There are serious risks involved in hospitalization, especially for pediatric patients. Each year more inpatients die from hospital-caused problems than from any other cause. Because many hospitals tend to focus on managing risks to their hospital, rather than quality assurance for the patient, and because of the nationwide shortage of nurses, you must become the risk manager for your family. As a parent there are specific things you can do to protect your hospitalized child from death or serious injury.
The first and most important thing is to be present, or to have some knowledgeable, competent adult present, with the hospitalized child at all times. This person can help manage potential error-causing situations.
“Universal precautions” refers to sterile/clean techniques that can prevent the spread of infection, such as handwashing after and before touching a patient, the patient’s equipment, or patient supplies, or medication or other items, which can carry an infection. Another sterile technique is to wear gloves and to change them between patients.
Busy hospital staff sometimes forget to follow universal precautions. You can help by making sure that everyone who approaches your child to provide healthcare or assistive services, such as changing the bed linen, follows universal precautions. This includes your physicians. Your job here is to politely say to each person, “Please make sure you have changed your gloves,” or “Please be sure to wash your hands before you help Jimmy.” This includes Jimmy’s doctor. Position yourself so that you can, if necessary, physically impose yourself between your child and incoming staff or visitors.
To prevent medication errors, be sure you have your physician explain, name, and describe the medication being prescribed, the dose, and the times. Be sure you understand the “route,” that is whether it is an oral dose [pill or liquid], an injection, or an IV medication. “IV push” means that the medication is injected from a syringe into the hanging IV setup. Be sure your MD knows what medications your child was on at home, and any allergies. Do not assume that your pediatrician remembers those details. Look at the documentation to make sure you can read it. Never give your patient a medication, even over-the-counter, while in the hospital without written instructions from the MD and making sure nursing staff know about it.
RNs are taught to use the “right” checking device. They will verify by naming the drug and the dose, verify the patient’s name, verify the time, verify the route, administer the drug, and then complete the documentation. When the RN brings the medication, if you don’t hear verification, ask the name of the medication and the dosage being given. Ask if the hospital uses pediatric dosing, or if the medication had to be calculated. Do not hesitate to ask the RN if he or she is an experienced pediatric nurse, and if not, feel free to ask the RN to have the calculation double-checked by one of the pediatric RNs on the unit. If the medication looks different, ask questions. Also, observe your child before and after medications. When you see any apparently negative change, notify the RN and ensure that staff check the child’s vital signs. If you want the pediatrician called, insist until the call is made – even at 3 in the morning.
Ask the doctor and the nursing staff if there is anything you can do to help, and what you should be taking notice of and reporting to staff. Make sure you are speaking to the RN assigned to your child, and not an aide or LVN. Since different nurses work different shifts and days and deal with many patients, make sure you keep them apprised of any problems.
Don’t be afraid to insist on adequate care. It is your right under the laws, rules, and regulations that govern the provision of healthcare and the practice of nursing. It is also your right and your duty to communicate with the state boards when any professional fails in the performance of his duty.
Remember, nurses are overworked, frequently underpaid, stressed out, and tired – and most of them care deeply about your patient and resent the difficulties under which they are forced to work, as much as anyone. They don’t see healthcare as an industry, but rather as a calling. Nurses become nurses because they want to take care of people, and they want to save them all. You can help your patient by showing consideration for the nursing and ancillary staff.
And while you are doing all of these worrisome little tasks, always remember to maintain a calm, positive affect for your little patient. Remember that your child takes his cues from your behavior. As long as he feels that you have everything under control, he’ll rest better and heal faster.
See the related articles “Preventable Pediatric Medication Errors,” “Preventable Pediatric Nursing Care Errors,” and “Risk Management and Pediatric Patients” for additional information on this problem.