Safety Now, Tomorrow and in the Future - Precepting

Safety Now, Tomorrow and in the Future - That's why I precept.

Tell me why you do or don't take students, I'm curious.

beeman

Patient education

Although this study was done for doctors, we as nurses should use this method. One and maybe the only thing of long lasting usage from my teaching credential program was the use of "paraphrasing of what the student said. In our case we explain to a patient about any number of things like home medications, hip precautions, and the return to ADL once they are home. We would ask them what their understanding of the instructions were to help clarify what the deal is.

Patients Prefer the Method of "Tell Back- Collaborative Inquiry" to Assess Understanding of Medical Information

Posted 04/08/2008

Evelyn C. Kemp, PsyD, RN; Michael R. Floyd, EdD; Elizabeth McCord-Duncan, MD; Forrest Lang, MD
Author Information

Abstract and Introduction

Abstract

Purpose: The goal of this study was to determine which approach to assessing understanding of medical information patients most prefer and perceive to be most effective.
Methods: Two videos were shown to participants: (1) a physician explaining a medical condition and its treatment and (2) a physician inquiring about patient understanding of the medical information the patient had been given using 3 different types of inquiry: Yes-No, Tell Back-Collaborative, and Tell Back-Directive.
Results: The Tell Back-Collaborative inquiry was significantly preferred over the other 2 approaches.
Conclusions: Patients strongly prefer the Tell Back-Collaborative inquiry when assessing their understanding. We recommend that physicians ask patients to restate what they understand using their own words and that they use a patient-centered approach.

beeman

Have you ever

Yesterday was great @ `0615, my two year old starts barfing, @ 0645 my open cell phone is completely drowning in waves of the good stuff - It must be her thoughts about having to eat something I was cooking - So much for skills day, as for the phone, I hope nobody can smell it hanging around in my backpack.
Later that morning I'm getting the little ones into the car for a trip to the doc and one of the neighbors comes up to me and starts talking about her son and the fact that she knows I am a nurse. Now for the record, this is the first time in almost eight years that she has ever said hi, or for that matter anything - I'm suspicious. Her son has CF and is waiting for a lung transplant at a well known hospital across the bay. Her concern is that the last time in the hospital she found an IV running into her son with the wrong name on it, and another time her son was almost impaled on a needle left in the bed by the nurse - Wow. She asked what was she supposed to do. For the record, I always include the patient and family members in the care I provide and actively encourage them to be involved in questioning what is the big plan, the day to day plan, having a list of pre-hospital meds for the doc's to see, and asking the question what is this or that med. I enjoy the back and forth between myself and the family members as education is one of my primary roles as a nurse, and one way to increase the safety of the med pass is to verbally review it with the pt and the family member prior to passing the med. I think she got the point as she walked off down the street with her shaggy dog. Have a great day, and remember that gifts come in unmarked boxes.

beeman

Let the light shine - We can do better!

Transparency in Adverse Event Reporting Pleases Patients

Norra MacReady

Medscape Medical News 2008. © 2008 Medscape

April 8, 2008 (San Diego) — Hospitalized patients who suffer an adverse event may learn little about it from medical personnel, especially if the event is preventable, according to findings presented here at Hospital Medicine 2008, the Society of Hospital Medicine annual meeting.

A survey of 603 patients who experienced 845 adverse events revealed that only 40% of those events were disclosed. The track record was even worse when the event was preventable — the disclosure rate of those events was only 28%, lead investigator Lenny Lopez, MD, from Massachusetts General Hospital, Boston, and colleagues reported.

The researchers conducted telephone interviews with adult medical and surgical acute-care patients who stayed in several Massachusetts hospitals between April 1 and October 1, 2003. Patients who said they had experienced an adverse event were asked whether anyone on the hospital staff had disclosed the event, explained why it happened, and offered to help the patient deal with the consequences of the event; the investigators also asked whether the event prolonged the patient's length of hospital stay or affected his or her perception of the quality of care. Finally, the researchers asked the patients whether they felt things could be done differently in the future.

Adverse events were more likely to be disclosed if they increased length of stay (odds ratio [OR], 1.82) or if the patient were male (OR, 1.53), whereas events deemed to be preventable were less likely to be disclosed (OR, 0.65). Patients who felt that they were able to protect themselves from adverse events were more likely to give high marks to quality of care (OR, 2.01), as were those who received an explanation of the event when it did occur (OR, 1.96). In contrast, patients who experienced significant discomfort were less likely to be pleased with their quality of care (OR, 0.62), as were those who felt things could be done differently in the future or who continued to experience repercussions from the adverse event (OR, 0.61 for both).

Clinicians may be reluctant to disclose adverse events to patients because of concerns over litigation, but these findings suggest that informed patients are more likely to be pleased with the quality of their care, the investigators said.

The low disclosure rate of preventable events was particularly unsettling, said Greg Maynard, MD, clinical professor of medicine at the University of California, San Diego. "With the technology we use, handoffs, complicated information systems, the powerful drugs and radiation, and the multiple interventions that many of these patients undergo, it's not surprising that some of these things are delivered incorrectly."

"[P]atients understand if the disclosure is done in good faith, and if the error was not the result of gross negligence," said Dr. Maynard, who was not involved in the study. However, "they get extraordinarily mad if the error is not disclosed and they find out about it accidentally."

The authors have disclosed no relevant financial relationships.

Hospital Medicine 2008: Abstract 47. Presented April 4, 2008.

J Hosp Med. 2008;3(suppl 1):26.

Dude you are so right on!

FP/CNA Adrian. First I want to thank you for POSTING - THANK YOU!!!!!
I also want to thank you for your insight into skin care and the prevention of skin breakdown. One of the goals that we as care providers are all tasked to is the found in the Hippocratic oath - Do no harm. Great health care is just that, doing no harm. One of the goals of a new program (Transforming Care at the Bedside)is by doing one hour rounding on each and every patient, even the ones that are completely alert, oriented and mobile. When I walk into the room for the one hour rounding I ask them if they have pain, reposition them if they are unable to do this themselves, ask them if they would like to use the bedside commode/bathroom/urinal/bedpan, and if there is anything I could do for them. One hour rounding is one of the keys that not only helps to prevent skin breakdown, but also falls from those pts that have to use the facilities but end up falling because they are to physically weak to walk.
As for urinary incontinence and what should we do. Hourly rounding where you would do the even hour and the rn the odd hour to see if the pt is soiled/wet. If you get in report that the pt is incontinent, use the barrier cream to coat the area(s) and then pay special attention to their bathroom needs. As for the use of diapers, I find them a real bummer, and next to giving someone a suppository, I hate to put them on anyone. I have found them depressing to the patient as it takes away their essence or locus of control - Depression is not to far around the corner when this happens. Diapers are just a coverup that don't really make our job easier. Only the illusion of making it easier.

Again, great job and thanks much for your keen insight!

Let me know if I can help you with anything,

beeman

Gettin' things rollin'

For people wondering how to sign in and make up a post, go to the upper left of the screen where it says "Sign In", and then type in the provided email and password.

Anyhow, this is your awesome FP CNA Adrian, and all this talk of medical reconciliation blows my mind, but we can use this as a means for NA's to communicate too. For the heck of it, I'm going to go on a whim, and say that I had the chillest day ever today sitting. My heart almost stopped chillin' so hard.

On a more relevant note, to both RN's and CNA's, there's a couple things I want to point about regarding skin care. Apparently, we're supposed to start using skin barrier now on patients heels (those at risk for skin breakdown) even IF there is no redness or breakdown present. It's more of a prevention measure. Also, we're supposed to use barrier cream on ALL incontinent patients, even if NO breakdown is present; again, a preventative measure. The price of increased use of the barriers pales compared to the price of dealing with pressure ulcers.

There are other measures as well, such as using the green pads only on patients that are incontinent or potentially incontinent. They promote skin breakdown I suppose, and their only real purpose is preventing changing a whole bed's sheets when a patient is incontinent. I am curious though, as what is the effective way of "minimizing the damage" cause by urinary incontinence if we aren't allowed to use briefs in bed.