As a board-certified, fellowship-trained orthopedic surgeon, I have worked in many hospitals of varying sizes in several states. As the Chairman of a Department of Orthopedics, I have helped to create and enact institutional policy. I continue to operate and evaluate patients in my office on a daily basis. I am in the trenches, so to speak, on multiple levels of the actual provision of healthcare.
In this era of shrinking bottom lines, resources are being stretched to their limits. Staffing is being reduced and those who remain are being asked to do more with less. Medical mishaps are usually related to simple human error and/or overworked staff.
Over the years as an insider, I have learned a few tips that may help you better navigate a potential hospitalization.
1. Check your ID band/bracelet often.
2. Have an accurate list of your current medication and allergies.
3. Be aware of potential latex allergies and sensitivities.
4. Special precautions for mastectomy patients.
5. Proper technique for safely receiving medication.
6. Proper technique for safe transportation to testing and labs.
7. Safety tips for elective surgery and invasive procedures.
8. Request MRSA screening
9. Infection prevention
10. Befriend the nursing staff.
Check your ID band/bracelet
Make certain that your name is spelled correctly, your birth date is correct and the proper attending physician is specified. Check it every day. The ID band/bracelet is commonly changed, sometimes without your knowledge. FYI: wrong name on ID band...wrong everything.
Have an accurate list of your medications
Print on your computer the name, dosage and frequency of each medication that you take. Include herbals, over-the-counter meds and vitamins. List all meds that you have an allergy to and the reaction (e.g. allergies....penicillin - itching).
Latex allergies and sensitivities
If the elastic band of underwear or band aids causes a rash, redness or itching, you may be allergic or sensitive to latex. Latex is extremely common in hospital products and equipment. Make hospital personnel aware of this potential reaction. Better safe than sorry.
Do not allow blood draws, IVs or blood pressure cuffs to be placed on the arm on the same side that you have had your breast removed. This may cause unnecessary painful persistent swelling.
Do not bring your medicine to the hospital with you. The hospital has plenty. Bringing your own is a great way to receive an accidental overdose. Before you take any medication make certain that the person presenting you the medication has checked your ID band before you take or allow the medication to be administered. Always ask what the medication and the dosage is before you take it. If you cannot take a common medication like aspirin or acetaminophen make certain that is posted conspicuously in your room (taped to the wall over the head of your bed).
Transportation for labs, testing or procedures
When the transportation person arrives at your room to take you anywhere within the hospital make certain that they check your ID band and you should be aware that this event is to occur. No surprises. If there is any question, ask for your doctor to be contacted and the event confirmed. When you reach your destination, once again make sure that your ID band is inspected prior to beginning the event. Hospitals are busy places. There are commonly many patients waiting, dressed just like you, and it is very easy to receive a test meant for some one else who is scheduled at the same time or has a similar name.
If you are scheduled to have elective orthopedic surgery please take a thorough shower with an antimicrobial soap (like Dial) the morning of the procedure.
With a black magic marker place an obvious X and the word "correct" with your initials at the proper surgical site (e.g. if you are scheduled for a total knee replacement on your left knee, then place an X with the word "correct" and your initials on your thigh just above your left knee cap).
Make sure that you speak face to face with your surgeon prior to receiving any sedation medication by the anesthesiologist or being wheeled into the operating room. You want to be sure that your surgeon is physically in the surgical department and prepared to perform your operation. The statement that your surgeon is "on their way" should not be reassuring.
Make sure that your surgeon is not planning to leave town prior to your anticipated date of discharge. If they do have such plans, you should be made aware of this prior to scheduling your elective surgery and be comfortable with the doctor that is designated to care for you in your surgeon's absence or choose another date.
Elective invasive procedures
Do not allow elective invasive procedures to be scheduled or performed at night, on the weekend or on holidays if it is safe to wait until normal business hours. Complications are a normal occurrence regardless of the quality of the physician. In the event of a complication, it is in your best interest to have every department in the hospital fully staffed, equipped and prepared to quickly and properly assess and correct the situation. Also you are far more likely to encounter tired caregivers during these "non-peak" times.
FYI: Anyone that allows themselves to undergo an elective heart catheterization on a Friday afternoon especially in the summer or a holiday weekend almost deserves what may lie ahead. Doctors despite what many may believe are human too. Your doctor thinking about beating the traffic to their shore house or party arrangements are unintentional distraction that you may ill afford.
FYI: Do not schedule elective surgery over holiday periods especially the week between Christmas and New Years. Newsflash: the hospital employees and physicians that are working probably have the least seniority/experience, staffing is minimal and not enthusiastic about being 'stuck' working over the holidays. You've been warned.
Hand washing. Hand washing. Hand washing. Do I need to say it again? After a surgical procedure, you should request that everyone prior to touching you to "please wash their hands" in your presence or use a readily available disinfecting foam or gel. An adequate hand wash should last at least 15 seconds (HINT: how long is 15 seconds without looking at your watch? Hum the "happy birthday" song twice and that is a good approximation).
Also limit visitors' and hugs and kisses. There should be plenty of time for all of that later. Visitors commonly unknowingly harbor all sorts of nasty little germs that you really don't want to know about. Pay special attention to this advice during the post-operative period when your immunity is lowered and you have incisions, IVs and tubes which make excellent routes of entry for infections.
MRSA is the current super bug (bacteria) that is getting all the press and driving hospitals crazy. People commonly think that they acquire this infection from the hospital but this usually is not the case. Actually, most patients bring the MRSA with them to the hospital in their noses. During the preoperative work-up, you should request that a nasal swab be taken to screen for MRSA. If you are found to be a carrier for MRSA, you can then be treated prior to your surgery.
Befriend the nursing staff
This may be the easiest and most important tip of all, but it is often inexplicably overlooked. The nursing staff is your lifeline during your hospitalization. Do not for any reason cut it. They execute 99% of all orders from your physician and provide 99% of all of the valuable care that you will or will not receive. Do not alienate them. And don't let your family members alienate them for you, because you will be the one that suffers. Remember, the nursing staff is a highly trained group of professionals. They do not exist to be your personal servant. They are commonly overworked and underappreciated. Do not add to this perception. Be very polite and friendly. Always thank them for the care and attention that they provide and encourage your family to do likewise. A gift of warm, fresh bagels for the day shift or snacks for the night shift is very appropriate and appreciated. Put your loved one's name and room number on them so every one knows who deserves the brownie points. Just trust me on this one.
Get out of the hospital as fast as you safely can
As soon as you are healthy enough to go home, do so. Don't try to hang around an extra day or two until you're perfect or it is more convenient. Plan and prepare for your return home prior to your admission or have a designated family member handle those duties as soon as you arrive to the hospital in an emergency situation. Every day in the hospital is another opportunity for a complication, infection or human error to strike. Do everything within reason to limit those opportunities.