Out of the surgical ICU and recuperating in your room, you will have little to do but read, chat with visitors, watch TV, and lament your virtuous, heart-healthy, bland new diet. Much of the time, that is. Nurses, doctors, specialists, and therapists will be frequent company. Each will have a particular mission—and the hospital where caregivers communicate seamlessly has yet to be discovered. Information can and will fall through the cracks. That spiral notebook should be at the ready to record the name of everyone who comes in, the time, and what they do or what directions they give. "If you can't remember who told you what, it's lost," says David Nash, chair of the department of health policy at Jefferson Medical College in Philadelphia.
In "Preventing Medical Errors," a 2006 report by the Institute of Medicine, which advises Congress on health matters, a key finding was that "on average, a hospital patient is subject to at least one medication error per day"—wrong drug, wrong time, wrong administration (such as giving a drug by IV instead of orally). And, of course, wrong patient. If your blood thinner came at noon one day and at 3 p.m. the next, asking whether that's OK is appropriate. The nurse should faithfully identify all medications, and match the patient name on the order to your ID band. Few of these slip-ups cause harm, but "vigilance is critical," says Nash.
That applies to the need for caregivers to disinfect their hands before touching patients, as well. Nurses, doctors, and therapists will take blood, manipulate IVs, change dressings, and clean wounds or incisions. They will hold your wrist to take your pulse, place a stethoscope on your abdomen to hear your digestive tract gurgle, put a sympathetic hand on your shoulder as you cough. Every one of these acts exposes you to possible infection. Yet in a survey published last year in the Journal of General Internal Medicine in which 46 percent of discharged patients said they were "very comfortable" asking medical staff whether they washed their hands, only 5 percent said they spoke up. You're well advised to be an exception.
The intent of many of your regular visitors will be simple: to make you work. Bodies need to move after surgery, to promote healing and to prevent blood clots that can form when blood pools or moves sluggishly because of inactivity. For Thomas Adams, a patient at Sentara Heart Hospital in Norfolk, Va., prevention took the form of repeated laps around the periphery of the step-down unit, guiding a wheelchair for stability.
The assignments in the step-down unit are the most basic imaginable—walking, coughing, breathing, navigating bathroom visits. After the trauma of surgery and the effects of general anesthesia, which can linger for weeks, these simple tasks take on a surprising level of difficulty. "That's as deep as I can go," became Adams' plaintive claim when nurses firmly encouraged him to take deeper and deeper breaths or inhale into his incentive spirometer (a hand-held plastic device used to help measure and restore lung capacity). For patients who have had open-heart surgery, every cough hurts, but forced hacking is a must, to clear mucus and exercise the lungs. Clutching a pillow or folded towel to the chest lessens the discomfort. Sentara gives patients a heart-shaped pillow with an anatomically correct picture of the human heart.
Making your way to the bathroom is trickier postoperatively not just because you're maneuvering an IV pole. You're weaker. And you're spending much of your time reclining, which makes you more prone to feel dizzy when you stand up. No wonder patient falls are among the most common safety problems in hospitals. Besides calling for help with a trip to the bathroom, you can fend off dizziness by sitting in a chair rather than staying in bed.
The catheter in your neck, or central line, might stay in place until you're cleared for discharge. Its large size makes it a convenient way to administer drugs and take blood measurements without a needle stick. When the urinary catheter comes out depends on hospital protocol. At Sentara, it is just before patients are transferred out of the ICU, and only after a fresh dose of pain meds. That's because pulling it out could be trivial, or briefly but acutely excruciating. There's no reason you, too, shouldn't have pain relief before the tube is extracted.
Continue reading: Hospital Guide, Part 8: Discharge Day >>
This story was originally reported on 7/15/07.