The importance of monitoring medical care for your loved ones

You may think that because you have carefully selected the best hospital and the finest doctors to operate on you that you can leave the treatment in their hands. You may be in for a rude surprise.

This is not a rant about the state of medical care in the 21st Century. It is a careful assessment of the realities of making sure that you or your loved one comes through a major operation with as few difficulties as possible.

No system is infallible and people forget to write things down or to send vital records or to install vital equipment properly.

The patient and those accompanying the patient need to take responsibility for being informed. You must ask questions about anything that doesn’t make sense to you.

So, even if your operation is done perfectly, the anesthesiologist may not have duplicated what the surgeon requested, your nurses may not have received the information needed to administer the proper drugs and medication, the incredibly complex and effective drug administering system may not have been plugged in to the electrical outlets, and the chilling system for your injured area may not have been connected properly.

I have seen all of this and more in this past week in the best hospital I have ever seen. The staff was friendly, the hospital was first rate, the procedures had more checks and balances than I have ever seen before, but things did drop through the cracks and I was able to bring them to someone’s attention before things got too far out of hand because I knew what to watch for.

Continue reading after the jump for some of the errors I have seen in five different hospitals:

In one hospital when I mentioned that the saline drip was running so fast that
the patient’s arm was swelling, all I got is an annoyed grunt from the
nurse as she inspected it and grudgingly corrected the flow.

In one hospital in Palo Alto, I watched the blood recirculation
apparatus begin to overflow and alerted a nurse who said
disinterestedly, "that will be fine". The next nurse I approached fixed
the problem immediately.

I have seen a nurse say she would get needed pain medication right
away and not come back…ever. Perhaps she went off shift, but no one
else got the word either.

If you go to a hospital, you should have someone accompany you who
will ask questions when things don’t seem right. Better yet, this
person should have some idea of what to expect from every action that
will be taken on you. When the nurse plugs in one of those high tech
systems for monitoring the flow of liquids into your body, someone
needs to ask what the display is measuring so they will know what is
supposed to happen and when the machine stops working.

In our most recent hospital visit there were several
instances where the equipment was left unplugged after the patient was
moved around. in the first instance, I got a nurse after one system beeped an alarm. She
looked at the catheter and the physical connection to the machine and
said everything was fine now. When I pointed out the dead display
screen, she said, "that’s all right" but finally looked on the floor
where the power cords were lying disconnected from the wall socket.

This hospital carefully checks and rechecks drug dosages and
medications. When the medication level needed to be changed, two nurses
checked the figures for each other and both were involved in resetting
the machine that monitors the flow into the catheter.

On the other hand, the system for patient self-administration of
pain medication did not work properly and it took repeated requests
until the system was fixed. The initial response was that the system
had a 20 minute lockout between doses to prevent patient overdose. I
persisted until the nurse tested the patient switch and found it was
not working.

The most annoying problems that we encountered recently were repeated
failures to send vital medical data between medical providers.

EKG
results, Xrays, blood tests, and urinalyses were carefully performed
and then not sent as promised to the next provider. This requires
duplicate testing and additional expense.

Even after leaving the hospital, this was a continuing problem.
Medical orders sent by the surgeon to the home health nursing provider
were mislaid and never passed on to the visiting nurse and therapists.

The bottom line is that we live in an amazing age where medical
miracles are almost commonplace, but patients and patient advocates
need to be informed and stay alert for omissions and errors in handling
of patients at every step of the way.

We will be sending our observations to the organizations involved
with our recommendations for reducing the incidence of errors in the
future. We were pleased by the care that was provided, but we are
doing our part to improve things where possible.

If any of your friends have an operation coming up, you might want to pass this on to them.