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Archive for April, 2013

Institute of Patient and Family Centered Care

April 20th, 2013 No comments

From April 14 to April 18, I attended the Institute of Patient and Family Centered Care intensive training course.  I was alerted to this conference by my colleague Lisa Freeman.  I was unfamiliar with this approach to healthcare, but I had attended a very nice presentation by Bev Johnson, Director , for the Patient Centered Medical Home practices here in Maine.  She is a brilliant and kind teacher.  She recognizes that Patients and their families must partner  with providers to improve healthcare.   So, I knew that at least Bev’s involvement in this organization would make this training worthwhile.

I have been involved in Patient safety advocacy and activism for over 4 years now.  I belong to and affiliate with different organizations and I attend meetings, conferences, online webinars, phone conference calls, PLUS, I read everything I can get my hands on about Patient Safety.  The solutions are out there to make healthcare safer, better, and cheaper.  I know the problems and the negatives in Healthcare, but I also know that healthcare can be an miraculous cure for what ails you.  I have definite ideas about solutions for problems, but the quandary has always been…How do we get there?

The IPFCC training taught me how.  We include patients and families in every aspect of care, from the primary care office through discharge from the Hospital and into post Hospital care, whether it is in LTC, rehab, or at home.   Partnering WITH patients through out the journey of care is absolutely essential.  Patient and family advisory councils at every level are necessary.   TOs and FORs are removed from conversations regarding patients and families and in their place we put WITH.

I was skeptical.  What exactly is accomplished when providers partner with patients and honor them and their families? These are the measurable improvements that I heard about this week.

1. Reduction in HAIs (my initial reason and primary focus for doing this work!)

2. Reduction of medication and medical errors

3. Reduction of Hospital readmissions

4. Improvement of HCAPS numbers, improved Patient Satisfaction

5. Improvement of Healthcare outcomes.

6. Reductions of costs.

7. Elimination of Visiting Hours.   Family members are partners, not visitors.  Ability of all patients to have a 24 hours bedside advocate.

8. Increased honor and respect of patients and patient dignity.

9. Improved employee satisfaction and improved employee retention.

10. Patient Portals to Electronic Records and how to use them.

11. Addresses all 3 arms of the IHI Triple Aim.

This is the short list.  I heard stories of success, from patients and patient advisers,  and from Hospital administrators, providers and workers.  I learned that this work is not easy, but it is worth every minute of effort.    It is an approach that is inclusive of everyone involved and affected by healthcare  in a collaborative partnership.

Now what?  I plan to tell my colleagues at the Maine Quality Counts Consumer Advisory Council about my training.  I hope to mobilize them and MQC to do a survey of Maine Hospitals and to assess where Maine is at in PFCC. How many Patient and Family Advisory councils do we have in Maine, and are they honored, valued and included in the work of caring for patients?   Then we will go from there.  I has to happen.  I hope that it will happen very soon.  We need the change. We need to do whatever it takes to make patients safer, control costs, and preserve our ability to access care.

Last week I attended the Maine Quality Counts annual conference about achieving the Triple Aim in Maine.  This week I connected some big ole dots on how to do the work.

 

Emotional and intellectual revelations in Patient Safety Advocacy

April 9th, 2013 2 comments

Every single day, I learn.  I am learning more now than I have in 43 years as an RN, about being a patient.  I have learned how to be a safe. engaged patient, from other patients and from patient safety activists and advocates.  A rare few professional doctor and nurse advocates are stepping forward too, and talking about important patient issues, like safety and good practices.  They discuss the necessary steps to avoid medical harm or infections in healthcare settings.  They talk about how unsafe staffing levels in hospitals and long term care facilities is a contributing factor to patient harm and complications.  Some of my colleagues are engaged more in the issues of healthcare transparency and accountability of both quality and costs.  They fight for affordable healthcare and reporting of all medical harm.  Some even work toward meaningful apologies by professionals and hospitals if harm has occurred.

I have come to realize that I worked for a dysfunctional industry and I was complicit in it.  That makes me feel sad and guilty.  I got coopted by my employers because I needed the paycheck.  I know, that is no excuse, but  I was part of things that I am ashamed of.

Example#1

When I was called “into the office” once and told about a woman who had been harmed when I was a triage nurse one day, I felt absolutely awful.  I remembered her in detail.  I remembered that she was in excruciating pain, and that her primary nurse was snotty to her and made derogatory remarks about her.  I remembered her very concerned and dedicated husband.  I remembered everything, and my first reaction was that I really wanted to talk to that patient.  My instructions were “you do not talk to anybody about this except the legal team.  you do not even talk to your coworkers about this”.  This patient had been harmed during surgery prior to her ER visit and then she was RE harmed in our ER that day.  She nearly died as a result.  A lot of years have passed, but someday I am going to call her and try to talk to her.

Example #2

When I worked in a Hospital employee health department, I got a call one day from the Loss Prevention Director.  He asked me about a SOAP nurses note I had written.  He wanted me to change it.  I believe he wanted that because it would help the Hospital’s case against that employee in a Workman’s Compensation hearing.  I was very proud of myself that day for not cow towing to that man.  I absolutely refused to compromise my professional integrity to “do good” for our employer.  The entire experience disgusted me, but that time I did stand by my patient and my convictions.

Example #3

Way back in my very early days of RN practice, a nurse always assisted the doctor. If  Dr. said jump the nurse asked “how high?”  One doctor I knew was a mean red faced bastard.  He was mean to me, and mean to patients.  He refused to allow any parents into the room when he sutured their children.  One child cried uncontrollably, even with my attempts to comfort him.  The doctor stuffed a wad of gauze sponges into the child’s mouth to silence him.  I was horrified….and I reported him to his superior.  But, I never told the parents.  I was complicit in that abuse, because I was scared out of my mind of this horribly mean doctor.   My fear overcame my moral responsibility to the patient and family.  It is the legal responsibility of all healthcare professionals to report known child abuse.  I was very young, stupid and scared.

I hate that all of this and a whole lot more,  happened during my practice as a nurse.  I have come to know that not all doctors and Hospital leaders are evil, but some are, and  many, if not most see evil every day and they turn away and ignore it.  I did to, and I live every day with that guilt.   The entire practice of nursing and medicine needs to be revamped if patients are ever going to become the priority.  Professional schooling needs to teach ethics, humanity, caring and compassion, instead of elitism and protectionism.

What can I do about it?  I can work my tail off in retirement to make things different for patients….ALL patients.  I can share my professional and personal stories in my writing, my presentations, amongst my friends and colleagues to make a difference.  I feel a burning need to do this…..something like breathing.  If I don’t, how can I ever say that I was/am a nurse?  How can hold my head up and be proud that  I helped thousands of sick vulnerable patients.  Sadly, not all of my patients’ needs were met, and some were even harmed.   I am proud of the good I did for patients, but now it’s time to see about the ones I (and others) have failed……

 

 

 

Transparency in Hospital Billing and Costs

April 8th, 2013 1 comment

I was seen a month or so ago for floaters and flashers in my left eye, in  Bangor, Maine.    I walked out of EMMC ER without being seen,  because of a very poor  and unprofessional reception, watching a suffering young woman being ignored, and a very long wait time.  I went across town to St Joes.  I was nicely welcomed, quickly and efficiently triaged, waited an hour in an exam room, and was seen by a competent and nice nurse practitioner for about 5 minutes, maybe less.  I had no medicines, no sterile instruments, no diagnostics, no treatments,   and nothing extra.  I walked out with instructions and an appointment with an ophthalmologist the next day.  I had a good experience of care.

Grand total   $1313.85.  HOLY CRAP!

I looked up St Joe’s list of usual ER charges online.  My charges, on my itemized bill were way out of whack.  So, even though my copay will not change ($125), I called St Joe’s billing inquiry line.  The lady was very nice until I asked to participate in the weekly inquiry meeting where they will discuss my bill.  I want to know what they have to say about my bill and be part of the discussion.   It was obvious that this was really really weird for them to deal with someone who actually wants transparency and details about how they came to this wild price for my visit.  She finally relented and said she would tell the supervisor who participates in their billing inquiry meetings that I want to be there.

I asked the billing lady if she has ever heard of the concept of “nothing about me without me”.  I know that this generally pertains to collaboration and communications about our actual care and plans for it, but why not billing and costs.

After reading Rosmary Gibson’s new book. Medicare Meltdown, I fully realize how important it is for healthcare consumers to fully engage in all aspects of quality and cost in healthcare.  We need to protect our ability to access and afford healthcare, because Hospitals, providers, medical device and pharmaceutical companies, for profit companies and others are usurping all of the cream..off the top of the fresh milk bucket of healthcare. They do this with predatory pricing and charging of all patients, and getting what they can from all payers, public and private.      If we do not engage, our existing systems will not survive.

$1313.85 for a 5 minute visit is outrageous and unexplainable….and I want to know details about how they came to that astronomical price.  We all need to become inquiring minds when it comes to healthcare costs and quality.

Maine Quality Counts Annual Conference, Afterglow

April 4th, 2013 4 comments

On April 2, Mike and I headed to Augusta for an overnight stay.  I had a very busy agenda lined up, mostly involving the MQC conference the next day. I helped to plan the event and I was going to participate in a couple of speaker panels.   But, I also planned to go to the Maine State House to testify in favor of LD 1066, an act to accept the Medicaid expansion for Mainers in need.  We arrived at around 1pm and with my 20 copies of testimony in hand and we left our car on the 4th floor of the garage across from the State House.  As we approached the door to the stairway, a woman suddenly collapsed in front of me.  She dropped like lead right onto her face, without breaking her fall in any way.   The woman with her was walking ahead and we all heard the thump.  Judy, the woman who fell, was knocked unconscious and she likely broke her nose and maybe other facial bones.  There was a lot of bleeding.  I immediately went to her side, plopped onto my rump on the ground and assessed her airway and pulse and her medical alert bracelet.  She was breathing, thank God.  I talked to her over and over, for about 3 to 4 minutes until she slowly came around.  I wasn’t the only one to help.  A group of complete strangers gathered and offered help.  One called 911.  Judy’s friend called her family and left messages for them.  Another lady brought a blanket to keep Judy warm.  Mike stood by in case we needed anything.  Then the EMTs arrived (heroes, each and every one of them).  Who knew that you cannot bring an ambulance up into that garage?  They lugged all their equipment up 3 flights of stairs.  They quickly and efficiently assessed Judy, and rolled her onto a back board, stabilized her neck, got some history from me, and then carried her back down those stairs.  They also facilitated Judy’s friend’s trip to the hospital ER, by telling her to bring her car around and to follow the second emergency vehicle…they showed her the way.  A very concerned and helpful  group of strangers rallied around Judy, to help her on her unexpected journey to the Hospital.

Judy was a kindred spirit.  She was on her way into the State house that day to testify against the use of insecticides on School yards and playgrounds.  She wanted to help protect our children from the toxic harm of chemicals.   She is just like me, she is an activist.

Judy’s fall impacted me in huge way.  Her fall is an example of how in one single second, our lives can change.  I suspect that Judy had a brain hemorrhage because of the medication she was on and the nature of her fall.   If I am correct, her life was altered in one second.  She was just beginning her healthcare journey, and already a dozen or more strangers had rallied to help her.  All of us were people who were not afraid to get our hands dirty to help another human being.

800 Mainers, also mostly strangers to each other, showed up on April 3, 2013 at the Augusta Civic Center to get their hands dirty, and to rally around Maine patients.   They came to hear the messages that Rosemary Gibson, and Dr Donald Berwick brought.  There were Healthcare providers, payers, consumers and leaders.  The messages they heard from our fierce bold speakers were that our healthcare system is unsustainable, unless we want to do without everything else we have grown accustomed to in our lives, like schools, libraries, snowplows, and food.   We heard that there is more than one way to get our hands dirty and take care of human beings.  Dr Berwick called them airplanes…..he talked about  discussions in Washington DC, where some said machines can’t fly, and he said “YES THEY CAN, LOOK UP, SEE THEM CIRCLING OVERHEAD!”   Because 800 people came to listen to-oh-so smart speakers and their dire message, I think they are willing to rally.  They are willing to do the work and address the costs and quality issues that we need to improve and sustain our healthcare system.

I was honored and so proud to be part of the MQC event.  I took part in a television interview seated next to Dr Lisa Letourneau and Rosemary Gibson!   I wouldn’t have even imagined that a year ago.  I managed to get back to the State House on April 2 to testify for the Medicaid expansion because I’d hate to think of any Maine woman having uterine cancer (like I did)  and not getting checked for it, because she couldn’t afford the visit to the doctor.  That evening, the MQC  hosted  a dinner at the Senator restaurant for the event planners, staff and speakers.   It was a very warm and inviting group. Everyone introduced themselves and each other.  Then we all trouped off to our homes and hotels to rest and prepare for our huge event April 3.

Judy’s unexpected fall and injury reminded me that she is what our work is about.  Her only thoughts must be to get back on her feet, safely and quickly (without breaking the bank)  and to get back home to her family.   And, eventually, when she is well again she can get back to the State House with her message.   Isn’t that exactly what we all want for ourselves when we are sick, and for all of the patients we work for.   I do believe healthcare reform is happening in Maine.

Although I am very inspired and enjoying the afterglow from the MQC annual conference, I have determined that helping Judy was the most important thing I did during my two days in Augusta.  She grounded me, and removed the stars from my eyes and taught me that helping and humanity is what it is all about.

Addendum:  I got this message just now, about the State of the State show interview.

This our State of the State Show with Rosemary Gibson, Lisa Letourneau and Kathy Day, it will air between April 16-26th

Time Warner Cable affiliates statewide air State of the State on Channel 9 on Tuesday the 16th and 23rd at 7:00 p.m., Thursdays the 18th and 25th at 6:00 p.m., and Friday the 19th and 26th at 10:00 a.m. However, air times may vary due to periodic program preemptions and rescheduling. To check the current Time Warner program schedule in your area, click here.

Other community television stations that are running the program are WOGT, Ogunquit; WVACTV Channel 2, Bethel; CATTV, Baileyville; Harpswell (for latest listings,click here), Freeport; Bath Community Television Channel 14, Mt. Blue Community TV, and Brunswick TV (for latest listings, click here)

April 16-26

Transforming Health Care in Maine

Guests:

Rosemary Gibson, National health policy advocate, speaker and author. Author of The Treatment Trap.

Kathy Day, Maine Quality Counts Consumer Advisory Council

Lisa Letourneau, MD, Executive Director, Maine Quality Counts