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Thursday, July 12, 2012

Back to the Basics

How many fields of business right now are calling upon their masses to get "BACK TO THE BASICS"?  Healthcare is.  Nursing is calling for hourly rounding on patients, more handwashing, and falls prevention.  Medicine is calling for better access to primary care, less reliance on expensive high-tech testing, and improved communication between doctor and patient.  Medicare is penalizing hospitals for hospital acquired infections, low cleanliness scores, and poor pain management.  For years, we have been learning to be high tech when the patient in all of us has been crying out for high touch. 

Florence Nightingale sent letters to nurses in training at St. Thomas Hospital between 1872 and 1900 on how they should practice as nurses (Nightingale 1915).  In those letters, she gave us many of the basics of patient care. 

"When we obey all of God's laws as to cleanliness, fresh air, pure water, good habits, good dwellings, good drains, food and drink, work and exercise, health is the result.  When we disobey, sickness."

I am now working with Environmental Services, Food Services, and Patient Transport Employees.  They don't realize that they are just as much heroes to the patients and family members at the medical center as the very doctors and nurses providing care.  Let's think about that.

Environmental Services:  Florence Nightingale herself spoke of the importance of cleanliness and good dwellings.  The government is adjusting reimbursement based upon hospital acquired infections.  EVS team members are critical to a hospital.  Everyone notices trash that is running over, body fluids not attended to, and a kind word from any member of the hospital team that enters a patient's room. 

Food Services:  You can look at my picture and know that food is important to me, especially when I'm stressed.  For patient's and family members it is important as well.  Food is a challenge in the hospital environment or in any institutional setting.  But back to Florence.  She talked about the importance of food and drink.  I am reminded of chicken soup when you have the flu.  It is so important to have that right thing that you can eat when you are able. 

Patient Transport:  I worked at a facility where a patient transporter was getting thank you notes all the time.  I finally asked him what he was doing that was special.  He beat around the bush for awhile and then confessed that he always introduced himself and called patients by name, OK that was expected, and then he revealed the magic.  For little old ladies, when he went by the blanket warmer, he stopped, got a warm blanket and wrapped their cold feet in a warm blanket.  Almost 100% of the time they would ask, what was your name again?  He had that special thing he did for people that made him enjoy his job and made the patients enjoy him. 

It's not that high tech is not important.  It is so exciting that today, if I start experiencing signs of a stroke, I can get rushed to a hospital and have an interventional radiologist snake a catheter into my brain and using fluroscopy can find the exact location of the clot and infuse a clotbusting drug directly on the clot, break it up and my stroke symptoms can resolve!  Wow!  Not that many years ago, I would have been a gonner.  Patients and families though continue to tell us that they judge us based upon what they know, not what we know how to do.  They don't know all that technical stuff.  They know the basics.  Did we smile at them?  Were we friendly?  Did we keep them warm?  Were they kept informed?  Was their environment clean or was there evidence of the prior patient left in the room?

We are judged on what the patient DOES understand.

Thanks to one of my long-time colleagues, friend, and now blog-readers, Jackie Ashburn for bringing to my attention the work of Robert Fulghum who wrote "All I Really Needed to Know I Learned In Kindergarten".  See his web site at http://www.robertfulghum.com/.  Now that is back to the basics!  He says that wisdom was not at the top of the graduate school mountain, but there in the sand pile at preschool.
So let's check out his wisdom and apply it to our workplace:

• Share everything.
• Play fair.
• Don't hit people.
• Put things back where you found them.
• Clean up your own mess.
• Don't take things that aren't yours.
• Say you're sorry when you hurt somebody.
• Wash your hands before you eat.
• Flush.
• Warm cookies and cold milk are good for you.
• Live a balanced life - learn some and think some and draw and paint and sing and dance and play and work every day some.
• Take a nap every afternoon.
• When you go out in the world, watch out for traffic, hold hands and stick together.
• Be aware of wonder. Remember the little seed in the Styrofoam cup: the roots go down and the plant goes up and nobody really knows how or why, but we are all like that.
• Goldfish and hamsters and white mice and even the little seed in the Styrofoam cup - they all die. So do we.
• And then remember the Dick-and-Jane books and the first word you learned - the biggest word of all - LOOK.

The Joint Commission describes some of the bad outcomes that occurs in hospitals as Sentinel Events.

Sentinel events most frequently reported* to the Joint Commission. Wrong-site surgery: 867 reports (13.5%), suicide: 770 reports (12%), op/post-op complications: 710 reports (11%), delay in treatment: 536 reports (8.3%), medication error: 526 reports (8.2%), patient fall: 406 reports (6.3%). (*6428 total reports as of September 30, 2009)

CMS list of nonreimbursable hospital-acquired conditions

1. Object inadvertently left in after surgery

2. Air embolism

3. Incompatible blood transfusion

4. Catheter-associated urinary tract infection

5. Decubitus ulcer

6. Vascular catheter-associated infection

7. Mediastinitis after coronary artery bypass graft

8. Certain types of falls and trauma

9. Surgical site infections after bariatric and certain orthopaedic procedures

10. Legionnaire’s disease

11. Manifestations of poor glycemic control

12. Iatrogenic pneumothorax

13. Delirium

14. Ventilator-associated pneumonia

15. Deep venous thrombosis/pulmonary embolism

16. Staphylococcus aureus septicemia

17. Clostridium difficile infection

When you look over these lists and think about how these things can be caused in hospitals, a lot of times you have to consider the basics that we have all been taught.  Be careful, don't work too fast, check twice, keep things clean, don't let people fall...

1 comment:

  1. Well said. Nursing's foundation was built on these principles. Thank you for giving us perspective.