One hundred years ago hospitals were dangerous places. Many Americans believed that if you went to the hospital you were taking your life in your hands. Sterile technique left a lot to be desired and infections were common.
A century later we like to think that modern hospitals are safe havens. There have been incredible advances in medical science, but unfortunately hospitals are still dangerous places for too many patients.
The Inspector General at the Department of Health and Human Services (HHS) has just issued a shocking report based on careful scrutiny of the records of 780 Medicare patients treated in October 2008. Here are the key findings:
* A projected 15,000 Medicare patients die monthly as a result of hospital care.
* One in seven Medicare patients were harmed in the hospital during that month.
* 44 percent of the adverse events could have been prevented with appropriate attention.
When sick people have to go to a hospital, they assume they will get the best care possible and not be harmed. This new study suggests, however, that far too often patients are put at risk.
Hospitals are teeming with bad bugs. These germs are often antibiotic resistant. When you come down with something called Clostridium difficile (C diff for short), it can be unpleasant at best and life-threatening at worst. C diff can cause intractable diarrhea that is very hard to cure.
Older people are especially vulnerable to adverse events in hospitals. For one thing, they often have more than one health problem that requires many medications. The more pills a person takes, especially in a hospital, the more likely it is there will be drug interactions with nasty consequences.
Blood thinners such as clopidogrel (Plavix), enoxaparin (Lovenox) and warfarin (Coumadin), pose a special risk. Anticoagulants can interact with dozens of other medications including aspirin. The HHS report on Adverse Events in Hospitals describes many cases of hemorrhage linked to difficulties with such medicines.
When you’re in the hospital, pain is common, especially after surgery. That often means heavy-duty narcotics. In older people these drugs can trigger confusion, delirium or hallucinations, which may lead to additional harm.
If you would like to know more about the medications that pose particular problems for senior citizens, we offer our Guide to Drugs and Older People.
Here are some suggestions for protecting loved ones if they have to be hospitalized:
* Have an advocate with the patient at all times. That needs to be a person who is willing to ask tough questions and be assertive if something seems amiss.
* Ask about all medications. Make sure the patient receives the three Rs: right drug, right dose, right time.
* Inquire about drug interactions. Most hospitals have computerized alert systems. Ask if there are any warnings on the combination the patient is receiving.
* When leaving the hospital, get detailed discharge instructions about post-hospital care, diet and exercise. Find out what symptoms might be worrisome and ask for a number to call if anything goes wrong.
Until hospitals become safer, families need to be alert to protect their loved ones.