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Protect Yourself In The Hospital – "What We Have Here Is A Failure To Communicate"
Two cases of accidental narcotic overdose resulting from miscommunication
Institute of Medicine identifies ‘health illiteracy’ as root cause of medical error
The Institute of Medicine (IOM) published a report on April 8, 2004 [IOM Health Literacy: A Prescription to End Confusion] stating that up to 90 million American adults lack the reading and math skills necessary to understand basic health information and navigate the American healthcare system. IOM has identified a conceptual entity with its new title, “Health Literacy: A Prescription to End the Confusion”.
The IOM report clarifies that the list of skills required for a US citizen to have health literacy is reading, writing, listening, speaking, arithmetic, and conceptual knowledge. The IOM has defined health literacy as “the extent to which individuals have the ability to obtain, process and understand basic information and services needed to make appropriate decisions about their health”. At some point, most individuals – even those who are well-educated and have strong reading and writing skills – come across health information about forms, a drug, or a procedure that they don’t understand. Along with calling on the health care system to address the issue through better health education, IOM called on doctors and other health care providers to listen to their patients to determine if they understood. what they needed to know to participate in their illness. care and/or improve their state of health through preventive measures.
In my professional experience, I have seen thousands of home patients over two decades. Most of the people I interviewed who were on medication did not know the name of their medication or the potential side effects. All they knew for the most part was the color, shape and what disease it was (i.e. high blood pressure, diabetes, nervousness or infection)
The IOM report presents two main areas of concern. The first is public awareness of where to go for what issues. It’s about public education and dealing with people before they enter the system and meet a health care provider. The second area of concern is the information provided by the physician or other health professional. This applies to people who are in the care of a particular care provider, whether that be a doctor, nurse practitioner, chiropractor, HMO, home infusion, etc. as a major cause of medical errors.
Therefore, part of the duty of a licensed healthcare practitioner is to ensure that the patient or responsible party understands the information that must be provided insofar as the patient or significant other may participate in the management of the disease and engage in preventive measures.
Case in point 1:
In the first case, a man living in the United States who did not speak English was given a prescription for Tylenol with codeine. The label said: “1 or 2 tablets every 3 hours as needed for pain”. The patient understood this to mean that he could take two tablets every 3 hours or more often as needed. He ended up taking two pills every hour until he collapsed from a narcotic overdose. He survived with a mild degree of anoxic encephalopathy (brain damage due to lack of oxygen). The patient filed a lawsuit claiming that it would have been simple to ask the patient, “What is your understanding of the instruction regarding your painkillers?” and not to do so was unreasonable.
Although many would say that people should take responsibility for misunderstanding simple instructions, IOM points out that approximately ninety million people in America are unable to understand medical instructions as provided on labels, instructions and verbally. On the other hand, it can also be said that people know whether they understand something or not and if not, they always have a responsibility to ask for further explanations. However, the core problem of miscommunication is not lack of understanding but misunderstanding. Health illiterate patients most often leave a consultation without realizing that they have a set of misguided instructions in mind that differ from what the health care practitioner said.
Therefore, it is the responsibility of the health care provider to take reasonable steps to ensure that the patient has received and understood the medical advice correctly. Also, we need to take a look at the standard instructions like “take one or two pills every three hours as needed for pain” and maybe change it to “take one or two pills three hours or less often. as needed for pain”.
Case in point 2
The second case involves a 63-year-old man who was discharged home from hospital on intravenous morphine administered by patient-controlled analgesia (PCA). The man died of an overdose on the second day of the infusion despite his wife monitoring him frequently throughout that time. During the ensuing investigation, it appears from the records that the nurse responsible for administering the home infusions did not provide sufficient teaching to the patient’s wife. The wife just looked at her husband, who slept most of the time, and thought he was fine because he was breathing and sleeping peacefully. Obviously, she didn’t have enough health knowledge to check if he was narcotic stupor by waking him up and seeing if he was hard to wake up. She needed to know if he could respond to the voice or if he needed tactile or even painful stimulation to wake him up. The nurse had to make sure that the woman understood how to assess the level of consciousness. It’s likely that with a few extra moments of effective communication, the wife could have known her husband was in trouble and would have called 911 soon enough to save his life.
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