Hospitals can be hazardous. Here’s how to avoid harm.
Hospital-acquired conditions
- Harm in the hospital, or “hospital-acquired conditions (HAC),” includes medication errors, falls, pressure ulcers, blood clots, obstetric adverse events and healthcare-associated infections
- A recent study of 11 hospitals in Massachusetts found that serious preventable harm occurred in about 1% of hospital admissions
- A “National Scorecard” on HAC details how often each type of problem occurs
Healthcare-associated infections
- Hospital patients are sicker than other people and hospital germs are more resistant to treatment than germs outside healthcare facilities
- Surgical sites, urinary catheters, “central lines” and ventilators all provide ways for germs to enter the body
- As a result, hospitalized patients are especially vulnerable to infection and to sepsis, a life-threatening response to infection
Sources & more info:
How Infections Spread
CDC.gov
Healthcare-Associated Infections
CDC.gov (Video)
Controlling infections
- Patients and families can take steps to control infections such as enforcing staff and visitor handwashing; disinfecting surfaces, especially high-touch surfaces; and seeking prompt removal of urinary catheters
- Patients and families should also be alert for signs of infection or sepsis, a life-threatening response to infection
- A mnemonic for detecting sepsis is TIME: Temperature, Infection, Mental decline and Extremely ill
Sources & more info:
Keep Your Hospital Room Safe And Clean
EngagedPatients.org
Reduce Your Risk
HospitalInfection.org
Infection Prevention & Control
WoundSource.com
Advice from CDC.gov:
Surgical site infection
Urinary catheter-associated infection
Centrao line-assocated infection
Ventilator-associated pneumonia
Symptoms of Sepsis
Sepsis.org
Medication errors
- Errors involving medication are one of the most common types of inpatient errors, with children at significantly higher risk than adults
- Patients and families can help ensure the “rights” of medication administration (right medicine, dose, patient, time, route, documentation, reason and response)
- “High-alert” medications such as blood thinners, insulin and narcotic pain medicines require special vigilance
Sources & more info:
Preventing pediatric medication errors
JointCommission.org
Medicine safety during your hospital stay
MedlinePlus.gov
6 Tips for Medication Safety During an Unexpected Hospital Stay
NCOA.org
The Top 10 Drug Errors
Medscape.com
High Alert Medications
ISMP.org
Safe Postoperative Pain Management
EngagedPatients.org
Falls
- Patients are more likely to fall in the hospital than at home
- Reasons for an increased risk include drugs that cause dizziness, drowsiness or confusion and dizziness when standing up after an extended period in bed
- Patients can take steps such as being extra careful getting out of bed, asking for help if dizzy or unsteady, and wearing slippers with nonskid soles
Blood clots
- Blood clots are the leading cause of preventable death in hospitals
- Signs of a clot include swelling, pain and tenderness in a leg, increased warmth in a swollen or painful area of a leg, and red or discolored skin on a leg
- Signs that a clot has broken free and traveled to the lungs include shortness of breath, chest pain, a racing heart and unexplained coughing
- Devices to improve blood flow and medications to thin the blood can help prevent clots
Pressure ulcers (bed sores)
- Bed sores can form when skin is under pressure, for example when a person is bedridden
- They can become infected and/or take months or years to heal
- Bed sores can be prevented with inspection, repositioning, padding, and care of the skin
Sources & more info:
Bedsores
HopkinsMedicine.org
Preventing pressure ulcers
MedlinePlus.gov
Complications of labor & delivery
- The US has high rates of maternal injury and death compared to other developed countries
- Patients and families can help protect themselves by checking in advance whether a hospital has recommended procedures in place to detect and manage hemorrhage (excessive blood loss), severe high blood pressure and blood clots
- Starting in Fall 2023, patients and families will be able to check whether a hospital qualifies as “Birthing Friendly” under a new quality and safety initiative from the Centers for Medicare and Medicaid Services
Rapid decline
- Signs of a rapidly declining patient include changes in mental status, shortness of breath, acute pain, and the patient stating that something is wrong
- In this situation patients and families should ask to see a physician immediately
- If necessary patients and families can call the hospital operator and ask for the administrator on call
Risks with hospital discharge
- Discharge from the hospital involves risks such as confusion about whether to continue pre-hospitalization medications and gaps in care between discharge and the next appointment with a physician
- Patients and families can speak up if a discharge seems unsafe and appeal any decision by Medicare or another insurer to stop paying for care
- Medicare’s Care Compare can help locate and evaluate nursing homes, home healthcare, inpatient rehabilitation and long-term hospitals
Sources & more info:
Checklist to prepare for discharge
EngagedPatients.org
Discharge Preparation Checklist
CareTransitions.org (archive)
Daily Medication Schedule (Form)
What to Do if You Feel You’re Being Discharged Too Soon
USNews.com
Getting a fast appeal in a hospital
Medicare.gov
Care Compare
Medicare.gov
- Medically reviewed August 2023