By Kathleen McCarthy
Be Inkandescent Magazine
“Going to the hospital can kill you,” says Patricia J. Rullo (pictured here), who discovered that firsthand when hospital staff didn’t notice that her mother was having a heart attack during surgery to repair her injured shoulder.
The ramifications of that mistake nearly killed her mother, and led to months of intensive care and a lengthy stay in a rehabilitation center — along with many more mistakes by health care staff. “I was caught completely off guard,” says Rullo.
The experience transformed her into an activist.
Rullo channeled her hard-won wisdom into a book — Speak Up and Stay Alive, which serves as a hospital survival guide — “so that no one else would have to endure the little-known hospital hazards that we encountered,” she says.
Every year, around half a million people in the United States die due to preventable medical errors, which makes medical errors the third leading cause of death, according to the Patient Safety Journal.
To help prevent hospital errors, you need a patient advocate, she says, and that person should be with you around the clock if possible. What is a patient advocate? “Someone to step in and look out for your best interests, and to bridge the gap between you, your doctors, and the hospital staff,” she says. “They are another set of eyes and ears — and a mouth when necessary.”
Scroll down for our Q&A, with Rullo, who tells us what’s dangerous about a hospital stay, and her top tips for surviving them.
Be Inkandescent: What motivated you to write “Speak Up and Stay Alive”?
Patricia Rullo: My mom’s horrifying hospital experience. After an accidental fall, she was having what should have been routine surgery to replace her injured shoulder. Despite numerous EKGs taken throughout her post-op recovery that clearly showed she was having a heart attack, no one recognized the event for more than nine hours.
That missed diagnosis resulted in her being in intensive care for four months. The ensuing mistakes and missteps that occurred during those months caught me completely off guard and threatened my mother’s life.
I later realized that the only reason she survived was that I was by her side nearly every single moment to watch, listen, learn, and speak up. I wrote “Speak Up” so that no one else would have to endure, or be harmed by, the common but little-known hospital hazards that we encountered.
Be Inkandescent: Why do you think patients need advocates — aren’t the nurses and hospital staff supposed to look out for patients’ best interests?
Patricia Rullo: Yes, the hospital staff is supposed to look out for everyone’s best interests — and that could be part of the problem. When a nurse has to care for multiple patients at a time, it’s not humanly possible for him or her to be everywhere, watching for nuances that may signal a change in the patient’s health and well-being.
And with so many caregivers coming in and out — doctors, specialists, RNs, LPNs, aides, transporters, housekeepers — something is bound to get lost during transition times. For example, during shift changes, vital patient information is supposed to transfer seamlessly between the incoming and outgoing nurse — but what if it doesn’t? What if something important is left out, added, or miscommunicated?
This is where the advocate steps in. Whether a family member, friend, or hired professional, the advocate knows the patient better than any member of the hospital staff, has only one patient to look out for, and knows what is going on with the patient.
By the way, many hospitals have a designated patient advocate on staff, but don’t let the name fool you. Hospital patient advocates are employees of the hospital, and they serve a risk management function for the hospital rather than as a patient ally. That means that a true patient advocate is a necessity, not a luxury.
Be Inkandescent: What kinds of mistakes happen most frequently in hospitals? What are the worst mistakes?
Patricia Rullo: The common mistakes very often are the worst ones. Most people think doing surgery on the wrong body part or wrong patient, which rarely happens, would be the worst mistake. Medication errors, which frequently occur, may sound minor, but can result in a more devastating outcome — death.
Other common mistakes are leaving foreign objects, such as surgical sponges, in patient’s bodies after a procedure. Pressure ulcers or bed sores occur frequently because the hospital staff are overextended and don’t have time to move patients often enough.
But the biggest problem — the one that I consider the most common as well as the worst — is cross-contamination and hospital-acquired infections. Sadly, these infections could easily be prevented if healthcare workers practiced better and consistent hand hygiene. More patients die or experience additional problems, more medications, more surgeries, and more complications due to this breach of protocol. And this is a perfect place for the advocate to step in and insist that everyone wash their hands prior to touching the patient. This extends to the use of gloves, stethoscopes, or anything else that comes in contact with the patient. It is not rude or weird to ask everyone to wash their hands upon entering your room.
And be aware that a squirt of hand sanitizer will not kill bacterium such as the C-diff virus. Only soap, water, and proper hand-washing can eradicate this bug. Yet I found after querying many nurses that they did not know this!
Be Inkandescent: What are the top five things people should do who have a planned hospital stay coming up to ensure they get the best care?
- First —
pre-pack a hospital bag. Include a
list of medications, health insurance information, clean undies, lip balm, a bottle of water, an extra pair of glasses, an extra pair of socks — one for the bed and one for the dirty floor, a canister of disinfecting wipes, hand sanitizer, and of course, a copy of my book, “Speak Up and Stay Alive,” along with our Patient Safety Logs. Or create your own logs to keep track of doctor and nurse visits, vital signs, tests, medications, and contact numbers, as well as advocate sign-up sheets, and question-and-observation logs.
- Bring a cheap pillow with you. Do not bring your favorite pillow from home because bacteria can live on fabric for months. Don’t give the germs you pick up from the hospital a free ride home on your pillow. And hospital pillows stay in circulation for years, which means the seams can harbor nasty pathogens left over from hundreds of other patients. Bring your own pillow and leave it at the hospital when you are discharged.
- Ramp up your nutritional needs ahead of time. Eat healthy foods, take supplements, exercise, meditate. It’s important to begin your stay in the best physical, mental, and nutritional state possible. In fact it’s wise to ask for a nutritional evaluation prior to admission as well as for continuous evaluation during your stay if it is a long one. You wouldn’t think malnutrition would be a concern when you’re in the hospital, but it is.
- Understand your diagnosis, the treatment plan, the risks, and the rewards. And get a second opinion if you have any doubts.
- Finally, decide who will be your advocate/s. Ideally advocates are paid professionals with health care knowledge; however, finding that person could take time and can be expensive. Alternatively, find a family member or a friend who has the stamina for the job. You want someone who is informed, persistent, and caring. Don’t choose someone who is loud, arrogant, or comes across as adversarial. It’s usually not possible for one person to handle everything, so instead ask for commitments from several friends and family members. Try to schedule four-to-six-hour shifts so that someone is with you most of the time. If this is not possible, then at least have someone with you during critical times such as admission, shift changes, transfers to different floors or locations, and especially at discharge.
Be Inkandescent: What should advocates do to prevent offending hospital staff and making adversaries out of the people who are supposed to be taking care of us or our loved ones?
Patricia Rullo: This is a classic question and a very important one. “Speaking up” is not synonymous with being rude. It’s important that advocates take extra care to “make nice” — to be friendly, to smile, and to say “please” and “thank you” — to everyone who is helpful, from physicians to the housekeeping staff. When word gets around that “the heart attack in room 306” has a nice family, you’ll get better service.
This is not to say that you should still be pleasant if a request goes unnoticed or ignored. Not at all. But if you are kind and decent most of the time, people notice and take action when you’re upset. I remember several occasions where I stood outside my mom’s door, hands on hips with a scary look on my face … people came running to ask what was wrong.
One more thing: If you are someone’s advocate, you can be more effective when you are informed. Research your patient’s diagnosis and treatment options. Listen, take notes, and learn how to use the Internet to find reliable sources of information. Also, I know this sounds a bit silly, but dress nicely. During my mom’s hospital stay, I couldn’t help but notice the number of people roaming the hospital halls who looked like they had just hosed down their garage. Couple a neat appearance with fact-based questions, ideas, and suggestions, and you’re more likely to be taken seriously.
Be Inkandescent: How can someone find an advocate?
Patricia Rullo: Begin by asking people you know, including folks at the hospital and nursing station, for recommendations. You can also search the Internet for patient advocates; for example check out the National Association of Healthcare Advocacy Consultants.
But keep in mind that there is no standardized formal training or certification for patient advocates. It’s up to you to interview and screen your candidates to make sure they are a good match for you and your family.
Whether your advocate is a professional or someone close to you or your family, remember that you can stay safe from little-known health care and hospital hazards, and it is my sincere hope that my book, Speak Up and Stay Alive and my weekly radio programs can help pave the way for a safe journey.
About Patricia J. Rullo
Pat Rullo speaks to audiences about the hazards of hospital stays, how to survive them, and the importance of having a health care advocate. She is also an insurance industry expert who has served on the advisory boards of New York Life Insurance Company and Transamerica Life Insurance Company. Author of numerous business magazine articles, she has also written several books: “Worksite Marketing—A Promise to Deliver,” “Succeed With Style,” and “When Daddy Plays Golf,” in addition to “Speak Up and Stay Alive.”
For her own health, Pat makes time for daily contemplation in her pink kayak at her summer home on the Chagrin River in Ohio and does tai chi in the desert at her winter home in the Superstition Mountains of Arizona.
For more information, visit: www.speakupandstayalive.com.