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Patient Safety

The Florida Agency for Health Care Administration (AHCA) is designated as the chief health policy and planning entity for the state and licenses and regulates health care facilities and health maintenance organizations (HMOs) across the state. AHCA also administers the Florida Medicaid program that provides health care to Florida’s low-income and disabled citizens. AHCA’s mission is to champion accessible, affordable, quality health care for all Floridians. To help achieve this mission, AHCA publishes the Consumer Awareness Series. This series consists of brochures designed to assist the public in making well-informed health care decisions.

A doctor helping a patient.

This brochure looks at medical errors and steps you can take to protect yourself. You are encouraged to use all available resources to learn more about patient safety. Resources can include your health care provider, pharmacist, local library, and Internet, as well as contacts listed in the Resource Directory at the back of this brochure.

Note: This brochure is not designed to offer medical or legal advice. Please consult with your physician for medical advice and an attorney for legal advice. Information in this brochure is current as of March 2007.

Introduction

The Institute of Medicine (IOM) of the National Academies reported in 1999 that between 44,000 and 98,000 people die in U.S. hospitals each year from medical errors. More people die each year from a medical error than they do from breast cancer, AIDS, and auto accidents. A medical error is defined as the failure to carry out a plan of action or use of the wrong plan. An individual can cause the error or it might happen because of a failure in the system.

Medical errors can take place in health care facilities, pharmacies, your doctor’s office, and even in your home. They can involve surgeries, medical procedures, treatments, medicines, equipment, diagnoses, or lab reports, among others. They can involve complex systems like how a hospital tracks the medical services given to patients, or common tasks like giving food high in salt to a patient who needs a salt-free diet.

While advances have improved medical care and extended the lives of many people, the complexity of the American health care system also contributes to medical errors. Poor communication between patients and their health care providers can lead to mistakes as well.

You can play an important part in patient safety by being actively involved in your own health care and the health care of your loved ones. This brochure will look at some of the problems and the actions each of us can take.

Health Care Team

Most people no longer have one physician who takes care of them throughout their lives and knows their entire history. You might change primary care physicians, visit various specialists, or find yourself in a hospital emergency department. At your doctor’s office you might see the doctor, nurse practitioner, or another professional. You might receive your care through a clinic where you see a different provider each time you visit.

The one constant in this care is you. You are an important member of your health care team. You know your history, medications, allergies, illnesses, and surgeries. Part of your responsibility is to educate yourself about your conditions and treatments and to share important information about your health with your health care providers.

A doctor helping a patient.

Communication between you and your health care providers is an important part of patient safety. You have the right to ask questions and to have matters explained to you in a way you understand. You have the right to know what treatment choices are available for your care.

In addition you may find yourself being an advocate for loved ones because they are unable to make health care decisions, or a loved one may need to represent you if you are unable to speak for yourself.

Tips for Being a Part of Your Health Care Team:

Health Care Surrogate Designation:

If you’re unable to be active in your health care due to physical or mental incapacity (like being in a coma or developing dementia) and if you don’t have a health care advance directive, health care decisions may be made for you by a guardian appointed by the courts, your spouse, adult child, parent, adult sibling or, under certain circumstances, another adult relative or close friend.

If you would like someone to represent you if you are unable to make decisions yourself you can designate a health care surrogate. Further information can be found in the pamphlet Health Care Advance Directives – The Patient’s Right to Decide. Request a free copy by calling the toll-free number (888) 419-3456 or view it on-line at www.FloridaHealthFinder.gov .

Medicine Safety

Actively managing and learning about your medications is an important part of patient safety. Following are suggestions to better protect yourself and your loved ones when taking medications.

Do your health care providers know all of the medications you take?

Some medicines and supplements may cause harm if used together. Learn about the medications and supplements you take and any interactions they may have. At least once a year review all of your medicines (prescription and non-prescription) and supplements (vitamins and herbs) with your health care providers.

Whenever you are prescribed medication ask if the new medicine will interact with other medications or supplements you currently take.

Can you read your prescription?

If you can’t read your prescription the pharmacist may misread it and give you the wrong medicine. Florida law requires that the prescription be written clearly, so make sure you ask for a clearly written prescription.

Before leaving the pharmacy check the medication label to see that it is written to you and it’s the same name and strength as written on the prescription. Check this every time you fill a prescription.

Be familiar with how your medicine looks. If it looks different than what you took before talk with your pharmacist before taking it.

Do you read your medication label and insert?

The label will tell you how much to take, when and how long to take it, and if there are restrictions. For example, the label might say you shouldn’t drink alcohol while taking the medication, stay out of the sun, or avoid certain foods or other medications. The insert will include information about safety precautions and side effects. (A side effect is, for example, when an allergy or cold medicine might also make you sleepy.) If you have questions about the label directions, safety precautions, or side effects talk with your pharmacist.

If you cannot clearly read the label ask the pharmacist to use larger type. If you don’t understand the directions ask the pharmacist to explain.

Is there a danger of buying medication that has been altered or that isn’t what the label says it is?

A good way to protect yourself is to confirm that the pharmacy where you buy your medication is licensed by the State of Florida. Each pharmacy is required to post the company’s license as well as the license of the pharmacy manager.

If you buy prescription medication over the Internet, or by mail order, it is important to be a wise shopper. First see your own health care provider for a prescription. Check to see if the company is licensed in the state in which it operates or if the National Association of Boards of Pharmacy (NABP) certifies the company through its VIPPS program (Verified Internet Pharmacy Practice Sites™). You can read more on the NABP website at www.nabp.net or call (847) 391-4406.

Be cautious buying medications over the Internet or by mail order. If the company is not legitimate, you may end up with fake, altered, or expired medication that will not help you and may cause harm. In addition, the website or mail order company may appear to be based in the United States, but actually be operating outside of the U.S. where quality and safety controls may not be available.

Is there a danger in taking over-the-counter (OTC) medications?

Some OTC medications should not be used with certain prescription drugs. Read your medication label and insert, and talk with your pharmacist if you have questions.

Also compare active ingredients before taking more than one medication at the same time. Many OTC and prescription medications contain the same active ingredient, which means you could take more than the recommended dose. For example, if you take a pain medication along with a cough, allergy, or sleep medicine, they may contain the same drug and the combination may be more than is safe to take at one time.

While your health care provider or pharmacist can alert you to unsafe combinations of drugs, you can also watch for the following two common ingredients:

OTC medications are meant for temporary relief. If you need to use a medication longer than it says on the label, see your health care provider. You may have a serious medical condition or your provider may recommend another form of treatment.

Why is it important to know the correct dosage to take?

Medications can make you sick, injure you, or sometimes cause death when taken incorrectly. Do not take more of the medication than is recommended. Some things to watch out for:

Tips on Safe Handling of Medications:

Safety Tips on Taking Medications:

Prescription Assistance Programs:

The following programs may offer assistance if you meet their eligibility requirements:

You may also want to read our brochure, Understanding Prescription Drug Costs. Order a free copy by calling toll-free (888) 419-3456 or read it on the above website.

For further information: The National Library of Medicine has a website with information on medicines and other health care topics: www.MedlinePlus.gov.

Safety in Health Care Facilities and in Home Care

As a patient or resident in a facility or a person receiving home care services it might be challenging to be an active member of your health care team. You may not feel well. You may be given medication that makes you drowsy. You may be frail and find it difficult to speak up for yourself. But even with these challenges you still play a very important part in your health care team and you have the right to be involved in your care.

It’s important to have clear communication with your health care providers. If you think you may not be able to be clear, due to a temporary condition or to longer term declining health, you may want to have a loved one be your advocate and speak up for you. You may also want to designate someone as your health care surrogate as mentioned earlier in this brochure.

Before entering a health care facility or receiving services from a home care provider you may want to learn more about the choices you have. You can request a copy of the following publications by calling the toll-free number (888) 419-3456 or view them on-line at www.FloridaHealthFinder.gov.

In addition, you can view information on Florida hospitals, emergency room care, ambulatory surgery centers, and health plans on a website established and maintained by the Agency for Health Care Administration at www.FloridaHealthFinder.gov.

The federal Medicare program also provides information on nursing homes, hospitals, home health agencies, and dialysis facilities that serve Medicare patients. To learn more view the Medicare website www.Medicare.gov.

You can see if a facility or home care provider is licensed, registered, or certified by the Agency for Health Care Administration on the Agency’s website www.FloridaHealthFinder.gov (click “Find Facilities”). Or you can ask the facility or home care provider to show you their license, registration, or certification.

While Receiving Care:

While Receiving Care in a Health Care Facility:

While Receiving Care In Your Home:

Safety Tips for Surgery & Medical Procedures:

Safety Tips for Anesthesia:

When preparing for a surgery or procedure you will also want to learn about anesthesia. Anesthesia is medication that keeps you from feeling pain and sensations during a surgery/procedure. Ask exactly who will give you anesthesia and monitor your vital signs.

Tell your doctor and the anesthesiologist if you have ever had a reaction to anesthesia. Tell them all the medications you take (prescribed, over-the-counter, vitamins, and herbal supplements) and any allergies you have. Also, let them know if you have any medical problems and, though this may feel personal, if you have a drinking problem or use drugs recreationally. This information is very important for safe anesthesia care.

Ask about restrictions on medications, food, and alcohol before and after the use of anesthesia.

After surgery under general anesthesia (the kind that puts you to sleep) you may continue to feel drowsy, tired, or weak for a few days and you may have problems with coordination and thinking clearly. For at least 24 hours after receiving general anesthesia don’t drive, use machines, or do things that could be dangerous if you are not alert.

If You Have a Complaint:

If you have a complaint about your health care provider or health care facility talk with them first to see if the matter can be resolved. If you are still not satisfied and want to file a complaint with the State of Florida call the toll-free number (888) 419-3456.

Prevention of Infections

The Centers for Disease Control (CDC) states that about two million people a year get an infection during their stay in a hospital in the United States. A person can also get an infection in non-hospital settings like nursing homes, dialysis centers, physicians’ offices, or in their own home.

Data is available on infection rates at Florida hospitals. If you are going to receive care or treatment in a hospital you may want to check your hospital’s infection rates or compare several hospitals in your area. You can find this information at www.FloridaHealthFinder.gov.

Tips on Infection Prevention:

Prevention of Falls

Injuries from falls are of particular concern for the elderly and for patients who might be frail or disoriented from illness, recovering from surgery, or on medication. Whether you’re in a health care facility or your own home, check for the following to help prevent falls:

Resource Directory

Agency for Healthcare Research and Quality
(301) 427-1364
www.ahrq.gov

American Association of Blood Banks
www.aabb.org

Anesthesia Patient Safety
American Association of Nurse Anesthetists
www.AnesthesiaPatientSafety.com

Association for Professionals in Infection Control and Epidemiology
(202) 789-1890
www.apic.org

Centers for Disease Control (CDC)
(800) 311-3435
www.cdc.gov

Food and Drug Administration (FDA)
(888) 463-6332
www.fda.gov

Institute of Medicine of the National Academies
(202) 334-2352
www.iom.edu

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
(630) 792-5000
www.jcaho.org

MedlinePlus (National Library of Medicine)
www.MedlinePlus.gov

National Center for Infectious Diseases
www.cdc.gov/ncidod

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National Patient Safety Foundation<
(413) 663-8900
www.npsf.org

Poison Information Center
(800) 222-1222
www.fpicn.org

The Leapfrog Group
(202) 292-6713
www.LeapFrogGroup.org

Additional Consumer Brochures Include:

For additional copies of this brochure, or any of the brochures listed above, please contact the AHCA Call Center at (888) 419-3456.

To view or print any brochure in the Consumer Awareness Series, please visit www.FloridaHealthFinder.gov.

This brochure may be copied for public use. Please credit the Agency for Health Care Administration for its creation.

If you have comments or suggestions, please call (850) 922-5771.

The Agency for Health Care Administration established the following websites to help Florida residents be well informed health care consumers.

www.FloridaHealthFinder.gov provides search tools to compare short-term acute care hospitals, ambulatory (outpatient) surgery centers, health plans, and nursing homes. The site includes the A.D.A.M. Health Encyclopedia with thousands of articles and illustrations. The site also provides a list of health care facilities; information about insurance, medications, seniors, medical conditions, and resources for medical care; a variety of consumer publications; information for health care professionals; and much more.

www.MyFloridaRx.com
This website provides pricing information for the top most commonly used prescription drugs in Florida.

http://ahca.MyFlorida.com
This website includes information on health care facility regulation and licensing, the Florida Medicaid program, managed care (HMOs), and other topics related to the Agency for Health Care Administration.

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Help for Florida Consumers.

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