This is a set of slides I put together for a briefing for the Metro Maryland Ostomy Association. It is on the topic of patients being involved with their healthcare and focuses on improving safety and quality to the extent practicable by a patient. I am a member of the Board of MMOA, and had an ileostomy for 13 years, up until just a few months ago when I had "j-pouch" surgery. I worked for the Dept of VA's National Center for Patient Safety from 2000 to 2010, and have been with the AHRQ Center for Quality Improvement and Patient Safety 3 years as of this posting.

1. 11
Improving the Safety
of Your Healthcare
(being an educated patient, advocating for
yourself, safe and patient-centered care)
For Metro Maryland Ostomy Association
Noel E. Eldridge, MSNoel E. Eldridge, MS
noel.eldridge@ahrq.hhs.govnoel.eldridge@ahrq.hhs.gov
neldridge202@yahoo.comneldridge202@yahoo.com
301 427-1156301 427-1156
202 641-5959202 641-5959

2. 22
What is Patient SafetyWhat is Patient Safety
Improvement Trying to Achieve?Improvement Trying to Achieve?
 Our goal is to prevent harm to patients asOur goal is to prevent harm to patients as
they receive medical care. For example…they receive medical care. For example…

Adverse Drug Events (overdose, wrong drug,Adverse Drug Events (overdose, wrong drug,
drug interaction, etc.)drug interaction, etc.)

Wrong or Mixed-up Procedure, Test, or X-rayWrong or Mixed-up Procedure, Test, or X-ray

Patient Falls and Wandering PatientsPatient Falls and Wandering Patients

Healthcare-acquired InfectionsHealthcare-acquired Infections

Problems with Medical Devices –Problems with Medical Devices –
Malfunctions or Accidental MisuseMalfunctions or Accidental Misuse

3. 33
Books for Patients amazon.comBooks for Patients amazon.com
Take This Book to the Hospital With You:Take This Book to the Hospital With You:
A Consumer Guide to Surviving Your Hospital StayA Consumer Guide to Surviving Your Hospital Stay
(4.5 stars)(4.5 stars)
 by Charles B. Inlanderby Charles B. Inlander
Buy this book withBuy this book with
How to Get Out of the Hospital AliveHow to Get Out of the Hospital Alive
(4.5 stars)(4.5 stars)
 by Sheldon P. Blau, Elaine Fantle Shimbergby Sheldon P. Blau, Elaine Fantle Shimberg

4. 44
II’m not a doctor or a nurse’m not a doctor or a nurse
 Information here is based:Information here is based:

On personal experiencesOn personal experiences

Reading and learning about adverseReading and learning about adverse
events in healthcare on my jobs overevents in healthcare on my jobs over
the last 12 yearsthe last 12 years

Listening to lots of doctors and nursesListening to lots of doctors and nurses

5. 55
Participating in Other SettingsParticipating in Other Settings
 What do bus passengers have to do?What do bus passengers have to do?

Get on the correct bus & pay the fareGet on the correct bus & pay the fare

Follow basic bus rules – stay behind whiteFollow basic bus rules – stay behind white
line, donline, don’t talk to driver while bus is in motion,’t talk to driver while bus is in motion,
don’t do anything crazy like leaning out of andon’t do anything crazy like leaning out of an
open windowopen window

Keep track of where you are -- look out of theKeep track of where you are -- look out of the
window so you can ring bell at correct place towindow so you can ring bell at correct place to
get offget off

Not like the extremes of being an airplaneNot like the extremes of being an airplane
passenger or driving your own carpassenger or driving your own car

6. 66
Patients Participating inPatients Participating in
Patient SafetyPatient Safety
 Hospital inpatients shouldnHospital inpatients shouldn’t have to do a’t have to do a
lot. Primary responsibility for inpatients islot. Primary responsibility for inpatients is
with hospital and healthcare providers.with hospital and healthcare providers.
 Why?Why?

People are sick in the hospital – even sickerPeople are sick in the hospital – even sicker
than they used to be.than they used to be.

Many sick people arenMany sick people aren’t at their best mentally’t at their best mentally
(I know this firsthand).(I know this firsthand).

Sick people receiving healthcare shouldnSick people receiving healthcare shouldn’t’t
have to be vigilant about it. (my opinion)have to be vigilant about it. (my opinion)

7. 77
What Patients Can Do (1)What Patients Can Do (1)

Before Surgery: Participate in informedBefore Surgery: Participate in informed
consent that is really informed and reallyconsent that is really informed and really
consent.consent. (Think mortgage, not rental-car(Think mortgage, not rental-car
agreement.)agreement.)

Ask your surgeon:Ask your surgeon:
• Exactly what will you be doing?Exactly what will you be doing?
• About how long will it take?About how long will it take?
• What will happen after the surgery?What will happen after the surgery?
• How can I expect to feel during recovery?How can I expect to feel during recovery?
• Tell the surgeon, anesthesiologist, and nursesTell the surgeon, anesthesiologist, and nurses
about any allergies, bad reaction to anesthesia,about any allergies, bad reaction to anesthesia,
and any medications you are taking.and any medications you are taking.

8. 88
What Patients Can Do (2)What Patients Can Do (2)

Ask questions until you understand toAsk questions until you understand to
the extent that you care to understand.the extent that you care to understand.

Try hard not be accusatory as you askTry hard not be accusatory as you ask
questions, doctors and nurses intend toquestions, doctors and nurses intend to
help…and most of the time thathelp…and most of the time that’s what’s what
will happen (or at least no harm).will happen (or at least no harm).

Pay attention to the extent possible.Pay attention to the extent possible.

Willingly participate in safer systems –Willingly participate in safer systems –
e.g., done.g., don’t complain about being asked’t complain about being asked
your name 3 times by 3 different people.your name 3 times by 3 different people.

9. 99
What Patients Can Do (3)What Patients Can Do (3)

Before an Office Visit: Make a writtenBefore an Office Visit: Make a written
list of symptoms, questions, etc., tolist of symptoms, questions, etc., to
review during visit or interaction withreview during visit or interaction with
clinician.clinician.

Tell the doctor the truth about yourTell the doctor the truth about your
symptoms and history.symptoms and history.

Take your medicine or tell the doctor ifTake your medicine or tell the doctor if
you stop.you stop.

10. 1010
What Patients Can Do (4)What Patients Can Do (4)

Ask your doctor to provide you with a list ofAsk your doctor to provide you with a list of
the medications he/she has prescribed for youthe medications he/she has prescribed for you
– and keep it up to date. Add on any non-– and keep it up to date. Add on any non-
prescription drugs that you take regularlyprescription drugs that you take regularly

When thereWhen there’s a “better” choice – actually’s a “better” choice – actually
choose the better specialist, hospital, healthchoose the better specialist, hospital, health
plan, etc. But, one problem is defining betterplan, etc. But, one problem is defining better
– more timely, nicer, smarter, more up-to-– more timely, nicer, smarter, more up-to-
date, safety-conscious, good listener, gooddate, safety-conscious, good listener, good
referrer, gentler, etc.referrer, gentler, etc.

11. 1111
Other Steps to Safer Health CareOther Steps to Safer Health Care
fromfrom www.ahrq.gov/consumer/5steps.htmwww.ahrq.gov/consumer/5steps.htm
 Get the results of any test orGet the results of any test or
procedure.procedure. Ask when and how you willAsk when and how you will
get the results of tests or procedures.get the results of tests or procedures.
Don't assume the results are fine if you doDon't assume the results are fine if you do
not get them. Call your doctor and ask fornot get them. Call your doctor and ask for
your results. Ask what the results mean foryour results. Ask what the results mean for
your care.your care.
 Make sure you understand what willMake sure you understand what will
happen if you need surgery.happen if you need surgery. Ask yourAsk your
doctor, "Who will manage my care when Idoctor, "Who will manage my care when I
am in the hospital?"am in the hospital?"

12. 1212
Special Ostomy TopicsSpecial Ostomy Topics
 Hydration (drink more water)Hydration (drink more water)
 Potential for Blockages (carefully consider whatPotential for Blockages (carefully consider what
you eat – based on physician advice and youryou eat – based on physician advice and your
own experience -- and remember to chew)own experience -- and remember to chew)
 Skin Care is Very ImportantSkin Care is Very Important
 Potential for Hernias or AbscessesPotential for Hernias or Abscesses
 Get Follow-ups as Recommended by yourGet Follow-ups as Recommended by your
Physician(s) or NursesPhysician(s) or Nurses
 Ask if a Hospital has WOC Nurse(s)Ask if a Hospital has WOC Nurse(s)

13. 1313
Other Patient Safety TipsOther Patient Safety Tips
 Agency for Healthcare Research andAgency for Healthcare Research and
QualityQuality

http://www.ahrq.gov/consumer/20tips.htmhttp://www.ahrq.gov/consumer/20tips.htm

http://www.ahrq.gov/consumer/5steps.pdfhttp://www.ahrq.gov/consumer/5steps.pdf
 New: Guide to Patient and FamilyNew: Guide to Patient and Family
Engagement in Hospital Quality andEngagement in Hospital Quality and
SafetySafety

http://www.ahrq.gov/professionals/systems/hospitahttp://www.ahrq.gov/professionals/systems/hospita

14. The GuideThe Guide’s sections include—’s sections include—
 Information to Help Hospitals Get Started Addresses:Information to Help Hospitals Get Started Addresses:
 Strategy 1: Working With Patients and Families asStrategy 1: Working With Patients and Families as
AdvisorsAdvisors
 Strategy 2: Communicating to Improve QualityStrategy 2: Communicating to Improve Quality

helps improve communication among patients, family members,helps improve communication among patients, family members,
clinicians, and hospital staff from the point of admission.clinicians, and hospital staff from the point of admission.
 Strategy 3: Nurse Bedside Shift ReportStrategy 3: Nurse Bedside Shift Report

supports the safe handoff of care between nurses by involvingsupports the safe handoff of care between nurses by involving
the patient and family in the change of shift report for nurses.the patient and family in the change of shift report for nurses.
 Strategy 4: IDEAL Discharge PlanningStrategy 4: IDEAL Discharge Planning

helps reduce preventable readmissions by engaging patientshelps reduce preventable readmissions by engaging patients
and family members in the transition from hospital to home.and family members in the transition from hospital to home.
1414