Why Not Provide a Visual Cue to Inform People of the Patient's Needs?

It's interesting to see how many Icons are present on this Information Board in the Patient's Room at a Hospital. Also, it's surprising to notice that there is no Icon to inform the staff the patient has T-6 Complete Paraplegia and is paralyzed below his injury with altered sensations. There is absolutely no visual cue. Also, there is no Wheelchair in the room. There are no notes on the board about what people 'should know' about the patient. The staff might get the idea the patient can get up and use the restroom, or fetch a bucket to vomit, or attend to some other need by himself. If there is an emergency, staff might think a young man can fend for himself and get out of the building by emergency exits. When I was visiting this patient in the hospital, I noticed there was no sign indicating need for wheelchair and there was no wheelchair for this paralyzed patient. I tried to find out who the Case Manager was. Nobody could put me in touch with the Case Manager. So I called the Brewster Ambulance Company that transported the patient to the Hospital and asked how to get the patient's Wheelchair to him at the Hospital. The Dispatcher explained to me that the Case Manager is responsible for informing the Ambulance Company that a patient is in need of a Wheelchair and then it's transported. The fabulous dispatcher organized to fetch the wheelchair upon my call. Fabulous. I thank Brewster Ambulance and wish I had known this before because for five years the patient has had a continual problem getting any wheelchair in any hospital or rehab or nursing home. Which I find to be very strange indeed. I finally wrote a few notes on the Information Board. Never heard a reply, but I think the staff realized someone was involved in advocating for the patient, and the Case Manager arranged a very nice transfer to an appropriate Rehab facility where he got the care he needed once his health issues were under control.

Once the Wheelchair showed up, at least there was a Visual Cue present in the room with the Patient. Hopefully, at least the presence of the Wheelchair would provide some kind of information to let the staff recognize what the patient needs, although it might be more effective if the need for a Wheelchair had been included in the ICONS and any other notes and planning for in the room Information.

Model System Centers

Model System Centers

T-6 Complete Paraplegic Spinal Cord Injury with History of Altered Sensations -- Suddenly Acquires Normal Sensations in Medical Record!

WOW! Did the patient suddenly recover? Why would the NP use Homan's Sign to look for Deep Vein Thrombosis in a person known to have altered sensations? It's not like this healthcare worker does not know the patient has Spinal Cord Injury -- although it is also documented here. So why does this person use a test inappropriate for a person with altered sensations? Then note the patient does not have Normal Sensations? How does this happen?

Patients Need Advocates Who Can Help Them Review Their Records to Improve Patient Safety

Interestingly, progress notes are more challenging than one might expect. Notice the notes excerpt from the Progress of an inpatient T-6 Complete Paraplegic Patient. The creator of the notes indicates: 'Patient denies: leg pain, pain with walking... Patient denies: pain, weakness... Patient denies: PARALYSIS... tingling, numbness, tremors.' Perhaps if it appeared on one page then there would be a clerical issue to deal with that might lead to inappropriate care or measures taken. But these notes appear over and over again in the patient's notes.

Operative Records Indicating NO Antibiotics Were Given

Patient with Spinal Cord Injury and Implanted Metal Rods Receives NO Antibiotics During Invasive Surgical Procedure

Kitty Campaign: I think it's important to Patient Safety for all documents that caregivers use during procedures and interactions with Patients to be ACCURATE in particular, accurate with regard to the Facts about the Patient and the Patient's health history, physical condition, etc. In that way, the people who have direct contact with the patient, nurses, physicians, phlebotomists, etc. might have appropriate information to direct their work and care. There are some obvious problems you can identify easily when you look through your own records. It's not so difficult. After reading a few records yourself, you will become familiar with how the documents are organized and what is in the documents. It will be easy to notice how important information can be omitted, carried over from other patient documents, or incorrectly noted in the chart. When a medical staff person has limited time, and goes from patient to patient, with workflow interrupted many times during a shift and across days while a patient is resident in a hospital or nursing home, there are many opportunities for confusion and errors to occur. A popular example involves medications errors. It's very easy to follow the flows of medication errors and many efforts are made to avoid these errors. However, there are many other easy to detect situations where errors can occur; even though systems have not been designed to avoid these errors. For example, this PROCEDURE document from the HOSPITAL indicating that the patient having a procedure has NO IMPLANTS. I find it curious since the HOSPITAL'S RADIOLOGISTS CONTINUALLY IDENTIFY METAL RODS AND IVC FILTERS IN the same patient's studies. This is one way that the care and management of the patient's case is continually going awry. Precautions should be taken with anybody who has an implant to avoid infections and the HOSPITAL RECORDS for this Patient NEVER IDENTIFY that the patient has IMPLANTS. In this chart, the patient was already resident in the facility for 18 days, yet nobody corrected the facts of the patient's condition and risk factors. The patient has also been diagnosed with resistant organisms during this inpatient stay, yet physicians have noted in the chart they are of no importance and may represent COLONIZATION. The nurses have inserted catheters to flush out the patient's ileal conduit bypass during this inpatient stay. If the chart had indicated a metal implant, the nurse would have a chance to correct the oversight of ordering flushing of the ileal bladder without prophylaxis antibiotics and notify the physician the patient needs antibiotics prophylaxis for the procedures. Metal implants can become infected very easily with few bacteria. Bacteremia is an indication for antibiotic care when a patient has an implant including 'metal rods in the spine'. It's very difficult to get infected metal rods out of the spine of a patient with a spinal cord injury and has an infection. It's a serious complication of care. The patient has infection and no antibiotics. In addition, the patient might be taken accidentally to the MRI for radiological studies. If the notes in the chart accurately indicated the metal rods implanted or the IVC filter, anyone ordering a radiology study would be made aware. Anyone transporting the patient to radiology would be aware and correct any order for MRI. The fact the chart does not indicate metal implants also prevents the physician from considering infected implant when diagnosing the patient's symptoms, and counseling the patient about how to avoid infections that might compromise his life.

Jeff Brady, M.D., on AHRQ'S Guide to Patient and Family Engagement in Ho...