Hospitals want involved patients

By Judith Graham
http://www.chicagotribune.com

Four years ago, when Edward Lawton was admitted to a New York hospital for surgery, he came prepared.

He brought his own case of sterile gloves and asked nurses to use them after washing their hands with soap and water.

He asked for a blood pressure cuff to stay at his bedside so it wouldn’t come in contact with other patients.

And he requested that newspapers not be delivered to his room because “newsprint is dirty” and he wanted to avoid the potential for contamination.

Lawton had reason to be careful: He had acquired several painful, debilitating hospital-based infections during a surgery nearly six years before.

“I learned from that, you have to be aware of what’s going on around you in hospitals,” he said, after testifying in April at a hearing of the U.S. House Committee on Oversight and Government Reform.

“You can’t be afraid to say to someone, ‘Excuse me, what’s going on?’ ”

It’s a message of empowerment that many hospitals across the country have begun to reinforce with programs that urge patients to speak up if they have concerns or don’t understand what nurses or doctors are doing.

“The bottom line is, it’s your body. If you had a problem with your car, you’d feel comfortable asking. It’s even more important with your health,” said Cathy Barry-Ipema, spokeswoman for the Joint Commission, a group that accredits hospitals, nursing homes and other health-care institutions.

The Joint Commission’s “Speak Up” program encourages patients to ask questions about their medications, medical tests, research studies, surgeries and living organ donation. Under preparation is a new unit on pain management.

Rush-Copley Medical Center in Aurora began encouraging patients to say what was on their minds almost three years ago.

“The old era of medicine where [a doctor] walked in and gave directions to the patient is over,” said Dr. Steve Lowenthal, the hospital’s chief medical officer. The name of the game now is involving patients in their care, he said.

When a patient asks a nurse if she has checked a medication order, “frankly, it allows the provider to step back, take some time and think about what they’re doing,” and that “promotes a safer environment,” Lowenthal said.

It helps if doctors and nurses are receptive and if they talk to patients and families in terms that they can understand. Rush-Copley Medical Center asks them to do just that each morning in the intensive care unit, when doctors, care managers, nurses and families meet at patients’ bedsides.

Yet even with encouragement, many people are uncomfortable questioning a medical provider for fear of appearing too aggressive, mistrustful and unappreciative.

Several research studies document this disconnect between what hospitals are asking patients to do and what patients actually feel comfortable doing.

Earlier this year, a study of 80 surgery patients in London reported that patients found it much easier to ask factual questions—”how long will I be in the hospital?”—than challenging questions such as “have you washed your hands?”

This reluctance could stem from the aura of authority that surrounds doctors, the authors speculated. The study was published in the British journal Quality and Safety in Health Care.

In December, a separate study of 856 adults in Pennsylvania discovered that 91 percent were willing to ask doctors or nurses to explain something they didn’t understand. But only 25 percent were prepared to ask providers whether they had washed their hands before an examination.

Patients were “less inclined toward practices that may be viewed as more confrontational,” concluded the authors, writing in the Journal of Patient Safety.

Proctor Hospital in Peoria has found a helpful way to deal with this: It suggests specific questions in a brochure handed to every patient on admission.

“It’s OK to ask what are my medications? what are they used for?” the brochure advises, as well as “for assistance using the restroom … health care workers to introduce themselves when they enter your room … your nurse to identify you by checking your name and birth date prior to any medication administration … if you cannot read the handwriting on prescriptions or other instructions” and much more.

Proctor started the effort as a way to help reduce hospital-acquired infections but broadened it last year after the Joint Commission encouraged hospitals to involve patients more thoroughly in their care, said Angie Moore, director of patient safety.

See Judith Graham’s post today on her blog, Triage, on how patients communicate with doctors. Go to chicagotribune.com/triage.

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