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Thursday, March 13, 2008

Before Surgery: Your Top 6 Hospital Risks

It's a fact of life: people checking into the hospital face risks. Expecting to get better, some actually wind up getting worse.

We've all heard the horror stories about hospital risks after surgery. There's the danger of medical complications, like bleeding or infection. Then there are the human errors, like getting the wrong drug or dosage. "Even though you've got a lot of well-trained people in a hospital working very hard, they're still people," says Fran Griffin, RRT, MPA, a director at the Institute for Healthcare Improvement in Cambridge, Mass. "And people sometimes make mistakes."

All these hospital risks can seem far beyond your control. It can leave you feeling pretty helpless.

But experts say that's not the case. "Patients are just too passive when they check into the hospital," says Peter B. Angood, MD, vice president and chief patient safety officer of the Joint Commission in Oakbridge Terrace, Ill. According to Angood and other experts, taking an active role in your health care can reduce many of these hospital risks. While you might feel out of control when you go into the hospital, you're really not.

So what can you do to cut your risks? Here's a list of the six top hospital risks and -- more importantly -- what you can do to avoid them.

Hospital Risk No. 1: Medication Errors

"Far and away, the most serious hospital risk is a medication error," says Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ) in Rockville, Md. "All it takes is for someone to miss a decimal point and you could have a life-threatening mistake."

A 2006 report from the Institute of Medicine estimated that every year, there are 450,000 injuries resulting from medication errors in hospitals, and perhaps many more that are unreported. What's especially frightening about these hospital risks is they "seem" completely beyond your control. How would you even know what medicines you need, or how much, or how often? How can you stop a doctor's poor handwriting on a prescription from being misread by a pharmacist or nurse?

But there are things you can do to reduce this hospital risk. Before surgery, you need to make sure that your doctor, your surgeon, and everyone else involved in your care know about every single medicine -- whether prescription, over-the-counter, or herbal supplement -- that you use. To make it easier, you can just stick all of your medicines in a bag and bring them to the hospital.

Then, after surgery, ask questions. When a nurse comes to give you medicine, ask what it is and why you need it, says Dale Bratzler, DO, MPH, medical director at the Oklahoma Foundation for Medical Quality in Oklahoma City. Make sure the nurse checks your ID bracelet against the name on the prescription.

"If you ever feel like something's wrong, you have to speak up," says Griffin. She's talked to nurses who said that they were about to administer the wrong medication or dose and were only stopped because the patient asked them to double-check." Just by saying something, they averted what could have been very serious medication errors," Griffin says.

Hospital Risk No. 2: MRSA and Other Hospital-Acquired Infections

Another top hospital risk is infection with bacteria or a virus. Hospitals are loaded with nasty bugs. According to the CDC, there are 1.7 million health-care-associated infections every year; 22% are infections of surgical wounds. Even more -- 32% -- are urinary tract infections. The rest are infections of the lungs, blood, and other parts of the body.

One of the most frightening hospital infections you can pick up is MRSA (methicillin-resistant Staphylococcus aureus) -- a type of staph infection that's resistant to many antibiotics. A 2007 study by the Association for Professionals in Infection Control and Epidemiology (APIC) suggested that almost one out of every 20 hospital patients is either infected with MRSA or carries it.

"The risk of MRSA is growing," says Clancy. "It's getting more common and more resistant to antibiotics."

So what can you do? First, ask whether you'll be getting antibiotics before and after surgery to lower your risk. Then after surgery, the best protection is simple: don't let people touch you until you have seen them wash their hands. That goes for everyone -- including doctors and nurses.

Now of course, you might feel intimidated by the idea of scolding your doctor for his bad hygiene. But experts say that your doctor or nurse shouldn't have any problem with it -- especially if you ask nicely.

Hospital Risk No. 3: Pneumonia

Although some might think of pneumonia as a minor complication, it can be quite serious. After urinary tract infections and wound infections, it's the most common hospital acquired infection. According to the CDC, estimates of hospital pneumonia's mortality rate are as high as 33%. It's most common in people who are in the intensive care unit or on ventilators.

Pneumonia is a common hospital risk after surgery for several reasons. During recovery, you might naturally take shallow breaths, since you're on your back and breathing deeply may be painful. After surgery, many people also have a partial collapse of the lung tissue -- called alectasis -- which further weakens lung function. All of this can make it easier for bugs that cause pneumonia to gain a foothold.

So what are some ways to avoid this hospital risk? Deep breathing is one. "I recommend that people try to take 10 to 15 really big breaths every hour," says Angood. If you smoke, you should quit or at least stop for a week or two before surgery, says Clancy. Just a short break can make a big difference in the health of your lungs.

Aspiration pneumonia has a more specific cause. It develops when you breathe in fluids, like vomit. This can happen after anesthesia because your normal coughing reflexes may be suppressed. The best way to avoid this type of pneumonia is to follow your doctor's advice about not eating or drinking after midnight the day before your surgery. If you don't have anything in your stomach to vomit up, the danger of aspiration pneumonia is quite low.

Hospital Risk No. 4: Deep Vein Thrombosis (DVT)

"DVT, it clearly ranks as one of the more significant risks after surgery," Clancy tells WebMD.

DVT -- or deep vein thrombosis -- is the development of a blood clot, typically deep in the veins of the leg. If the clot breaks free and travels through the bloodstream, it can get lodged in the arteries of the lungs, cutting off the blood's supply of oxygen. This complication, called a pulmonary embolism, can be fatal.

Surgery significantly increases your risks of DVT for several reasons. If you're immobile in bed, your circulation gets worse. That makes the blood more likely to pool and clot in your legs. Also the blood vessels in your legs can become very "relaxed" during the anesthesia used for surgery and the blood can slow down its movement enough to form a clot, especially if the vessel has had prior damage (for example, by way of a previous history of a broken leg) . The trauma of surgery itself also increases the blood's clotting tendency.

Without preventative treatment, the odds of getting DVT after a prolonged major surgery are 25%. For some surgeries, like joint replacement, the odds of DVT are more than 50%.

Fortunately, careful use of blood thinners can slash the risk of DVT without increasing your risk of bleeding. But as effective and safe as this preventative treatment is, studies have shown that these precautions are often ignored. So you should always ask about it.

"Never be afraid to ask about the risk of DVT after your specific surgery," says Angood. "Ask whether you will be getting preventative treatment and for how long."

Another method of DVT prevention is something you can do on your own. "The sooner you can start moving around, the lower your risk of DVT," Clancy says. Stretching and -- when your doctor gives you the OK, getting up and walking -- will get your circulation back to normal.

Hospital Risk No. 5: Bleeding After Surgery

While clotting is a risk for DVT, uncontrolled bleeding after surgery causes problems of its own. However, there's good news. "Bleeding after surgery is not as much of a problem as it once was," Griffin says, thanks to improved surgical techniques. Still, you should make an effort to lower the risks further.

That starts with making certain that your doctor knows every medication -- vitamins, supplements, or homeopathic medication -- that you use. Common medicines -- like the painkillers aspirin and ibuprofen -- can thin your blood, increasing the risk of bleeding. Your doctor will probably tell you to stop taking any medicine that might have this effect a week or two before surgery, Clancy says.

If you forget and take one of these drugs, say something. "There's a simple blood test that can be done to check if your blood is too thin for surgery," says Griffin. "But your doctor might not think to do the test unless you tell him or her."

Also mention if you've ever had excessive bleeding before, even for something minor, like the removal of wisdom teeth. "The biggest predictor of serious bleeding after surgery is having bled after surgery before," says Clancy. If your surgeon knows, he or she can take precautions.

Hospital Risk No. 6: Anesthesia Complications

While many patients still worry about anesthesia, experts say that it's really quite safe these days. "There's no doubt that the biggest advances in improving surgical safety have been in anesthesiology," Clancy tells WebMD. "They've made enormous strides."

But while the risk of problems is now low, there are still precautions you should take. First, ask to meet with your anesthesiology team to discuss your options. Some only need a local or regional anesthetic, while others will need full general anesthetic. Go over the benefits and risks of each one.

Although rare, some people have allergies to certain anesthetics. Rare genetic conditions can also trigger anesthesia complications. "It's always worthwhile to check and see if any other family members have had a bad reaction to anesthesia," Clancy says. If you suspect you might be at risk, you may have testing done before the surgery.

Speaking Up Lowers Hospital Risks

When you're in the hospital, it's very easy to feel intimidated. While you lie in bed, groggy and disheveled in a sweaty johnny-coat, you may feel pretty powerless compared to the brisk, lab-coated doctors who appear at your bedside. What could your puny opinion matter to all these experts? It may be tempting to give up control, to lie back and just hope that your doctors and nurses will remember everything.

But you should never give up responsibility for your own health. The advice from all the experts is to pay attention and ask questions.

"In the old days, good patients were the ones who didn't make any noise and were grateful," says Clancy. "It turns out that those patients don't do so well. The ones who do well are the ones who ask questions."

So to lower your hospital risks, you have to be an active and involved patient. Not only will it give you a feeling of control over your situation, but it may even improve your care. If you're too dazed after surgery to pay attention, your family members should be asking questions on your behalf.

"Questioning authority is never easy," says Nancy Foster, vice president of quality and safety policy at the American Hospital Association in Chicago. "But remember it's your body, your health, and your life. If you ever have questions or concerns about anything during your hospital stay, you have to speak up."

Via: http://www.webmd.com

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