Hospital

Social worker: Families in the ICU may benefit from talking to a clinical social worker, sometimes called a case manager. Social workers are trained to help with communication between medical team members and family. An ICU social worker may offer emotional support, provide referrals to community resources, assist with the transition out of the ICU and help families navigate the end-of-life decision making process.

Clergy/chaplains: Hospital clergy members provide emotional and spiritual support to ICU patients and their families. Some ICUs have their own dedicated chaplains; others have a hospital chaplain that serves patients and family in all hospital units.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm Social worker: Families in the ICU may benefit from talking to a clinical social worker, sometimes called a case manager. Social workers are trained to help with communication between medical team members and family. An ICU social worker may offer emotional support, provide referrals to community resources, assist with the transition out of the ICU and help families navigate the end-of-life decision making process.

Clergy/chaplains: Hospital clergy members provide emotional and spiritual support to ICU patients and their families. Some ICUs have their own dedicated chaplains; others have a hospital chaplain that serves patients and family in all hospital units.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm

Ask your loved one’s nurse if it’s okay to bring in pictures and comfort objects, like blankets and stuffed animals, to help them feel more at home. You may also want to offer to help with routine care, like combing hair, swabbing the mouth, massaging or putting lotion on their arms or legs.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm Ask your loved one’s nurse if it’s okay to bring in pictures and comfort objects, like blankets and stuffed animals, to help them feel more at home. You may also want to offer to help with routine care, like combing hair, swabbing the mouth, massaging or putting lotion on their arms or legs.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm

Doctors recommend that one family member act as a conduit for information between the rest of the family and the medical team. This person can write down everyone’s questions and speak with the medical team at a convenient time. Don’t be afraid to ask your doctor to explain if you don’t understand the terminology they are using. If you are having trouble communicating with your loved one’s doctors, you may want to talk to a social worker or case manager. The hospital may have a social worker on staff or be able to recommend one to you.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm Doctors recommend that one family member act as a conduit for information between the rest of the family and the medical team. This person can write down everyone’s questions and speak with the medical team at a convenient time. Don’t be afraid to ask your doctor to explain if you don’t understand the terminology they are using. If you are having trouble communicating with your loved one’s doctors, you may want to talk to a social worker or case manager. The hospital may have a social worker on staff or be able to recommend one to you.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm

Talk to the ICU nurse. ICU nurses reassess pain regularly and administer medications as necessary, but it doesn’t hurt to advocate for your loved one.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm Talk to the ICU nurse. ICU nurses reassess pain regularly and administer medications as necessary, but it doesn’t hurt to advocate for your loved one.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm

Though policies vary from hospital to hospital, most ICUs allow you to visit someone during visiting hours. Children under the age of 14 may not be allowed because of the risk of infection and the potential for the child to be affected psychologically. Be aware that patients in the ICU may have bruising, swelling, bandages, catheters or tubes in the nose or mouth. Due to their illness or medications, patients may have trouble thinking or speaking clearly and may be disoriented, hostile or confused. While you are visiting, you may be asked to leave during certain medical procedures.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm Though policies vary from hospital to hospital, most ICUs allow you to visit someone during visiting hours. Children under the age of 14 may not be allowed because of the risk of infection and the potential for the child to be affected psychologically. Be aware that patients in the ICU may have bruising, swelling, bandages, catheters or tubes in the nose or mouth. Due to their illness or medications, patients may have trouble thinking or speaking clearly and may be disoriented, hostile or confused. While you are visiting, you may be asked to leave during certain medical procedures.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm

Because the patients are so sick, intensive care units (ICUs) are busier than other hospital units. They may also have more ambient noise from machines and monitors. ICUs have more nurses, with each nurse only taking care of one or two patients. The layout is more open, so nurses can easily monitor patients; rooms may not have doors, or may only have three walls.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm Because the patients are so sick, intensive care units (ICUs) are busier than other hospital units. They may also have more ambient noise from machines and monitors. ICUs have more nurses, with each nurse only taking care of one or two patients. The layout is more open, so nurses can easily monitor patients; rooms may not have doors, or may only have three walls.

To learn more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm

If you or a loved one is in the ICU (sometimes referred to as critical care), you'll come in contact with a variety of medical professionals. Here's a brief who's who:

Intensivist: Doctors who diagnose ICU patients and direct their care and treatment are called intensivists. Intensivists, also called critical care doctors, have specialty and subspecialty training in treating critically injured and ill patients. Intensivists usually work in the ICU full-time.

ICU nurse/critical care nurse: ICU nurses carry out the intensivist's plan of care. They monitor the patient, assess pain, administer medications and perform tasks such as placing tubes and managing equipment. They also work closely with families, explaining the patient's condition and care.

Nurse manager: The nursing unit manager, or charge nurse, oversees the nursing care in the ICU and assists the nurses when necessary.

Specialty physician: Depending on the reason for being in the ICU, a patient may see one or more doctors with extra training and knowledge about a specific organ or condition.

Pharmacist: Pharmacists prescribe medicine dosages for ICU patients. Like intensivists, ICU pharmacists have specialty training in prescribing medicines for critically ill and injured patients.

Therapist: Several types of therapists work with the critical care team. Respiratory therapists help ICU staff monitor the patient's breathing. Physical therapists work to minimize permanent disabilities. Occupational therapists in the ICU help patients to perform daily tasks independently.

For more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm
If you or a loved one is in the ICU (sometimes referred to as critical care), you'll come in contact with a variety of medical professionals. Here's a brief who's who:

Intensivist: Doctors who diagnose ICU patients and direct their care and treatment are called intensivists. Intensivists, also called critical care doctors, have specialty and subspecialty training in treating critically injured and ill patients. Intensivists usually work in the ICU full-time.

ICU nurse/critical care nurse: ICU nurses carry out the intensivist's plan of care. They monitor the patient, assess pain, administer medications and perform tasks such as placing tubes and managing equipment. They also work closely with families, explaining the patient's condition and care.

Nurse manager: The nursing unit manager, or charge nurse, oversees the nursing care in the ICU and assists the nurses when necessary.

Specialty physician: Depending on the reason for being in the ICU, a patient may see one or more doctors with extra training and knowledge about a specific organ or condition.

Pharmacist: Pharmacists prescribe medicine dosages for ICU patients. Like intensivists, ICU pharmacists have specialty training in prescribing medicines for critically ill and injured patients.

Therapist: Several types of therapists work with the critical care team. Respiratory therapists help ICU staff monitor the patient's breathing. Physical therapists work to minimize permanent disabilities. Occupational therapists in the ICU help patients to perform daily tasks independently.

For more about ICUs, check out our Prepared Patient Feature, "Cutting Through ICU Confusion," here: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue8.cfm

Try to strengthen your immune system prior to entering the hospital, to lower the chances of being infected with anything, especially during surgery. 1. Ask everyone to wash their hands before touching you.
2. Ask medical professionals to wash their hands and put on a fresh pair of disposable gloves before touching you.(Some patients are nervous about asking medical professionals to do this. If you are polite, and explain that you are nervous about the highly publicized MRSA and C.diff, or some other simple explanation, your request will go down easier)
3. Ask your advocate to bring in bleach wipes for meal tray tables, bed rails, TV remote control etc.. as they are covered with germs/bacteria.
4. If you are able to get out of bed, wash your hands frequently with warm soapy water for 20 seconds. Use bacterial gel often, but it is not effective for MRSA, C.diff and others.
5. Ask your doctor to swab his/her stethoscope (round flat part) with an alcohol wipe before touching you. Think about where that instrument has been before you.
6. Ask your doctor if you can be screened for MRSA before you enter the hospital.
7. Research your hospital's infection rates.
8. If you are to have surgery, ask if you can avoid being shaved. Razors can leave nicks, open sites. You don't want any open sore or cut where bacteria can enter.
9. Keep your fingers away from your nose, mouth and eyes.
10. Enlist the help of a loved one to help you with these tasks as you are recovering if you are in the hospital.

These are excellent suggestions. I would add that if you are a BC survivor with lymph nodes removed on one side, I'd go so far as to wear something on that arm that says 'No I.V. in this arm'. Nothing fancy, you could even just use one of those rubber bracelets, with a colored piece of tape attached. This may sound over-the-top, but as mentioned above - tired staff forget things, or do not inform the next shift.

Also - this may sound odd - but make sure you have an i.d. bracelet on right away. This past fall, I had an entire 8-hour surgery without a bracelet. Five hours after surgery, I had to ask someone to get me a bracelet. It's possible for charts to get mixed up, so you want them to know who you are...especially if you're allergic to anything. That's a big question! I'll try to keep this short as there is so much information to give you.
1. Enlist the help of a loved one to be your advocate. That person will be your eyes and ears during your hospital stay. Also choose one point person to communicate with the doctors and nurses. If these professionals have to take calls from your family and friends and tell them the same story about your, it takes time away from caring for patients.
2. Create a patient checklist or go to my website and use the one I provide. You will repeat this at every new medical encounter; your name, date of birth, your diagnosis, your physician's name. This helps to prevent patient name mistakes and much more.
3. Keep a list of your medications. Medications look alike and sound a like. Write down the brand and generic names of your meds, the dosage, what your meds look like, pay attention to labels. Ask questions if anything seems unusual or out of the ordinary.
4. Most nurses and doctors are overworked and are taking care of too many patients. You want to stand out and be remembered as a human being, not as the shoulder surgery in room 201. Make eye contact with your nurses and doctors, tell them a little about yourself, establish a bit of a personal relationship with each of them, ask questions so they know you are interested in your health (they will be too if they see that you are invested in your health and medical care) and say thank you. Showing appreciation if very important.
5. Make requests only of your primary nurse, that is your registered nurse. Too many nurses from interviews from my last book, told me sad stories about patients or their advocates asking nurse's aids or techs for medication for pain and the requests never getting received. Medical staff dress alike. Write down your primary nurse's name. Chat with her/him. Establish some sort of personal relationship.
6. Ask everyone to wash their hands before touching you. You can even place a hand made sign on the wall above your bed that says, "Please wash your hands before touching me."
7. Wash YOUR hands before eating. Hospital meal tray tables, bed rails, TV remote controls and more are covered with germs/bacteria. Ask your advocate to bring in bleach wipes for those items, and wash your own hands with warm, soapy water for 20 seconds.
8. If you are confused or don't understand something about your medical care, speak up. This is very important. Medical errors so easily occur when there is a communication snafu.
9. If your doctor or nurse does not speak your language, bring in a loved one to translate for you. Hospitals are required by law to have an interpreter but one may not be available when you are in need. Hospitals have by-phone translation services but not all nurses like to use them.

If you have a very common name it is a good idea to know your medical record number or check that the date of birth is right every time...for medications and tests. Large hospitals and cancer centers can have a ton of patients with the same name and mistakes do happen. I recommend using a patient safety checklist.
1. Know what medication you are taking, the dosage, the generic and brand names, and understand why you are taking it.
2. Before medication is administered to you as a patient in the hospital, repeat your name, date of birth, your physician's name, your diagnosis, and the medications you are supposed to be taking.
3. Check to see if the medication that is about to be administered to you matches what you know. If something is unusual or different, ask questions and speak up in a polite manner.
If you are unable to implement these strategies, enlist a loved one to act as your advocate.
Medication mistakes are the most common medical errors, harming 1.5 million patients a year. You can prevent this simply by being your own watchdog and understanding which medications you are taking.

As a resident of West Greenwich Village, the closing of St. Vincent's Hospital here, and it's Trauma 1 emergency room, have resulted in public advocacy and anger over the loss of the hospital. A small local newspaper has done numerous articles about this loss and what it means to the community. From my understanding, a hospital emergency room with Trauma 1 capabilities, which St. V's had, cannot be replaced by an Urgent Care Center, which has been presented to replace St. V's, as the ER can handle life threatening emergencies, while a UCC cannot. Also, hospital ER's have beds for patients needing follow up care, which UCC's don't have. These differences have been the subject of many of the articles in the local paper referred to, along with many emotional testaments communicated by readers, which have pointed out why getting to an ER in a timely manner can save lives, which a UCC cannot replace. As a resident of West Greenwich Village, the closing of St. Vincent's Hospital here, and it's Trauma 1 emergency room, have resulted in public advocacy and anger over the loss of the hospital. A small local newspaper has done numerous articles about this loss and what it means to the community. From my understanding, a hospital emergency room with Trauma 1 capabilities, which St. V's had, cannot be replaced by an Urgent Care Center, which has been presented to replace St. V's, as the ER can handle life threatening emergencies, while a UCC cannot. Also, hospital ER's have beds for patients needing follow up care, which UCC's don't have. These differences have been the subject of many of the articles in the local paper referred to, along with many emotional testaments communicated by readers, which have pointed out why getting to an ER in a timely manner can save lives, which a UCC cannot replace.

Go to an emergency room when you have a medical emergency. The American College of Emergency Physicians recommends that anyone with any of the following symptoms go to an emergency room:

Difficulty breathing, shortness of breath
Chest or upper abdominal pain or pressure
Unusual abdominal pain
Fainting, dizziness, weakness
Changes in vision
Confusion or changes in mental state
Sudden or severe pain
Uncontrolled bleeding
Severe or persistent vomiting or diarrhea
Coughing or vomiting blood
Suicidal feelings
Trouble speaking

For more about emergency medicine, see our article: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue1.cfm
Go to an emergency room when you have a medical emergency. The American College of Emergency Physicians recommends that anyone with any of the following symptoms go to an emergency room:

Difficulty breathing, shortness of breath
Chest or upper abdominal pain or pressure
Unusual abdominal pain
Fainting, dizziness, weakness
Changes in vision
Confusion or changes in mental state
Sudden or severe pain
Uncontrolled bleeding
Severe or persistent vomiting or diarrhea
Coughing or vomiting blood
Suicidal feelings
Trouble speaking

For more about emergency medicine, see our article: http://www.cfah.org/hbns/preparedpatient/Vol4/Prepared-Patient-Vol4-Issue1.cfm