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Making the Most of a Visit With Your Healthcare Provider

3/5/2023

Author- Lisa Johnson RN, BSN, CCP

Many people feel that when they visit their healthcare provider, they don’t have enough time with the practitioner to ask questions and clarify concerns. If that’s you, you are not alone. The majority of people seeking care in the U.S. feel that time with their healthcare provider is too limited, regardless of the reason for their visit. In fact, studies have shown that many patients feel a great deal of dissatisfaction with the care that is provided based on the length of their visits, even if their healthcare concern was taken care of (Guttman et al., 2021).

As was mentioned in a previous blog, there are three crucial aspects to remember as a patient.

*You are a member of your healthcare team
*You have a voice in your care
*You are at the center of your care

Hospital accrediting organizations, such as The Joint Commission, emphasize the importance of high-quality patient-provider communication. Research has proven that poor communication between patients and medical providers can have severe outcomes for the patient (Guttman et al., 2021). With this in mind, let’s explore ways to make the most of your medical visit.

1. Prioritize what you would like to discuss, particularly the symptoms you have been experiencing, write them down, and take the list with you to the appointment.

2. Write down three or four of your most important questions or concerns, and let the provider know you have questions at the beginning of the visit.

3. Bring a list of your medications with their dosages. (Include over-the-counter medications, vitamins, and supplements)

4. Consider bringing a family member or friend along with you.

5. Take notes, or have a family member or friend do so.

6. Medical information can be challenging to understand. It is ok to ask your provider to explain it again.

7. If this is your first visit, arrive a few minutes early to fill out forms.

Following these simple steps can go a long way to improving communication with your healthcare provider and getting the most from your visit.

Para obtener información en español, visite este sitio:
https://www.nia.nih.gov/espanol/como-prepararse-cita-medico

For additional information, please visit the National Institute on Aging (NIA-NIH)
https://www.nia.nih.gov/sites/default/files/d7/talking_with_your_doctor_presentation_handouts_508.pdf

Guttman, O. T., Lazzara, E. H., Keebler, J. R., Webster, K. L. W., Gisick, L. M., & Baker, A. L. (2021). Dissecting communication barriers in healthcare: A path to enhancing communication resiliency, reliability, and patient Safety. Journal of Patient Safety, 17(8), e1465–e1471. https://doi.org/10.1097/PTS.0000000000000541

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Talking about Advance Directives

3/4/2023

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Author- Lisa Johnson RN, BSN, CCP

“Advance what,” you say. Advance directives (AD) are the legal documents that convey your end-of-life wishes for healthcare in writing if you can no longer speak for yourself. ADs also allow you to appoint a healthcare agent to ensure your wishes are carried out as you would like. These days a broader term is being applied in some circumstances. That is Advanced Care Planning (ACP). Regardless of the term you use, the endpoint is the same (Wan et al., 2022). Let me share some information about ADs and ACPs.

As the population ages, we find that individuals in their last days, weeks, or months often face the end alone. Patients who have not expressed their preferences for treatment, resuscitation, or artificial life preservation because they believe their time of death is far off are often left with relatives and, in some cases, healthcare professionals making the decisions for them. An AD or ACP is a way for individuals to clearly express how they would like to experience their last days. It is a way to express autonomy regarding how you would like medical treatments to proceed at the end of your life. You can think of it as the one last assertion you make on behalf of yourself (Wan et al., 2022).

Well, “this is a heavy topic,” you think to yourself. While it does require serious consideration, the benefits of putting ADs or ACPs in place are numerous. First, when a family knows how you wish to spend those last days of life, a significant burden is removed from them, knowing that they are not responsible for making those difficult decisions on your behalf. Second, it empowers you as the patient to direct your care in those last precious days. Most importantly, it ensures that your wishes cannot be disregarded and overridden (Wan, 2022).

Here is a quick planning guide to help you start the conversation with family and friends.
THINKING
Think about choices you would make specifically related to medical care, spiritual care, and your surroundings at the end of life.
This would include considerations about CPR, breathing support, food, hydration, and where you would like to be in your final days and with whom. This may also include specifics about the comfort measures you would like to be provided.

CHOOSING
Choose a Healthcare Agent (HCA) or Proxy. This is the person who knows your wishes in detail and can speak on your behalf if necessary. This is often one of the most challenging steps in the process.
An essential step in choosing an HCA is knowing that the HCA is aligned with your wishes and will have the courage to carry them out.

TALKING
Talking about your decisions can feel stressful to you and your loved ones, but the benefits are great.
Share your desires with family members. Planning ahead decreases the likelihood of family disagreements in the overwhelming moments families feel at the end of the life of a loved one.

DOCUMENTING
Put your decisions in writing. Having the legal document at hand removes uncertainty for those around you.
Forms for ADs are available online. Each state has a form that can be downloaded. You can usually complete an AD without the assistance of a lawyer. Two witnesses who are not family members must sign the form to make the AD legal.

Watch as a family has a conversation about putting an AD in place.
Click the link below to see an ABC World News Clip with Diane Sawyer as she follows a family as they discuss and make decisions about end-of-life care. https://www.youtube.com/watch?v=J1r0Xbh0UVo&t=11s

ADDITIONAL RESOURCES
Para obtener información en español, visite este sitio:
https://www.nia.nih.gov/espanol/planificacion-anticipada-cuidados-salud

Included below are links for guide sheets that can be downloaded to assist you as you work through the process.
What to Talk About
https://www.planningmyway.org/en/open-guide-sheet/talk-about
Choosing a Spokesperson
https://www.planningmyway.org/en/open-guide-sheet/choosing-spokesperson
Whom to Contact in an Emergency
https://www.planningmyway.org/en/open-guide-sheet/who-to-contact
Treatment Decisions
https://www.planningmyway.org/en/open-guide-sheet/treatment-decisions
End-of-life Arrangements
https://www.planningmyway.org/en/open-guide-sheet/end-of-life
My Personal Statement
https://www.planningmyway.org/en/open-guide-sheet/personal-statement

Planning My Way Website https://www.planningmyway.org/en
*Information on this site is also available in Spanish https://www.planningmyway.org/esp

The National Hospice and Palliative Care Organization (NHPCO) provides information on Advance Directives with links to each state’s Advance Directive Forms
https://www.caringinfo.org/planning/advance-directives/

Wan, Z., Chan, H. Y. L., Chiu, P. K. C., Lo, R. S. K., Cheng, H.-L., & Leung, D. Y. P. (2022). Experiences of older adults with frailty not completing an Advance Directive: A qualitative study of ACP conversations. International Journal of Environmental Research and Public Health, 19(9). https://doi.org/10.3390/ijerph19095358

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Fall Prevention

3/3/2023

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Author - Lisa Johnson, RN, BSN, CCP

Falls among older individuals are much more common than we know. One in four individuals falls each year, many resulting in severe bone fractures and head injuries. In fact, falls are the most common cause of traumatic brain injuries around the world and the primary reason for injury-related hospital admissions in those over sixty-five. (Harvey& Close, 2012)

Edelman & Ficorelli (2012) noted the following causes of falls related to the physical body:
1) Advanced years, 2) A recent fall, 3) Impaired gait, balance, flexibility, or vision,
4) Impaired cognitive ability, 5) Urinary and bowel incontinence, and 6) Medications that cause drowsiness or dizziness.

The good news is that falls can be prevented! Making some minor adjustments in your home can be life-saving. And don’t forget to speak to your healthcare provider about additional changes that can be made to improve your physical well-being, including a visit with an Occupational Therapist who can come to your home and make suggestions as to how to make your environment safer. Visit the American Occupational Therapy Association at www.aota.org for additional tips.

Fall Prevention Techniques:
1)Remove clutter and make sure walkways are open and well-lit
    This would include books, magazines, boxes

2) Remove or secure rugs and electrical cords
    Adding a nonskid backing to rugs and taping electrical cords can be very helpful

3) Clean up spills immediately
     Water and grease are serious hazards

4) Wear rubber-soled tie shoes; avoid wearing loose-fitting or backless slippers
      Shoes with support improve balance

5) Add a nightlight to bathrooms and hallways
     Improved vision adds stability and balance for walking

6) Stay well hydrated
    When the body is well-hydrated, muscles are stronger

7) Talk to your medical provider if medications are making you drowsy or dizzy
      Alternative medications with fewer side effects may be available

8) Exercise to stay strong and flexible
    Hip flexibility and core strength improve balance

9) Install or secure handrails on staircases and in hallways
     Having something sturdy to grasp if you lose your footing can prevent a serious mishap

10) Consider subscribing to a medical alert alarm system
      Knowing that you can reach someone if you are in need of help provides peace of mind

Para obtener información en español, visite este sitio:
https://www.cdc.gov/steadi/spanish/pdf/patient/checkforsafety-final-spanish-508.pdf

A number of additional resources can be found on the CDC Patient and Caregiver brochure page https://www.cdc.gov/steadi/patient.html

Edelman, M., & Ficorelli, C. T. (2012). Keeping older adults safe at home. Nursing. https://doi.org/10.1097/01.nurse.0000408481.20951.e8

Harvey, L., & Close, J. C. T. (2012). Traumatic brain injury in older adults: characteristics, causes and consequences. Injury-International Journal of the Care of the Injured, 43(11), 1821–1826. https://doi.org/10.1016/j.injury.2012.07.188

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Polypharmacy- What is it?

3/2/2023

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Author Lisa Johnson RN, BSN, CCP

Polypharmacy is defined as taking more than five medications per day. As the population ages and with an increase in chronic illness, the necessity to take medications is increasing. According to the CDC (Products - Data Briefs - Number 347 - August 2019, n.d.), over 20% of individuals over age 40 take five or more pills per day. Not only is it common for individuals to take multiple prescription medications, but many also take over-the-counter drugs, vitamins, and other supplements that can complicate the routine even further. You might think, “ok, so what’s the big deal?”

Managing multiple medications can be confusing and potentially dangerous. Medications are meant to have a specific effect on the body, but there is a potential for side effects. The more medications one takes the more side effects that may occur. Taking more than one medication also increases the risk of interactions between the drugs.

While this may seem a bit overwhelming, there are several ways to reduce your risk and keep safe.

1) Take your medications as prescribed and on schedule.
• When picking up your medication at the pharmacy, confirm the dosage and timing for each medication with the pharmacist.
• Keep a schedule of when your medications are due to be taken – keep a copy on your refrigerator for easy reference.
• Create a routine for taking your medication – this creates a habit and makes it less likely to forget.
• Consider using a pill organizer. This helps reduce the chance of taking the wrong pills or taking pills you’ve already taken for the day.
• Use a reminder alarm to keep on schedule. Pill reminder apps are now available for mobile phones.

2) Fill your prescriptions at one pharmacy
• Get to know the pharmacist, and don’t hesitate to ask questions.
• If the cost of your drugs is a problem, talk to your pharmacist about options.

3) Make sure all of your medical providers know the drugs you are taking
• Make a list of your medications that includes the dose and how often you take the drug daily.
• Keep the list with you in your wallet or purse, and update the list each time a new drug is prescribed.
• When meeting with a new medical provider, present the list so that it can be added to your medical record.
• Make sure your medical providers know your allergies.

4) Let your medical provider know if you are having any problems with your medications
• If you experience a side effect after taking your pills, notify your medical provider immediately.
• If you think you are experiencing an allergic reaction, call your provider. If you experience difficulty breathing or shortness of breath, seek medical attention immediately by calling 911.

Para obtener información en español, visite este sitio:
https://www.nia.nih.gov/espanol/adultos-mayores-uso-seguro-medicamentos

Azhagesan, C. (2017) Role of nurse in polypharmacy. Nursing & Health Care International Journal 1(4): 000123.

Hales , C. M., Servais, J., Martin, C. B., & Kohen, D. (2019). Prescription drug use among adults aged 40–79 in the United States and Canada. NCHS Data Brief, No. 347. Retrieved March 2, 2023, from https://www.cdc.gov/nchs/data/databriefs/db347-h.pdf

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5 Key Elements to Staying Safe At The Hospital

2/23/2023

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Author- Lisa Johnson RN, BSN, CCP
Patient safety should be a top priority for everyone within the healthcare system. Right? While healthcare providers do their best to keep their patients safe, we know that process failures, equipment issues, caregiver fatigue, and plain old human error can wreak havoc on a “simple visit to the hospital.”

You may ask, "what are those medical errors I've heard about?" According to a Johns Hopkins study, "medical mistakes kill more than 250, 000 people every year."(Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S. - 05/03/2016, n.d.)

Among the top medical mistakes:
1) Medication errors, 2) Delayed medical diagnoses,
3) Incorrect medical diagnoses, 4) Infections,
5)Malfunctioning or defective medical devices.

In 2023, we are faced with a labor shortage in healthcare that we haven’t seen in many decades. This alone increases the potential for medical errors. But overcrowded emergency departments, high rates of mental and moral fatigue resulting from the pandemic, and insurance companies pushing to get patients discharged faster create an even bigger recipe for disaster.

Patient safety should be a shared belief. Healthcare is known to be a high-risk environment, but patient safety is everyone’s responsibility. Knowing how to keep yourself or a loved one safe at the most basic of levels is a great starting point for ensuring a positive outcome.

Here are five key elements to staying safe.

1)Patient, Staff, and Procedure Identification
At every encounter with a hospital staff member, ensure that they are introducing themselves and checking your armband. In addition, if being taken from your room for a procedure, verify that the procedure they are doing was ordered for you by your MD.

2)Hand-washing and Infection Prevention
One of the most basic infection prevention techniques is good hand washing. Before allowing any caregiver to interact with you physically, make sure they’ve washed their hands. And, if they haven’t, ask them to do so.

3)Medication Reconciliation and Safety
Whenever you are being given medications, ask, “what is that, and what is it meant to treat.” If you feel that the drug is being given in error, you may refuse it and ask to speak with your doctor. If you are on longstanding medications for chronic illnesses, ask your MD if they will be continued during your hospital stay. Certain medications should not be discontinued abruptly.

4) Informed Consent
Informed consent is the process by which a fully informed patient can a) participate in choices about their healthcare and 2) agree to be treated.
Prior to any procedure, your MD should explain how the procedure will be done, the risks and benefits, and the expected outcomes. Do not feel pressured to sign consent forms until all of your questions are fully answered.

5)Asking Questions About Procedures or Treatments
Always ensure that procedures and treatments are explained to you in understandable terms. Ask about risks, side effects, and what to expect afterward. If anything is unclear, continue to ask questions until you feel comfortable about what to expect.
(Rodziewicz et al., 2021)

 Remember!
~You are a member of your healthcare team.
~You have a voice in your care.
~You are at the center of your care.

Para obtener información en español, Comuníquese con Chesapeake Health Advocates y se le puede enviar por correo electrónico una copia de "Los 5 Elementos Clave Para Mantenerse Seguro en el Hospital".

Rodziewicz, T. L., Houseman, B. T., & Hipskind, J. (2021). Medical error reduction and prevention. StatPearls. https://pubmed.ncbi.nlm.nih.gov/29763131/

Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S. - 05/03/2016. (n.d.). https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us

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Making the Most of a Visit With Your Healthcare Provider

Talking about Advance Directives

Fall Prevention

Polypharmacy- What is it?

5 Key Elements to Staying Safe At The Hospital

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