinary
47
Copyright 2013: Sherri T. Loeb RN, BSN!
51. Twenty Years Of Measurement In Health Care Has
Not Given Patients What They Want Or Need
— Measures of process, while improving quality, do not help patients
make better health care decisions
— Outcome measures matter, but are hard to measure
— Patient safety measures are (so far), not helpful to providers or to
patients (especially measures of improvement in patient safety)
— Where are the measures of patient choice?
— Incentive payment programs based on measures at the hospital
and physician level are a grand, uncontrolled experiment
— There are too many irrelevant and unreliable measures
51Copyright Jerod M. Loeb, PhD. January 2013
52. 52
Front-Line Lessons!
• The power of friendship triumphs
• Care is not the same from MD to MD or from HCO to HCO
★ Patients should not be compared
• Nursing and compassion are not the same
• Standard of care may be perfect for some - but not for all
• Importance of leadership, leadership, leadership
• Patient and family engagement means everything
• Hiring the right employees is key
Copyright: 2013: Sherri T. Loeb RN, BSN & Jerod M. Loeb, PhD.
54. — “...No, you can't always get what you
want
— No, you can't always get what you want
— No, you can't always get what you want
— But if you try sometime, you just might
find
— You get what you need....”
54
55. “Do something – if it works, do more of it; if
it doesn’t, do something else”
55Franklin D. Roosevelt