From the patients experience Going from patient room to radiology - - PDF document

I.C.U…. Can you See Me?

Crossing the Chasm from the Patient’s Perspective Della M. Lin, M.D. “I never knew when a doctor was going to come in and do something to me….”

Patient

“When I asked questions, I was

• ignored. The focus was between two

doctors between themselves…”

Patient

“She seemed very frustrated that she

had to come AGAIN and it’s the fourth time and its 300AM…”

Patient family member

“I asked what was the “oops!” about? She replied, “Oh nothing! Nothing’s wrong, there’s nothing to worry about”

Patient

“It’s really a horrible sinking feeling when you are your loved one’s advocate and you don’t know what’s going on…”

Parent of Patient

“You feel like you have to fight for your loved one, and that you become an adversary and you are no longer a partner…”

Newborn Patient’s Parents

“Although you are invited to rounds,

you are really an invited observer… at the end, THEN you are asked if you have any questions… it’s not really a feeling of involvement…”

Patient

“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

• Patient focus groups
• Patient rounding

From the patient’s experience…

• Going from patient

room to radiology in a gurney

• Taking a tour through

the hospital from a wheelchair

• Observing the last

two hours prior to discharge in a patient’s room Dignity and Respect Information Sharing Participation Collaboration

From Our Point of View…

• 50% of patients don’t take medications as

described

• Medication non-adherence is the 4th

leading cause of death

• Medication non-adherence is the

leading cause of accidental death

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?

What can we learn from a Japanese Coffee shop?

From our view…

• Focus on never events….

From the patient’s experience…

• Focus on always events….

Always Events…?

• Teach me Back x 3
• Always use a SMART discharge
• Always receive a visual medication schedule
• Always know who is in charge of their care
• Always use trauma care team “twitter”
• “Kangaroo care” in all preterm infants
• End of life program for neonates
• Dementia screening in all patients > 70
• http://alwaysevents.pickerinstitute.org/

Competence Questions… always?

• Can you tell me in your own words… What is treatment

likely to do for you and what do you believe will happen if you are not treated?

• 48% of patients found NOT to

have capacity to consent to medical treatment

• Only ¼ of those were

identified by the treating team

*Appelbaum PS, Assessment of Patients’ Competence to Consent to Treatment, NEJM 2007;357:1834-40

“In your opinion, what are the most important things that should always happen for every patient (or family member) using our services

What might you do… ALWAYS

Dignity and Respect Information Sharing Participation Collaboration

From our view…

• Do you have an advanced directive?

From the patient’s experience…

• What will be most important as time gets

short?

Dignity and Respect Information Sharing Participation Collaboration

What might a patient compact look like ?

• Treat you with respect,

honesty and compassion

• Include you as a member
• f the team
• Always tell you the truth
• Help you to set goals
• Listen to you and answer

your questions

• Respect your right to

information and privacy

• Communicate openly…
• Treat you with respect,

honesty and consideration

• Be a responsible and active

member of my team

• Always tell you the truth
• Tell you what medications I

am taking

• Understand my care plan to

the best of my ability

• Communicate any

problems I have with the plan for my care

Dignity and Respect Information Sharing Participation Collaboration

• “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.

• 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

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