Wanted: an advocate for a hospital patient. Long hours, no pay. Must be articulate, assertive, able to ask tough questions and stay cool under pressure. Blood relative or close friend preferred. Knowledge about the health-care system a plus.
It has become an unwritten rule of hospital care that patients should always have a friend or family member by their bedside to make sure they're getting the right care and to be on the lookout for medical errors. But while there are some professional advocates out there and some organizations that offer training for family members, most people learn on the job, so to speak.
"It would be ideal to have Dr. Marcus Welby looking in on you and coordinating everything, and giving you a big reassuring smile but that's not the reality right now," said Karen Curtiss, who wrote a handbook about managing the care of a hospitalized relative, based on her own experiences ("Safe & Sound in the Hospital" available through PartnerHealth.com).
Curtiss points out that the patient has a right to know the name and position of the physician who is overseeing their hospital care. All care providers should introduce themselves when they come into the room; if they don't, remind them.
Patients also have a right to review their medical records at the bedside and to receive information about the benefits and risks of any procedure or treatment they are offered. If the patient is mentally competent, he or she can give an advocate permission to see the records; it can be done verbally, and the advocate's name can be put in the medical chart.
To help advocates, the patient safety organization PULSE has drawn up a checklist that uses the acronym FILMS, which stands for "falls," "infections," "literacy," "medication" and "surgery":
- Falls. Make sure the staff are aware when a patient is at risk of falling, and have the patient evaluated if you are concerned. Falls are a leading cause of hospital injuries.
- Infections. Don't be shy about asking health care providers if they have washed their hands or asking them to do it again in front of you.
- Literacy. Read any forms the patient is asked to sign. (He or she may be unable to absorb the information completely.)
- Medication. Doctors and hospital staff members should always explain to the patient which drugs they are being given. Ideally, medication should be in the original wrapper. Medication errors injure 1.5 million people each year.
- Surgery. Before an operation, make sure the site of surgery is marked and verified by the doctor. The advocate can and probably should be present when this is done. There are still 40 cases every week of surgeries done on the wrong body part. If the patient has not been given antibiotics, ask if there is a reason; taking antibiotics preventively before surgery has been shown to reduce infection risk. Also, make sure the patient has a warm blanket before and after surgery, since staying warm also reduces infection risk.
It's a good idea to go to the hospital with a notebook and pens, and a file of information including the patient's insurance, names of doctors, contact information for key family members and friends, and lists of the patient's allergies, past procedures and surgeries, medications, vitamins, supplements or herbs, and any special dietary needs.
Take antibacterial wipes to wipe down bedrails, the TV remote, phone and doorknobs, says Pulse's Ilene Corina.
If the advocate feels the patient is in danger and they are not being heard, he or she should approach the nurse's station and say they are calling a "Condition Help" and need a rapid response team. The phrases "Condition Help" and "rapid response team" are red flags to the hospital staff that the situation is grave, and the words should not be used lightly. "'Condition Help' is like calling 911 in the hospital," Curtiss said. "Ask yourself: 'If we were not in the hospital, would I call 911?'"
Last but not least, trust your gut: If you think something is wrong, get help.