Patient safety advocates use a set of five standards to determine the appropriateness of medication administration. “The 5 Rights of Medication Administration” dictate that the right patient receives the right drug at the right dose via the right route at the right time. These simple goals are incredibly powerful. Hospitals and practices that systematically commit to achieving them can dramatically improve the quality of their care.
Private health care should have a similar set of standards, by which high quality can be defined. One should expect the same level of expertise from a private healthcare provider as he or she would receive in a top hospital. These 5 Rights of Private Care should be the standard by which private healthcare agencies are measured:
· Right provider – Beyond professional credentials, a private nurse should be respectful of a client’s home, individualism, and lifestyle preferences. Unlike a hospital or clinic employee, a private nurse is welcomed into a client’s home. Many clients prefer that a private nurse dress in casual attire, in order to be less conspicuous to neighbors and guests. A nurse should also be conscious of rules of the home, such as taking shoes off when entering, folding towels after using them, or hanging a coat in the appropriate location.
· Right training – A private care provider should have the appropriate training and credentials for the needed level of care. Some non-nursing agencies have been known to allow health aides to dispense medications in order to retain a client. In the state of Massachusetts, only Registered Nurses are qualified to dispense medications. Though a seemingly simple act, pharmaceuticals are powerful chemicals, and should not be dispensed by unskilled providers.
· Right skills – Healthcare is a broad industry, encompassing many different services and competencies, each of which demands a different set of skills. A nurse whose experience is limited to a dialysis center may not be able to adequately care for a surgical patient. Even within the surgical realm, specialized knowledge is needed to care for someone who has had cardiac surgery—or a hip replacement—or a face lift.
· Right patient – There are many agencies in the private care industry that will provide services for anyone willing to pay for them. Not everyone who requests services, however, needs 24 hour nursing care. A good private care agency will discuss your needs and concerns with you, your family, and your medical team, and offer the appropriate services. You should be confident that your caregiver has the skills required to perform those services, and that their qualifications are not inappropriately excessive (and expensive).
· Right time – Many people do not anticipate the need for a private nurse until one is needed. A private care agency should be responsive to your needs—whenever and wherever they may occur. It should welcome opportunities to provide high-quality, comprehensive care—even if it means an extra visit to the hospital before you are discharged, or travelling with you to doctors’ appointments.
HotelRecovery commits to the 5 Rights of Private Care, and seeks specialized training and certification for its providers in all areas of its service. We have begun by sending our nurses to training at The Boston Center for Ambulatory Surgery, one of the city’s premier surgical centers. In the coming weeks, our providers will gain competencies in oncologic nursing and geriatric psychiatric care.
As Boston’s first and finest Physician-Directed Private Healthcare Personnel agency, HotelRecovery will provide the best care possible to every client, every time. Click on the 5 Rights of Private Care icon above to speak with a nurse or doctor for free.
HotelRecovery is not a physical hotel, nor does it provide care exclusively in hotels. The name HotelRecovery was adopted at the company's inception, more than ten years ago. At the time, most of its clients were people who had travelled to Boston from other states or countries to seek top quality healthcare. Over the years, so many of our neighbors in the greater Boston area have sought our care that the majority of our services are provided in local homes.
Although most of HotelRecovery's clients now receive care in their own homes, the HotelRecovery name conveys a sense of the professionalism and attention to detail that its caregivers offer. HotelRecovery nurses are often asked to supplement care provided by hospital staff, and to travel with clients to other states and internationally. No matter where they work, however, their focus is the same: provide the highest quality health care at our patients' convenience and on their terms.
Whether you live in greater Boston or not, Comprehensive Care for Recovery can help you to recover more quickly and comfortably. Click below to speak with a nurse or doctor for free !
The Liberty Hotel, located next to Massachusetts General Hospital in Boston's Beacon Hill neighborhood, has hosted HotelRecovery clients for years. Due to its proximity to MGH and experience with guests requiring health care services, The Liberty is an ideal place to recuperate from surgery or acute medical treatment--especially if you do not live near Boston.
Now, The Liberty offers discounted rates to HotelRecovery clients. Click on the Liberty Hotel button below to talk with a nurse or doctor about Comprehensive Care for Recovery and to book a Liberty Hotel room at the Hotel Recovery rate!
Discharge from the hospital to home or another healthcare setting is a complicated process, during which medical errors are known to occur. A lot of information is conveyed by nurses and doctors: new medications, changes to medications, follow-up recommendations, and ongoing treatment plans. This information can be difficult to synthesize and retain for anybody--especially those without a medical background.
HotelRecovery nurses can provide assistance with discharge. They make sure that medications are continued or discontinued as recommended, and can communicate information from the hospital-based medical team to outpatient doctors. In fact, Comprehensive Care for Recovery is most effective when a HotelRecovery nurse is part of the discharge process.
HotelRecovery believes that discharge assistance is an important part of care coordination, and offers it for free to those who schedule ongoing nursing care. Click on the Free Discharge Assistance button above to speak with a nurse or doctor.
Congratulations to Annie O'Connor, HotelRecovery's Nurse Manager for being selected as a finalist for the Home Care Alliance's 2010 Manager of the Year Award! The Home Care Alliance consists of over 160 member agencies, as well as allied and individual members, throughout Massachusetts.
Annie works tirelessly to assure that HotelRecovery's high standards for quality, coordinated care are consistently met. This recognition by her peers is testimony to the professionalism, compassion, and dedication that Annie's patients and HotelRecovery colleagues know first-hand.
Clostridium difficile (C. difficile) is a bacterium that was named in 1935 for the difficulty that scientists had in isolating it.[i] Eighty-five later, C. difficile is anything but difficult to reproduce. It causes an infection of the large intestine known as C. difficile colitis, which is becoming alarmingly common in hospitalized patients and those in other healthcare institutions. The infection can be very serious—in some cases, requiring surgical removal of the colon. Less severe cases can also be very challenging to treat, because the treatment itself predisposes one to developing the infection.
C. difficile colitis is common in hospitals, nursing homes, and other environments in which patients with weakened immune systems are clustered. Antibiotics change the balance of bacteria that naturally exist in the colon, making it easier for C. difficile to flourish. Most cases can be treated with antibiotics that attack the C. difficile bacteria. However, they also affect the “good” bacteria living in the colon, which are part of the body’s natural defense against C. difficile.
Even after a C. difficile colitis infection has been cured, the bacteria typically remain in the intestines—they are simply not numerous enough to overcome the body’s immune system and cause an infection. However, the risk of recurrent infection is high. Roughly 20% of those who have had C. difficile colitis develop the infection again—usually, within four weeks of finishing treatment for the initial bout.[ii] After a second case, the risk of another increases to about 40%; after a third case, to about 60%.[iii][iv] Each bout of C. difficile colitis can require additional hospitalization. It can be something of a self-perpetuating illness.
The risk of developing C. difficile colitis is a compelling reason to limit the duration of time spent in the hospital to that which is truly medically necessary. While C. difficile exists outside of acute care facilities such as hospitals, one is much less likely to develop an infection while recovering at home or in another private setting. Good home care providers routinely clean indwelling catheters, such as IVs and Foleys, with antibacterial fluid, and assure good hand and personal hygiene. Nurses, nursing assistants, and home health aides can also teach other caregivers the simple steps needed to keep you safe from infection while recovering at home.
[i] Kelly CP, Lamont JT. Clostridium difficile—More Difficult Than Ever. N Eng J Med 2008;359;1932-40.
[ii] Wilcox MH, Fawley WN, Settle CD, Davidson A. Recurrence of symptoms in Clostridium difficile infection—relapse or reinfection? J Hosp Infect 1998;38;93-100.
[iii] McFarland LV, Surawicz CM, Greenberg RN, et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA1994;271:1913-18.
[iv] McFarland LV, Elmer GW, Surawicz CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 2002;97:1769-75.
An article in the May 6, 2010, issue of the New England Journal of Medicine entitled "Effect of Bar-Code Technology on the Safety of Medication Administration" (full text available at http://content.nejm.org/cgi/content/full/362/18/1698) demonstrated a 41% decrease in medication administration errors, and a 51% reduction in potential adverse drug events from these errors. Such systems allow automatic documentation and cross-checks with a patient's other medical information at critical points: when the order is written by a doctor, the drug is prepared by a pharmacist, and when it is given by a nurse. Improved documentation may also help reconcile a patient's medication during transitions in care, such as during discharge.
Medication errors in hospitals are common, seriously impact patient safety, and are preventable. Bar code technology, used at grocery store check-out counters for decades, has the potential to dramatically reduce medication errors. However, new systems may also introduce new types of errors. In fact, the authors of the New England Journal article note that previous research on electronic medication administration systems (such as those using bar-code technology) have shown mixed results in terms of effectiveness in reducing error rates.
Many of the difficulties seen with information technologies such as this one occur during and soon after implementation. The electronic medication administration system evaluated in this study, at Boston's Brigham and Women's Hospital, had been implemented before the study was conducted. Given the seriousness of medical errors, hospitals have been reluctant to introduce clinical information systems that may present new types of errors, despite their potential for improving patient safety in the long run.
What do you think? Should hospitals be more aggressive in their adoption of such technologies? Are healthcare providers so careful not to commit errors, that they allow errors of omission (by forestalling potentially lifesaving advances in clinical information management)? Or, are they right to be so cautious? After all, errors in medication administration are far more serious than those in pricing groceries.
As defined by the Patient-Centered Primary Care Collaborative, a consortium of healthcare providers, insurers, and payers, “The Patient Centered Medical Home (PCMH) is a health care setting that facilitates partnerships between individual patients, their personal physicians, and when appropriate, the patient’s family.” It is a model of practice built upon a strong foundation of primary care. It aims to improve the quality of care by coordinating the efforts of all of a patient’s health care providers.
Studies have shown that systems in which a primary provider orchestrates the various aspects of a patient’s care are more effective and less costly than those without such a design. In fact, a lack of coordination and communication between providers is often cited to explain the finding that, broadly speaking, more medical care does not result in better health outcomes.[i] In fact, the PCMH model has improved outcomes and lowered costs in various settings. Data from several PCMH interventions, published by the Patient-Centered Primary Care Collaborative, show decreases of up to 50% in ER visits and 24% in hospital admissions. Johns Hopkins saw an annual net savings to Medicare of $1364 per patient. Similar results have been seen in different populations, including children.
Defining principles for the PCMH model were established jointly in 2007 by four professional societies representing primary care physicians: the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[ii] Among these principles are:
· Personal physician: “each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous, and comprehensive care”; and
· Whole person orientation: “the personal physician is responsible for . . . all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals”.
The failed “gatekeeper” model employed by health maintenance organizations (HMOs) in the 1990s shared these noble aims. However, the PCMH model has taken some lessons from the unpopular managed care experiment. PCMH doctors do not stand between a patient and a specialist physician. Primary care providers are not financially accountable for restricting the use of specialist services as they were under managed care. Patients are also free to choose their doctors, and not restricted to a pre-approved panel of providers. The primary care physician’s role is to facilitate communication of a patient’s medical history to the specialist, and to integrate information from the patient’s other providers into a comprehensive medical record.[iii]
The PCMH model was designed to be just that—patient-centered. Its conceptual framework and success may ultimately derive from the attention paid to patients’ needs. Many are optimistic about its potential to improve the quality of healthcare while lowering its costs. It is currently being implemented in many states and healthcare systems throughout the country—including Massachusetts.
[i] Fisher ES, et al. The Implications of Regional Variations in Medicare Spending. Ann Int Med. 2003; 138:288-298.
[ii] American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association. Joint principles of the patient-centered medical home. Mar 2007. Accessed May 4, 2010.
[ii] Brody, JE. “PERSONAL HEALTH; A Personal, Coordinated Approach to Care”. New York Times, 23 Jun 2009.