What You Need to Know to Protect a Family Member While They Are Hospitalized

As the population ages, we are all faced with the inevitability of having a loved one hospitalized. This information has been compiled In order to ensure that errors are not made and that your family member is safe.

The current status of health care facilities ensures that the most modern and up to date equipment is in place. Everything is computerized. The rooms are clean and usually tastefully decorated. But appearances alone can be misleading. As you may have heard, there is currently a nursing shortage. This may not mean a lot to you on a day to day basis, but when your loved one is ill and hospitalized, it can mean the difference between minor complications versus serious adverse events. As a registered nurse, it is my opinion that every patient hospitalized needs an advocate with them at all times.

Imagine that your parent is hospitalized. It could be for something as simple as a cholecystectomy (gallbladder removal) or something as serious as a myocardial infarction (heart attack). When they are admitted to the hospital, a nurse will perform an admission assessment which will include a physical assessment, a review of their past medical history, and a medication reconciliation. As people age, forgetfulness increases. This is magnified when illness strikes. The patient may not feel like answering a lot of questions, and may not be as focused on the questions as they should be. Some questions may be answered inappropriately. Medications that the patient takes may not be taken down correctly. This can be due to at least two factors: 1) The patient may have their medication bottles with them. Even if they do, there may have been changes in the medication that is not reflected on the current prescription label. For example, Mom was taking 40 mg of lasix daily but Dr. Joe increased it last week to 60 mg. 2) The patient does not have their medications or an up to date medication list with them. When asked what medications they take, they state, "a heart pill, a fluid pill, and a sugar pill". That clearly leaves a lot to explain. This can usually be clarified by calling the physicians office to determine the patients current medication list, but if the office is already closed and it is Friday evening, then you are stuck at ground zero. Especially if the patient lives in a rural area and their physician does not practice at the medical center they have been admitted to.

Imagine that your parent is hospitalized and you have been with them through the admission process and all is well. You decide to go ahead and go home for the night to get some rest, gather some clothes and return tomorrow. Mom is in an unfamiliar room, its noisy, people keep coming in and out, and she is restless. The nurse decides to give her "something to help her rest". After all, most physicians have "routine" PRN orders. This means that physicians have a preprinted order sheet with certain medications listed that nurses may administer as needed. This may include medication for fever, nausea, diarrhea, constipation, pain, and insomnia. Mom takes the "sleep" medicine. In elderly individuals, medications that an average 30-40 yr old can tolerate without any problems, sometimes cause adverse reactions such as increased confusion and increased agitation. So, sometime around 2 am, mom gets up unassisted to go to the restroom and falls. She sustains a hip fracture. Elderly individuals do not recover well from hip fractures. Has this ever happened? Yes.

Imagine that your parent is in bed A and there is another patient in bed B. The nurse brings in the morning medications. Mistakenly she gives the medications intended for pt B to your parent. This happens because when the nurse came in, she said "Ms Blue" here are your morning medications. Your mothers name may or may not be Ms Blue. And she may not have heard the statement at all. All she knows is that she is being presented a cup of medications to take. After all, she's in the hospital, she loves Dr. Joe and he always takes good care of her, and the nurse is so sweet. She takes the medication, even though the pills don't really "look" like the ones she takes at home. Has this ever happened? Yes.

The list can go on and on. It can include medication errors, wrong tests being done on the wrong patient, and wrong surgeries being done on the wrong site.
This is not intended to scare you away from hospitals, but to make you aware that we must all be proactive in our care, especially when we are hospitalized. During a typical 8 hour hospital shift, a nurse will have a team of 5-6 patients. During that 8 hour shift, each patients chart has to be checked, medications have to be administered, and assessments have to be performed. Generally, there are 3 different medication pass times on any one shift. Assuming that there are no discharges and new admissions and the nurse keeps the very same team of 5-6 patients for the entire 8 hour shift, then each patient will receive a grand total of 90 minutes each. This does not mean one on one time. Because at least 50% of a nurses job is documentation. So assuming that, then each patient will have a total of 45 minutes each one on one. That includes doing an assessment, administering medications, changing IV fluids, restarting IV's, assisting the aide with a bed change, giving additional medications as needed for pain, assisting patients to the restroom, and the list goes on. That's a lot to get done in that length of time. And again, that is if all things remain unchanged and there are no other problems with any other patients. Is it any wonder that mistakes might happen.

In order to protect your family member, I recommend the following:
1) Someone must be with the patient at all times.
2) Keep a notebook in the room so that you can write down what time and what medications are given. Yes, actually ask the nurse what they are giving them. If there is a medication that you are unsure of, then ask them to clarify who ordered the medication and when. They may get irritated, but it may prevent a medication error. They will get over it. And you can do this in a kind manner. If you don't understand what the medication is, then ask them for an education sheet on the medication. These are readily available.
3) Before being taken down for any test, ask what the test is. If you are present, then you should be aware of what the Dr. is planning to order. If you are unsure,
ask.
4) Write down questions during the day when you think of something you want to ask the Dr. about. Then, when he makes his rounds, have your notebook ready.
5) If your family member is going to have surgery, carefully review the operative permit. Make sure that the correct procedure is listed and the correct site that is to be operated on is listed. For example, the right breast, not the left breast. Patients are now asked to initial the correct side as well, prior to going to surgery.
6) If you have an elderly parent with a new diagnosis and new medications, then request that the discharge planner be consulted to arrange for Home Health services once your family member is discharged to home. The visiting nurse will be able to check on them and educate them regarding their diagnosis and medications. They may also be able to arrange for an aide to assist them with bathing and Physical Therapy services until they regain their strength.

Hopefully, this will put you on the right track and prevent any complications or errors in care.