Notes from the Hospital Bedside

Dad had back surgery Friday morning.

As many of you know, I don’t ordinarily work as a patient advocate. My work is about supporting patient advocates – so I look at these kinds of experiences as opportunities to learn, and to use some of the excellent advice I’ve learned from many of you over the years.

I’m relieved to say – I haven’t had much opportunity to make a difference!  Dad’s care has been quite good.  So, as his advocate, my last 72 hours have been…. well…. boring.

But there have been a few things I have observed, and a few things I’ve learned, to share with you. And two “saves” that may have been important – although – I prefer to hope they made no difference. More about that in a moment.

Dad’s surgery took place at Sarasota Memorial Hospital (Florida). SMH has an excellent reputation – well deserved. From the free valet parking which is mere steps from the elevator that took us to the surgery check-in, to the “Clean Remote” on the TV in the pre-surgery prep room (seriously – a TV with a remote control that is simply wiped clean with an antiseptic cloth – a simple and smart way to prevent infections from spreading) to a “family valet” – a woman whose sole job it is to help family members get through the experience, to a “traffic” board in the OR waiting room  (I was given a code number for Dad, and could watch his progress on a monitor on the wall from prep to surgery to post-op), then later being escorted to his post-surgery room where we’ve been for two days. Oh – and let’s not forget the free coffee, available everywhere.

Dad’s nurses have done their jobs well.  Only twice have I asked for hands to be washed and both times, no hesitation, hands were washed.  I observe the use of antiseptic foam everytime they walk in the door – and everytime they walk out the door, too.  The halls are permeated by the odor of the foam, but in a way, that’s comforting.

Only twice have I felt my presence made a safety difference beyond the requests for handwashing.  The morning after the surgery, as the new nurses took over after the change of shift, the nurse came in with three pills for Dad.  I asked what they were.  Two were drugs he takes regularly.  The third I had never heard of.  I asked what the drug was used for (remember, I don’t know anything about medicine!) and was told it was to reduce his blood pressure.  Knowing his blood pressure had been mostly very low the day before, I asked the nurse to take his blood pressure again, before Dad took that pill.  She did.  It was 97 over 45.  No drug was dispensed.

The second incident was shortly after Dad’s first post-surgery walk.  He did pretty well, and afterwards, the physical therapist wanted him to sit in a chair for 30 minutes.  That proved to be too much, though, and he began to fall forward.  Had I not been there, he would have ended up on the floor because no one else was there to catch him.  Did they feel comfortable leaving him alone because I was there?  Perhaps. But I shudder to think what might have happened had I not been there to stop the fall.

I should also mention that no one ever gave me the impression they were upset, or put out, or fazed by my presence. Granted, I’m a daughter first. But Dad was the one who clearly introduced me as his advocate.  He would go on to explain what I do for a living. More than anything, that explanation was met with curiosity. One nurse replied that she didn’t know why anyone would consider hospitalization without an advocate.

Here’s what I have learned:  SMH is an outstanding hospital and Dad’s care has been excellent – yet there were clearly times that having an advocate was an absolute necessity for Dad.

Knowing that, I now have a better understanding of how VITAL it is for any other hospital patient – one who isn’t being treated in a top hospital – to have an advocate.

And what can you – a patient advocate – learn from my experience?  Learn to appreciate that your patient benefits from not just the big things you do for him or her, but the little things, too.  I suggest you keep track of them – make a record of everything takes place: good, bad, boring or life-saving, while you are there by your patient’s bedside.  They won’t remember much (those good pain drugs!) but at the end, they’ll realize the extent to which they got their money’s worth because you were there to keep them safe and improve their experience.

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| FOR PATIENTS | FOR ADVOCATES |
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  1. Tammy Porter
    July 18, 2011 at 9:13 am

    Thank you for sharing, Trish, and so glad your dad is doing well. Happy you were there with him. The point you make about him being in the chair is one of the reasons why I feel strong about the importance of bedside advocacy; my son’s godfather was left alone in the hospital and fell, died shortly after. Great to hear that the nurses were ‘foaming in’ and ‘foaming out’ from his room!

  2. Steve Luptak
    July 18, 2011 at 9:30 am

    Good luck to you and your father. He is lucky to have you!

    Steve Luptak

  3. July 18, 2011 at 10:54 am

    Your saves – the blood pressure pill, the chair seating/falling forward are what family advocacy needs to be about. I also suggest Arnica tablets under the tongue – they do NOT interact with drugs but help reduce bruising, bleeding and inflammation from any surgery.

    Ann F. Found, the Annie Appleseed Project

  4. Julie Heath
    July 18, 2011 at 12:35 pm

    So glad to hear your father is doing well. He is blessed to have you by his side!

    I too have been bedside. My mother had surgery on Thursday. I breathe a sigh of relief that she is safe today and back at home. Our experience seems unlike yours and I cannot state strongly enough that I am truly shocked at the number of errors and “almost” errors that have occurred. Our troubles began 4 days before surgery during the pre-admit process and continued up and through her discharge. After the very first serious error (requiring and incident report) we had hospital clinical managers, charge nurses and others ‘checking up’ and ‘checking in’ during her visit, yet incidents continued to occur. I documented continually, kept mom safe, and have a lot of follow up to do with the hospital.

    I felt my presence was unwelcome as an observer, a daughter, and certainly unwelcome as an advocate (i.e., proactive, involved family member). Speaking up yet being diplomatic and building rapport with staff was difficult. This is something I’ll have to get comfortable with as I plan on being by many bedsides in this particular hospital.

    I am more dedicated than ever to the cause of patient safety and advocacy and I will absolutely pursue this new career path!

    Thank you for the work you do for patients and for their advocates and I hope your father has a quick and uneventful recovery!

  5. July 18, 2011 at 2:44 pm

    Trisha,

    It was so nice to meet you on Friday! A tweet up in the OR waiting room – a first for us! (: Thank you for the honest feedback here. Patient (& guest) experience is something we’ve been focusing on for some time. I appreciate it and will pass it along to our leadership team.

    Again, if you need anything, let me know. And, like I said on Twitter, the cafeteria is serving shrimp scampi tomorrow and it’s actually GOOD! (I never thought hospital food would be good, but SMH has proved me wrong!) Thanks Trisha! Glad to hear dad is doing well!

    -Megan Tommasi
    Social Media Specialist
    Sarasota Memorial Health Care System

  6. Michelle Lewis
    July 18, 2011 at 4:19 pm

    Trish, so glad to hear your dad is doing well and is on the road to recovery. Thank you for sharing your experiences with us.

  7. July 19, 2011 at 4:47 pm

    Trisha: Thanks so much for reinforcing the need for advocates, from everything from reminding personnel to wash their hands, to being there to keep an “abandoned” patient from falling. (A pet peeve of mine is personnel already gloved when walking into the room.) These are important items to post in marketing materials as to how people benefit from utilizing a patient advocate. And thanks to your father for letting his experience be educational for us, as well!

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