Patient Safety Not Improving In Hospitals

  

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Two new studies reported on by the New York Times reveal that, despite efforts to improve patient safety in hospital settings, hospital-associated infections and mistakes have not decreased.

The first study, published in the New England Journal of Medicine found that 98,000 deaths and more than one million injuries occur each year in the US. About 18 percent of patients receiving health services at hospitals in the study were harmed by medical care, and 63.1 percent of those instances were judged to be preventable. Problems specific to older populations included falls and urinary tract infections (UTIs) caused by urinary catheters. Overall, 2.4 percent of problems were directly related to a patient's death.

Another study examined only Medicare patients and found that 13.5 percent of Medicare beneficiaries experienced an "adverse event" during a hospital stay. These events were identified by the presence of "triggers" such as a readmission, a bedsore or the use of a drug to reverse an overdose.

In the study of Medicare patients, 2.9 percent of patients who experienced an adverse event ended up with a permanent injury, and over 8 percent of adverse events were life threatening. The majority of errors, however, were minor and included medication errors, UTIs and low blood sugar in diabetic patients.

Still, in both studies, experts caution that events may be underreported and therefore the true number of undesirable patient outcomes may be even higher.

Recommendations include making public all patient safety data so that members of the public can avoid the riskiest hospitals, implementing checklists so that hospital workers and caregivers avoid mistakes, and computerizing pharmacies so that patients are always given the correct drugs.

When A Parent Needs Long Term Care or Home Care

  

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As youngsters, we are accustomed to seeing our parents as infallible. They are heroes who help us grow and provide for us. However, roles can reverse as we get older and our parents age, too. This can be especially stressful when a parent needs long term care or care at home.

In order to make the transition from full independence to home care as comfortable as possible, it is important that children of parents in need of home care keep in mind the physical, emotional and practical needs of the very parents who cared for them so many years ago.

According to Dr. S. Brian Lindsay, there are six key steps to dealing with a parent who needs long term care or home care:

- Prepare for the transition in care. Your whole family should be involved in the coordination of care, including spouses, in-laws and children. Planning ahead and discussing potential changes in care mean that important decisions can be discussed calmly and with ample time.

- Remember that your parent changes as they age. Just as you are no longer a young child, your parent is a different person than they were when you were young. They have grown and matured and may have different concerns.

- Look at things from their perspective. Realize that nobody is comfortable with change, and know that seniors are especially upset by disruptions in a routine. As Dr. Lindsay says, "the only thing worse than change, is change that you have no control over."

- Do whatever you can to help your parent maintain as much independence as they are capable of handling. 

- Don't ignore finances and paperwork just because there is an urgent medical need. Make sure routine bills are paid. If possible, hire an assistant to help.

- Help your parent stay healthy. Good health can help a parent enjoy a long, full and independent life.

By taking into account the changes that your family will go through and that your parent will encounter during a transition in care, both you and your parent can gain some comfort in a difficult time.

Dementia, Delirium in Elderly Patients Linked to Infection

  

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A new study shows that sepsis, an illness that causes inflammation throughout the whole body, could cause physical and mental impairment among the elderly.

Elders who survive sepsis, also known as "blood poisoning," are three times more likely to undergo a severe physical or mental decline according to a University of Michigan Medical School study. The findings may explain why some elderly people lose independence after a hospitalization and end up in need of long term care.

Many years ago, sepsis was a cause of death for many elderly patients who were said to have "died of old age." Today, advances in medicine mean that sepsis is a condition that can be treated -- but elderly patients often survive with severe impairment that robs them of their independence along with physical and mental function.

"Among people with no mental or physical limitations before sepsis, around 40 percent could not walk without assistance in the years after," lead researcher Dr. Theodore Iwashyna said. It is uncertain whether sepsis alone causes cognitive decline, as delirium, often a complication of sepsis, is also associated with worsening cognitive impairment. 

Sepsis occurs most often in infants and in the elderly. Those with compromised immune systems are at high risk, in addition to those with urinary catheters, breathing tubes or artificial joints. As urinary tract infections and bedsores can often lead to sepsis, it is important for hospitals, doctors, nurses and other caregivers to monitor an at-risk patient's health to prevent illness.

Diseases such as flu and pneumonia can also make an elderly person more susceptible to sepsis. This is why vaccinations are important for individuals of all ages.

More research is needed to determine the link between sepsis and cognitive and physical decline. In the meantime, infection prevention in hospital and long term care settings as well as vaccinating the elderly for flu and pneumonia are important ways to combat sepsis.