Patient Safety: Speaking Up

Here’s a scenario everyone dreads when a loved one is in the hospital.  A family member, let’s call Joe, is admitted to the hospital for a routine/elective surgery like a knee replacement.  The surgeon has explained possible problems that can occur during surgery and the consent form is signed.  Joe has been asked his name and birthdate multiple times as well as which knee is being replaced.  It all seems to be going well and after a short time in pre op, the nurses take Joe to the operating room.

The family  is sent to the waiting room.  Finally, the surgeon emerges and gives the thumbs up to the procedure and the result.  “All went well and Joe will be in the room in about 2-3 hours.”  A big sigh of relief .  It is looking good.

Three hours pass and no notification about whether Joe has gone to the room.  It takes four hours and all you are being told is “It is just taking longer to get Joe awake.”  You ask to go to the recovery room and are refused.  Then the message comes, the Joe is being taken to the room.  You rush up to the room.

Joe is very drowsy.   You sit with him all day and sleep in the chair.  After about 12 hours, he seems OK although not sure what happened.  By the next day, he is more chatty and looking forward to rehab.  Then on day three, you notice he doesn’t look good.  He isn’t speaking as much and he says he feels woozy.  You think it is just post surgical weakness.  But as the day continues, he becomes paler and says he just doesn’t feel well.  

When the nurse comes in, you express your concerns.  She says his temperature is slightly above normal and will page the resident.  The resident changes the anti nausea medication.   The medicine doesn’t change anything.  He continues to say he feels bad.  Something in your gut, says this isn’t right.  The next thought is,  but I am not medical and the doctors and nurse have been in and said all was well.

Then Joe starts to complain of increased pain, nausea and tightness in the knee.  He doesn’t want to eat and is drinking minimal amounts.  You asked the nurse again if this is normal.  She says she will let the resident know.  And you wait.  Joe doesn’t look good and you are getting scared.  What should you do?

Here is what you do.  First, trust your gut because you are probably right.  Nobody knows your loved one like you.  If you suspect there is a problem brewing, trust your instinct.    Speak with the nurse as many times as you need to get your point across.  Explain the changes you see and your concerns.  

Next, ask to have the attending paged.  If  no one shows up within the hour, ask to have them paged again. This time  tell the nurse to let the attending know you are concerned and need some answers.  Do not back down until the attending shows up.

When the attending does come, explain the changes.  Be ready to get simple and placating answers.  Again, don’t back down until an exam is done and some remedy is given.  Try to have the nurse there also, because if new orders are given, the nurse can follow up more quickly.  Make sure you ask, when you can expect some improvement and what to do if there isn’t any. Ask what medications will be prescribed and what the expected outcomes may be.  At this time, if you can, get other family support.

If things worsen, again page the attending.  Keep pushing. Call the surgeon’s office and asked them to be paged.  Keep calling.  Don’t worry about being a pest.  You need to be the advocate because no one else will. I tell people to be fearless.  Call anyone in the hospital who is a position of authority from the director of nursing to the medical director.

Will the staff get annoyed? Probably but it doesn’t matter.  I have witnessed family members save their loved one’s life by doing the above.  The only one who has your family member’s best interest in mind, is you!  Don’t back down.  The staff, in the end, will be grateful for your persistence and fearlessness.