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Encourage Patient Advocates to Ask Questions
Some of the most alarming statistics to date are in regard to the rate of medical accidents and injuries from human error. The smartest action patients can take nowadays is to have an advocate come with them to appointments and emergency rooms, when checking in for surgery and procedures, and during hospital stays. Sometimes patients are in pain or too emotionally stressed to be fully aware of what is being done to them. Even when a patient is fully alert and fully capable of asking the right questions, the old saying that “two heads are better than one” still applies.
We need to encourage our patients to have an advocate with them. Parents can advocate for their children, adults for elderly parents, and spouses for each other. Virtually any trusted friend or companion can act as an advocate for healthcare.
Advocates do not need to have medical knowledge. An advocate does not have to understand medication to ask healthcare providers about the medications they are giving to a patient—what each medication is, what it is for, and so on. Just asking such questions will make the healthcare provider think twice about the medication, and that is often enough to prevent a wrong medicine being given to the patient. Asking healthcare providers about wound care, hot packs, cast care, prescriptions, diagnostic tests, and test results can alert healthcare providers to errors that may have occurred or be in the process of occurring.
As an example, if an elderly woman is in the hospital for a clot in her leg, her advocate (possibly a relative, friend, or neighbor) can ask the nurse how often the hot pack should be applied and how long it should stay on. The nurse might double-check the doctor's orders to verify the timing and discover an error; perhaps the nurse thought the doctor said 40 minutes twice a day when the doctor actually had ordered 20 minutes four times a day. The advocate may next ask questions about an injection the nurse is preparing to give the patient. The advocate can ask what the medication is for, how much the patient is getting, and whether that amount is a standard dosage. Such questions might prompt the nurse to mentally recheck the dosage, which could prevent an error. In situations like these, the advocate doesn't need to have any medical knowledge, since just asking the questions might prevent errors.
Although most serious injuries and deaths due to medical mistakes occur in hospital and inpatient settings, the urgent care clinics and ambulatory settings are also arenas in which patient advocates should be alert. In the clinic setting, for example, when a medical assistant is scheduling a patient for an IVP, the advocate can ask, “Is there any danger in this procedure?” That question might alert the medical assistant to obtain more information and discover that the patient is allergic to something routinely used in the procedure. Even without having medical knowledge, the advocate thus has alerted the healthcare provider to a potentially dangerous situation for the patient.
As medical assistants, we should encourage our patients to use advocates and teach them how to ask questions as well as which questions to ask. We should also be willing to answer questions from advocates without feeling like we are being challenged or that we don't have time.
Medical errors kill an estimated 50,000 to 90,000 people per year. This is a serious concern. The American Hospital Association lists the following as some common types of medication errors:
- Incomplete patient information (e.g., not knowing about patients' allergies, other medicines they are taking, previous diagnoses, and lab results)
- Unavailable drug information (e.g., lack of up-to-date warnings)
- Miscommunication of drug orders, which can involve poor handwriting, confusion between drugs with similar names, misuse of zeroes and decimal points, confusion of metric and other dosing units, and inappropriate abbreviations
- Lack of appropriate labeling as a drug is prepared and repackaged into smaller units
- Environmental factors (e.g., lighting, heat, noise, and interruptions) that can distract health professionals from their medical tasks
For more information, go to http://www.fda.gov/fdac/features/2000/500_err.html#Most and search under common medical errors or death from medical error.
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