Comments on: Death By Hospital: Is it Avoidable? Part Two of a Series. http://pjmedia.com/phyllischesler/2008/11/13/death-by-hospital-is-it-avoidable-part-two-of-a-series/ Fri, 01 Oct 2010 20:06:10 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Becky http://pjmedia.com/phyllischesler/2008/11/13/death-by-hospital-is-it-avoidable-part-two-of-a-series/#comment-16404 Becky Sat, 12 Sep 2009 19:26:14 +0000 http://pajamasmedia.com/phyllischesler/?p=403#comment-16404 I read the interesting article while doing research for work. Then read up to the #34 comment. I had to stop and process and write a bit of my own. I'm a seasoned RN, meaning I'm 50, been a practicing RN for 30 years, in many settings, including hospitals, schools and even a women's prison. 20 of those years I worked part time or per deim, which was great for our active, growing family. The last 5 yrs, I have worked fulltime. The last 3 yrs, I have cared for very sick people at times, at Cleveland Clinic Hospital in Weston, Florida. The author mentions her experience in a hospital and I do hope she is fit again. I hope she thanked her caregivers too, but if not, I doubt most will hold it agianst her. We are human and may have complained a bit if she wasn't apprecitive and respectful but most of the nurses I have worked with are nurses because they want to help people. We want to ease people's suffering, educate regarding health needs and support optimum wellbeing of each person. I don't deny that there maybe a few in nursing who are there because it's a decent living. And my own father said "Bec, it's GREAT job security. There will always be people who need a nurse, whether sick or well and we all know doctors need nurses to care for patients properly." (He said that with a sweet grin, as he could talk with the nurses easier than the doctors and understand us better too.) I have a few more comments, so let me number them for clarity and brevity. #1 I went into nursing because I was 'called'into it. I minister God's love and care as cardfully as a pastor does on Sunday mornings. No offense intended to any pastors who may read this. At age two, my parents said I'd line up my stuffed animals and wrap them in toilet paper to mimic casted arms and legs and bandaged heads. I love to help people and it seems hurting people find me 'safe'. That's the word many use. I thought about being a doctor for about a year, but it seemed I'd have more flexibility and job opportunities as an RN, not to mention a 'life' outside of 'career'. My prioritys were and are God, family, career. No offense, but I have found more female docs make greater sacrifices than male docs. It's not easy for anyone in medicene but having a good, supportive, understanding wife on the homefront helps any man be better at his profession.(And behind every great doc are lots of great nurses! Not to mention all the other staff necessary to care for patients well.) #2 Errors. They do happen, even in the best hospitals, even with our many, many checks and safeguards. And like the commenting doc wrote, most do not have an adverse effect on patients. We aim for no errors. But when those 'sentinal' ones, as we call them in healthcare,do occur, like cutting off the wrong leg or leaving an instument in a body cavity, we are trained not to cover it up.Even if it causes conflict. Most hospitals even have an outside number staff can call to report inappropriate events and behavior, so they won't need to fear reprisals. Most hospitals have policys set up to take care of the patients in case of medical errors and investigate internally, before it would ever need to go to an 'outside'court. None of us wants to see errors happen and we all work to see how we can prevent them in the future. Respectable, lawabiding caregivers want integrity in coworkers as much as our patients want it. We have laws and courts to discipline negligent providers and ways to weed out those who perform malpractice instead of good medicene. #3 The author talks alot about nurses.I don't have much personal knowledge of unions as I practice in the south. I much prefer 'shared governance', where nurses have a voice and use it responsibly to determine salaries, policys, education requirements, even the day to day workings of their working area. Nursing has changed, alot, over the mere 30 years of my experience. Patients are typically sicker. And we are in a season of insanity, with EVERYONE knowing we need healthcare reform but seemingly few willing to listen to the healthcare providers who are in the thick of it. Oh, and I must say, we do need more nurses at the bedside, but I don't agree with the author of the article. We haven't lost anything to have an RN move 'up' to administration in a hospital. I see it as an ally who has walked in the bedside nurses shoes and can help bridge the gap, between the 'bedside' providers and 'beancounter' providers. Again no offense, healthcare is a business. But as I will continue to say, the patient is the patient, everyone else maybe a client, but to the nurse, the patient is the person we care for. Never forgetting That is the nurse's business. #4 Reforms. We must 'get real'. Let me just say, it is well intentioned, maybe, to refuse to pay for a Medicare patient whose foley catheter or central line gets infected, but it's foolhardy. Why? Because even with the most careful handwashing some will get infected. We will fight those germs in many ways and teach the patients too However, elderly patients are 'high risk' for infection. Immune depressed people are too, and immunities can be depressed for many reasons, beyond anyones control. (Unless malpractice or negligence can be traced to a specific cause, it is reprehensible to deny people health coverage for something they have no control over.)There, I said my piece on that. Last thing, we nurses treasure the trust given to us. And when people are treated poorly, please speak up. We do care, but we are only human. Please be humane too. I have been told from my earliest days "You are such a good nurse." But I believe I've grown because of two things-being a patient myself! and listening to those couragous souls who spoke up when I didn't address their need. Thanks for the forum. I read the interesting article while doing research for work. Then read up to the #34 comment. I had to stop and process and write a bit of my own.
I’m a seasoned RN, meaning I’m 50, been a practicing RN for 30 years, in many settings, including hospitals, schools and even a women’s prison. 20 of those years I worked part time or per deim, which was great for our active, growing family. The last 5 yrs, I have worked fulltime. The last 3 yrs, I have cared for very sick people at times, at Cleveland Clinic Hospital in Weston, Florida.
The author mentions her experience in a hospital and I do hope she is fit again. I hope she thanked her caregivers too, but if not, I doubt most will hold it agianst her. We are human and may have complained a bit if she wasn’t apprecitive and respectful but most of the nurses I have worked with are nurses because they want to help people. We want to ease people’s suffering, educate regarding health needs and support optimum wellbeing of each person.
I don’t deny that there maybe a few in nursing who are there because it’s a decent living. And my own father said “Bec, it’s GREAT job security. There will always be people who need a nurse, whether sick or well and we all know doctors need nurses to care for patients properly.” (He said that with a sweet grin, as he could talk with the nurses easier than the doctors and understand us better too.)
I have a few more comments, so let me number them for clarity and brevity.
#1 I went into nursing because I was ‘called’into it. I minister God’s love and care as cardfully as a pastor does on Sunday mornings. No offense intended to any pastors who may read this. At age two, my parents said I’d line up my stuffed animals and wrap them in toilet paper to mimic casted arms and legs and bandaged heads. I love to help people and it seems hurting people find me ‘safe’. That’s the word many use. I thought about being a doctor for about a year, but it seemed I’d have more flexibility and job opportunities as an RN, not to mention a ‘life’ outside of ‘career’. My prioritys were and are God, family, career. No offense, but I have found more female docs make greater sacrifices than male docs. It’s not easy for anyone in medicene but having a good, supportive, understanding wife on the homefront helps any man be better at his profession.(And behind every great doc are lots of great nurses! Not to mention all the other staff necessary to care for patients well.)
#2 Errors. They do happen, even in the best hospitals, even with our many, many checks and safeguards. And like the commenting doc wrote, most do not have an adverse effect on patients. We aim for no errors. But when those ‘sentinal’ ones, as we call them in healthcare,do occur, like cutting off the wrong leg or leaving an instument in a body cavity, we are trained not to cover it up.Even if it causes conflict. Most hospitals even have an outside number staff can call to report inappropriate events and behavior, so they won’t need to fear reprisals. Most hospitals have policys set up to take care of the patients in case of medical errors and investigate internally, before it would ever need to go to an ‘outside’court. None of us wants to see errors happen and we all work to see how we can prevent them in the future.
Respectable, lawabiding caregivers want integrity in coworkers as much as our patients want it.
We have laws and courts to discipline negligent providers and ways to weed out those who perform malpractice instead of good medicene.
#3 The author talks alot about nurses.I don’t have much personal knowledge of unions as I practice in the south. I much prefer ‘shared governance’, where nurses have a voice and use it responsibly to determine salaries, policys, education requirements, even the day to day workings of their working area.
Nursing has changed, alot, over the mere 30 years of my experience. Patients are typically sicker. And we are in a season of insanity, with EVERYONE knowing we need healthcare reform but seemingly few willing to listen to the healthcare providers who are in the thick of it. Oh, and I must say, we do need more nurses at the bedside, but I don’t agree with the author of the article. We haven’t lost anything to have an RN move ‘up’ to administration in a hospital. I see it as an ally who has walked in the bedside nurses shoes and can help bridge the gap, between the ‘bedside’ providers and ‘beancounter’ providers. Again no offense, healthcare is a business.
But as I will continue to say, the patient is the patient, everyone else maybe a client, but to the nurse, the patient is the person we care for. Never forgetting That is the nurse’s business.
#4 Reforms. We must ‘get real’.
Let me just say, it is well intentioned,
maybe, to refuse to pay for a Medicare patient whose foley catheter or central line gets infected, but it’s foolhardy. Why?
Because even with the most careful handwashing some will get infected. We will fight those germs in many ways and teach the patients too However, elderly patients are ‘high risk’ for infection. Immune depressed people are too, and immunities can be depressed for many reasons, beyond anyones control. (Unless malpractice or negligence can be traced to a specific cause, it is reprehensible to deny people health coverage for something they have no control over.)There, I said my piece on that.
Last thing, we nurses treasure the trust given to us. And when people are treated poorly, please speak up. We do care, but we are only human. Please be humane too. I have been told from my earliest days “You are such a good nurse.” But I believe I’ve grown because of two things-being a patient myself! and listening to those couragous souls who spoke up when I didn’t address their need.
Thanks for the forum.

]]> By: Nightmax http://pjmedia.com/phyllischesler/2008/11/13/death-by-hospital-is-it-avoidable-part-two-of-a-series/#comment-10166 Nightmax Mon, 09 Feb 2009 02:34:58 +0000 http://pajamasmedia.com/phyllischesler/?p=403#comment-10166 Hello, I am really upset about my treatment recently by a Dialysis Head nurse in my clinic. Last weekend, she called me to yell at me for not getting the right lab tests done. It came as such a shock to me that I was automatically stunned into silence while she ranted and raved about not getting the correct lab tests done. When I told her I had nothing to do with the lab work she immediately jumped into to tell me that she had given me a lab requisition that I was supposed to give to the lab technicians at at local Quest lab? I remember the exact conversation I had with her, about previous doctors giving me my own Standing Order Requisition which I had carried in my purse for well over a year. What she does is at an Epogen appt she hands me a lab slip. Then a few days before my appointment she faxes the same lab slip to the lab. I stopped carrying my lab skips when the lab said that they received faxed requests. ALl of a sudden she calls and for 30 minutes I deal with her yelling about what I am not doing right. Then the following Monday, the Dietician calls me to yell that my labs are way off, and instead of just telling me to get back on track, she too somewhat yells that obviously its my fault because I now need a contract to sign and return to follow directions. After six years od waiting for a Kidney Transplant and following directions, how dare they send me a contract to sign about actions they want me to agree to to keep Phosphorus levels between 3.5 and 5.5, Calcium levels between 8.4 and 9.4, limit fluid gain, maintaining an Albumin level of 4.0 to become more physically active, etc. How dare they. Actually, I am one of the only patients at the Dialysis Lab who maintains her labs at a decent level. I personally feel with all of the stress I have to deal with Davita Dialysis, they are lucky that I follow directions at all. I find their actions to be extrememly unprofessional and unwarranted and now, do not want to be bothered with Nurses/Dieticians who loose theie perscpetics. Not to mention she had the audacity to complain about my last name? "I don't know what last name you are using, but when I call for your lab results, they can never find you. SOunds like a lab issue not mine. Especially when I have to hand them my Insurance cards and they get a faxed law slip form from the head nurse. How is that all of a sudden my problem? I sign it using the same last name as listed on my insurance card, however they have hyphenated my last name so how again is that my problem? I am literally fed up with the nonsense I receive from dialysis nurses. I do well and am almost taking care of my self. They have placed the owness of my health care on me and are almost not really doing anything but going over lab slips, and giving me an EPO shot every two weeks. I manage my own dialysis treatments at home and am using the doctors treatment plan as required. I am literally tired of the back and forth I get. If you have too many patients and can't deal with me, then give me to someone who has the time. Yet, the doctor can close his office early on Friday for a golf game and send the nurses home early is he has any office day on Friday at all? This is my third dialysis clinic and I won't go into why I've switched clinics so often, but its been ridiculus. Hello, I am really upset about my treatment recently by a Dialysis Head nurse in my clinic. Last weekend, she called me to yell at me for not getting the right lab tests done. It came as such a shock to me that I was automatically stunned into silence while she ranted and raved about not getting the correct lab tests done. When I told her I had nothing to do with the lab work she immediately jumped into to tell me that she had given me a lab requisition that I was supposed to give to the lab technicians at at local Quest lab? I remember the exact conversation I had with her, about previous doctors giving me my own Standing Order Requisition which I had carried in my purse for well over a year. What she does is at an Epogen appt she hands me a lab slip. Then a few days before my appointment she faxes the same lab slip to the lab. I stopped carrying my lab skips when the lab said that they received faxed requests. ALl of a sudden she calls and for 30 minutes I deal with her yelling about what I am not doing right. Then the following Monday, the Dietician calls me to yell that my labs are way off, and instead of just telling me to get back on track, she too somewhat yells that obviously its my fault because I now need a contract to sign and return to follow directions.

After six years od waiting for a Kidney Transplant and following directions, how dare they send me a contract to sign about actions they want me to agree to to keep Phosphorus levels between 3.5 and 5.5, Calcium levels between 8.4 and 9.4, limit fluid gain, maintaining an Albumin level of 4.0 to become more physically active, etc. How dare they. Actually, I am one of the only patients at the Dialysis Lab who maintains her labs at a decent level. I personally feel with all of the stress I have to deal with Davita Dialysis, they are lucky that I follow directions at all. I find their actions to be extrememly unprofessional and unwarranted and now, do not want to be bothered with Nurses/Dieticians who loose theie perscpetics. Not to mention she had the audacity to complain about my last name? “I don’t know what last name you are using, but when I call for your lab results, they can never find you. SOunds like a lab issue not mine. Especially when I have to hand them my Insurance cards and they get a faxed law slip form from the head nurse. How is that all of a sudden my problem? I sign it using the same last name as listed on my insurance card, however they have hyphenated my last name so how again is that my problem? I am literally fed up with the nonsense I receive from dialysis nurses. I do well and am almost taking care of my self. They have placed the owness of my health care on me and are almost not really doing anything but going over lab slips, and giving me an EPO shot every two weeks. I manage my own dialysis treatments at home and am using the doctors treatment plan as required. I am literally tired of the back and forth I get. If you have too many patients and can’t deal with me, then give me to someone who has the time. Yet, the doctor can close his office early on Friday for a golf game and send the nurses home early is he has any office day on Friday at all? This is my third dialysis clinic and I won’t go into why I’ve switched clinics so often, but its been ridiculus.

]]> By: Jenny Hatch http://pjmedia.com/phyllischesler/2008/11/13/death-by-hospital-is-it-avoidable-part-two-of-a-series/#comment-8319 Jenny Hatch Sat, 22 Nov 2008 23:15:48 +0000 http://pajamasmedia.com/phyllischesler/?p=403#comment-8319 Phyllis, I believe complete privatization of the medical system is the only thing that will save it. Getting all government money out of it and letting the market decide what will stay and what will go is the only way to shake out the fraud and waste. My blog is dedicated to home childbirth. The promotion, education, and defense of it. As a childbirth educator I have spent the past twenty years studying and writing about normal childbirth in every spare minute. Believe me, even with 99.1% of American Women receiving prenatal care, the prematurity rate, infant and maternal mortality rates are going UP UP UP, and the problem is NOT lack of money or resources. I believe that the American System works well with emergencies. True emergency childbirth, accidents, traumas, we have all watched the amazing stories that are available to share the good news of our medical system. Seeing a soldiers face restored by plastic surgery, or technology used to replace limbs or excellent psychotherapy to help a traumetized person heal...all of these sides of the american system are awesome. We do have a free market health care system in America. It is called Alternative Healing. And it is thriving. Wether it is homebirth midwives, chiropractors not covered by insurance, homeopaths, massage therapists, herbs, chinese medicine, etc etc...for the most part these therapys and healing modalities are NOT covered by health insurance and/or government money and the practitioners of these healing arts are thriving. The fact that the medical powers that be want to regulate and even dismantle that system has been well documented. Perhaps the best documentary on the subject is found here: http://herballure.com/Special/WeBecomeSilent/QuickTime.html The global elites love the promotion of drug and surgery socialized medicine because it just makes us all more toxic, dependent, and broke...while they cash in, and we the people are much more easy to manipulate and control when we are doped, drugged, and dealing with toxic children. Do you personally know a family with an autistic child? The whole family dynamic revolves around the needs of that child, finanacial, emotional, safety issues....etc etc... Socialized medicine only addresses one aspect of healing...the allopathic side of drugs and surgery. And if America decides to fully nationalize that particular side of health care and then outlaws natural healing as is being done in Europe right now, I predict the next fifty years are going to be a hellish time for families, especially for those of us who are giving birth to our children and grandchildren. What I promote on my site is a near complete divorce from the medical system, medical self sufficiency, and the promotion of a constitutional amendment that would protect consumers in their health care choices. Personal family responsibility coupled with completely privatized health care will win the day...but with the way things look in America, we will all get a chance to see how a nationalized health care system will run in America. A medical system that is somewhat deadly, disorganized, and dangerous will gradually become a rationed behemoth of dysfunction and death. My only prayer is that no one from the government will be standing by with a gun to my head to go force me to give birth to my next child in the hospital as it gets socialized. Jenny Hatch Phyllis,

I believe complete privatization of the medical system is the only thing that will save it. Getting all government money out of it and letting the market decide what will stay and what will go is the only way to shake out the fraud and waste.

My blog is dedicated to home childbirth. The promotion, education, and defense of it. As a childbirth educator I have spent the past twenty years studying and writing about normal childbirth in every spare minute. Believe me, even with 99.1% of American Women receiving prenatal care, the prematurity rate, infant and maternal mortality rates are going UP UP UP, and the problem is NOT lack of money or resources.

I believe that the American System works well with emergencies. True emergency childbirth, accidents, traumas, we have all watched the amazing stories that are available to share the good news of our medical system. Seeing a soldiers face restored by plastic surgery, or technology used to replace limbs or excellent psychotherapy to help a traumetized person heal…all of these sides of the american system are awesome.

We do have a free market health care system in America. It is called Alternative Healing. And it is thriving. Wether it is homebirth midwives, chiropractors not covered by insurance, homeopaths, massage therapists, herbs, chinese medicine, etc etc…for the most part these therapys and healing modalities are NOT covered by health insurance and/or government money and the practitioners of these healing arts are thriving.

The fact that the medical powers that be want to regulate and even dismantle that system has been well documented. Perhaps the best documentary on the subject is found here:

http://herballure.com/Special/WeBecomeSilent/QuickTime.html

The global elites love the promotion of drug and surgery socialized medicine because it just makes us all more toxic, dependent, and broke…while they cash in, and we the people are much more easy to manipulate and control when we are doped, drugged, and dealing with toxic children. Do you personally know a family with an autistic child? The whole family dynamic revolves around the needs of that child, finanacial, emotional, safety issues….etc etc…

Socialized medicine only addresses one aspect of healing…the allopathic side of drugs and surgery. And if America decides to fully nationalize that particular side of health care and then outlaws natural healing as is being done in Europe right now, I predict the next fifty years are going to be a hellish time for families, especially for those of us who are giving birth to our children and grandchildren.

What I promote on my site is a near complete divorce from the medical system, medical self sufficiency, and the promotion of a constitutional amendment that would protect consumers in their health care choices.

Personal family responsibility coupled with completely privatized health care will win the day…but with the way things look in America, we will all get a chance to see how a nationalized health care system will run in America. A medical system that is somewhat deadly, disorganized, and dangerous will gradually become a rationed behemoth of dysfunction and death.

My only prayer is that no one from the government will be standing by with a gun to my head to go force me to give birth to my next child in the hospital as it gets socialized.

Jenny Hatch

]]> By: Tina Trent http://pjmedia.com/phyllischesler/2008/11/13/death-by-hospital-is-it-avoidable-part-two-of-a-series/#comment-8302 Tina Trent Fri, 21 Nov 2008 17:44:20 +0000 http://pajamasmedia.com/phyllischesler/?p=403#comment-8302 Allston -- you hit the nail on the head (watch out though, those nails are expensive). We pay more for a few inches of IV tubing than we pay the nurse's aide who is sticking it into the patient. AVI -- interesting point about putting dialysis patients automatically onto Medicare. Unfortunately, when they get transplants, that changes, and disability, which ought to be automatic for them as well, is not. Disability remains a game in which the ones who need it least are the most successful at getting it because the process is onerous and lengthy, and, also, whoever screams loudest gets a special place at the front of the line. But the real lesson for those who oppose any and all government intervention and regulation is dialysis clinics themselves. They are exempt from ordinary nursing rules in many states -- thanks to the owners' lobbies -- and they employ grossly untrained people to do what basically consists of serious, multi-hour surgery on chronically ill and physically unstable patients. Yet, they bill the government richly for providing the service: they're not hurting. Or, they're not hurting themselves. They get paid thousands to dialyze every patient, then cut corners with nursing staffs and patient safety, then scream like evil infants when people ask to hold them to the types of staff licensing standards we demand of cosmetologists. Here is the reality of medicine in America today: if you are rich enough to afford the best care, you'll probably get it. If you're poor and flagrant and have lots of babies but don't marry the fathers or demand money from them; or if you're otherwise so irresponsible that you just expect others to pay your medical bills, or if you're illegal and simply expect Americans to foot your bills, you get all the care you need. By law. And that care is more comprehensive than what the rest of us -- the working and middle-classes who pay for their own insurance and medical costs -- receive. They only people being denied care in America today are the vast middle, who have watched their co-pays and premiums soar and their access to doctors and real insurance shrink. Or disappear. When I worked in social services, I saw firsthand the quality, quantity, and accessibility offered to indigent patients. It was better than anything I ever got, or could afford. We have two political parties in the country: the one that pretends we aren't already "socializing" grossly inflated, government-supported pay-outs to the insurance and medical bureaucracies they pretend represent a free market, and the other Party, which cares exclusively for the indigent, illegal immigrants, and others they deem oppressed people. Hillary would have changed that, but the DNC wants what the DNC wants. The rest of us are simply being lied to and ignored by both ideological extremes. And people die from that. Allston — you hit the nail on the head (watch out though, those nails are expensive). We pay more for a few inches of IV tubing than we pay the nurse’s aide who is sticking it into the patient.

AVI — interesting point about putting dialysis patients automatically onto Medicare. Unfortunately, when they get transplants, that changes, and disability, which ought to be automatic for them as well, is not. Disability remains a game in which the ones who need it least are the most successful at getting it because the process is onerous and lengthy, and, also, whoever screams loudest gets a special place at the front of the line.

But the real lesson for those who oppose any and all government intervention and regulation is dialysis clinics themselves. They are exempt from ordinary nursing rules in many states — thanks to the owners’ lobbies — and they employ grossly untrained people to do what basically consists of serious, multi-hour surgery on chronically ill and physically unstable patients. Yet, they bill the government richly for providing the service: they’re not hurting. Or, they’re not hurting themselves. They get paid thousands to dialyze every patient, then cut corners with nursing staffs and patient safety, then scream like evil infants when people ask to hold them to the types of staff licensing standards we demand of cosmetologists.

Here is the reality of medicine in America today: if you are rich enough to afford the best care, you’ll probably get it. If you’re poor and flagrant and have lots of babies but don’t marry the fathers or demand money from them; or if you’re otherwise so irresponsible that you just expect others to pay your medical bills, or if you’re illegal and simply expect Americans to foot your bills, you get all the care you need. By law. And that care is more comprehensive than what the rest of us — the working and middle-classes who pay for their own insurance and medical costs — receive. They only people being denied care in America today are the vast middle, who have watched their co-pays and premiums soar and their access to doctors and real insurance shrink. Or disappear.

When I worked in social services, I saw firsthand the quality, quantity, and accessibility offered to indigent patients. It was better than anything I ever got, or could afford. We have two political parties in the country: the one that pretends we aren’t already “socializing” grossly inflated, government-supported pay-outs to the insurance and medical bureaucracies they pretend represent a free market, and the other Party, which cares exclusively for the indigent, illegal immigrants, and others they deem oppressed people. Hillary would have changed that, but the DNC wants what the DNC wants.

The rest of us are simply being lied to and ignored by both ideological extremes.

And people die from that.

]]> By: Saul Wall http://pjmedia.com/phyllischesler/2008/11/13/death-by-hospital-is-it-avoidable-part-two-of-a-series/#comment-8293 Saul Wall Fri, 21 Nov 2008 04:20:08 +0000 http://pajamasmedia.com/phyllischesler/?p=403#comment-8293 While some hospital acquired (nosocomial) infections are caused by failures in hygiene, it is not all about incompetence or indifference. Bacteria are given lots of opportunity to develop defenses to disinfection agents and antibiotic agents while being provided with many reservoirs of immuno-compromised or otherwise weakened patients to re-establish themselves in. I recently heard about a nosocomial infection which authorities were trying everything to track down. They had employees in for retraining, they monitored their hand washing, their janitorial practices were scrutinized - people were tearing their hair out about this bug that was causing infections in people who came into the hospital. Eventually someone decided to test the disinfectant soap. The bacteria was living in the stuff. People were washing and scrubbing their hands with stuff meant to kill the bug. I am as critical of government and bureaucratic organizations as anyone but nosocomial infections are not largely the fault of hospital employees but an intrinsic result of having large numbers of very sick and injured people being treated with antibiotics in close proximity to each other. While some hospital acquired (nosocomial) infections are caused by failures in hygiene, it is not all about incompetence or indifference. Bacteria are given lots of opportunity to develop defenses to disinfection agents and antibiotic agents while being provided with many reservoirs of immuno-compromised or otherwise weakened patients to re-establish themselves in.

I recently heard about a nosocomial infection which authorities were trying everything to track down. They had employees in for retraining, they monitored their hand washing, their janitorial practices were scrutinized – people were tearing their hair out about this bug that was causing infections in people who came into the hospital. Eventually someone decided to test the disinfectant soap. The bacteria was living in the stuff. People were washing and scrubbing their hands with stuff meant to kill the bug.

I am as critical of government and bureaucratic organizations as anyone but nosocomial infections are not largely the fault of hospital employees but an intrinsic result of having large numbers of very sick and injured people being treated with antibiotics in close proximity to each other.

]]> By: morbshock http://pjmedia.com/phyllischesler/2008/11/13/death-by-hospital-is-it-avoidable-part-two-of-a-series/#comment-8283 morbshock Thu, 20 Nov 2008 23:04:57 +0000 http://pajamasmedia.com/phyllischesler/?p=403#comment-8283 It's all true what you wrote in your article. My wife is a RN for close to 30 years. She is burnt out from working in those conditions. It’s all true what you wrote in your article. My wife is a RN for close to 30 years. She is burnt out from working in those conditions.

]]> By: Tex Taylor http://pjmedia.com/phyllischesler/2008/11/13/death-by-hospital-is-it-avoidable-part-two-of-a-series/#comment-8255 Tex Taylor Tue, 18 Nov 2008 21:53:43 +0000 http://pajamasmedia.com/phyllischesler/?p=403#comment-8255 It is folly to think that a hospital can prevent all infectious disease. While hospitals can do everything possibly to prevent it, and some should do better, there is still a degree of risk in exposure. It is difficult to completely sterilize an environment. It is practically impossible to continually remain that way. In addition, many of the more ill patients are immunocompromised person making them particularly vulnerable to infectious disease. While I argue with no one the board in particular, I sometimes wonder if it isn't our expectations needing to be fixed first. As a doctor in making, I can perform no miracles, nor am I capable. And like most medical practitioners, whether techs, nurses, or the doctors, you'll just have to trust me when I say, given the set of circumstances, the incredible degree of irresponsibility prevalent in society, and the difficulty of continual learning while working rotten hours, most of us are doing the best that we are capable. It is folly to think that a hospital can prevent all infectious disease. While hospitals can do everything possibly to prevent it, and some should do better, there is still a degree of risk in exposure.

It is difficult to completely sterilize an environment. It is practically impossible to continually remain that way.

In addition, many of the more ill patients are immunocompromised person making them particularly vulnerable to infectious disease.

While I argue with no one the board in particular, I sometimes wonder if it isn’t our expectations needing to be fixed first.

As a doctor in making, I can perform no miracles, nor am I capable. And like most medical practitioners, whether techs, nurses, or the doctors, you’ll just have to trust me when I say, given the set of circumstances, the incredible degree of irresponsibility prevalent in society, and the difficulty of continual learning while working rotten hours, most of us are doing the best that we are capable.

]]> By: L. Davis http://pjmedia.com/phyllischesler/2008/11/13/death-by-hospital-is-it-avoidable-part-two-of-a-series/#comment-8254 L. Davis Tue, 18 Nov 2008 16:13:58 +0000 http://pajamasmedia.com/phyllischesler/?p=403#comment-8254 I wonder if the figure of 100,000 people dying of drug resistant hospital infections is even close to the reality. My personal experience is something I'm still trying to understand and cope with long afer 2005, when my Mother went in for hip surgery (determined by her surgeon as a success) and died of MRSA. She died 15 months after her surgery, in a nursing home. The infection appeared relatively soon after her surgery...although I was never told under months later that it was MRSA. After a follow-up operation to 'cut out the infection' and subsequently multiple rounds of strong antibiotics that had many side effects, it was determined that she was 'not responding' and no more treatments were given. She died over a period of days from rampant infection and no more intervention which meant no food, fluids, diabetic medication, etc. She didn't die in the hospital where she got MRSA, but in a nursing home. I am certain that this was not 'counted' as a MRSA death by the hospital or anyone else. I am also certain this happens over and over again, taking the responsible institution off the hook and changes the national infection rate dramatically. I am also convinced that this infection was due to incompetency and carelessness. Sorry I sound bitter.... but I am. I wonder if the figure of 100,000 people dying of drug resistant hospital infections is even close to the reality.

My personal experience is something I’m still trying to understand and cope with long afer 2005, when my Mother went in for hip surgery (determined by her surgeon as a success) and died of MRSA. She died 15 months after her surgery, in a nursing home. The infection appeared relatively soon after her surgery…although I was never told under months later that it was MRSA.

After a follow-up operation to ‘cut out the infection’ and subsequently multiple rounds of strong antibiotics that had many side effects, it was determined that she was ‘not responding’ and no more treatments were given. She died over a period of days from rampant infection and no more intervention which meant no food, fluids, diabetic medication, etc. She didn’t die in the hospital where she got MRSA, but in a nursing home.

I am certain that this was not ‘counted’ as a MRSA death by the hospital or anyone else. I am also certain this happens over and over again, taking the responsible institution off the hook and changes the national infection rate dramatically. I am also convinced that this infection was due to incompetency and carelessness.

Sorry I sound bitter…. but I am.

]]> By: RF http://pjmedia.com/phyllischesler/2008/11/13/death-by-hospital-is-it-avoidable-part-two-of-a-series/#comment-8250 RF Tue, 18 Nov 2008 09:51:03 +0000 http://pajamasmedia.com/phyllischesler/?p=403#comment-8250 59. JGAlt, MD: Yes, very good post. Excess, and lack of education is a big part of the problem here. "detrimental effects of alcohol on the fetus may also be transmitted by paternal alcohol consumption." - Darryl S. Inaba, Pharm.D. This is just one tiny example of how much damage people can do. "alcohol-related crashes cost an estimated $148 billion in the United States every year." (NHTSA, 2005, NIAAA, 2000) Doesn't matter what the government does, the people have a problem. 59. JGAlt, MD: Yes, very good post. Excess, and lack of education is a big part of the problem here.
“detrimental effects of alcohol on the fetus may also be transmitted by paternal alcohol consumption.” – Darryl S. Inaba, Pharm.D.
This is just one tiny example of how much damage people can do.

“alcohol-related crashes cost an estimated $148 billion in the United States every year.” (NHTSA, 2005, NIAAA, 2000)
Doesn’t matter what the government does, the people have a problem.

]]> By: Phlebotech http://pjmedia.com/phyllischesler/2008/11/13/death-by-hospital-is-it-avoidable-part-two-of-a-series/#comment-8249 Phlebotech Tue, 18 Nov 2008 08:25:39 +0000 http://pajamasmedia.com/phyllischesler/?p=403#comment-8249 Med Tech/CLS here. After working in three hospitals in two different states for over a dozen years, I can tell you that nurses aren't underpaid; they do quite well compared to the other professions. They don't suffer from a lack of respect; as a result of the "Poor Nurse" propaganda campaign they have run for several years now, they have an overinflated view of themselves with Hospital Administrators doing everything they can to keep them happy. This contributes to the poor patient care received by so many: "I'm a Nurse; it is the Aide's job to take care of the patient." It is frightening to think how thin the resources of the hospital are stretched. While Administration is hiring nurses and freezing or cutting other positions, patient care is compromised by under staffing other departments. When you consider the ratio of nurses to patients, ask your self what is the ratio of Respiratory Therapists, X-ray techs, phlebotomists, or MLT/MTs for every patient? Due to costcutting by one hospital, I was the only Med Tech on nights for several months at a one hundred bed hospital. As I could draw blood, run the tests and do the maintenance on the equipment, others weren't replaced as they left. Doctors may yell at nurses but I have had many nurses scream at me because I couldn't be in Labor and Delivery sticking a patient, crossmatching blood for surgery, and running a urinalysis on a baby at the same time. Eventually I left for a better paying job where there are more MTs in the lab. Poor care comes from unhappy people. Many places claim to have a healthcare team in place, but there are too many chiefs and not enough indians. It is time to re-organize and reassess healthcare. Patient care should come before perks; good workers should be recognized and administrators need to be few and far between. Regulators should be required to explain the rules in plain English and then, if there are any conflicts between one set of rules and another, the rules won't be implemented until they are resolved. Med Tech/CLS here. After working in three hospitals in two different states for over a dozen years, I can tell you that nurses aren’t underpaid; they do quite well compared to the other professions. They don’t suffer from a lack of respect; as a result of the “Poor Nurse” propaganda campaign they have run for several years now, they have an overinflated view of themselves with Hospital Administrators doing everything they can to keep them happy. This contributes to the poor patient care received by so many: “I’m a Nurse; it is the Aide’s job to take care of the patient.” It is frightening to think how thin the resources of the hospital are stretched. While Administration is hiring nurses and freezing or cutting other positions, patient care is compromised by under staffing other departments. When you consider the ratio of nurses to patients, ask your self what is the ratio of Respiratory Therapists, X-ray techs, phlebotomists, or MLT/MTs for every patient? Due to costcutting by one hospital, I was the only Med Tech on nights for several months at a one hundred bed hospital. As I could draw blood, run the tests and do the maintenance on the equipment, others weren’t replaced as they left. Doctors may yell at nurses but I have had many nurses scream at me because I couldn’t be in Labor and Delivery sticking a patient, crossmatching blood for surgery, and running a urinalysis on a baby at the same time. Eventually I left for a better paying job where there are more MTs in the lab.
Poor care comes from unhappy people. Many places claim to have a healthcare team in place, but there are too many chiefs and not enough indians. It is time to re-organize and reassess healthcare. Patient care should come before perks; good workers should be recognized and administrators need to be few and far between. Regulators should be required to explain the rules in plain English and then, if there are any conflicts between one set of rules and another, the rules won’t be implemented until they are resolved.

]]>