From our view From the patients experience Going from patient - PDF document

I.C.U…. Can you See Me? “I never knew when a doctor was going to come in and do something to me….” Crossing the Chasm from the Patient’s Perspective Patient Della M. Lin, M.D. “ She seemed very frustrated that she “When I asked questions, I was ignored. The focus was between two had to come AGAIN and it’s the fourth doctors between themselves…” time and its 300AM…” Patient Patient family member “It’s really a horrible sinking feeling “I asked what was the “oops!” about? when you are your loved one’s She replied, “Oh nothing! Nothing’s advocate and you don’t know what’s wrong, there’s nothing to worry about” going on…” Patient Parent of Patient

“ Although you are invited to rounds, “You feel like you have to fight for your you are really an invited observer… at loved one, and that you become an the end, THEN you are asked if you adversary and you are no longer a have any questions… it’s not really a partner…” feeling of involvement…” Patient Newborn Patient’s Parents “There really is a power imbalance between you and the doctors and the nursing staff… they have the knowledge and you feel like you don’t…” Patient Dignity and Respect Information Sharing Participation Collaboration

From our view From the patient’s experience…  Going from patient  Patient focus groups room to radiology in  Patient rounding a gurney  Taking a tour through the hospital from a wheelchair  Observing the last two hours prior to discharge in a patient’s room From Our Point of View… Dignity and Respect  50% of patients don’t take medications as described Information Sharing  Medication non-adherence is the 4 th leading cause of death Participation  Medication non-adherence is the leading cause of accidental death Collaboration CDC From the Patient’s View… What should I do if I miss a dose?  If your next scheduled dose is more than four hours away, take the missed dose as soon as you remember it. If you are scheduled to take another dose in less than four hours, take the missed dose when you remember it but do not take the next dose at the scheduled time. Instead, wait four hours until you take the next dose. Take any remaining doses for that day at least four hours apart. If you miss two or more doses in a row, take only one dose when you remember them. Do not take more than one dose at a time.

Teach me Back  Three essential questions:  What is my main problem?  What do I need to do?  Why is it important to me? From our view…  Focus on never events…. What can we learn from a Japanese Coffee shop? From the patient’s experience…  Focus on always events….

Always Events…? Competence Questions… always?  Teach me Back x 3  48% of patients found NOT to  Always use a SMART discharge have capacity to consent to  Always receive a visual medication schedule medical treatment  Only ¼ of those were  Always know who is in charge of their care identified by the treating team  Always use trauma care team “twitter”  “Kangaroo care” in all preterm infants  End of life program for neonates  Can you tell me in your own words… What is treatment  Dementia screening in all patients > 70 likely to do for you and what do you believe will happen if you are not treated?  http://alwaysevents.pickerinstitute.org/ * Appelbaum PS, Assessment of Patients’ Competence to Consent to Treatment, NEJM 2007;357:1834-40 “In your opinion, what are the most important things What might you do… that should always happen for ALWAYS every patient (or family member) using our services From our view… Dignity and Respect  Do you have an advanced directive? Information Sharing From the patient’s experience… Participation  What will be most important as time gets Collaboration short?

Dignity and Respect What might a patient Information Sharing compact look like ? Participation Collaboration •Treat you with respect, •Treat you with respect, Dignity and Respect honesty and compassion honesty and consideration •Include you as a member •Be a responsible and active of the team member of my team Information Sharing •Always tell you the truth •Always tell you the truth •Help you to set goals •Tell you what medications I Participation am taking •Listen to you and answer your questions •Understand my care plan to Collaboration the best of my ability •Respect your right to information and privacy •Communicate any problems I have with the •Communicate openly… plan for my care

 “What patients want is not rocket science…  Which is really unfortunate…  Because if it were rocket science, we would be doing it. We are great at rocket science. L I S T E N  We love rocket science.  What we’re not good at are the things that are so simple and basic that we overlook them.” … Laura Gilpin