Diabetes Forecast

10 Ways to Stay Safe in the Hospital

By Tracey Neithercott ,

It's every patient's worst nightmare: You're admitted to the hospital for routine surgery and end up with a dangerous infection. Or you're given a drug dosage 10 times what was prescribed because someone misread the doctor's order. Or you go in for an operation, and the surgeon works on—gulp!—the wrong body part.

A groundbreaking 1999 report from the Institute of Medicine found that as many as 98,000 people die yearly in hospitals because of medical mistakes. In the years since that report was released, hospitals have adopted new safety procedures with hopes of reversing the trend. In the best scenarios, that means a system like this: Nurses debrief one another on patient details as they prepare to change shifts. Patients sit down with care managers before an operation to review the procedure and again post-op to go over treatment guidelines and medication dosing. Doctors and nurses involved in surgery pause before starting so they can review the operation procedure, make sure they have the correct patient, and know exactly which body part will go under the knife—all while the patient is awake. And staff members all wash their hands, again and again and again.

Yet despite the new awareness about safety, a New England Journal of Medicine study published in November found that errors remain common. Researchers analyzed records from 10 hospitals in North Carolina—a state that has made efforts to improve patient safety—and found that 18 percent of patients were hurt as a result of a medical procedure, medication, infection, or other cause. Of those harms, 63 percent were preventable and a small number (about 2 percent) contributed to a patient's death. According to the study's authors, there are plenty of potential reasons why hospitals haven't made strides: They haven't implemented electronic systems for medical records and order entry; nurses and physicians work longer hours than are known to be safe; or simple measures like hand washing just aren't followed.

Getting educated on ways to prevent medical mishaps is especially important for people with diabetes. In 2008, 1 in 5 hospitalizations was related to the disease. And people with diabetes tend to have longer, more expensive stays than those without. Reducing your risk for errors can lessen the likelihood you'll spend extra time in the hospital.

The best approach, it turns out, is to take charge of your own health. "It's important that patients take an active role in their care," says Tom Balcezak, MD, associate chief of staff and vice president for quality and safety at Yale–New Haven Medical Center. "If they notice a concern, they should say something." That includes asking your doc to wash his or her hands before touching you—even if you feel uncomfortable making the request. It can also mean enlisting someone else, like a family member or friend, to be your advocate during your hospital stay to keep an eye on your care, listen carefully to doctors and nurses, and speak up if you are unable to do so yourself.

Here are 10 ways the experts say you can reduce your risk for both big dangers and more run-of-the-mill misadventures in the hospital—whether you have diabetes or not.

1. Ask questions.

Medical jargon can sound like Ewok to even the most astute patients. Don't worry about asking too many questions. The better informed you are, the smoother your treatment will go. "Patients could really take a more active role," says Shannon Phillips, MD, MPH, of the Cleveland Clinic's Quality and Patient Safety Institute. "[You] need to come in empowered, really need to feel as though you're a part of the team that's in charge of your care. To do that, you need to ask questions." Taking notes can help you remember details later, a smart idea since you'll often have a lot of information to take in.

So, if a doctor is suggesting surgery, make sure you understand exactly why it's necessary and how it will be performed. You should also learn about potential complications before you go into the operating room. "When you meet with the person who is going to do your surgery, it's not impolite to ask: How many have you done? What's the most likely common complication? And how often does that happen?" says Phillips.

When your doctor or nurse explains how your treatment went, feel free to speak up if you're confused. If you're spending time in the hospital, ask which insulin you're being given as well as which other medications you're taking—and why. "If people are saying two different things, ask for clarification," Phillips says. "That can be hard for patients because sometimes
they can feel intimidated."

2. Be up front.

Hiding things from your doctor hurts only you. Be honest about your drug and alcohol use, sexual activity, and any medications and supplements you're taking. Knowing everything about your health will help your health care providers take necessary precautions and better diagnose problems. It's also important that your doctor and caregivers know about any allergies you have. This is especially true in a hospital setting, where you may come in contact with multiple doctors and nurses. Don't assume that all caregivers have been brought up to speed. For instance, it's important for your nurse, surgeon, and anesthesiologist all to know prior to surgery if you have a latex allergy. Similarly, it's OK to remind a new nurse that you've been allergic to penicillin since you were a child.

3. Follow pre- and post-op instructions.

Your medical team will advise you how to prepare for surgery. Sometimes this includes fasting for hours and stopping medications beforehand. Talk with your doctor about adjusting your insulin regimen to accommodate the fast. "People with diabetes are often told to fast before a procedure," says Balcezak. "They need to be very clear with their provider what they're doing with their medicine."

According to Mark Schutta, MD, medical director of the Penn Rodebaugh Diabetes Center at the Hospital of the University of Pennsylvania, an injection of background insulin the night before surgery should generally cover you through the next day while you fast; you'll avoid rapid-acting insulin, however. Patients taking oral medications should discuss whether or not they should skip doses before surgery as well.

When you're ready to leave the hospital after a procedure, your doctor or a medical professional from the hospital should review your home-care guidelines. Make sure you're clear on which medications you should take and whether they will affect your blood glucose levels. Find out what to expect when you return home (for instance, if pain is normal) and any warning signs that you may have a setback, such as an infection. If you know what to look for, you can contact your doctor before a problem becomes serious.

4. Understand your prescription.

After surgery, you may need new medications. Before you leave the pharmacy, check the drug's label to be sure the pharmacist filled the right prescription and that the dose and frequency are correct. If there are special instructions (usually highlighted on the bottle or in the medication material your pharmacist prints out for you), take a moment to understand them. Your pharmacist can answer any questions you may have, including whether you should take the drug on an empty stomach or if it will interact with any other medications you may be taking.

At your next doctor's office visit, make sure you understand the details of any prescription your physician writes. Counting on the pharmacist to understand the doctor's intentions (and scratchy handwriting) leaves room for medication errors. Facts to note: the name of the drug, the dose, whether your doctor wants you to take a generic or brand-name version, and how often you should take it.

5. Know your medical history—and share it.

Just because you filled out a medical history form when you arrived at the doctor's office or hospital doesn't mean every caregiver you interact with will remember it. For instance, if you're in the hospital for a procedure unrelated to diabetes—say, a knee replacement or cancer treatment—you'll need to remind your doctors and nurses that you have diabetes. "Things can get missed between the cracks," says Phillips. "We have doctors. We have nurses. We have therapists. You can't say enough, 'I have diabetes.' That's being participatory in your care. By being passive, you're not getting the best care."

6. Move around.

It may seem counterintuitive—you're in the hospital to rest, after all—but staying active, even if that simply means walking down the hall once a day, can keep you healthy. When people spend too long in the same position, they can develop blood clots or pressure-related injuries, otherwise known as bedsores. Since people with diabetes are more prone to infections (and infections can raise your blood glucose levels), it's important to keep moving.

That said, if you're sick enough, walking around can become a danger. "Fall-related injuries in the hospital are very common, especially for people who are acutely ill," says Balcezak. If you're disoriented by your illness or medication, you can injure yourself simply by trying to navigate your way to the bathroom at night. Stay safe by asking for help—from either a nurse or a friend—when you need to walk around.

7. Be a germophobe.

If a caregiver begins to treat you without first washing his or her hands, speak up. "Making sure people wash their hands before they care for you is the No. 1 thing you can do to prevent infection," says Phillips. You may feel awkward doing so, but asking doctors or nurses to wash their hands before tending to your care is crucial.

8. Speak up.

Doctors and nurses aim to improve your health. Still, they're only human. If you spy something suspicious, say something. It's better to question why a nurse is dosing four more pills today than yesterday (or ask why yesterday's pills were blue when today's are white) than to get the wrong medication. "Yes, errors can happen," says Phillips. "So you as a patient need to say, 'Oh, that's not the dose I took yesterday.' " Similarly, if a doctor isn't following the rules, make your concerns clear. Accredited hospitals require that their doctors take a "time out" before surgery (while you're still awake) to discuss the procedure with the entire surgical team, verify they're operating on the correct patient and correct body part, that the site has been marked and initialed, and that a checklist of pre-surgery to-dos has been met.

9. Choose your hospital wisely.

Sure, you don't have much choice if you're in the back of an ambulance having a heart attack. But when you're able to plan for a hospital stay, there are a few things to consider. If you see an endocrinologist, consider having surgery at the hospital where he or she has admitting privileges. If you have surgery at a hospital your doctor doesn't work with, he or she might not be able to manage your diabetes care during your stay. "The scenario or method that works best," says Schutta, "is that if the patient is under the care of an endocrinologist, the anesthesiologist or surgeon contacts the endocrinologist, who can then make recommendations for preoperative care for that patient."

You may also want to take into consideration whether the hospital has a diabetes management team, including a diabetes educator, a dietitian, and others. While it's not necessary, it can make a hospital stay easier for people with diabetes.

10. Take matters into your own hands.

No, that doesn't mean you need a medical degree. But you should take control of your diabetes if you feel you're not getting the best possible care. Patients who have excellent control on a regular basis or those who are on an insulin pump, Schutta says, often do better in the hospital when they manage their own diabetes. If they're willing to sign a waiver, he allows them to self-manage by using their pump or testing and dosing insulin on their own (though a nurse still enters readings on their charts). Those who are too sick or mentally unstable must stick with nurse care, though.

If your hospital does let you manage your own blood glucose, know that you probably won't have the same control as you're used to. "It is very common to have hyperglycemia in a hospital setting because patients are under stress—they're going in for surgery, they're going for tests, they may be on high doses of steroids," says Schutta. Also keep in mind that your insulin requirements may be less if your hospital meals are smaller than your normal fare.

By following these 10 tips, you can lower your risk for medical mistakes. In which case, your main concern will be getting well and deciding whether to slurp down the green or orange Jell-O.



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