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It's that time of year: hospital admissions are escalating dramatically as people come down with the flu and, if they're disabled or elderly, develop life-threatening complications like pneumonia. I wrote a diary almost three years ago about the nursing shortage and it's the second most requested link I'm asked for. Today I've pulled out the parts about keeping yourself and your loved ones as safe as possible while hospitalized.

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Don't expect Florence Nightingale when you or someone you love is hospitalized. While a precious few hospitals have managed to maintain high staffing levels, most have not. A friend of mine left the profession after one terrible shift when she had to choose between a patient who was hemorrhaging and a patient in respiratory failure. A nurse will assess you when you are admitted. You'll get your medications, hopefully the right ones, but seldom on time. It's a good idea to shower before you arrive because bathing is becoming a lost art in hospitals. If you are restricted to bed, good luck finding someone to bring you a bedpan. Don't count on your linens being changed with much regularity, either, and try not to touch anything you haven't disinfected yourself. In spite of the presence of superbugs in hospitals, housekeeping has been cut to the bone in many.

If you have an IV, monitor the site yourself and start raising hell if you see swelling or redness, or if it starts to leak or hurt. If you have a urinary catheter remember three things: The collection bag should never be allowed to touch the floor, it should never be raised higher than the level of your bladder, and it should be measured and emptied by someone every shift or when it gets full. If you have a wound from trauma or surgery, keep an eye on your dressings. Report obvious bleeding immediately. If you have a cast on an extremity, the fingers or toes should be watched for swelling, coldness and color change.

Don't let anyone touch you until you see them wash their hands. Don't let anyone use a non-invasive instrument on you -- stethoscope, blood pressure cuff, that kind of thing -- until you see them disinfect it. If your physician wears a necktie, ask him to tuck it into his shirt.

Create a "clean zone" around yourself, your bed, your bed table, your call button, and anything else you may touch, using the strongest disinfectant you can lay your hands on. NEVER let your bare feet touch the floor. Wear slippers when you get up and take them off before you swing your legs back into the bed. Whenever you touch any surface that you haven't personally disinfected -- doors, anything in the bathroom -- wash your hands. Nosocomial (hospital acquired) infection should be your greatest fear, and there's a lot you can do to protect yourself. Make your family and visitors take the same precautions. I don't care if you're a shrinking violet in every other aspect of your life, be assertive while you're a patient. Get madder than a pet monkey if you have to. Your life may depend on it.

Another area that requires vigilance is medications. I know you wouldn't be in the hospital if you were at your best, but please, please try to monitor your medications. There are times when mistakes are more likely to occur. When you're admitted, all your meds are entered into the hospital's pharmacy software. Transcription errors occur. When you're transferred between services, say from the ICU to a floor, misunderstandings about what you've already been given and what you need to be given can lead to over- and under-dosages. All orders are suspended when you have surgery and must be re-entered, with appropriate changes, afterwards. Finally, any change in medications can lead to an error: your doctor decides to switch your antibiotic or try another painkiller, and someone has to look at the last dose of the terminated drug when scheduling the beginning dose of the new drug. It gets complicated.

I know nursing from both sides of the bed. I've had eleven surgeries in the past eleven years, and I've seen both the true heart of nursing and its dark, understaffed side. The one thing I know for sure is I will never enter a hospital alone. Someone is always with me, even at night, asking questions and keeping watch. When someone I love is hospitalized, I'm there with them. Keeping watch.

I made my son read this advice before my spinal fusion in August. He probably thought I was overstating my case - until he started seeing the hospital world through my eyes. He saw how long it took to answer alarms and call bells, he saw a physical therapist set my catheter bag on the floor by the bed, he saw the medication problems, and he saw how hard I worked to meet my goals: stay out of ICU, and get discharged in three days. He saw how rarely and how poorly the rooms were cleaned and disinfected. He noted that I was given one quick partial sponge bath throughout my stay. More than anything, I think he sensed my fear and my desperation to get out of there.

Originally posted to KosAbility on Sun Dec 30, 2012 at 02:00 PM PST.

Also republished by Monday Night Cancer Club.

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