Thomas A. Sharon, R.N., M.P.H.

UnconventionalWoman.com-Mainstream Medicine

Book Review February 5, 2008

Protect Yourself in the Hospital: Insider Tips for Avoiding Hospital Mistakes for Yourself For Someone You Love

Thomas A. Sharon, R.N. M.P.H.
McGraw-Hill, November 2003

Sharon starts out by saying, “It is my intent to educate and not to frighten people.” He goes on to say that hospitals are a necessary part of our lives, but that “because we do not have the presence of mind to scrutinize the services they provide, we put too much trust in doctors, nurses, and corporate management. We keep quiet for fear of antagonizing the people on whom we depend for survival.”

However, this is a frightening book. Everyone who might have a loved one in the hospital at some time should read it. As a registered nurse who has been reviewing hospital charts for malpractice attorneys for the last 25 years, Sharon has homed in on a number of “repetitive, preventive calamities” that occur regularly in hospitals all over the country. . .

. . . An alert, watchful attitude, and a willingness to ask questions and speak up loudly if something doesnt seem right is necessary, and most of us cant summon that kind of focus when we are the patient. And if the patient is perceived as a “complainer,” that can affect the quality of care one receives.

However, you can skip lot of the histories and just read Sharons excellent descriptions of how to choose a hospital or a doctor, what to watch out for, how to plan in advance to prevent mishaps and what to do in the event that something goes wrong. He identifies these areas as meriting special attention:

1) Injuries that happen in a particular area of the hospital, like the emergency room or operating suite, because of inherent defects in hospital design and methodologies of delivering services.

2) Hospital-induced complications such as bedsores and infections which can be prevented by proper care from staff.

3) Patients being deprived of proper treatment because financial incentives have caused hospital executives to decide against more effective technologies, and patients are never informed of other choices that exist.

4) Hospital-induced anemia too much blood can be drawn for lab tests, especially from patients in intensive care, and the patient can suffer multiple complications, including death, as a result.

5) Nursing staff levels in many hospitals are so low that the quality of care suffers.

6) Typical medications errors, especially narcotic overdose causing respiratory depression and death, often associated with self-administered pain meds.

7) Nursing staff does not respond to patient calls for help because they see patient as emotionally needy and trying to get attention.

Problems caused by financially motivated early discharge: sending patients home without necessary follow-up tests or with equipment too complicated to be cared for in the home.

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Protect Yourself in the Hospital: Insiders Tips for Avoiding Hospital Mistakes for Yourself or Someone You Love
by: Thomas A. Sharon 2003
This book will guide you on how to prevent infections and other problems you may have at the hospital.

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Protect Yourself in the Hospital

A 1999 Harvard study found nearly 100,000 people die accidentally in the hospital each year. However, there are ways to protect you and your loved ones. This book by Thomas A. Sharon, RN, MPH, offers practical and possibly lifesaving advice. From the emergency room to the operating room and every ward in between, find the tools to feel safe and secure. Sharon, a registered nurse and a legal consultant for malpractice cases, covers topics including: the importance of room placement; making sure the correct body part is operated on; simple ways to prevent such common conditions as bedsores and hospital-acquired infections; and how to advocate for oneself or a loved one without alienating hospital staff.

Pages: 224
Price: $12.95, soft cover
HTTP://www.books.mcgraw-hill.com

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San Antonio Personal Injury Lawyer
Beware of PCAs (Patient Controlled Analgesics)

Editor: Beth Janicek

Firm: Law Offices of Beth S. Janicek

March 13, 2007

By Staff Writer

Category: Medical Malpractice

Many hospitals and healthcare facilities offer Patient Controlled Analgesics (PCAs), which are ways for patients to administer and manage their own pain medication. Most of these patients are not aware of the dangers of narcotic overdose that may accompany PCAs.

One nurse reports that the information available to patients about PCAs is misleading and unreliable. Thomas A. Sharon, R.N., M.P.H. reports “public misinformation” on many Web sites regarding the use of PCAs. He points out that many sites do not offer enough information about the possible risks and side effects of using PCAs, which often are narcotics. These may include:

accidental overdose
machine malfunction
human error
nausea and vomiting
depressed respirations
reduced heart rate
lowered blood pressure

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INSURANCE jOURNAL

Malpractice Reform Must Focus on Reducing Patient Injury
January 26, 2004

Reducing medical injury is essential to solving the current medical malpractice crisis, and physicians must play an active role in developing and implementing systems to improve patient safety, according to an article published in the Jan. 6 issue of Annals of Internal Medicine.

In “Malpractice Reform Must Include Steps to Prevent Medical Injury,” Stephen C. Schoenbaum, M.D. of The Commonwealth Fund and Randall R. Bovbjerg of the Urban Institute say that focusing solely on capping malpractice awards—the solution most commonly promoted by physicians in the current debate—leaves out the largest problem: patient injury.

“Physicians must use their abilities to make care safer and injuries rarer, by developing, evaluating, and implementing safety improvements,” said Schoenbaum, senior vice president at the Commonwealth Fund. “More active work on the part of physicians to improve care and reduce harm is clearly in the best interest of the public and physicians.”

The current medical liability system works poorly for patients and physicians. Steep increases in malpractice premiums lead to physicians practicing “defensive medicine,” which in turn contributes to rising health care costs, in addition to patients’ enduring unnecessary medical procedures. Meanwhile, large numbers of Americans continue to suffer preventable medical injuries.
The authors point to reforms such as the highly successful effort of anesthesiologists in the mid-1980s, who adopted practice guidelines that reduced both patient deaths and insurance premiums dramatically, as one of many physician-led models of safety improvement. The experience with such models has shown that system-wide reform, rather than blaming individual physicians, leads to more effective improvements in patient safety.

Legislative or regulatory efforts to motivate this type of change could include:

• Licensure requirements such as the risk management training required by the Massachusetts Board of Registration.
• Insurance regulators could provide premium discounts on malpractice insurance based on physicians’ performance-an up- front investment in quality improvement that would reap savings in the long term.
• Tort reform could be contingent on reporting of errors, or implementing specific activities that increase patient safety.
• Health plans, Medicare, and Medicaid could provide partial subsidies of physicians’ premiums in return for specific safety enhancements.
• Physicians should invest in tools such as electronic prescribing aids and automated systems for tracking of tests.
• Better information on patient safety is needed to facilitate safety improvement and physician involvement.

Subject: Protect Yourself in the Hospital
Posted On: March 1, 2004, 12:11 pm CST
Posted By: Thomas A. Sharon, R.N., M.P.H.
Comment:
It is refreshing to see someone in the insurance industry call for error reduction in health care rather than finding ways to punish palintiff lawyers for doing their jobs.

I am a registered nurse of 27 years with a master in public health (MPH) degree. For the past 18 years, I have advised attorneys on hundreds of cases in which hospitals and nursing homes were accused of preventable errors. I have recently authored a book entitled Protect Yourself in the Hospital: Insider Tips for Avoiding Hospital Mistakes for Yourself or Someone You Love (Contemporary Books/McGraw-Hill; Oct/Nov. 2003; $12.95), which provides life-saving information.

According to the often quoted Harvard University Study of 1999 and other notable reports, almost 100,000 people die in hospitals each year from preventable, accidents, oversights, blunders or abuse. Many more suffer catastrophic injuries such as irreversible brain damage, amputation and paralysis. The most common negligent acts of commission or omission are neglect, failure to provide professional assessments, failure to follow established protocols and policies, incompetently performed procedures, failure to intervene with protective and preventive measures, careless blunders, medication errors, and criminal assaults. The consequences of such acts or failures are traumatic injury, bedsores, choking, nerve damage, infection, narcotic overdose, brain damage respiratory failure, or cardiac arrest. The disturbing aspect to all this is the fact that these mishaps occur in every hospital from coast to coast with alarming regularity.

The solution to the health care/malpractice debacle lies in educating the consumer. Since most hospital mistakes are preventable, the patients and their family members can learn how to recognize most dangerous conditions and situations before death or injury occurs. We also need new legislation that will require hospitals to report and publicly disclose the rate of unexpected deaths and injuries occurring as a result of any medical procedures and/or medications. Furthermore, Hospital management teams can reduce the number of fatal or injurious mistakes by making the patients and family members a part of their continuous quality improvement (CQI) process. They can include the consumers by providing full disclosure of the known perils that lie in wait.

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THE NEW YORK TIMESBOOKS ON HEALTH; Surviving the Healing During a Hospital Stay
By JOHN LANGONE
Published: February 17, 2004
”Protect Yourself in the Hospital,” by Thomas A. Sharon. Contemporary Books, $12.95.
”Health Smart Hospital Handbook,” by Dr. Joseph Sacco. Alpha Books, $14.95.
”Dr. David Sherer’s Hospital Survival Guide,” by Dr. David Sherer and Maryann Karinch. Claren Books, $14.95.”The sooner patients can be removed from the depressing influence of general hospital life,” Dr. Charles Mayo observed in 1916, ”the more rapid their convalescence.”Indeed, hospitals are essential, but too often they are bastions of bureaucracy, neglect and sometimes outright ineptitude. One often cited statistic from a 1999 Harvard study puts the hazards of a hospital stay in chilling perspective: hospitals kill nearly 100,000 people a year because of human error, faulty techniques, malfunctioning equipment, wanton carelessness, oversights or assaults.”Many more leave the hospital worse off than when they went in,” writes Mr. Sharon in his book, one of these three that outlines the pitfalls of a hospital stay and how to make the best of it.

Mr. Sharon, a registered nurse and legal consultant, offers what he calls ”insider tips for avoiding hospital mistakes,” information that includes ways to prevent mishaps in intensive care units, play the ”emergency room waiting game,” communicate with staff to get better service and deal with managed care when you’re told that ”your request for treatment has been denied.”

Much of his advice depends on the patient’s asking questions and being observant and insistent. In the I.C.U., for example, he advises asking the nurse what each wire and tube is for, checking for swelling and redness from the insertion of intravenous lines, and seeing to it that, in the case of a transfusion, the nurse matches the serial numbers and the blood type between the transfusion ticket and the label on the blood product unit — in the presence of a second nurse.

”Pay attention to how many patients your nurse is assigned to,” he writes. ”If there are three or more, lodge a complaint with the health administration and follow up with the health department if you do not get a satisfactory response.”

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WOMEN’S HEALTH

Special Report: How Safe is Your Hospital?

By Jennifer Pirtle, Women’s Health

Kathy McCabe, 31, had already seen two doctors about the stabbing pain in her stomach. But when it worsened, she headed to the ER near her home in Washington, D.C. After lying on the hospital floor in anguish for more than 2 hours, McCabe was given a CAT scan so doctors could see 3-D images of her organs. The radiologist said the CAT scan showed nothing unusual, so the ER staff gave McCabe two things. A prescription: More painkillers. And directions: Go home. The next day McCabe visited three more doctors. One internist referred her to a surgeon, who wanted her to undergo exploratory surgery. The third doctor, an internist who specialized in geriatric issues, questioned McCabe thoroughly and then urged her to retrieve her CAT scan from the hospital. He took one look at the film and told McCabe that she had advanced diverticulitis, a serious infection of her digestive tract. Worse, her bloodstream was overwhelmed by the resulting bacteria.

“He couldn’t believe how sick I was,” McCabe says. “He said my colon was in danger of bursting.”

The doctor put McCabe on antibiotics for 2 months. Although McCabe says she didn’t suffer any lasting health complications from the “nothing’s un-usual” diagnosis at the ER, the experience has shaken her confidence in the healthcare system and made her apprehensive of hospitals.

“I now know I can’t take what a doctor says as 100 percent true,” she says.

150,000
Shortage of Nurses Nationally

More than ever, medical mix-ups, errors, and misjudgments have turned safe havens into potentially dangerous ones. Just consider the stats:

As many as 98,000 people die each year in U.S. hospitals from medical errors, according to the Institute of Medicine of the National Academy of Sciences. That’s more than from car accidents, breast cancer, or AIDS.

Nearly 2 million people pick up infections in hospitals each year largely due to preventable errors and 90,000 people die from them.

While it’s tempting to blame a staff’s ineptitude, ignorance, or irreverence, experts say the problem is simply 21st century health care. “It’s safe to make the assumption that every person who goes to work in a hospital is there to help. Unfortunately they quite often end up doing the opposite,” says Thomas Sharon, R.N., M.P.H., author of Protect Yourself in the Hospital.

The rise of HMOs during the past 2 decades, coupled with lower reimbursements by Medicare and Medicaid, has created a financial climate that has led hospitals and clinics to cut staff and attempt to do more with less. The result: Poor communication among staff, a faulty system of checks and balances, and overworked or minimally trained workers. The hardest hit has been the nursing profession. The United States has a shortage of nearly 150,000 nurses (the shortage is attributed, in part, to early retirements caused by the physical and emotional demands of the job). That shortage is expected to climb to more than 800,000 in 15 years, according to a report from the U.S. Department of Health and Human Services.

“The general public doesn’t know how much of an impact the nurse has on the safety of their care,” says Ronda Hughes, Ph.D., senior health science administrator at the Agency for Healthcare Research and Quality in Maryland. It’s the nurse, for example, who administers medication and ensures that unsterile devices or products aren’t used.

Simply, fewer nurses means more mistakes. In 2002 the Joint Commission on Accreditation of Healthcare Organizations examined more than 1,600 hospital reports of patient deaths and injuries since 1996. It found that low nursing staff levels were a contributing factor in 24 percent of the cases. And adding just one additional patient over four already in a nurse’s care has been shown to raise a surgical patient’s risk of death by 7 percent.

“Nurses are trying to meet the needs of the patients, but they’re stressed, angry, and frustrated because they know there aren’t enough of themselves on staff,” Dr. Hughes says. With the average age of nurses at 45 and most nurses retiring in their late 50s, it’s becoming especially challenging to find enough new recruits. Why? Nationally, there simply aren’t enough good instructors to train them. “Schools are looking for doctor-trained faculty, but these people have to take huge salary cuts to teach,” says Dr. Hughes, who estimates that most nursing institutions are missing an average of five full-time instructors. “Most just aren’t willing to do that.”

235,000
Number of Medication Errors Hospitals Make Every Year

Julie botteri, 34, of marathon, florida, was visiting a nearby hospital 4 years ago for an inflamed cat bite on her left hand. The attending physician looked at her index finger which had swelled to twice its normal size and immediately ordered an intravenous antibiotic drip. Because a cat’s needle-like fangs inject bacteria deep into a wound, the resulting infection could enter the bloodstream and make its way into tissues and organs, causing life-threatening complications like pneumonia, heart infection, or the loss of a limb. “He warned that if the bite didn’t improve quickly, he’d need to slice open my finger to release some of the infection,” Botteri says.

Botteri estimates she received four or five bags of the antibiotic solution before a nurse changed the IV. “For the 30 minutes it took the new bag to drain, it felt like ice-cold water was flowing down my arm and across my chest,” she says. “I pressed the nurse call button several times, but no one came until the shift change. The nurses seemed overworked and exhausted.”

Although the cool sensation Botteri felt was likely because one liquid was colder than another, the temperature disparity was enough to make Botteri ask questions. At Botteri’s urging, the new nurse checked her charts and discovered that her predecessor had mistakenly given saline instead of the crucial antibiotic. Botteri resumed antibiotics, the infection cleared, and she returned home within 3 days.

The most common type of medical error now is a medication mistake. In 2003, 570 hospitals and health-care facilities reported more than 235,000 medication errors to the database of the U.S. Pharmacopeia, a nonprofit watchdog group that works with the FDA. There were 13 different kinds of slipups, including vague or unreadable prescriptions, right medications given to the wrong patient, and mix-ups of similarly named medications, such as giving Zantac, an acid-reflux drug, instead of Zyrtec, an allergy drug.

Much of the problem circles back to the shortage. A 2004 study from the University of Pennsylvania found that the risk of making an error increased when hospital nurses worked more than 12 hours per shift, worked overtime, or worked more than 40 hours per week. (Several states are now banning or limiting mandatory overtime.)

“In hospitals you have the best people who are sometimes at their worst,” says Sharon, who has more than 20 years of experience in the health-care field. “You can’t expect 100 percent performance of them every time they go to work.”

40
Percentage of Doctors Who Don’t Wash Hands Enough

Ann eide, 37, from columbus, Mississippi, had a small biopsy on her leg to test for mitochondrial myopathy, a rare offshoot of muscular dystrophy. The resulting incision was just 1-inch long and sutured with seven stitches, yet Eide says that when she returned home from the hospital, the wound “looked really red and was oozing pretty badly.”

She immediately called the hospital and was told over the telephone not to worry, that the redness was “normal.” The next day, same thing. With the infection worsening, Eide became concerned and went to an ER at another hospital.
“The doctor who looked at my leg was shocked,” Eide says. “He called the wound ‘horrific’ and asked who had done this to me. He told me that if the stitches had been left in my leg much longer, the infection could have become very serious.” Antibiotics cleared the infection within 1 week, but the wound remained tender for nearly 4 months. “To this day it still throbs from time to time,” Eide says.

Hospital-acquired infections account for $4.5 billion in excess health-care costs annually, the Centers for Disease Control and Prevention says. Infections, which can be caused by bacteria, fungi, viruses, or parasites, might already be in your body, or they can come from the environment, contaminated hospital equipment, health-care workers, or other patients. The most common:

Urinary tract infections. While a healthy bladder is sterile, the bacteria that march up the rubber or plastic tube can cause infection if the insertion site is not properly cared for. A study at the University of Michigan’s Department of Internal Medicine found that more than 1-quarter of catheter patients develop urinary tract infections within 2 days of having a catheter inserted. (They’re relatively minor and go away with antibiotics, but they add an average of 1 extra hospital day to a patient’s visit.)

Pneumonia. It often arises when intensive-care patients are put on ventilators to help them breathe easier. Patients who have had tubes inserted are 20 times more likely to develop pneumonia than ones who haven’t, mainly because the ventilators make it easier for bacteria or vomit to get into the lungs, according to the Association for Professionals in Infection Control and Epidemiology.

Surgical infections. “Surgery increases a patient’s risk of getting an infection in the hospital, as broken skin gives bacteria a way to enter into normally sterile parts of the body,” says Lance R. Peterson, M.D., director of clinical microbiology and infectious disease research at Evanston Northwestern Healthcare in Illinois. So-called surgical site infections can originate with contaminated equipment, with health-care workers, or anything in between. The CDC estimates that 500,000 such infections occur annually in the United States. A single infection resulting from cardiac surgery can cost a hospital as much as $42,000 to treat.

Hypervigilant hygiene, including proper wound care, is crucial in preventing and combating infection. Staphylococcus aureus (also known simply as “staph”) are bacteria that can live harmlessly on many skin surfaces, especially around the nose, mouth, and genitals. But when the skin is punctured or broken, as during surgery or when a catheter is inserted, the bacteria can enter the wound and make a person extremely sick. (Of mounting concern is a sometimes-fatal staph variant known as MRSA, which can be resistant to antibiotics.)

The most effective way to protect patients against bacterial infections is hand-washing. Scrubbing just 20 to 30 seconds with soap and water, or rubbing with an alcohol-based gel, helps health-care workers beat most bugs. Yet hand-washing compliance by doctors in hospitals is around 60 percent, mainly because of busy workloads and a heavy patient rotation, according to a recent report in the Annals of Internal Medicine.

“Health-care workers know they need to be doing it,” Dr. Peterson says, “but they’re not very good in practice.”

Zero
Cases of Ventilator-Induced Pneumonia at One Hospital Using a New Protocol

Today more states and agencies are trying to make changes to improve safety. Illinois, Pennsylvania, Missouri, and Florida have passed laws requiring the publishing of hospital-acquired infection rates (15 others are considering legislation). And last year the FDA called for the inclusion of bar codes (think supermarket scanners) on prescription drugs and over-the-counter drugs commonly used in hospitals. New medications covered by the rule will have to include bar codes within 60 days of the medication’s approval by the FDA; most previously approved medicines and all blood and blood products will have to comply with the new requirements by 2006. They’re good changes in theory, but many states have shot down laws that would require hospitals to report infection data (many hospitals don’t want data made public because of the bad press), and the FDA ruling doesn’t require hospitals to install bar-coding systems. Another government-led initiative to create a national electronic health network to share clinical information will take at least a decade to create and implement.

“More often than not, the government will try to start some positive motion but will get bogged down in the details,” says Jeffrey Goldstein, M.D., senior physician consultant for HealthGrades, an independent healthcare quality ratings company in Golden, Colorado. That’s why change will likely come from other places. Dr. Goldstein points to the “100,000 Lives” program, which was launched in December 2004 by the Institute for Healthcare Improvement, a nonprofit organization in Cambridge, Massachusetts, which aims to show that 100,000 deaths can be avoided through simple interventions. One hospital that joined the campaign, Newark Beth Israel Medical Center in New Jersey, reduced cases of ventilator-induced pneumonia to zero just by weaning patients from ventilators more quickly.

Many others from individual hospitals to larger grassroots groups are making their own changes. For example:

The Department of Veterans Affairs began using a proprietary bar-code system in its 1,300 care facilities more than 5 years ago. Under the system all units of medication leave the pharmacy with a bar-coded label that can be scanned to correspond with a bar code on the patient’s hospital wristband, providing a way to track missed doses and pinpoint errors in dispensing. Now the VA reports a significant reduction in problems caused by medication mistakes.

This year Evanston Northwestern Healthcare began using a presurgical nasal swab screen to identify staph DNA in 2 hours, as opposed to 4 days with older techniques. This has helped the company’s hospitals cut postsurgical staph infection rates among patients fivefold.

The Leapfrog Group, a collection of more than 170 companies and organizations that buy health care for more than 35 million employees nationwide, is rewarding hospitals with perks like bonus payments and increased reimbursement rates. For a hospital to benefit, it must pass recommended quality and safety practices. These “leaps” include the use of a computerized system to order tests and medication, assurance that patients with high-risk conditions are cared for using procedures shown to improve outcomes, and an intensive care unit supervised by specialists in critical care medicine.

In 2003 Leapfrog’s first three quality and safety practices were estimated to have the potential to save over 65,000 lives, prevent as many as 907,000 medication errors each year, and save $41.5 billion.

Ideally, hospitals, agencies, and the government will look to provide optimal care and make patient safety a priority, but these decisions may be tempered by financial constraints, Dr. Goldstein says. “The patient doesn’t care about cost or similar factors that play into clinical decision-making,” he says. “The only thing that matters is that he or she receives the best and safest care possible.”

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NATIONAL PATIENT SAFETY FOUNDATION

NPSF Bibliography
NPSF CURRENT AWARENESS PATIENT SAFETY LITERATURE ALERT
JUNE #1, 2004

The NPSF Information Resource Center, in an effort to monitor the landscape of patient safety, routinely identifies articles that may be of interest to the patient safety community. This twice-monthly publication is not an exhaustive list of citations, but does pinpoint items of interest from a wide array of publications. Copies of the articles may be obtained through your local medical or public library and the web.

19. Protect yourself in the hospital: insider tips for avoiding hospital mistakes for yourself or someone you love.
Sharon TA.
Chicago, Ill: McGraw-Hill; 2004. # 0-07-141784-2.
Each chapter in this comprehensive book examines the types of errors found in different phases of the hospital stay and the steps patients and their families can take to help minimize those errors. Checklists and recommended questions and answers are included, along with personal and patient stories of medical error experiences.
Code: GEN; CON