Patients with Special Needs - Can We Do It All? Yes, and with Great Care
Note: Risk Management CME Questions and Answers Can Be Found at the End of this Article
Each patient is uniquely different. Each patient may have needs that go beyond the normal medical care for the diagnosis he/she presents with. The spectrum of patients with special needs ranges from those who are blind, quadriplegic, and obese, to those who do not have command of the English language. There are many regulatory guidelines which dictate what accommodations need to be made, for example, the American with Disabilities Act. Additionally, there are public relations courtesies which dictate how/when to accommodate patient needs.
Continuum of patient care and patient safety are definitely affected by attention and coordination of special needs for any given patient:
- A quadriplegic admitted to the hospital should be afforded the same call bell options as any other patient. Some hospitals have a special chin call bell that can be utilized by patients to communicate with the nursing station.
- A patient who cannot speak English or does not have good command of the English language must be provided a professional interpreter to assure, at minimum, a proper assessment, proper consent, and proper education/discharge instructions. CKHS hospitals have a professional interpreter service that can provide a live person and/or three way phones to accommodate most any language or dialect.
- A patient “of size” should be provided appropriate equipment to safely accommodate them as well as ensure the safety of staff. Bariatric equipment to be considered might include: bed, trapeze, wheelchair, commode, CPM machine, hoyer lift, and chair. Additionally, special procedural needs should be assessed, such as: pharmacology and airway management.
Attention should also be provided for those patients who have personal medical care equipment desiring to bring it to the hospital, such as: BiPap machine, medication pumps, motorized wheelchairs, and pd dialysis. The hospital policy provides that no personal medical care equipment will be permitted for use. The hospital will provide the appropriate equipment while the patient is inpatient status. If it is determined to be infeasible to provide such equipment, then special assessment and arrangements will be made, per policy.
The primary goal is to provide a safe environment for everyone. The best way to accomplish this is to communicate any/all needs as soon as possible into the admission and/or prior to an admission. At the time of scheduling an OR procedure or at the time of admitting a patient the hospital staff should be informed of and/or recognize any special needs so arrangements can be made as soon as possible.
Potential claims have surfaced because physicians have failed to utilize the services of a professional interpreter thus resulting in misdiagnosis and mismanagement of a patient. The patient-physician relationship is a fiduciary one. Your duty is to the patient. All communication should be directed to them personally. Note: communication through a relative and/or friend may also pose a HIPAA violation in addition to compromising your medical care. Cultural barriers also have an effect on the care provided. In certain cultures the family may “protect” the elderly or women from a diagnosis or making medical decisions and not appropriately translate what you are stating.
Potential claims have surfaced because facilities were not adequately prepared to deal with the bariatric patient and provide a safe environment. Care of this patient population is very challenging as these patients have numerous co-morbid conditions, such as heart disease and diabetes. About 9 million American adults are morbidly obese- approximately 100 pounds overweight or more than two times the ideal body weight. This not only taxes the patient, but staff caring for the patient. Preparing for a safe environment by providing proper equipment to care for and to lift patients is crucial to minimize risks of fall for patient and injury to staff.
Most patients are already self-conscious and may be upset that they are hospitalized. We do not want to compound the problem by highlighting or having it appear that their special needs is an inconvenience or burden. Their special needs are part of quality care that we provide. Prompt, thorough communication of any needs is important to have delivery of care seamless and ensure expedient recovery. Once again, communication is the bottom line to continuum of safe patient care.
CME Questions - December 2009
CME Answers - December 2009