3 really great ways to reduce medication errors among discharged patients.

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A middle-aged man with Asthma and hypertension was experiencing breathlessness and was rushed to the Emergency department.

He was given oxygen and nebulization. Then after he became calm, he informed us that;  when he began to experience the asthmatic attack, he couldn’t identify his asthma medications from his anti-hypertensive drugs.  

Another female patient in her 50s was admitted at the ED with hypoglycemia.  She had both hypertension and diabetes but could not differentiate between her drugs. She complained that she didn’t know which of her medications was for the hypertension or the diabetes.

 

Why this is a Problem ?

1. There are several patients in Ghana who share the same plight as the two patients. Patients who suffer more than one chronic conditions like; Diabetes and hypertension,  chronic kidney disease and hypertension, HIV and tuberculosis, etc are given more medications. These medications perform different functions and treat both medical conditions separately. But most of our patients are ignorant of the various medications and what they do. Because of this, patients tend to have emergencies due to their inability to differentiate one drug from the other in terms of their conditions. 

Patients are therefore not able to control their medication intake when their levels are either high or low;  example is when a diabetic has low Random blood sugar (RBS)  level but takes her anti-be tic drugs anyway because she doesn’t know which of her medications is for diabetes.

2. More chronic disease patients experience a worsening of their conditions which results in an increase in hospital admissions,  early re-admissions, prolonged hospital stay and increased healthcare cost. All these factors affect the Sustainable  Development  Goals and prevents Ghana from achieving her goal.

What can be done? 

1. Colour coded medication dispenser: I believe as a country with a high illiteracy rate of 24% (CIA, world fact book), using colour coded medication dispensers to serve drugs in our pharmacies especially during discharge could really help control medication errors at home after patients are discharged.joshua-coleman-623117-unsplash.jpg

 

2. Colour coded plastic bags:Plastic-Bals.png

Photo credit: 3JS Brand

Even though the use of  plastic bags is not favourable to the environment, it’s use i’s not currently banned in Ghana. Most hospital pharmacies /dispensaries use plastic bags to package medications for patients.

With these colour coded bags , patients will be able to easily identify which drugs are for which particular condition. This can greatly reduce the rate at which medication errors occur at home.

3. Education, Education, Education! Our patients mostly walk out of our health facilities with just the dosage of their medications explained to them. If they are lucky* they are informed about when exactly to take their drugs whether before or after meals.

But much more needs to be done. Patients need to know and understand well the following;

a. The name of the drug

b. What it does and what condition it treats.

c. When to take the drug and why it should be taken at those times. This helps patients to appreciate more the need to adhere to the instructions if they know how important it is.

d. When to stop taking it. Example: A diabetic taking blood sugar control medications. The patient needs to understand that if the RBS is low, he/she needs not take the drugs.

e. Side effects of the drugs.

Lets help promote the health of Ghanaians and the world at large.

If you thing this post was helpful, please leave a comment, share with others to make impact and follow my blog for more quality  health education.

Thank you!

Have a great day. …

 

 

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7 things every parent should know if you have a sick child.

Being a  parent is a big responsibility. Having a sick child can be very stressful in all levels and more so if you  have a chronically ill child.

A Chronic illness is any illness that persists over a long period and may last throughout a person’s life. This type of illness demands continuous medical management.

It can be overwhelming for a parent to know their child is suffering from an illness, much more if it will not be for a short while. Because of this, most parents become helpless not knowing what and how they can help their young ones.

In this post you will learn how as a parent you can be your child’s biggest advocate and help in their treatment and care.

1. Know your child’s medical condition: Know everything about the disease condition of your child. From the name of the condition, what might have caused it, how it is being managed. You can know all this by asking your child’s doctor. You have a right to know so ask. The doctors and nurses also have a responsibility to inform you and educate you on it. When you know, it gives you control over how you can care for your young one.

2. Be a part of their care: You become a part of your child’s care if you accompany them on their hospital visits. Your child may be a teenager who can attend the clinic by themselves , but it always necessary for a parent to be present with them.

3. Know and monitor their medication: rawpixel-600792-unsplash.jpg As a parent, you should know the medications your child is taking. The name, the type of drug, what it is used for and possibly even the anticipated side effects. You can make a habit of reading drug leaflets for such information. It gives you an idea as what to expect. And in times they may be reacting to a particular drug , you can be aware.

4. Speak to their school: If your child is chronically ill. For eg; if your child is a diabetic, you need to alert the school especially if they provide lunch for the kids so they know what your ward can eat or not. If it’s a boarding house, your child’s house master/mistress should be made aware of your child’s condition so they can provide him/her with the necessary assistance and care to help them maintain their health.

5. The whole family should be aware: When a member of the nuclear/immediate family is chronically ill, it is important if the others know about it more so if it’s a minor. This is beneficial and sometimes life saving in case of an emergency. This makes everyone in the family capable of giving an accurate history of the patient’s medical history.

6. Be an advocate for your child:  I have met parents who are not able to fight for the rights of their children in hospitals, schools and even in our communities. But that is something as  parent you should know how to do. Speak up when your child is not receiving the best of care or attention. That is your child so protect them with everything in you.

7. Give them all your love: Even though caring for a sick child can be stressful, it is very good for the children to know that you love them regardless of the stress, frustrations and financial strain you may be experiencing due to the illness. Remember love is also healing.

There has been many instances where parents with chronically ill children are ignorant about their children’s condition. These have led to poor choices with their care and management. But by observing these 5 points, you are sure to promote the health and wellbeing of your child.

 

 

Poor referral attitudes among most Ghanaian healthcare centers affecting health of Patients

There is a serious practice going on in some hospitals , clinics and health centers in Ghana by physicians, Physician assistants and other health professionals which has been detrimental to the health of patients for far too long.

There is a protocol to follow when referring a patient from one facility to another. There are things you as a doctor need to do before sending a patient to another health facility.

This includes

1. Writing a concise and clear report of the patient’s condition, what has been done at your facility for him/her, and why you are referring the patient to another hospital.

2. The referral report should include the personal details of the patient being referred. That is the name, age, etc.

3. The report should also include the name and  signature of the referring doctor.

4. The Name of the hospital should be indicated in the report.

But what we see in our hospitals are patients being referred with incomplete referral notes and an improper way of transporting patients.

A referral accompanied a father of a 19-year-old boy who was dead on arrival at the emergency department.

The incomplete referral that had the name and signature  of the “doctor ” missing was given to the father at the clinic to take his very sick son who needed emergency care to get a car and come to the ED. The father took the letter and boarded a taxi outside of the clinic with his son and on their way to the hospital the young man died.

His condition according to tge referral note was typhoid perforation. This condition called typhoid perforation is one of the most dreaded and common complication of typhoid fever remarkably so in developing world; it usually leads to diffuse peritonitis, requiring early surgical intervention. (AK. Sharma, 2013)

This patient should have been referred with at least,

1. IV fluid therapy ongoing to help correct any fluid imbalance .

2. A nasogastric tube (tube through the nose into the stomach) to help empty any abdominal fluid content .

3. A urethral catheter with a drainage bag attached to drain his urine and know how much he is producing.

4. A nurse or doctor to monitor him throughout the journey to the ED.

5. The patient should have been put in an ambulance!

6. The father informed and educated about the condition of his son.

But none of these was done for this young boy and his father. The boy had clearly aspirated on his vomit because he had fluid coming out through the nose and the mouth.

Now I ask. ….

Till when will Ghana continue to be a health hazard to its citizens?

Till when will proper monitoring of health facilities be done to ensure the right things are done for the patients and their relatives ?

Till when will Ghanaians stop being ignorant of their own right to good health instead of  seeing it as a favour done us by Government?

Till when will my colleague health professionals stop being cruel, lazy and unjust in this honourable work of ours?

So help us God, we will continue to name and shame till this nonsense stop!

Share and let’s stop this menace. It can be anyone.

 

15 Patient’s rights you never knew you had in Ghana.

 

 

The ignorance of most Ghanaian patients is something that lots of stakeholders benefit from with the exception of the patient who bears the disadvantage. From the government heads to the hospital heads, the doctors, nurses, pharmacists, midwives, medical laboratory scientists, and all other working professionals and auxiliaries in our health facilities across the nation. Because the patient doesn’t know their right, they are more often than not given any kind of care. But learning your right as a patient can not only arm you to demand the right care, but also put others on their toes to deliver the best care.

THE PATIENT’S RIGHTS

As a patient;

  1. You have a  right to quality basic health care regardless  of your geographical location ( it is your right, do not let anyone make you feel like they are doing you a favour).
  2. You are entitled to full information on your condition and its management and the possible risks involved except in emergency situations when you are unable to make a decision and the need for treatment is urgent. (As a patient, always ask questions. If the nurses and doctors are not telling you, you have the right to ask. So ask and be informed about your own health. Never leave the hospital not knowing what you are suffering from, what caused it, how to prevent and manage it).
  3. You have the right to know of alternative treatment(s) and other health care providers within the Service if these may contribute to improved outcomes.
  4. You have  the right to know the identity of all your caregivers and other persons who may handle you  including students, trainees and ancillary workers .
  5. You have the right to consent or decline to participate in a proposed research study involving you after a full explanation has been given. The patient may withdraw at any stage of the research project.
  6. If you decline to participate in or withdraw from a research project, you are still entitled to the most effective care available.
  7. As a patient you have the right to privacy during consultation, examination and treatment.
  8. In cases where it is necessary to use the patient or his/her case notes for teaching and conferences, the consent of the patient must be sought.
  9. You are entitled to confidentiality of information obtained about you and such information shall not be disclosed to a third-party without your consent or the person entitled to act on your behalf except where such information is required by law or is in the public interest.
  10. You are entitled to all relevant information regarding policies and regulation of the health facilities that you attended.
  11. Procedures for complaints, disputes and conflict resolution shall be explained to patients or their accredited representatives.
  12. Hospital charges, mode of payments and all forms of anticipated expenditure shall be explained to the patient prior to treatment.
  13. In case of any exemption facilities, they shall be made known to the patient.
  14. As a  patient you are entitled to personal safety and reasonable security of property within the confines of the Institution ( As a patient in a hospital, it is the duty of the hospital to protect you from any kind of harm. If the hospital fails to do so, you have the right to demand for it or in severe cases, take legal action against them).
  15.  You (patient) have the right to a second medical opinion if you so desire. (This means if you are not comfortable, convinced or satisfied with the care and options you are being given by a particular doctor or hospital, you can ask or choose to seek another opinion).

 

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How to prevent infection next time you visit a patient in the hospital. (Protect yourself and your loved one)

At some point in our lives we all visit the hospital whether as a patient or a relative. Whiles in the hospital to see a loved one on admission, people pick all sorts of infections without realising that they do. In this post you will learn how to better protect yourself and prevent infections whiles visiting a patient in the hospital.

1. Never visit a patient whiles sick: When sick, stay home. Especially when your condition is infectious like colds and flu, or when having diarrhoea. When you visit a patient while sick, you expose your loved one to more sicknesses. Also you expose yourself to other infections in the hospital because your immune system is down. Just stay home if you’re sick.

2. Always ask the doctors/nurses before you see the patient: For some medical conditions, visiting the patient might not be a good idea because of the infectious nature of the condition, or the critical nature state of the patient. So always take time to ask the nurses / doctors if it is okay to see your loved one.

3. Never sit on a patient’s bed  the hospital:  Always use the chair provided at the bedside. If there are no chairs, just stand for the few minutes you are there. Sitting on a patient’s bed in the hospital can expose you to a series of infections which you might be taking home with you.

4. Indulge in hand hygiene whiles in the hospital: Hand sanitizer /alcohol hand rub should be used to clean your hand before you enter the ward and when you’re about to leave. This practice will greatly reduce your espouse to infections. If you visit the hospital and you don’t find one, ask.

Rub the alcohol between your palms and your fingers and fingernails for about 30 seconds.

5. Do not leave your stuff  (belongings like handbags, bowls, water bottles, etc.) on the floor of the ward/hospital. This is bad for you, since you might be carrying infections from the floor to your body.

Stay healthy whiles visiting your loved one at the hospital.

Why Cervical cancer is the leading cause of cancer deaths among women in Ghana; a look at the women

Cervical cancer is cancer that affects the cervix. The cervix is found at the opening of the uterus of the woman.

An image showing the cervix 

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Cancer is an abnormal growth of the cells in any part of the body. In this case, the abnormal growth of cells in the cervix is what is termed, cervical cancer.

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Cervical cancer affects only women because the cervix can only be found in the woman. But the virus that causes cervical cancer which is the Human Papillomavirus (HPV) can affect both men and women through sexual contact.

Being a woman automatically puts you at risk of cervical cancer. Even though you may never be affected.

But the moment you engage in sexual activity regardless of your age, you greatly increase your risk of cervical cancer especially if you do not use condoms for protection.

It is a known fact that women who use contraceptives (not condoms) are at a greater risk of getting cervical cancer. This is because, most women in Ghana use contraceptives for protection against pregnancy not infections. Due to thus reason, other contraceptives aside condoms are mostly patronized by the women.

Now the problem is, because the women are protected from pregnancy, they practice unprotected sex. Which exposes them to the virus (HPV) amongst other sexually transmitted diseases like syphilis, gonorrhoea and HIV.

According to the 2017 fact sheet (ICO/IARC Information Centre on HPV and Cancer), Hormonal contraceptives ( pills, injections, etc) use caused 22.9% of cervical cancer in Ghana. 

This does not mean that hormonal contraceptives are bad or that they cause cancer, but that they do not prevent infections and so if a woman is in a relationship which doesn’t promise monogamy, the practice of using condoms should be paramount to prevent the virus.

If you cannot abstain, then be faithful to one sexual partner. Always use a condom to protect yourself and your partner against STDS.

Condom is the only contraceptive that prevents infections !

The Ghanaian society is yet to empower women to be able to negotiate for their own protection during sex. In our community, the woman is powerless to defend herself and her health in relationships so if the man does not initiate condom use, the woman is unable to demand for it.

But the woman in our time must speak for herself. You need to demand for protection if it is not marriage. abstinence is still best.

And even in marriage if there is infidelity, you must protect yourself until both of you have undergone tests to show you are free from infections.

Don’t compromise on the quality of your health. Life is too short.

#Cervical cancer can be prevented.

 

 

Faithfulness is healthy; Cervical cancer Prevention by the man.

Cervical cancer is the leading cause of cancer deaths among women in Ghana. It is also known as a sexually transmitted disease. This is because the virus that causes this type of cancer (Human Papillomavirus ) is transmitted through sexual contact. This virus can be found in all places in the body but when it gets to the cervix of the woman it leads to cervical cancer.

Both men and women may carry this virus and by engaging in unprotected sex with a partner who is infected with the virus, you can get infected too.

Every sexually active woman stands a risk of getting cervical cancer because of this virus.

More women use contraceptives to prevent getting pregnant but not as a protection from sexually transmitted infections. ” with the exception of condomsContraceptives only prevent pregnancy and not infections

Condoms use is something that is still not practiced in many sexual relationships. This is a dangerous practice especially in unmarried relationships that monogamy is not assured.

The man has the ability to protect his woman  (wife, girlfriend, fiancée) from cervical cancer by staying true to her. By maintaining a monogamous sexual relationship, the man reduces greatly  the woman’s risk of cervical cancer. This is because the risk of infecting each other with the virus decreases if it’s just you two. Faithfulness is healthy.

What the man can do to prevent Cervical cancer in his partner. 

1. Try faithfulness to her. No sexual gallivanting.

2. Encourage her to undergo cervical screening.

3. Help her to stay healthy physically, emotionally, and psychologically.

Let’s keep our women alive and well.

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Lack of monitoring of private hospitals causing harm to patients’ health in Ghana.

 

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At the emergency department (ED), a patient was rushed into the most critical unit with an RBS (blood sugar) of  2.1mmol/L. Patient was 54 years old male accompanied by his wife. He was unconscious.

Patient arrived at the ED in an ambulance with two staffs from a private hospital. After resuscitating the patient, the accompanying “healthcare professionals” were asked certain questions and this is what we found out;

The patient was brought to their facility with difficulty in breathing. Without assessing the oxygen saturation (SPO2) they decided to refer because there was no oxygen in the hospital. No vital signs were checked (Blood pressure, Random blood sugar, pulse, respiration or temperature) and no other assessment was done on the patient. He was just put in an ambulance and brought to another hospital. Patient became unconscious en route to our facility.

At this point I was both disappointed and shocked to witness such, because the man (patient ) would’ve lost his dear life due to gross carelessness and ignorance on the part of these “health professionals” who were supposed to help him.

Now looking at the two young people (a woman and a man)  that brought the patient I couldn’t help but ask who they were;

The lady said she was a nurse but the gentleman with him answered quietly “I’m not a nurse”. Then I asked so who are you? He now says shyly “I’m a cleaner at the hospital, but I help bring patients from time to time when there is no one.”

“Huh! Herrrrrrh! ” was my reaction because I couldn’t believe my ears were hearing right.

A cleaner in the hospital accompanying an unconscious patient to a referral point. This is someone’s father, his wife was right with then but she wouldn’t know a thing because in Ghana everyone takes advantage of the ignorance of the citizens without reproach. He would’ve been dead and these two wouldn’t know anything.

We now took our time to educate “the nurse” who happens to be an unregistered nurse trained on the job. Taught her on the step by step assessment of patients when they are rushed to the hospital. And first steps in managing hypoglycemia.

This is my plight and plea;

1. Ghana has become so cheap a country and so careless of the lives of its citizens that we give licences to people to operate facilities that cater for the health needs of the people but fail miserably to monitor their operations. Some of these private facilities employ cheap labour in the form of unregistered/unlicensed nurses to cause such harm to patients who need genuine care.

There should be proper monitoring of such facilities to ensure quality care and improved health outcomes.

2. Professional bodies like the Nurses and Midwives Council should be proactive in protecting the name and standard of the profession by ensuring registered and licensed nurses are employed in all hospitals and clinics regardless of their private status.

Ghanaians deserve better than this!

So many lives are lost not due to their medical conditions but from such carelessness and ignorance.

Let’s protect Ghana

Better monitoring of health facilities can save lives.

 

 

 

 

 

 

 

 

 

Dear Ghana, we can fight rabies. It is possible : (Findings from the Healthy Pets Healthy Humans Campaign).

In 2015 I witnessed a series of rabies cases in the Emergency department which all ended in the death of the victims.

What all victims had in common were that;

1. They had all experience dog bites.

2. They were all ignorant of first aid after a dog bite.

These patients died basically due to ignorance.

The Healthy pets, Healthy humans campaign was birth after a patient who had sought medical care after the dog bite was given tetanus injection and asked to go home, only to acquire rabies later.

I realized then the problem of ignorance was not just with the people but the health care givers as well. 

The campaign was started in December 2015. This was what we did…

1. We created audio CDs on Rabies education and prevention in the local Twi dialect. The audio included how rabies was transmitted, animals that can transmit rabies, what to do after a bite, signs and symptoms of rabies, etc.

2. We partnered with  some  Assembly men in the Kumasi metropolis who in turn led us to the various information centers. After speaking with them, they played the audio CDs for a week to sensitize the people.

3. After playing the CDs, we organized mass anti-rabies vaccination for those communities.

4. In all three communities were visited for vaccination but the audio was played in five communities. 50 dogs were vaccinated against rabies.

These were our findings after interactions with the people:

1. The people were eager to vaccinate their dogs after they heard the education via the information centres.

2. Secondly, the people were willing to pay to vaccinate their animals contrary to popular belief that Ghanaians wanted free vaccination and there were no funds for that.

3. Most dog owners were discouraged from sending their dogs to the veterinary due to;

a. Long distance from their homes to the roadside.

b. Transportation cost from taking a taxi with the dog to and from the veterinary hospital.

4. Others also did not know the severity of rabies so they never thought it wise to send their dogs.

Thsee are  my recommendations:

1. I believe the education on Rabies should be made paramount to the understanding of the average Ghanaian. Innovative strategies like ours need to be employed to deliver the message to the people.

2. Our health care workers need to be abreast with the management of Rabies and other conditions that frequently present at their facilities. Tetanus as the only treatment after a dog bite has to stop! People are dying when they shouldn’t.

3. Well functioning animal laws need to be put in place and monitored to control and reduce the reckless ownership of animals and stray dogs in our societies.

4. Ministry of health and the Government at large need to start giving attention to quality health education and preventive health as a whole to better improve the health and choices of Ghanaians.

NB: Healthy pets Healthy humans is a campaign that needs to supported adopted by the Government and other stakeholders to be done on regional and national levels to help combat the incidence of Rabies in our dear country Ghana. 

This approach can very well be adopted by other African countries.

It is Possible!

Help me spread the word.

 

How to manage dog bite in the hospital: For the health care givers

The hospital /clinic or health center is a place people come to seek medical help to get better from their sickness or ill-health.  But in Ghana, some health service centers are gradually becoming mere scare crows of what they should be. And instead they are rendering services that are causing more harm to the patients.

One of such harms is the management of patients with dog bites. The trend in most Ghanaian hospitals and clinics is the administration of tetanus injections to people after dog bites and sending them home. 

This act has caused the death of many Ghanaians who thought they had received adequate care after visiting the hospital. The patients who are given tetanus injections end up getting Rabies and then they die.

It is sad to know that these persons took the initiative to go seek medical help but due to the “inexcusable ignorance” of some “health professionals” in Ghana, they lose their lives.

“Tetanus does not prevent rabies after a dog bite! “

So here is what should be done after a patient comes with a dog bite. 

  1. Ask when the dog bite happened. 
  2. Where it happened. Most dog bites that are often reported happen outside of the victim’s home. Some happen in the bush, in the farm, in the vicinity where they live or in someone’s house. Knowing where it happened gives you an idea as to the kind of dog that bit the patient if the dog is a stray dog (which is mostly the case) or has an owner. Stray dogs have a high probability of carrying rabies.
  3. What was done after the bite. The right thing to do is to wash the area affected with soap under running water. But if something else was done, the area should still be washed thoroughly at the clinic with povidine iodine.
  4. Give anti-rabies post exposure prophylaxis. This is an injection given after the bite. It may not be available in some health care centers so if you can’t get it in your hospital or clinic, please write it for the patient to buy from a pharmacy or refer them to another hospital higher than your facility.
  5. Ask them to monitor the dog: If a dog with rabies bites a person,  the dog usually dies after a few days. By monitoring the dog, you can know if the dog has rabies or not.

Let’s learn together to save lives.

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