Appendix A - 20 Tips to Help Prevent Medical Errors

1. The single most important way you can help to prevent errors is to be an active member of your health care team. That means taking part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. Some specific tips, based on the latest scientific evidence about what works best, follow.

Medicines

2. Make sure that all of your doctors know about everything you are taking. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs. At least once a year, bring all of your medicines and supplements with you to your doctor. “Brown bagging” your medicines can help you and your doctor talk about them and find out if there are any problems. It can also help your doctor keep your records up to date, which can help you get better quality care.

3. Make sure your doctor knows about any allergies and adverse reactions you have had to medicines. This can help you avoid getting a medicine that can harm you.

4. When your doctor writes you a prescription, make sure you can read it. If you can’t read your doctor’s handwriting, your pharmacist might not be able to either.

5. Ask for information about your medicines in terms you can understand-both when your medicines are prescribed and when you receive them.

  • What is the medicine for?
  • How am I supposed to take it, and for how long?
  • What side effects are likely? What do I do if they occur?
  • Is this medicine safe to take with other medicines or dietary supplements I am taking?
  • What food, drink, or activities should I avoid while taking this medicine?

6. When you pick up your medicine from the pharmacy, ask, “Is this the medicine that my doctor prescribed?” A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.

7. If you have any questions about the directions on your medicine labels, ask. Medicine labels can be hard to understand. For example, ask if “four doses daily” means taking a dose every 6 hours around the clock or just during regular waking hours.

8. Ask your pharmacist for the best device to measure your liquid medicine. Also, ask questions if you’re not sure how to use it. Research shows that many people do not understand the right way to measure liquid medicines. For example, many use household teaspoons, which often do not hold a true teaspoon of liquid. Special devices, like marked syringes, help people to measure the right dose. Being told how to use the devices helps even more.


9. Ask for written information about the side effects your medicine could cause. If you know what might happen, you will be better prepared if it does-or, if something unexpected happens instead. That way, you can report the problem right away and get help before it gets worse. A study found that written information about medicines can help patients recognize problem side effects and then give that information to their doctor or pharmacist.

Hospital Stays

10. If you have a choice, choose a hospital at which many patients have the procedure or surgery you need. Research shows that patients tend to have better results when they are treated in hospitals that have a great deal of experience with their condition.

11. If you are in a hospital, consider asking all health care workers who have direct contact with you whether they have washed their hands. Hand washing is an important way to prevent the spread of infections in hospitals. Yet, it is not done regularly or thoroughly enough. A recent study found that when patients checked whether health care workers washed their hands, the workers washed their hands more often and used more soap.

12. When you are being discharged from the hospital, ask your doctor to explain the treatment plan you will use at home. This includes learning about your medicines and finding out when you can get back to your regular activities. Research shows that at discharge time, doctors think their patients understand more than they really do about what they should or should not do when they return home.

Surgery

13. If you are having surgery, make sure that you, your doctor, and your surgeon all agree and are clear on exactly what will be done. Doing surgery at the wrong site (for example, operating on the left knee instead of the right) is rare. But even once is too often. The good news is that wrong-site surgery is 100 percent preventable. The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site to be operated on before the surgery.

14. Speak up if you have questions or concerns. You have a right to question anyone who is involved with your care.

15. Make sure that someone, such as your personal doctor, is in charge of your care. This is especially important if you have many health problems or are in a hospital.

16. Make sure that all health professionals involved in your care have important health information about you. Do not assume that everyone knows everything they need to.

17. Ask a family member or friend to be there with you and to be your advocate (someone who can help get things done and speak up for you if you can’t). Even if you think you don’t need help now, you might need it later.

18. Know that “more” is not always better. It is a good idea to find out why a test or treatment is needed and how it can help you. You could be better off without it.

19. If you have a test, don’t assume that no news is good news. Ask about the results.

20. Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources. For example, treatment recommendations based on the latest scientific evidence are available from the National Guidelines Clearinghouse at http://www.guideline.gov. Ask your doctor if your treatment is based on the latest evidence.

20 Tips to Help Prevent Medical Errors Patient Fact Sheet. AHRQ Publication No. 00-PO38, February 2000.Agency for Healthcare Research and Quality, Rockville, MD.

 

Appendix B - CES-D Self-Report Depression Scale
Overview
The Center for Epidemiologic Studies (CES) of the National Institute of Mental Health Self-Report Depression Scale was developed for research in the general population. It can be used to monitor a person before during and after intervention. Responses are for how the person felt that way during the past week:

0 ~ rarely or none of the time (less than 1 day)
1 ~ some or a little of the time (1-2 days)
2 ~ occasionally or a moderate amount of time (3-4 days)
3 ~ most or all of the time (5-7 days)

During the past week:

1) I was bothered by things that usually don’t bother me. 0 1 2 3
2) I did not feel like eating; my appetite was poor. 0 1 2 3
3) I felt that I could not shake off the blues even with help from my family or friends. 0 1 2 3
4) I felt that I was just as good as other people. 0 1 2 3
5) I had trouble keeping my mind on
what I was doing. 		0 1 2 3
6) I felt depressed. 0 1 2 3
7) I felt that everything I did was an effort. 0 1 2 3
8) I felt hopeful about the future. 0 1 2 3
9) I thought my life had been a failure. 0 1 2 3
10) I felt fearful. 0 1 2 3
11) My sleep was restless. 0 1 2 3
12) I was happy. 0 1 2 3
13) I talked less than usual. 0 1 2 3
14) I felt lonely. 0 1 2 3
15) People were unfriendly. 0 1 2 3
16) I enjoyed life. 0 1 2 3
17) I had crying spells. 0 1 2 3
18) I felt sad. 0 1 2 3
19) I felt that people dislike me. 0 1 2 3
20) I could not get “going. 0 1 2 3

No score was set to indicate depression but the higher the score the more likely it would be (> 40 was selected for the implementation).
The Center for Epidemiologic Studies (CES) is part of the National Institute of Mental Health (NIMH), 6001 Executive Boulevard, Bethesda, MD 20892-9663 U.S.A

 

Appendix C - Diabetes Management Flow Chart
Patient______________________

Year
200
                                 
Date                                  
                                   
Blood Pressure  
Systolic
                                  
Diastolic
                                  
Rx                                  
1                                  
2                                  
3                                  
   
FBS                                  
HgbA1C                                  
Rx                                  
1                                  
2                                  
3                                  
4                                  
5                                  
                                   
Lipids  
Total Cholesterol
                                  
LDL
                                  
HDL
                                  
Triglycerides
                                  
Rx                                  
1                                  
2                                  
3                                  
                                   
Renal  
Microalbumin
                                  
BUN
                                  
Creatinine
                                  
Creatinine clearance
                                  
Urinalysis
                                  
Rx                                  
1                                  
2                                  
                                   
Physical Exams  
Weight
                                  
BMI
                                  
Feet
                                  
Eyes, dialated
                                  
                                   
Immunizations  
Influenza
                                  
Pneumococcal 23 PS
                                  
Other                                  
                                   
Counseling  
Smoking
                                  
Diabetes
                                  
Education
                                  
Weight Reduction
(BMI >27)
                                  
Diet
                                  
Exercise
                                  


Medication List

Drug Sig Number Refills Date Discontinued
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           

Reprinted courtesy of Family Care Medical Center, Denver, CO.