Reinke Faces Life

“UPON FURTHER REVIEW”

Interesting. I finally had time to go thru the exit documents that they made her sign before they let her go. Those instructions are ten pages of virtually unreadable “barbara streisand”. Let’s examine what the hospital bureaucrats — no doubt advised by lawyers — wasted paper and toner on.

Under the heading of “just stupid”, this patient doesn’t smoke, virtually never has. (Me either. Ever kiss a smoker? Yuck. And it makes your wee willie shrink up prematurely. For boys and girls. Look it up. That should be enough to get any youngster to quit. Unless the don’t like using. TMI? Hey this is life. Face it. Like the blog title says.) So why are there THREE separate sections of this load of “barbara streisand” about quitting smoking. One section might be a mistake, two an oversight, three is just no one reads the “barbara streisand” pumped out.

Under the heading of “downright dangerous”, are the two pages of medication instructions. (I have yet to exit the hospital with Frau where these are correct. From my memory, EVERY time we’ve left — and we’ve left a lot — there has been at least ONE serious fmpov error.) SO let’s take score of these instructions.

— We have duplicate instructions on insulin. Literally, separated by incorrect insulin instructions. Luckily, DIABETICDOC#3 was clear with her instructions about what she wanted Frau to take. “Regardless of what is in your discharge instructions”. (So obviously the docs know that these instructions are cobbled together “barbara streisand”.) And, give her even more credit, Frau’s discharge was just a rumor when she gave her exit instructions. (You have to like someone who’s on top of their game. You could almost hear her say: “I don’t care what everyone else is doing. My part of the problem is done right.” She should be in charge. Her or the cleaning lady. Both have their act together.)

— In two items, dosages have been changed which MAY or MAY NOT be correct. (If the lesser dosage is right, then where are the RXes for the new form. Since these dosages were NOT given in the hospital, we’re assuming that this is wrong.)

— Two of her important medications have no instructions at all; so in one case we resumed her old regime and in one case we did not. (Maybe that’s right, maybe that’s wrong.)

— The instructions might as well be written in Babylonian cuniform. It has chemical name, followed by another chemical name in parenthesis sometimes, dosage, instruction, start date, the phrase “ordered as”, and the brand name. (Boy that’s as clear as mud.) The start date is always identical. No where does it say “Take it”. (I know that’s “obvious”. But we are dealing with humans here.) And there’s no indication of what doctor ordered what? (Did my cardiologist really order me to take this cardiac drug or is it one of the other docs covering for him? Who gets sued when it’s wrong and kills me?)

The entire ten page document is a virtually unreadable. I have 20/20 corrected vision. And, I know the tricks one can play with fonts and kerning to pack print on a page. There is a mix of fonts, bolding, and compression that make it a mess to try and read. (Didn’t these folks ever hear of “information mapping”?) As “evidence”, I have a the input from a sample of one, Frau. After scribbling her name on the last page, with it being literally the last thing between her and the door, she look at it, said to me “it’s junk. Can you see if there’s anything important in it?” And, that’s an opinion I can agree with.   

How would I improve it?

Well since not everyone getting out of the hospital has 20/20 vision or a Patient Advocate (PiA) to worry about the “barbara streisand”, I’d completely redesign it using the principles of Information Mapping. It’s not a form; it’s a letter. Signed by the principle doctor and nurse.

It should say. “In order to recover, we want you to take” and then a simple list of drug, dose, and time. And, leave the chemical jargon to the pharmacist. If the patient take Nexium, don’t tell them to Esomeprazole Delayed Release.

For each specialty, it should say: “your DIABETICDOC want you to take:”.

Then a section on follow ups. And don’t tell the patient to do the work. “We have taken the liberty to schedule the following appointments. DIABETICDOC on August 31 at 10AM, BLOODDOC on August 13 at 10AM, CARDIODOC on September 15 at 10AM. You, of course, are free to reschedule these as needed.” (Wow, do some value adding work? What a novel idea.)

Print it all in a nice clean 16 point font and we’re good to go.

Argh!

Information Technology Architecture and Business Process Reengineering are so easy when someone just cares about the results.

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After Frau’s recent stints in the hospital, I was thinking about their poor use of technology.

The lowly call button is the problem. Patients push but … and frustration ensues.

Sitting there with little to do, I mused about how, if I was KING, I’d rework that.

It’s a perfect call center application.

In my world, I’d have room full of “911 operators” to answer the calls. And, I’d have the staff equipped with the latest mobile technology. Like a push to talk cell phone on their hip with a blue tooth headset.

Patient pushes the call button! ,

In the current system, the unit clerk usually answers the bell with a not so cheery “whaddayawant”. OK, that’s not the exact words, but it really is the exact message.

In my system, the “911 operator” would answer: “Yes, is this urgent?” If response = “yes”, set priority to “immediate”. If response = “no”, set priority to “routine”. “What do you need?” And parse the response. “Pain” = “Nurse” “Bedpan” = “Aide” “Spill = Housekeeping” “Lawyer” = “Notify Risk Management” (You get the idea?)

Then, my system would be different in many ways. For “urgent”, I’d go down the list for first available: patient’s regular nurse, the backup, the charge nurse, any available floor nurse, and finally the Director of Nursing. (Wanna bet how many hit the honcho’s phone?)

For routine requests, the “911 operator” would speak to the appropriate party (i.e., nurse, tech, or housekeeper). If they were busy, they could queue it with a “remind me”. The “911 operator would have the person’s queue of items on screen and be able to say “you have five reminders, can I get you some help?”

Nothing would be “forgotten”. Response times would be measurable. Patient satisfaction would improve.

And I’d FLOG the leadership to help motivate them. :-)

These folks work very hard with what I call “a suit from Omar’s” (You know the tailor that has two sizes — too big and too small.) for technology support.

I can quickly list: bp / temp / pulse ox machines that down’t talk to the patient records; blood glucose testing devices that have to be docked to communicate; static white boards that have last shift’s names on them; quality assurance sheets to be signed each hour to ensure that the folks physically visit the rooms and are filled out just before the end of shift; no one monitors what the patient eats; ripoff tv and phone service; no exercise equipment; no technology for communication — people yell for people even on the quiet critical units.

It’s a Leadership problem. It obvious; they just don’t care. Argh!

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http://news.cnet.com/2100-1017-245428.html

September 7, 2000 11:45 AM PDT
AmEx unveils “disposable” credit card numbers
By Stefanie Olsen Staff Writer, CNET News

*** begin quote ***

American Express today announced a new suite of online security and privacy products, the first of which is a “disposable” credit card number for its members.

As previously reported by CNET News.com, cardholders using the disposable credit card option will be able to log on to a secure Web site and receive a one-time-use credit card number to make purchases over the Internet.

The free service will be offered to small businesses and consumer cardholders within the next 30 days.

*** end quote ***

MISSED IT BY THAT MUCH!

Response (Shweta Shiv) 08/01/2010 02:46 PM

Dear Ferdinand J Reinke,

I’d like to inform you that American Express does not offer such a service at this time.

However, I assure you that we remain committed to protecting the privacy and security of all of our Cardmembers, both online and offline. We believe that our current security measures, including our sophisticated monitoring systems to detect unusual or fraudulent card activity, provide strong, ongoing protections for our Cardmembers. In addition, you are further safeguarded by our Online Fraud Protection Guarantee, which ensures that Cardmembers are not held liable for any fraudulent charges on their account.

With the Online Fraud Protection Guarantee, you will not be held responsible for any unauthorized online charges, and if someone uses your Card without your consent, you will not pay any part of the fraudulent online charges—not even the first $50.

We are committed to protecting the privacy and security of all of our Cardmembers, and we will continue to develop innovative ways to protect our customers.

Thank you for choosing American Express.

We truly value your association with you.

Sincerely,
Shweta Shiv
Email Servicing Team
American Express Interactive Services

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Sorry, but that’s what I could use!

Lost the use of one credit card from a recurrent charge that could not be killed, which I am STILL fighting about. I want ONE TIME USE credit card numbers. I don’t care that the issuers will indemnify the risk, they don’t have the clean up hassle.

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