Hospitalized 3: Consumer Reports Study

The Consumer Reports National Research Center recently completed a study of what subscribers (13,450) to Consumer Reports had to say about their own or a loved one’s recent hospitalization and what nurses (731 nurses working in patient care areas) reported on their most recent week at work. Responses varied considerably. For example
• While 13% of patients said their care wasn’t coordinated properly, 38% of nurses said that was a problem.
• 4 % of patients said the facility wasn’t clean, compared with 28% of nurses asked a similar question.

In interviews with hospital personnel, including doctors, nurses, social workers, dietitian and hospital pharmacists, suggestions were made about the best ways to get through a hospitalization safely and minimal confusion.

Do your Homework
- Check your health plan for its rules on hospitalization
- Research hospitals on-line
- Ask about a surgeon’s experience with unusual or complex treatments
- Ask about nurse-patient ratios.

Plan for a Smooth Admission
- Know what medications you are taking; write them down and bring them to the hospital
- Keep your regular doctor in the loop
- Understand the hospitalist’s role (A hospitalist, usually an internist or pediatrician, who has received advanced training in the practice of in-hospital medicine. Usually takes over from your regular outside doctor during your stay.)
- Avoid the ER except for genuine medical Emergencies

Avoid Chaotic Care
- Have a friend or relative with you as much as possible during your stay
- Keep a bedside log of tests, treatments, and consultations
- Identify a single individual to coordinate your care, whether a physician, hospital social worker, case manager or patient advocate
- When using the call button, be specific about your needs
- Be respectful to the staff, but don’t hesitate to ask to speak to a nursing supervisor if you feel your needs aren’t being met

Stay vigilant for problems
- Make sure caregivers wash their hands
- Check medications and doses before you take them
- Be insistent if you’re unhappy with your care or don’t understand something

Plan ahead for discharge
- Make sure you understand plans for your patient discharge
- If you’re not satisfied, ask for help from your hospital’s advocate, social worker or case manager
- Insist on medication reconciliation between home and hospital drugs
See your primary care physician within a week of your patient discharge and arrange for him or her to get copies of your hospital records.

Cards/Relax/Family History

While this coming Friday is the National Day of Listening (see Nov. 22 post), since 2004 the Surgeon General has declared Thanksgiving to be National Family History Day. Over the holiday or at other times when families gather, the Surgeon General encourages Americans to talk about, and to write down, the health problems that seem to run in their family. Learning about their family's health history may help ensure a longer, healthier future together. To help families organize their health history, the US Dept. of Health and Human Services has developed a web based tool called My Family Health Portrait

Thanksgiving ushers in the holiday season. For the next six Wednesdays (Take a Break Day), I will be including both “art breaks” (things you can make as presents or for your own enjoyment) as well as ideas for taking a break from the hustle of the season.

Today’s post is all about cards, how to make them or what to do with ones you’ve received. The “relaxation tip” is creating a spa bath at home.

MAKE YOUR OWN CARDS

Postcards: Cheaper to mail than a greeting card, there are a variety of options to consider:
• Premium Postcard A service of the US Post Office, you create a picture postcard on-line, which is then mailed for you. You don’t even have to stamp it.

• Postcards from Your Photographs: There are now a variety of products on the market to help you turn your photographs into post cards.
- The 2 Buds Vintage Postcard Shop offers backings you can peel and stick on your photographs.

- Avery makes a Postcard for various types of printers, so it’s possible to print off a selection of your photographs. Not only can you send them as a greeting card, but you can print off different photographs and give a stack as a present. Most office supply stores, such as Staples, carry Avery postcards.

Potato Printing: A simple project that not only results in beautiful cards, but it can also be used to make T-shirts, napkins etc. Cut a large potato in half, cut out your design, apply paint and start stamping. Simple cookie cutters can be used to cut out the design.

Martha Stewart’s Card Making Center

E-Cards: Here’s an option that requires no postage. There are many free sites.
My Card Maker
Blue Mountain
Funny E-Cards
Care2 E-Cards

MAKING THINGS WITH CARDS
Gift Tags: Or To/Froms as we use to call them, can easily be made by cutting the card into tag size and either taping them to the package, or using a hole punch, string a bit of ribbon through it. Using pinking shears, or other type scissors, gives the tag a fancier look.

Bookmark: Depending on the size of the card and the weight of paper, you can several things:
• cut a 8-inch by 2-inch strip of the card if size and weight permit
• take a strip of cardboard or poster board and cut up the card, gluing it to the board. To make it more durable, cover with contact paper or laminate it.

Create a Gift Box

Ornaments

RELAXATION TIP
Create Your Own Spa Bath

National Day of Listening

This coming Friday, Nov. 27 is National Day of Listening. National Public Radio (NPR) has a website that can provide a number of resources to help you conduct a successful interview. Since this is the day after Thanksgiving, family and friends may still be around and you can take turns interviewing each other.

If you haven't already done so, along with family stories and lore, ask about your family's health history. Make sure the information you gather is available to other members of the family.

Holidays: OVER-DO THE LAUGHTER AND UNDER-DO THE STRESS

The “holiday season” seems to be starting earlier and earlier each year. With the hype of “black Friday,” the day after Thanksgiving and the number one shopping day of the year, already building to a feverous pitch, I thought it might be helpful to dust off a piece I wrote several years ago about coping with the holidays.

While the strains of “Chestnuts roasting on an open fire” may bring a smile to some, for others it makes their skin crawl. Whether you are caring for, or living with, chronic health problems, or have no health problems at all, the holidays, starting with Thanksgiving and running through January 1, can be a reminder that life is now different and old expectations or ideas no longer fit. With limited finances, changes in relationships, to say nothing of the piling snow in your driveway; it’s not surprising that many people become depressed, bored, frustrated, angry, and/or resentful.

For a time of year that is supposed to be about peace, love and good will, we over indulge, have unrealistic expectations, over spend our budget, try to do more than we can realistically do, which ultimately results in a “Holiday Hangover” that can last until Valentine’s Day. With that in mind, here are some tips for a Healthy and Happy Holiday season.

Humor: Being able to laugh will help you get through some of the difficult situations.

Alone: The holidays are about being together. If you need time to yourself, take it. However, if you are feeling lonely, reach out to family, friends, neighbors, your support group, church or social services. Consider volunteering at a community or religious function. Getting involved and helping others can lift your spirits and broaden your social circle. You don't have to be alone.

Pace: Set the pace for what you feel comfortable doing, and what’s important to you. It’s ok to change traditions or let some go. Plan ahead as much as possible. However, if things change, be flexible and “go with the flow.”

Presents: Set a limit on what you can spend and don’t exceed it. Consider reducing the number of presents you need to make or buy by drawing names or holding a Yankee Swap. Give gift certificates of your time, or make special treats that you know people like. If it’s difficult to get out and shop, order from catalogues or on-line. A donation to a non-profit organization, or charitable group, is a gift that will last throughout the year.

Check out the Wednesday posts for things to make that you can give as presents.

Yesterday: “Don’t look back in anger, or ahead in fear, but around in awareness.” James Thurber You can’t change the past, or predict the future, so live in the present.


Health: You’re still in charge of your health care so you need to continue to exercise, take medications as prescribed, and watch what you eat and drink. Have a healthy snack before holiday parties so that you don't go overboard on sweets, cheese or drinks.

Options: No is an option. People will understand if you can't do certain projects or activities. If you say yes only to what you really want to do, you'll avoid feeling resentful and overwhelmed.

Let others do. Reduce stress by asking for help, and accepting it when it’s offered.

Ideal: The ideal holiday is the one you enjoy.

Differences: Try to accept the people in your life as they are, even if they don't live up to your expectations. The holidays are a stressful time for all, so let things slide and wait until after the first of the year for the discussions you’d like to have.

Acknowledge your feelings: It's okay now and then to take time just to cry or express your feelings. You don't have to force yourself to be happy just because it's the holiday season. If you find that you continue to remain sad, anxious, unable to sleep, feel hopeless, or unable to do routine activities, for several weeks, talk to your doctor.

You: Take care of yourself. If you don’t take care of yourself, you can’t take care of others. Find the balance that allows you to be present for those that you love and care about, but not at the expense of harming yourself.

Sleep. Take time to get the rest and relaxation you need. Stay on your schedule so that you do have the energy for the fun and laughter. De stress with a massage, a bubble bath or curling up on the couch with a good book.

Take a Break: Feed the Birds

There is something very soothing and mesmerizing about watching birds up close. At this time of year, putting out food is one way to ensure they’ll be some to see.

As a child, my mother liked to make sure the birds had a Christmas present, so she’d take suet, put it in mesh bag, and hang it in the tree by the dinning room window. My Aunt’s approach was to scatter day old bread in the backyard. One of my favorite summer activities is to watch the birds flock to our yard just after the grass has been cut.

There are a wide array of bird feeders and bird feed. To learn more about the different type of feeders and ways to attract a variety of birds go to Project Feeder Watch

Hospitalized: Take 2

I’ve continued to hear from people about what to do when a friend or family member is hospitalized. There is no doubt that patient advocacy is critical. As for supporting patients in the hospital, I'm for the 24/7 approach. I can't imagine leaving loved one in the hospital alone.

One person wrote of their experience with a family member who has Parkinson’s Disease as well as her own issues following surgery. Sometimes a particular diagnosis requires some extra special attention, and so I have included the comments, eliminating identifying information.

When J was in hospital for extended stays, I found that monitoring his PD (Parkinson’s Disease) medications was extremely important. Often meds are given at the convenience of the pharmacy and the nursing staff, and PD meds in particular have to be administered according to the patient's schedule. The problem is often that every change of nursing staff ( 2 - 3 times a day, and especially on weekends or holidays when there may be brand new people with no experience with this whatsoever) requires constant monitoring. I once gave J his meds from my own supply in the ICU when no one could tell me whether or when he last had his meds, and I knew he had been in the ICU through a complete meds time schedule, not a good situation at all.

Be aware of cognitive changes, changes in behavior, attitude, etc. J experienced severe depression and suicidal behavior in reaction to a new prescription (this was at home) and a severe psychotic reaction to a morphine-derivative painkiller given while he was in the hospital after surgery. No one on the staff seemed to be aware that he was acting very strangely. This is an important point, as you will know what’s normal for the patient and staff wont necessary know.

Be there to help the patient with getting comfortable, changing the bed position, moving pillows, tightening or loosening top sheets, helping with drinking, using the nurse call button. The patient may not be able to do these things or even be aware that there is a problem. When I was recovering from my surgery and was alone, I wanted a walker and was told by the nurse that it would take three days to get a PT evaluation to even discuss getting the walker. I enlisted the aid of a young med student to get the walker, and was out of the hospital two days later, a full day before the scheduled PT evaluation. Help the patient to order food and to eat if necessary. Eating in bed is not easy.

The bottom line is that your patient is one of many to the staff; he is your one responsibility and you are his advocate.

Hospitalized: What Family and Friends can do

Recently, I experienced a situation that prompted me to send the following survey to colleagues and friends “Based on your experiences, as patient, friend, family member, and/or provider, what are the top five things you would list that someone could do to ensure that the inpatient receives the care he or she needs.”

The responses were identical - the number one response was-BE AN ADVOCATE.

From my experience as an inpatient as well as the daughter of one, there must be someone at the bedside to advocate for the patient. If it can't be 24/7, then perhaps shifts can be taken by people who care. I don't know of any other way, given the situation at most hospitals or perhaps all of them. ..I've literally saved the person's life, because no one was around to notice there was an abrupt change…”

Too weak to advocate for myself, the whole process of "saving" me happened only because of the chance timing of a visit from a neighbor(s) -one a retired nurse the other a retired social worker.

My friend and colleague Grace outlined five ways to be an advocate:

1) Be an advocate for the person who is ill. Speak with (polite) authority to his/her medical providers and make it clear what you know the patient needs and what you reasonably expect them to offer.

2) Question procedures and prescriptions, making sure that what the provider is doing is not going to have a detrimental impact on the patient.

3) Explain the patient’s home situation to the doctor so (s)he will prescribe outpatient care and prescription medicines that are realistically affordable for the patient and can actually be realized; it does no good to recommend physical therapy or “third tier” medications if the person can’t afford them or has no access to get treatment.

4) Act as or organize an information conduit so the patient doesn’t have to answer dozens of phone calls from friends asking the same questions over and over again about the state of her/his health. Make sure other family and friends are informed as much as the patient wants them to be and request that calls be limited to encouragement and support instead of asking for daily healthcare updates from the patient. Also, be willing to return calls on behalf of the patient so (s)he isn’t overwhelmed with inquiries when (s)he doesn’t feel up to talking.

5) Offer to take care of some of the daily responsibilities the patient may have at home or organize a group of volunteers to help out: feed the pets, mow the lawn, shovel the snow, take in the mail, do the laundry, clean the house, do whatever makes sense to alleviate the patient’s worrying about what (s)he will find upon coming home.

One respondent noted, Sometimes I've found that people, including close friends and loved ones, can't deal with illness and such. These people feel helpless and family/friend don't even realize that all they need to do is hold the hand of their loved one, who feels so alone, vulnerable and frightened to death.

Several respondents noted the need for possible volunteer programs to help with advocacy. Personally I think this is a huge need - not only in hospital but in outpatient. I have pondered if there might be some way for a group of savvy women to start and advocacy team.

In doing an on-line search, I found that the University of Minnesota’s Taking Charge of your Health has information for the patient and family and friends on ways to help during a hospitalization. Similar to my survey findings, their number one recommendation is to “Have someone with you at all times.”

A tight economy, budget cuts, an aging population and sicker inpatients are causing considerable stress on an already stressed system. As noted in Have Healthy Hospitalizations from the University of Minnesota’s Taking Charge of Your Health While it may seem ironic, hospitals are not necessarily healthy environments. According to a 1999 Institute of Medicine study, as many as 98,000 people die each year due to medical errors.

Therefore to help your family for friend obtain the best possible care, be an advocate, use Grace’s tips above and/or those offered by the University of Minnesota’s Health Hospitalizations.

If you are not able to be with a friend or family member, the patient and/or their designee, should check with the hospital to see if they have a program where a volunteer can sit with them.

I know that several people have said they’ve tried to join the blog but weren’t able to do so. Please don’t hesitate to e-mail margoc@tds.net me directly with your comments and suggestions.