Participatory Healthcare at Grand Rounds

Grand Rounds is a "must visit" place today irrespective of whether you're a consumer, healthcare provider, or have another dog in the fight to improve healthcare. You'll find clear explanations of what "participatory healthcare" is and have a chance to assess how it's emerging.

One thing about participatory healthcare that jumps out at me is how well it aligns with the way I was taught to approach patient care when I was an undergrad nursing student in the mid '80's. That curriculum also came with a hefty dose of "change management" theory, something that drew disdain from the "where's the beef?" crowd and, unfortunately, didn't change much.

But what does seem to be changing things is the information revolution. Patient access to information, ideas, outcomes, and communication modalities is doing more than just shoring up foundational changes in "how we do things around here," (the easiest way to describe healthcare culture). These changes must occur to make the delivery of healthcare more reliable, more safe.

I see patient engagement as transformational, meaning we're likely to get somewhere better as a result of letting patients take the lead for part of the journey. So take a trip to Survive the Journey and see how far we've come.

When you do, you'll find that a number of the people who contributed to the participatory healthcare Grand Rounds appear on the inaugural list of "Top 25 Patient Safety Tweeps" I published last month, among them Dave DeBronkart (epatientDave), Amy Romano (midwifeamy), and John Sharp (JohnSharp). The experience of patients is central to efforts to improve patient safety. So are initiatives and incentives arising from clinicians, organizations, payors, industry partners, regulators, and academics. I'll publish an updated list this Friday, 10/16/09.

I welcome nominations of individuals or organizations from any of these categories for consideration on Safety Nurse's Top 25 Tweeps for Patient Safety list. The entity must have a current, active presence on Twitter. The volume of tweets is less important than the quality of patient safety information that's passed along.

Thanks for participating!

Feeling Silly Saturday

I have a second blog that sits on Medscape's platform. It's a forum where I share medication safety strategies with professionals, and I named it On Your Meds: Straight Talk about Medication Safety. Comments left at On Your Meds are always interesting, often enlightening, funny, and sometimes sad. I think what nurses share there says a lot about the fitness of the systems we use to deliver medications.

I joke that I should have a blog called "Get On Some Meds" or "Stay On Your Meds." Apparently, someone has been listening.

Comments at On Your Meds usually pop up in the week I post something new. So I was surprised to receive a series of notices showing new comments on an old post, entitled, hmmmm, "Not exactly the language of love: Words to identify and prevent errors."

Since error-reporting is a guiding tenet of safety engineering, I thought it might be useful to let others know what happens when you include the words "language of love" and "medication" in the most searchable elements of electronic media, which appears to be the error I made. Can you say "erectile dysfunction spam"?

Unfortunately, none of the cheap generic sildenafil and tadalafil spam I cleared the other day were as amusing as this:



Oh, and by the way: This is not a product endorsement. It's advice about managing a blog. I don't give medical advice, and you should consult a healthcare professional for any problem you might have, including an erection lasting longer than 4 hours. You can find standard safety information about tadalafil and sildenafil here and here.

Change of Shift is changing the world

Change of Shift is up at Emergiblog. Take a look to find out what nurses are talking about.

I included a post I wrote last Sunday about how social media (SM) may be the equivalent of the "big reveal" on a reality TV show, only what we're revealing on blogs and Twitter is the culture of healthcare. Making healthcare more transparent by sharing not what should be done, ought to be done, or even what we wish we could have done. SM seems to be a vehicle in full-throttle that captures what's actually done.

That said, I'm wondering how professionals who blog and tweet feel about their stories being picked up and used to illustrate how well the systems frontline clinicians rely on work (or, in many cases, don't work.) The knowledge, attitudes, values, and beliefs of individuals are reflected in the accounts we share. This information is often very personal, and it may reflect organizations individuals chose to identify. There's a lot of "hot talk" about respecting the privacy rights of patients in social media, but what about others?

My work focuses on how people perform within a system. The goal is to improve outcomes by improving the fitness of the system, being mindful of the strengths and limitations that humans bring to high-stakes endeavors. But this is not a universal approach, and "blame, shame, and re-train" approaches to performance improvement remain operational (even if they are not tacitly endorsed). For this reason, I chose not to "hot link" the stories I shared lest it draw unwelcome attention to individuals who simply shared a "day in the life of" account.

I'd love to have some feedback. Am I being overly cautious? Is posting and tweeting a "let the buyer beware" endeavor?

Trolling for patient safety in social media

People are asking lots of questions about social media (SM). More specifically, I think, we're wondering whether Facebook, Twitter, and blogs have meaning beyond what I've recently counseled my 21 year old daughter to beware of: trolling for amusement.

SM can knock on the door of its evil cousin, "addiction." It has, on occasion, claimed rather large chunks of my life in a way I failed to notice or care about while engaged. So am I a Twaddict? A Blogopath? Am I locked in to Linked-in?

Life is meant to be lived. Not mindlessly thumbing through electronic messages in hopes of finding something more interesting than what's happening where you are. So I've been reflecting about whether time spent at social networking sites can be counted as really living?

I don't know for certain that social media is "life," but I think it reflects life. More specifically, it's a barometer of culture. As a person who follows how culture in healthcare organizations impacts safety very closely, I find that SM opens a window into experiences and settings that are otherwise closed. Since you can only learn--individually and collectively--from mistakes and near-misses that you know about, I think greater transparency is among the greatest gifts SM offers the discipline of patient safety.

Here are just a few examples that captured my attention in the past few months. Since this is not a forum to fully deconstruct each event, I'm titling each to show the behavior or belief that undermines safest practice:

• It's okay to carry things that will be injected into patients' veins in the same manner as a Bic pen: A promising young nurse shares stories about her entry into the nursing profession. One day, she photographs what she carries in her pocket. Scissors, tape, "flushes," and pens are among the things she finds helpful to store there.


• We all have nights from hell: A seasoned intrapartum nurse describes a busy shift where she cares for multiple high-risk patients, all of whom are receiving high alert medications (those highly likely to cause harm if used in error). Staffing inadequacies and a pervasive "get 'r done" culture prevent post-procedure medication and patient monitoring. Everything turns out okay in the end.


• Smart people don't make stupid mistakes: A resident caring for a patient receiving intraoperative dialysis takes a picture of the machine used to perform dialysis. She questions whether it's necessary to have adjunct labeling ("Dialysis Only. Do Not Drink") affixed to the front. And she asks this in a way that suggests this photo may wind up in an upcoming collection of "Darwin Awards."

People share their stories and experiences in SM venues in ways that often remove standard filters, many of which we rely on to be successful (or at least functional) in "real life." Bloggers and tweeps are not in "inspection mode," and they're not usually engaged in defensive posturing. Most accounts come from regular people, telling stories about how they take on the business of providing care. Details about obstacles faced, choices made, and opinions expressed reflect the culture of healthcare.

I saw this from Dr. Val, tweeting from a live speech by Francis Collins last week:

Collins: If you want to find a cure for cancer, you don't need to just research cancer. The answers may come from somewhere else. #RSOS.

So, too, with curing what ails healthcare.

Here's to you!

Ben Franklin is credited with saying,

"Beer is proof that God loves us and wants us to be happy."

So here's a picture of the beers my husband and I will drink tonight, lifting a glass to support the President, the professor, and the police officer whose small get together this evening is something worth emulating.

Here's to saying, "I may have been the one who messed up (or maybe it was you this time). Let's try to make things better as we go forward."

Cheers. God loves you and wants you to be happy.