The
Informed Patient
By Laura Landro
Steps That You Can Take
To Safeguard Your Care
What can patients do to make hospitals safer?
At the annual meeting of the National Patient Safety
Foundation, which runs through Saturday in Washington,
health-care groups are unveiling an array of new
professional programs to help doctors and nurses
prevent deadly mistakes and improve the quality
of care.
But the most striking part of the agenda during
"Patient Safety Awareness Week" is the
increased focus on teaching patients how to play
a far more aggressive role in ensuring their own
safety.
Whether by joining patient advisory councils in
hospitals or making a nurse run through a bedside
checklist of medications, consumers are being urged
to keep a watchful eye on health-care providers
and help make sure they don't make the kind of mistakes
that could harm or even kill.
Patient safety has never been more prominent on
the national radar; Wednesday the House passed legislation
that would create a voluntary national database
through which hospitals can confidentially share
information about mistakes.
Still, the notion that patients have a crucial role
to play in safety gets mixed reviews in the medical
community, where many clinicians are resistant to
the idea of patients telling them how to do their
job.
For consumers, it's hardly comforting to think it
is up to us to make sure we get the right medication
-- and don't get the wrong operation. But there
is something empowering about the idea we can take
an active role in safety procedures, and we needn't
be intimidated by the idea of challenging the people
who are taking care of us in a vulnerable setting.
Though many patients have become savvy in seeking
information about their care, it is equally important
to actively monitor and question the way that care
is delivered.
Safety advocates hope to inspire patients with the
motto: "Nothing about me without me."
"In the traditional medical model, the doctor
has the parental view and the patient is childlike,"
says Dennis O'Leary, a physician who is president
of the nonprofit Joint Commission on Accreditation
of Healthcare Organizations, the leading hospital
accreditation group and a co-sponsor of the patient-safety
conference. "But today, as a doctor in this
highly complex, litigious and risky environment,
I appreciate a patient helping me out because I'm
less likely to make a mistake."
The National Patient Safety Foundation has a number
of free online brochures and fact sheets for patients
on its Web site (http://www.npsf.org/) that provide
guidance on how patients can check safety procedures,
such as how infections are prevented in the hospital.
The group is also selling a $70 video designed for
hospitals to air for patients titled "Patient
Safety: Your Role in Making Health Care Safer,"
which features a series of role-playing vignettes
showing patients how to ask questions that might
seem rude or challenging of authority figures.
Among them: asking a doctor if she has washed her
hands before examining your surgical incision or
asking the nurse to double-check the name of the
medication if it sounds different from the drug
the doctor said you would be receiving.
Safety groups recommend that consumers get involved
through hospital advisory boards that include patients
and their families in reviewing hospital safety
procedures and increasing awareness of possible
errors. Beverley Johnson, president of the nonprofit
Institute for Family-Centered Care, says patient
advisory councils can help hospital staffs understand
that families "are not just visitors,"
but have an active role to play.
A guide, "Developing and Sustaining a Patient
and Family Advisory Council," is available
on the group's Web site, (http://www.familycenteredcare.org/)
for $30, and the site offers free material on other
safety issues.
A new Web site for health-care professionals being
unveiled at the NPSF conference Thursday, QualityHealthCare.org,
will host online tutorials on patient safety, including
models for establishing patient councils and safety
programs. The site, which is also accessible to
consumers, includes a case study of the Josie King
Patient Safety Program at the Johns Hopkins Children's
Center.
The center was started at the hospital after a toddler
receiving intensive care for burns died after a
sequence of medical errors. The child's mother is
on the safety team.
Donald Berwick, whose Institute for HealthCare Quality
developed the site in partnership with the British
Medical Journal, says that by sharing safety tools
and programs over the Internet, hospitals have a
better chance of learning what has worked at other
institutions. Lucian Leape, the Harvard School of
Public Health professor whose Institute of Medicine
committee released the controversial 1999 report
that said 44,000 to 98,000 people die from medical
errors each year, will host the safety programs.
Though Dr. Leape cautions that hospitals can't put
too much responsibility on patients for safety,
because it may end up shifting blame for error to
the victim, he adds, "the fully informed patient
is the safest patient."
Roxanne Goeltz, who works in air-traffic control,
became involved in patient-safety activities after
her brother died unexpectedly while hospitalized.
Though the family decided not to sue, Ms. Goeltz
often speaks to hospital groups about the importance
of being open with patients about mistakes, which
many believe can actually reduce malpractice claims.
She is helping to lead a workshop planned for this
spring by the Partnership for Public Safety (http://www.p4ps.org/)
on how patients can share lessons learned about
hospital safety.
As an air-traffic controller, Ms. Goeltz says, "a
light went on in my head when I saw how far behind
our health-care system is in learning from errors.
Though we've always been taught to think that hospitals
are safe, certain aspects of them are not safe."
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