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An Ear for Patients


Amanda Owen’s first order of business with patients is to encourage their participation in their own care.
Amanda Owen’s first order of business with patients is to encourage their participation in their own care.

When Amanda Owen approached her patient with her thyroid medication, Owen was already suspicious of the high dose. Although the patient wasn’t sure how much she took, she knew the amount was low because she had just started the medication. “We pulled out her med list from home and, sure enough, the dose that was ordered was 10 times what it should have been,” says Owen, who works as a bedside nurse on Nelson 4 as well as being the wound care specialist for the Department of Medical Nursing. “But because we both questioned the dose, everything was fine.”

Such events show what can happen when patients and staff work together and listen to each other. Even if the concerns prove unjustified, pausing for a brief time-out can put them at ease and encourage future input.

Getting patients and families to play an active role in safety is a goal of the Health System—and the Joint Commission—in 2007. But the feedback of patients and families can’t go far if it isn’t taken seriously. “Too often, patients are the subject of our work and aren’t seen as having a role in their own care,” observes Lori Paine, Hopkins Hospital’s patient safety manager.

The hospital has taken some definitive steps to encourage a mind-set change. A new “partnership pledge,” which is  handed out to every person on admission, requests that patients and family members raise questions and concerns, check that their ID bracelets have the correct information, and wash their own hands frequently, among other proactive steps. The hospital promises that caregivers will solicit concerns and address them, verify identification before ordering medications and tests or beginning procedures, and wash their hands. A video produced by the hospital, which began streaming on the patient television network last spring, also tells patients how to get involved.

Although Doris Alwine, the hospital’s patient and visitor services coordinator, says these efforts can improve patient awareness, it can take much longer for this partnership between those giving care and those receiving it to become the norm.

“We’re at the very beginning of all this,” she says. “We don’t know how difficult it’s going to be to do everything that we’re promising.” Fulfilling the pledge, Alwine continues, will require diplomacy and insight from caregivers to deal with patients as individuals.

There’s little in the medical literature to indicate whether efforts aimed at increasing patient and family involvement will ultimately improve safety. But there have been medication errors and other mistakes resulting from unwillingness to address patients’ concerns.  

Caryl Siems has no difficulty speaking up when it comes to the care of her 12-year-old daughter, who has been coming to the hospital for years. Her daughter also isn’t shy, reminding caregivers to make sure they wash their hands.

“We’ve had great care teams from the very beginning,” says Siems, a patient representative on the hospital’s Patient Safety Committee. “But you occasionally run into somebody who will have a more officious manner and doesn’t want to listen. Fortunately, I’ve never been shy about speaking up.”

Siems thinks that caregivers should empower more reticent patients to be diligent in their own care—for instance, by explicitly asking that they bring up concerns.

“When you’re dealing with different specialties and different rotations, the only consistent people in the process are often the patients and their families,” she says. “The care will be better if you bring them in.”

—Jamie Manfuso



Johns Hopkins Medicine

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