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Engagement Awareness
for Championing Care

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​Real Stories from Real People
patients & families having a voice, sharing experiences at the ground level 

Patient Assessment, Quality Care Standards

7/10/2017

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My mom was in the hospital for kidney stones and they did a great job coming in regularly to ask how she was doing and managing her pain every few hours. Her only complaint was the ten pounds of fluid they put on her.
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They were supposed to be assessing my elderly mom to make sure they were not causing a hospital acquired condition (HAC), such as pulmonary edema when her GFR was 52. The nurses should have been touching her to see her swelling (edema); they were supposed to not only be tracking her urine amount, but straining it to see if stones passed, and have her on a bed that automatically weighed her to see that she was retaining fluid which is dangerous with someone with high blood pressure (hypertension).
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​Clinicians should always assess the patient - look, listen, feel - even when stable to always have a baseline, and to monitor if treatments are being successful, to avoid complications before machines alarm.
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My mom fell and was in the hospital and rehab for weeks

5/12/2017

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My mom has severe dementia in her 80s and fell in the long term facility where she was living. After the hospital, they took her to rehab for weeks.
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The average rehab stay for her age and condition was 14 days.
The phone number earlier for Medicare (CMS), to have a case manager involved earlier, who called to get my mom discharged because they were not doing rehab over the weekend and she should be transferred back to her home.
A couple of months later my mother became unresponsive. The home called an ambulance and she was taken to the emergency room (ER) where she revived and was fine. The doctors speculated her heart rate went very low in the 30s-40s and then came back up on its own, no treatment.
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The difference between a living will and advanced directives, so having a 'Do not resuscitate' (DNR)/no code status, to also have an open discussion with advanced directives documents clearly defined when to call an ambulance, and when to leave my mother, allowing her to go peacefully in her home when it is her time - without invasive treatment.
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"They took such good care of me, they were so nice!"

8/1/2016

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An elderly woman with confusion, vomiting, weakness and malaise is taken to the ER, admitted for a three day hospital stay and discharged. She was given a patient experience survey with the response, "Oh, they took such good care of me, they were all so nice."
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​My primary care physician had me on meds that caused my sodium to drop and he never checked it, and there was no care coordination with any of the other five doctors he kept referring me to.​
​The admitting attending-hospitalist should not have walked in and asked me why I was there or how much IV fluid I was given - she was supposed to have been fully briefed from the ER doctor and read the electronic medical record to tell me along with review of my plan of care and advanced directives with me.
​The admitting nurse should have introduced herself, read the record in front of her on the laptop, instead of asking a confused person the same questions already clearly uploaded. She should have known my life threatening primary diagnosis, she should have done a full physical and level of awareness assessment to establish a baseline upon admission to compare to as treatment was given instead of only touching her keyboard. She should have called in a case manager to coordinate advanced directives to be done and begin discharge planning of an elderly confused person with complications from lack of follow up by primary care physician, and to also contact that physician regarding the admission.
Numerous staff throughout the three days should have been doing level of consciousness (LOC)/awareness checks to note the increased confusion which can be caused by raising sodium too quickly; they should have contacted the primary physician for the last time labs were checked, and the discharge planning status was not supposed to be To Be Determined (TBD) two hours after the discharge order was written; planning should have been initiated the first day admitted. 
A hospitalist who had never seen me wrote the discharge summary incorrectly, changing it from the admission of low sodium (hyponatriumia) which i was treated for, to reflect symptoms for low potassium, with the discharge diagnosis of hypokalemia.

There is a difference between experience questions that do not reflect quality care delivered, and that of value care delivery along with engagement questions. There is a Population and Experience Officer in health systems and to contact them regarding poor care coordination, clinical quality assessments and poor engagement and listening of extended family members - while still in the hospital to ensure good care.
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  • DHC
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    • why is it needed
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    • resources
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    • Healing Love & Ripple
  • Books
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