The headline and subheader tells us what you're offering, and the form header closes the deal. Over here you can explain why your offer is so great it's worth filling out a form for.
Mr. W had a heart attack and was in the ICU last week. While reviewing his discharge medication list, you realize Mr. W unintentionally discontinued his medication for hypertension and dyslipidemia. Unfortunately, these medications were not on the discharge medication list.
Jay has been a well controlled diabetic for many years. Today his A1C is 10.5. He insists he is taking his medication regularly.
A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. 1 Efforts to decrease or prevent medication errors often focus on improving systems and procedures utilized by nurses, physicians and pharmacists during the multistep process of medication administration. Decreasing medication errors by patients must also be addressed.
According to the landmark 2006 report "Preventing Medication Errors" from the Institute of Medicine, medication errors injure 1.5 million Americans each year and cost 3.5 billion in lost productivity, wages and additional medical expenses.2 1/3 of medication errors occur in outpatient settings. Patients often unintentionally discontinue medications after a hospitalization or transfer of care. Numerous studies have shown that patients with chronic conditions adhere only to 50% to 60% of medications as prescribed despite evidence that medical therapy prevents death and improves quality of life.3 Knowledge deficits and poor understanding of drug label directions often result in medication errors initiated by patients.
How to reduce medication errors by patients:
Decrease medication knowledge deficits. Review with patients in plain language what medications were prescribed, how to take them, discuss side effects and address concerns regarding drug interactions and cost. Use visuals and show me techniques to ensure patient understanding. Enlist the help of the PCP and pharmacist for additional education.
2. An accurate medication list that includes discharge medications and/or chronic care medications is essential. Learn how to take an accurate medication history. Use clear communication techniques during conversations with patients. Provide patient and PCP with discharge medication list.
Monitor for medication adherence. Ask patients to bring in all of their medications or contact pharmacies for information on most recent refill dates. Evaluate and address medication knowledge deficits. Medication reminders, automatic med refills, medication home delivery, assistance of family members or home care services can be utilized to improve adherence. Call recently discharged patients to ensure they are taking prescribed medications and chronic care medications.
1 National Coordinating Council for Medication Error Reporting and Prevention: http://www.nccmerp.org/aboutMedErrors.html
2Anderson, Pamela, and Terri Townsend. "Medication errors: Don't let them happen to you." American Nurse Today 5.3 (2010): 23-27: http://www.nursingworld.org/mods/mod494/MedErrors.pdf
3 Bosworth, Hayden, Bradi Granger, Stephen Kimmel, Larry Liu, John Musaus, William Shrank, Elizabeth Buono, Karen Weiss, Christopher Granger, Phill Mendys, Ralph Brindis, Rebecca Burkholder, Susan Czajkowski, Jodi Daniel, Inger Ekman, Michael Ho, and Mimi Johnson. "Medication adherence: A call for action." American Heart Journal 162.3 (2011): 412-424. Print.
4 Preventing Medication Errors: Quality Chasm Series Committee on Identifying and Preventing Medication Errors, Philip Aspden, Julie Wolcott, J. Lyle Bootman, Linda R. Cronenwett, Editors
By Stephanie Wilborne, APRN FNP Contributing author to DiversityNursing.com
John takes five pills every day. He does not know the names of all his medications, but he recognizes each pill by its shape and color. Taking medications every day is a struggle for John. Sometimes he forgets to take his pills. Frequently, he has problems paying for his prescriptions. John missed two appointments to see the eye doctor. He forgot about the first appointment and was so late for the second, they refused to see him. He's been told in the past that people with diabetes have a "higher risk" of eye problems. John still does not understand why he needs to see an eye doctor.
John is your patient today. His blood pressure reading is high again. And unfortunately, his hemoglobin A1c readings are still too high. His diabetes and hypertension are poorly controlled. You ask what pills he takes. He can’t remember. Reading in his chart, you see at his last visit he was given a list of all his medications. Trying to figure out why his high blood pressure and diabetes are uncontrolled, you ask tons of questions. "Are you taking your medication every day? Why did you miss the second eye appointment,” you ask him? Frustration sets in.
The term health literacy refers to a set of skills people need to effectively manage their health. More than two decades of research has associated poorer health literacy skills with less frequent screening for diseases such as cancer, higher rates of disease, mortality and worse health outcomes. It is important for health care providers to understand that patients with poorer health literacy skills may struggle at times with health related tasks.
Taking Medications: May have difficulty reading prescription bottles and understanding when, how and how often to properly take medications.
Disease Self Management Skills: May have less knowledge concerning their disease or condition resulting in poorer disease and self management skills. For example, diabetic patients with poorer math skills are more likely to have problems interpreting glucometer readings and therefore miss that blood sugars are too high, low or normal.
Risk: May have difficulty understanding the concept of risk and how it may impact their health.
Navigation: Patients with poorer reading skills may have difficulty reading a bus schedule, following directions and other hospital or healthcare signage.
Communication: Patients with poorer health literacy skills are more likely to report problems understanding and following conversations and verbal instructions of health care providers.
In 2003 the National Assessment of Adult Literacy for the first time measured the health literacy level of more than 26, 000 American adults. Only 12% of Americans were found to have proficient health literacy skills. Based on this data, the majority of adults may have problems functioning in our current healthcare system at different times of their life. Unfortunately, health information that patient's receive from health care professionals is often too complex for them to understand. The United States government, American Medical Association, Joint Commission and many other agencies are advocating that all health care professionals incorporate clear communication techniques and strategies into clinical practice with ALL patients.
John’s nurse turned her frustration into action. How many times a day he needs to take his medication was reduced to once a day. His prescriptions are now written for a 90 day supply. To help John manage his diabetes and hypertension better, John sees a nurse or clinician more often. His health care team has completed training on utilizing clear communication techniques and strategies into clinical practice. John now receives verbal and print instruction that incorporates plain language principles with less medical jargon. Teach back is used to confirm understanding. Brief conversations with John revealed he didn’t know that much at all about diabetes or hypertension. His clinician and nurse devised a plan to provide short bursts of education for future appointments. They are also trying to coax John into attending diabetes self management classes And yes, John finally had an eye appointment. His nurse arranged for a family member to take him to his appointment.
All of the interventions mentioned above are based on more than two decades of research on how to improve the health care delivery and health outcomes for patients with poorer health literacy skills. How health care providers communicate and deliver care can improve the ability of patients with poorer health literacy skills to manage their own health. Nurses, we have the power to transform our healthcare system. Learn more about health literacy and incorporate clear communication into your clinical practice.
Thank you to Pilar De La Cruz-Reyes, MSN, RN from the California Institute for Nursing and Healthcare for the content of this video.
Breaking the Barriers is a great compilation of nursing stories put together by the California Institute for Nursing & Health Care that show how everyday people can overcome adversity to follow the career of their dreams. The nurses in this video will inspire you and show to our young people how you really can achieve if you have the desire and passion for a career in nursing.
Once you watch this video, we would love to hear your feedback. Please comment here on our blog when you have a minute.
Recently, Working Mother Magazine released its 2011 list of the best places to work for multicultural women – essentially, a survey of the availability and usage of diversity programs, as well as the accountability of the managers who oversee them at top corporations. For the fifth year in a row, Pepsico has been named number one, along with with 23 other companies, all of which are committed to supporting women of color with strong diversity, leadership, and education programs. Here are four of the most innovative initiatives included on 2011 list, that help advance and retain diverse women.
IBM IBM’s cutting edge Reverse Mentoring pilot program turned mentoring on its head. Ten senior executives were given the opportunity to choose a culture they wanted to learn more about and for 10 months, and multicultural women (who were primarily non-executives) from these cultures acted as their mentors, helping them better understand cultural differences. The need for the program was identified as a key initiative of the Multicultural Women’s Group at the company, whose mission it is to attract, retain, and develop women through mentoring, networking, fostering a sense of community, and exchanging information.
According to Angela Archon, IBM’s VP of systems and technology, the program promoted cultural sensitivity and adaptability and demonstrated the impact of globalization and why culture matters.
“The hallmark of the program was to increase knowledge and sensitivity around cultural differences and continuously improve global collaboration. It helped dispel myths; it provided clarity to issues related to stereotyping; and it increased cultural awareness,” Archon said. “Executive mentees gained knowledge about their mentor’s culture and how business is done in that culture and the multicultural women who served as mentors had the opportunity to build a relationship with an IBM executive and enhance their leadership capabilities.”
Deloitte It should come as no surprise that the ever impressive Deloitte was featured on Mother’s list for the sixth year in a row.
This year, two of Deloitte’s programs were spotlighted on the list: Navigation to Excellence and the Leadership Acceleration Program. After an internal survey of almost 4,000 multicultural employees, the firm found that multicultural women desired more formal sponsorship, so Deloitte launched its Navigation to Excellence pilot program, a one-year program that matches female managers and senior managers of color with leaders who help them orchestrate a career plan, gain access to key assignments, and enhance their knowledge of what it takes to advance. The 18-month Leadership Acceleration Program even allows female partners and principals to shadow their sponsors on the job, receiving intensive mentoring and coaching.
To continue moving these types of initiatives forward, the firm has quietly invested $300 million towards the creation of a state-of-the-art learning and leadership development center that will open its doors this fall after two years of construction.
According to Barbara Adachi, the National Managing Principal for Deloitte’s award-winning Women’s Initiative, it was never the firm’s intention to be a leader, but awards and recognition such as those given by Working Mother, inspires them to keep moving forward.
“We’re our biggest critics and we’re our biggest motivators. We don’t do this for the publicity. Diversity is a business imperative here. I recently read that half the population will be comprised of minorities in 2050 and I strongly believe that by being diverse, we attract the top talent in the market and we better serve our clients,” Adachi said. “We’re not doing this because it’s the right thing to do, but because this is the way business should be done.”
Chubb Group of Insurance Companies This is the third time Chubb has been featured on Working Mother’s list, but the company has a long-standing commitment to promoting diversity with decades old programs and initiatives in place. According to Trevor Gandy, Chubb’s chief diversity officer, in order to form lasting business relationships with customers and become a true global leader in the industry, the company must understand its customer’s “diverse cultures and decisional processes- and not merely their languages.” To do so, the company strives to create a diverse workplace through programs such as their Count Me In: A Culture of Inclusion micro inequities program. The program began over 10 years ago and aims to help the company educate their workforce on the often small details and behaviors that help build an atmosphere in which all employees feel they have a voice.
Chubb also has a 29-year-old Minority Development Council whose mission is to advance the company’s business objectives by fostering the career development of people of color into leadership roles. Even more impressive, the company’s Women of Color strategy strengthens the bonds between women of color and their managers by providing them with meaningful feedback and structured development plans. The overriding goal, according to Gandy, is to prepare the company’s female multicultural employees to compete for leadership positions.
CA Technologies Like Chubb, CA Technologies firmly believes that their business relationships in more than 140 countries drives their commitment to workplace diversity and it enables them to create, support, and sell the best IT management software.
The company’s Women in Technology Mentoring program is geared towards female employees that are in technical and quasi-technical roles within the company’s technology and development organization. The program was established to ensure that female employees are provided with the appropriate environment, knowledge, and sponsorship to achieve their full potential within the company. The company also supports the pursuit of higher education and provides up to $5,250 a year in financial assistance to eligible employees completing undergraduate and graduate level courses. CA Technologies also offers 15,000 online courses that employees can access. An adoption assistance program includes reimbursement of adoption-related expenses up to a maximum of $5,000 per child and $10,000 per family within a two-year period.
CA Technologies also aims to help working parents, so nearly 30 percent of the company’s North American employees participate in a full-time telecommuting or work from home program. The company also has Global Marketing and Finance associate rotation programs that were developed as a way to attract and develop entry level candidates and enable them to jump start their professional career with structured training programs, job shadowing, and access to mentors.
According to CA Technology’s VP of human resources, Beth Conway, the company is focused on fostering diversity both inside and outside the company.
“In addition to our efforts within the company, we’re also an active partner of the Anita Borg Institute for Women and Technology, a nonprofit organization dedicated to increasing the impact of women on all aspects of technology,” Conway said. “We also sponsor ABI’s annual Grace Hopper Celebration of Women in Computing conference in the U.S. and India. We’re dedicated to helping the leaders of tomorrow develop their talents and career paths by providing and encouraging a collaborative working environment.”
Margaret Stineman spent many of her formative years in the slow classes that were then the domain of children who were, as she delicately puts it, "not achieving."
Born with a severely deformed spine and shoulders, she endured 15 operations as a child on her eyes, internal organs, and misshapen bones. She spent much of her adolescence in a body cast, making her the object of ridicule. Problems with the muscles that control her eyes severely limited her vision. People around her did not think she was capable of much, and she agreed.
How that child - functionally illiterate when she left high school - became an artist and then a doctor and then a respected researcher and then a member of the prestigious Institute of Medicine is a remarkable story of serendipity, determination, motherly devotion, and well-timed mentoring.
Then there's the emotional alchemy. A set of circumstances that would have made many people angry, bitter, or at least deeply insecure seems instead to have forged a woman who is, at 58, confident, profoundly thoughtful, joyful, and serene.
Joel Streim, a longtime friend and research collaborator at the University of Pennsylvania, called her "one of the special people of the world." Just as Stineman focuses on her own strengths rather than weaknesses, he said, she sees other people's abilities and "has a real talent . . . to make them more creative and innovative."
Now a professor of both physical medicine and rehabilitation and epidemiology whose work has focused on measuring and compensating for disability, Stineman does not like talking about her physical problems. But she recently gave a rare speech to colleagues at Penn about how she had made it in academia, and now hopes her story will help fellow health workers see the potential in their patients.
Stineman's journey to the upper levels of medical research began with art. Bored in school, unable to see well, and plagued by medical problems, she turned inward and expressed her private world by painting and sculpting. In early adaptations for her handicaps, she used templates and mirrors to compensate for a lack of depth perception. Some of her teachers noticed her talent, and it got her into Temple University's Tyler School of Art.
Soon after art school, Stineman won a prestigious scholarship that would have sent her to Rome to paint for two years. She said members of the selection committee rejected her after she had a physical. "They didn't want to send a crippled person to represent the United States," she said.
She was crushed at first, but then looked at the problem from another angle - a defining quality of both her life and art.
"I was hurt. I was upset. I was angry," Stineman said. "This transformed into something that was so beautiful: a recognition that I must be smart or I wouldn't have won this thing. I must be smart. Something must have been missed. That's when I had the wake-up of my life."
For a while, she rejected art - she saw it as too emotional - and threw herself into the discipline and rules of science. Stineman's dream, and she knew it was probably an impossible one, was to become a doctor. Engineering was her fallback.
Her inventor father worked as a machinist at Drexel University. She enrolled as a special student there, taking one class at a time. "I decided that I would do absolutely anything to learn," Stineman said. "I was so infatuated with the fact that I could go from barely knowing arithmetic to getting an A in calculus just because I had applied myself."
She met what might have been her Waterloo in biology. She did well on the fill-in-the-blanks part of a test but flunked the essay.
"You can't spell," the professor told her. "You have no sense of sentence structure, and you can't formulate your ideas. Are you from a foreign country?"
Instead of taking offense, Stineman took an English-as-a-second-language class.
"This professor really saved my career," she said.
After using her art portfolio to talk about visual perception, she got into Hahnemann Medical College. It was a lot harder to keep up there. She almost quit, but some key professors helped her at crucial moments. Because Stineman learns better through hearing information - and can process it quickly - than by reading it, her mother read her textbooks into a special tape recorder that Stineman then played back at high speed.
She brought a different perspective to the care of people with disabilities. "I felt as a child they kept trying to fix me," she said, "but nobody was helping me to learn how to live with the way I was."
Stineman can walk short distances, but usually uses a motorized wheelchair or cart. Patient reaction, she said, ranges from dismay - "Now even my doctor's disabled" - to "Oh, my God, if she can do it, I can do it."
She reconciled with art after she recognized the creativity in science.
One day, she was fascinated by how a spherical bottle stopper inverted the landscape outside her window. She decided to write a mathematical formula explaining why that would happen. Yes, that's her idea of fun.
"I painted the image, and then I used mathematics to solve the image. This has been what has driven my whole life," Stineman said. "If you want to understand something, whether it is human nature, whether it is a scientific problem, use many different ways of looking at it."
Her facility with math and computers led to her biggest claim to fame: She helped design the system Medicare began using in 2002 to decide how much to pay for rehabilitation care for individual patients.
She remembers the responsibility she felt going to work the day the hospital began using the new system. "I was practicing medicine under rules that had come out of my head," she marveled.
As Stineman waited for the elevator, she said the prayer she says each day about her patients. "May I have the strength to see what I need to see, to know what I need to know, so that I can care for you in the best possible way."
Stineman, whose long brown hair is streaked with gray, focuses on research now. She is in charge of three large National Institutes of Health grants aimed at identifying the most helpful rehabilitation services after stroke and leg amputations and at helping older people stay in their homes. Although lung problems reduce her stamina, she is known as a tireless worker. A computer that speed-reads documents out loud makes it possible for her to handle the work.
She stands only 4-foot-9, barely tall enough to see over a lectern. She estimates she'd be 9 inches taller if she had a normal spine. She often props herself up with her knees and elbows to sit upright.
She does special exercises and eats an organic vegetarian diet. Although she has had suitors, Stineman said she had never loved anyone enough to curtail her work. She relaxes in a Zen garden her mother created at the house where she lives near the university. She said she had dealt with the pain in her life by creating art, writing music, and keeping journals.
During her recent speech to coworkers, Stineman used self-portraits to explain the evolution of her art and her psyche. A high school effort shows a pretty, intense-eyed girl's face framed by dark, ill-defined hair. There's no body, and the work lacks perspective. Another early, harsher piece shows her twisted body lying on a table in a bare room with a pit.
In 2004, she did a painting of her face and body as an adult with an X-ray-like rendering of her curving spine highlighted.
Two years later, she added her white lab coat, stethoscope, and gold caduceus with the word courage carved in it. Finally, Stineman had put it all together, proudly.
"My body is a vehicle for my mind, and I can wear this coat and I can take care of others," she said, displaying the painting on a screen.
"Was I disabled or was I gifted or am I both?" she asked. "Are we all both? I believe we are."
We want to hear from you. What do you think about Dr. Stineman and her ability to overcome all the obstacles in her life?
