| I am sure that many of you have heard the | | | | in could ask "How many times have you had |
| saying "What you don't know can't hurt you." | | | | alcohol in the past two weeks and how much on |
| From much experience I know that just isn't true | | | | each occasion?", thus checking for abuse |
| in many cases, especially in healthcare. Consider | | | | problems. |
| these cases if you will: | | | | Leaders, including the CEO, at McLeod Regional |
| Because I am presently involved in alcohol and | | | | Medical Center in South Carolina routinely make |
| other drug research, I have the opportunity to | | | | morning rounds to check all areas of the hospital, |
| hear many stories from recovering alcoholics. One | | | | including talking with patients and auxiliary |
| story related directly to care this person was | | | | personnel. Just by making contact with various |
| receiving for a persistent cough. The patient's | | | | personnel they open up communication in the |
| doctor had prescribed cough syrup with codeine; | | | | hospital, as well as becoming aware of various |
| the patient reported to fellows at an AA meeting | | | | problems from many different points of view. By |
| that she wanted to drink it all at once. Clearly, the | | | | understanding problems from different viewpoints |
| codeine appealed to her addictions. A doctor who | | | | they are in a position to provide effective |
| had been aware of her past and who knows the | | | | leadership in solving the problems. Harvey MacKay, |
| problems with narcotic substances for recovering | | | | the guru of networking, in "Dig Your Well Before |
| alcoholics would never have made this prescription. | | | | You Are Thirsty," states that one of the most |
| Failure to know what medications a patient is | | | | important functions of leaders is networking with |
| taking account for many of the errors at | | | | the employees, even to the point of helping with |
| hospitals. For instance, not knowing a male patient | | | | their job. |
| is on aspirin therapy can lead to complications | | | | Teams comprised of representatives from areas |
| during surgery. That is why JHACO is emphasizing | | | | affected by a specific problem can further |
| reconciling medications at admission to hospitals. | | | | understanding of miscommunication. Rather than |
| I am sure that many of you are familiar with the | | | | playing the "blame game," these teams can |
| "blame game" found in many medical settings. It | | | | develop clear lines of responsibility and action |
| goes something like this: "If only that person in | | | | through such tools as value stream mapping. |
| the pharmacy would get the drugs to our staff | | | | Although problems will probably not completely |
| on time there would not be any problems here!" I | | | | disappear (errors are always present in any |
| am sure many of you have thought of this in one | | | | system), staff morale will dramatically improve |
| setting or another. An April 2005 issue of "Quality | | | | and errors will become rare. |
| Progress" detailed in "Lean Six Sigma Reduces | | | | I have one last suggestion for improving |
| Medication Errors" the anger between staff | | | | communication. Learn to listen well to your |
| nurses and the in hospital pharmacy staff over | | | | patients and clients. One technique that I learned in |
| the timely delivery of medication. The ultimate | | | | Toastmasters is to listen carefully to any |
| issue in this story was that neither party | | | | question, pause a moment to rephrase it in your |
| understood the others' processes in the | | | | mind, and then repeat it to make sure you heard |
| medication routine. | | | | it correctly. This will also help improve the trust of |
| The root of most of the problems listed above | | | | the patient or client. |
| was failure in communication. Fortunately, the | | | | Just a quick recap, then. Many problems in |
| tools of quality improvement stress | | | | healthcare arise from failures in communication. |
| communication in many forms. One such tool is to | | | | Fortunately, good practices exist to overcome |
| standardize processes so that all follow the same | | | | these. Standard screening questions will help |
| basic process route. For instance, if primary care | | | | identify problems. Leaders who are actively |
| physicians incorporated screening for alcoholism in | | | | involved in their environment point the way to |
| routine care, the errors related to addictive | | | | solutions. Representative teams stop the blame |
| behavior could be avoided. For instance, the typical | | | | game and lead to excellent solutions. Listening skills |
| form handed out to patients before physicals | | | | put all at ease. |
| could certainly include the CAGE questions for | | | | I hope that you are able to put these tools to |
| alcohol screening, much as these questionnaires | | | | use in your setting. Remember, don't give up in |
| include questions about tobacco use. The nurse | | | | frustration. Be firm in your resolve and you will |
| checking blood pressure before the doctor comes | | | | find errors and problems dissolving. |