JKF Journal

HIPAA-Its Negative Influence on Mental Health Care?

2011-09-19T10:48:00.001-04:00

I recently received this letter about HIPAA from a husband who believes it played a role in his wife’s death. I was saddened to read his letter, but grateful to him that he is speaking out in order to do something to improve health care in his wife’s memory. With his permission, we are sharing it with you- the patient safety community- to generate discussion. We would love to hear your thoughts.

Sorrel and the Josie King Foundation

Hi Sorrel:

Nearly three years ago, my wife took her life shortly after an anti-depressant prescription change. She had been treated for depressive illness for several years. The change, a very risky period when psychotropic drugs are consumed, produced dramatic mood changes, a continual desire to sleep and other danger signs all indicated on the manufacturer’s warning label. The manufacturer also stressed that no one should take the medication without the knowledge of family or others close to the patient.

Unfortunately, my wife was essentially alone in her medication program. Although she had told me she was taking anti-depressant and anti-anxiety drugs, I did not know the details of possible side effects, including a suicide risk. Her doctor, who knew the manufacturer’s emphasis on family awareness, failed to advise the family or counsel my wife to make sure I and other loved ones knew the risks and their danger signs. The doctor elected to prescribe the drugs without counsel, citing HIPAA confidentiality restrictions.

HIPAA, The Health Insurance Portability & Privacy Act of 1996, was originally intended to control electronic distribution of personal medical information by insurance companies. It has since evolved to become a much broader restrictive force. My wife had elected confidentiality at the beginning of treatment, assuming it would apply to the content of sessions with the psychiatrist and therapist, not to the details of medication, especially the risk of fatal reactions. Medical staffs receive regular briefings that focus on HIPAA penalties which have created a high level of paranoia among health care providers to the point where they are intimidated from passing essential knowledge to those, especially the spouse, who are in most frequent contact with patients.

Family awareness is arguably most essential because doctor monitoring of anti-depressant medication is undependable, especially during the risky medication change periods. Policy, established by the American Psychiatric Association, requires that medical providers check the patient at least once every seven days. In my wife’s case that was too late. She demonstrated negative reaction the day after prescription change. Doctors expect the patient to call if there is a medication problem before the next appointment. But my wife was in no condition to call anyone. She probably did not realize she was having a reaction. And she was a registered nurse with 40+ years of experience. And I, who noticed her behavioral changes immediately, did not see them as potentially dangerous, and certainly not suicidal. But I had not been briefed. There was no family awareness. My wife was essentially alone as a direct result of misguided HIPAA interpretation.

Before more lives are lost, HIPAA needs to be revisited by Congress and its implementing agency, the U.S. Department of Health & Human Services. HIPAA is going in the wrong direction. It has become a barrier to effective health care.

Disclaimer: These views are those of the author, not those of the Josie King Foundation.

Guest Blogger - "I Want More"

2011-04-15T12:20:00.003-04:00

Hello everybody-

Last month, Sorrel visited the New York College of Osteopathic Medicine to speak to a group of medical students. It was a terrific visit, and we wanted to share a med student's perspective on Sorrel's visit. First year med student Syed Gillani shares some interesting thoughts. Thank you, Syed!

I want to tell you the story of a little girl named Josie King. She had a whole life ahead of her that was drastically cut short due to medical error. Today, she would have been in middle school thinking about her next soccer game, dance recital or sleepover at a friend's house. However, on February 22, 2001, Josie King died at the Johns Hopkins Hospital at eighteen months of age.

Rolling forward to February 9, 2011. It was lunchtime and a Student Osteopathic Medical Association (SOMA) meeting was scheduled. Like all other meetings, people signed in, grabbed their food and settled down in their favorite seats. The speaker was Sorrel King, Josie's mother, and the room was packed. I am not sure whether it was because of our gourmet food or Sorrel King, but I'll let you figure it out on your own. I signed in and sat in the front row, waiting for the speaker to talk. Since I am a SOMA E-board member, I had heard about the speaker's tragedy in and E-board meeting, but did not anticipate how it would play a role in my life.

Dean Scandalis introduced Sorrel King and she took the stage. This confident, professionally-dressed woman started out telling the details of her daughter's death as a result of a medical error. Right from the very first minute of her talk, I felt that she engaged everyone in the audience. I was not an exception. The story was so emotional that my throat started to get dry. Being in the front row, I was sitting very close to all the refreshments, but I could not get up and grab a drink. My eyes were locked on Sorrel and I would not want to be distracted for anything. I felt a different energy in the room than most lunch meetings, and I am sure that I was not the only one in the room who was feeling like that. As I noticed the face of a guy sitting next to me turning red, I knew he was as emotional as I was.

I still remember Sorrel King telling us that during the last days of her life, Josie was thirsty and asking for more water. That helped me to forget about my dry throat, which was bothering me. I cannot imagine the shock and emotional trauma this entire family had to bear. I can tell that Sorrel King has not yet recovered from that loss and, not surprisingly, may never recover fully. I found her to be passionate about patient safety and uniquely aware of the factors that affect patient outcomes.

As Sorrel so insightfully stated, we all go through some sort of trauma sometime in our lives. It ranges from having a bad day at work to losing a loved one. The kind of human beings we are is defined by how we react to these events and the choices we make down the road. Sorrel King turned her adversity into an opportunity to delivery her message effectively. She has made choices that are making a difference in so many lives. She started to dig deeper into her tragedy and found out that 98,000 people die every year from medical errors, making it one of the leading causes of death in the United States. She decided to build the platform that would help to decrease the deaths from this particular cause. She formed the Josie King Foundation (JKF) with the money she received as compensation from her daughter's death....

As we begin our professional lives in medicine, I strongly recommend that you visit www.josieking.org and read all of the information at your own convenience. This information will be very helpful in the future and gives a different perspective of what it means to be a physician. I was overwhelmed to discover how much power I will have based solely on the trust my patients will place in me. As always, power comes with accountability. Since I have a choice, I would rather create my own accountability than have someone else do it for me. I would rather facilitate medical error prevention by acquiring updated knowledge and developing effective communication skills than be externally reprimanded following an adverse event I caused out of ignorance. According to research, communication breakdowns are the most common cause of patient death due to medical error. I have learned that in my future practice, when I am not sure about something, I'll simply ask. I will not let any factor stop me from being a patient advocate. At the end of the day, I may only be able to save one family from their lifelong grief, but that is the priceless reward.

It was after 1:00pm, but few people had gotten up to leave and the room was still silent. Due to time constraints, Sorrel had to wrap up the talk quickly, but she had effectively conveyed her message. I left the room with my dry throat and I was not even able to talk for awhile. I wanted to walk down to Alyssa Bennett, current President of SOMA who arranged this unforgettable event, and ask her (out of necessity, in the sign language my fourteen-month old nephew uses) "I Want More!" I want more awareness and education about the prevention of medical malpractice. I want children like Josie growing up to a rightful old age, having trust in our health care system and processes.

Donating One's Body to Science

2011-03-31T10:23:00.002-04:00

Hello everybody,

Lately we've been thinking about progress in health care- how advanced medical care has become, how we still are working towards even more advancement (particularly with regard to safety improvements), how we got to the point where we are. Knowing that there are a multitude of roads that got us to this point (i.e., evidence-based medicine and its application in the clinical setting, biotechnology, the list goes on and on...), we've recently become interested in the medical advances engendered when volunteers donate their bodies to science. Thanks to these donors, researchers can discover causes (and potentially cures) for diseases and medical students gain essential first-hand knowledge of the human body.

It seems like we don't hear enough of these donors' stories.

Have you considered donating your body to science? Why or why not? We would love to learn from your reasons. If you would like to share your story, please email me at awesol@josieking.org, or post a comment.

Thanks!

Andrea

A New Meaning for Halloween

2010-10-28T08:48:00.004-04:00

I don't particularly like Halloween. I never really have. The candy makes everyone feel sick; the pumpkin carving is difficult even when you have the special little tools; and the costumes- it's just too hard to decide what to be. Three of my children- the teenagers- luckily have sort of outgrown it, except now instead of having to worry about costumes I have to worry about what they are doing as they run around the neighborhoods with a bunch of other teenagers at night. Eight-year-old Sam is still into the trick-or-treat thing. Every year I have grand plans of the two of us making his costume together, and every year we end up going to the "costume express" website where he picks out a costume (which usually comes with a plastic weapon of sorts and probably has a "Made in China" label somewhere on it). We type in a credit card number and pay for express shipping because we put it off until the last minute.

Last year, though, I started to think about Halloween a little bit differently, thanks to a special person named Cindy. Cindy makes Halloween feel a little bit like Christmas here at the Josie King Foundation. I met her a few years ago when I was speaking to a group of doctors and nurses. She was in the audience not because she was a doctor or a nurse, but because her husband died from medical errors in 2008.

I remembered Cindy because after that speech she handed me a sealed envelope with the word "confidential" printed on the front and she had tears in her eyes. I didn't open the envelope until I was on the plane heading home. In the letter she told me about her husband Steve and the medical errors that led to his death.

Steve's birthday was on Halloween. He loved Halloween. Each year, he would decorate his garage with strobe lights, flying witches and scary sounds that reverberated a block away. He loved to sit out front and greet all the neighborhood children who came to trick or treat and wish him a happy birthday. He would give them handfuls of candy, and then he would bring out the good stuff- little scary presents like glow necklaces, flashing teeth and pumpkin pins.

As the first Halloween without Steve approached, Cindy struggled with what to do. Should she go out of town? Should she visit a friend and pretend Halloween didn't exist? She couldn't possibly put on a happy face, greet the trick-or-treaters with a smile and do what her husband was meant to be doing. A part of her wanted to shut the door on it all and just leave a bowl of candy on the doorstep.

That year Cindy read my book Josie's Story. She told me that she felt a connection to the book and to the Josie King Foundation. She knew what she was going to do for that first Halloween. She was going to dedicate Halloween to her husband and to raising awareness on patient safety. She purchased a case of books and placed them next to the bowl of candy. As the trick-or-treaters rang the doorbell she handed them the candy and the little presents, just as Steve had done. Then she took a copy of Josie's Story and handed one to each parent who committed to reading it, and asked that they spread the word on the need to make medical care safer.

A few weeks ago, as the weather cooled off and the leaves in Baltimore began to turn red, yellow and orange, Cindy contacted the Josie King Foundation again. She told us that for this Halloween she would like to hand out Care Journals, our little green book for patients and families to help them track new, complicated medical information during a stay in the hospital. Once again Cindy will follow through with what her husband would have wished- candy and little presents for the children, along with doing what she can to educate her friends and neighbors on patient safety and the need to prevent medical errors.

Thank you, Cindy, for your support and for the generous donation to the Josie King Foundation. Thank you for your work in preventing medical errors. Most of all, thank you for making this a special day to remember Steve- even for those of us who never knew him.

Happy Halloween to you, and to everyone else.

-Sorrel

A Morning with Blue Cross Blue Shield Executives

2010-10-11T12:55:00.003-04:00

Last week I spent the morning in Chicago at the Blue National Summit of the national Blue Cross Blue Shield Association. This conference was unlike any previous conference that Blue Cross Blue Shield had put together. In the past, each separate entity of the Blues- the account people, the marketing people, the information technology people- would have their own separate conference. This year, however, the Blues decided to mix it up. They decided to bring everyone together- 1,100 executives from varying backgrounds all under one roof for a three day conference.

A few months earlier I had been asked to be one of the conference's keynote speakers. I was hesitant to accept. This was not my usual hospital group of doctors, nurses, CEOs. How could I make a difference in the way health insurance executives think about patient safety?

In my efforts to answer that question, I simplified it, as I sometimes have to do in order to understand something. I began to see more clearly that these Blue Cross Blue Shield executives were just a group of people who wanted to help their clients- people like me and 100 million other people: they help pay our bills when we are in the hospital; they don't want us to receive a hospital-acquired infection; and they don't want us to be put into harm's way by medical errors, because these things lead to longer hospital stays or even death.

These executives don't want any of this to happen to their clients because it will cost them more money AND because they are good people. They want their clients to receive quality care, which is what we deserve and what they are paying for- nothing less.

BCBS is a big, powerful company. If I could somehow inspire them to put added pressure on the hospitals to prevent central line bloodstream infections or other medical errors that kill 98,000 Americans annually, then my job and that of the Josie King Foundation could possibly be made easier. They could come at this patient safety work from a different angle.

I decided I would miss Jack's soccer game and Eva's hockey game and I flew to Chicago. Usually when I am asked to address an audience I choose to stand behind the podium because it gives me a little sense of security. But this time I stepped away from the podium and moved closer to the edge of the stage, closer to the audience. I had only one chance, forty minutes to make a difference. I shared Josie's story and I asked the audience for their help. I flew home after the conference hoping that Josie's story had moved them.

That afternoon, the Josie King Foundation began to receive emails from people who were in the audience. They told us that they would remember Josie's story, and that they planned on using the story along with some Josie King Foundation programs to transform their work. That was all I needed to hear. I knew that the trip had been worth it. There would be many other soccer games, but not many opportunities like the one I had been given in Chicago.

Thank you to all of the wonderful BCBS executives who gave me forty minutes of their time last week. Thank you for letting Josie's story into your hearts. Thank you most of all for taking that story and letting it be more than just inspiration. Thank you for your work in encouraging hospitals to provide us with safe care. Please keep up the good work and know that the Josie King Foundation is counting on you.

-Sorrel

Patient Journal App Now Available, Created for You by the Josie King Foundation

2010-09-07T19:29:00.023-04:00

I am so happy to make this wonderful announcement- The Josie King Foundation presents the Patient Journal App, a tool for your iPhone that you can use to record important information related to a hospital stay. Please take your iPhone out of your pocket and go to the Apple iTunes Store. Search for "Patient Journal" or "Josie King" and there it is. (You can also go directly to the app via this link: http://itunes.com/apps/PatientJournal.) You will recognize the pretty Josie King Foundation logo. Go ahead and download it. It's completely free.

Let me tell you a few things about this most wonderful Patient Journal app, which is based on our successful Care Journal. So, there you are in the hospital. You, your child or a loved one is sick. You are scared and confused. You may feel a bit powerless until you whip out your beloved iPhone and click on that pretty little leaf and up pops your Patient Journal.

Each day your Patient Journal prompts you to type in important information like:
-Parking Place: If you are a hospital visitor like me, you are always forgetting where you parked your car in that huge parking lot. Noting it in your Patient Journal app means you have one less thing to remember.
-Medical Team on Duty: Doctors, nurses, aides, therapists- they are all vital members of the medical team. It is nice to remember their names.
-Daily Goals: The medical team has daily goals for their patients (like keeping blood potassium at a certain level or walking ten laps around the ward, for example) and we should be aware of them and do what we can to help.
-Medications: It is important to know what those meds do and what the potential side effects may be.
-Procedures: What is the procedure for? Why did the doctor recommend it? Don't forget to ask for the results.
-Diet: It is a good idea to record what liquids and foods the patient is taking. Some patients need to drink a certain amount of water daily, or slowly work up to eating solids after surgery.
-Questions to Ask: I really like this one. This is where you note the questions that you have for your medical team. It is easy to refer back to this list when the doctors and nurses make their rounds. No worries about forgetting the important questions.

Each day you will keep all of this very important information tucked away safe and sound in your pocket. What could be easier?

Now here is what I REALLY like about the fabulous Patient Journal app. Your husband is out of town and asks you how things are going and instead of having to remember each procedure, each medication, each doctor and nurse (because you are so tired) all you do is whip out your iPhone, open your Patient Journal, enter his email address, and push "send".

Maybe your family physician wants to know how the patient is doing, so you enter her address and push "send". Maybe you want to talk to a specialist on the other side of the country; enter the email address and push "send". Basically, you hae created your own set of informal medical records.

So to all of the Josie King Foundation friends, to all of Josie's Story friends, to all of my friends and family...well, really to EVERYONE who will every be in the hospital please, please, PLEASE use the Patient Journal app. It is a gift from us to you. We hope you like it as much as we do. Please send us your thoughts and comments. Email us at app@josieking.org.

Your friend (who is VERY excited about this project),
Sorrel

P.S.- Many thanks to the super smart team at Spinapse, the terrific software development company that worked with us to make the Patient Journal such a smart, easy-to-use, helpful app.

Summer Jobs

2010-07-13T12:05:00.007-04:00

This summer has been a big work summer for my four children and their nine cousins. I’d like to say it is because their parents have instilled in them a good, firm work ethic, but the truth of the matter is that I think it is all due to their beloved and very generous grandfather (my father) Pop Pop.

At the beginning of the summer Pop Pop sent a letter to each of his grandchildren telling them the importance of summer jobs and saving money. Pop Pop is wise enough to know that simply saying “get a job” does not always translate into getting a job. He added a tasty little carrot, a P.S. that said, “For every dollar you earn, I will match it. If you make $20, I will give you an extra $20”. He explained that part of the deal was that they each had to email him a work log which included a description of the job, the dates and the amount earned. He set a deadline- the first of each month. If the deadlines were not met, then there would be no match.

And so the summer began with Pop Pop’s thirteen grandchildren scrambling to find jobs, and the emails began flooding his inbox. Benjamin landed a construction job in Washington D.C.; Jack worked on a farm digging post holes and baling hay; Lee put together a summer camp; Relly and Eva painted the garden fence and Sam stuffed envelopes for the Josie King Foundation.

Stokes (15) and Andrew (14), my two nephews who live in Virginia, came up with a particularly interesting money making scheme. They named their enterprise A.s. You Like It Car Care. (The “A” stands for Andrew and the “S” stands for Stokes. I asked Andrew why the “A” was upper case and the “S” was lower case. He said he designed the logo, and that’s why the “A” was upper case.) They sent flyers to all of their neighbors and friends. They bought car cleaning supplies. They set up a table with magazines and lemonade. Then they turned on the hose and started scrubbing.

On the lemonade table was Josie’s Story and information about the Josie King Foundation. They told each customer that 30% of all the proceeds would go to benefit the Josie King Foundation. As they scrubbed they answered questions about their little cousin who died nine years ago from medical errors and they explained the Josie King Foundation and why they supported it.

I received a check a few days ago from A.s. You Like It Car Care. I want to thank Andrew and Stokes for being so creative and clever and, most of all, for being so generous and thinking about not only the bikes they are saving up for, but also for thinking about the Josie King Foundation.

Thank you also to Pop Pop for inspiring his grandchildren to put in those extra long hours of hard work.

To all of his grandchildren—keep on working. Just six more weeks until summer ends.

-Sorrel

A Thank You to Nurses

2010-05-12T10:42:00.003-04:00

[Sorry for the delay in getting this up. We ran into some problems with Blogger, our blog host. Thanks for understanding!]

Over the years throughout my journey into the health care industry I have been lucky enough to meet hundreds of nurses, maybe even thousands. Sometimes they pick me up at airports and drive me back to their hospitals. They give me hospital tours, taking me from floor to floor, introducing me to their nurse friends along the way. I have lunch with them. We sit in meetings together. Most of the time I meet them at patient safety conferences where I am a speaker. The nurses are the ones sitting in the front rows, who come up to me after I speak, shake my hand, give me a hug and tell me their own stories of medical errors. They tell me about their patient safety work- the things they are doing to make care safer on the unit.

I am grateful to nurses for many reasons, first of all, for the simple fact that they are nurses. They wake up each day and go to work with one goal in mind- to make someone's life a little better. They work long hours and are on their feet all day or all night. Sometimes they are short staffed and have to work extra hard. They are being pulled in a million different directions, but they seem to do it all with a smile on their faces. Wherever I go, I always come home with little tidbits of wisdom that I pick up from the nurses I have met:

-When you are on your feet for long hours like they are, the most comfortable shoe is a good quality tennis shoe. The Skecher brand is a favorite, especially the kind with the curved sole. Several nurses I've met call them "butt-lifters". I bought a pair for myself and have not noticed the butt lifting aspect of them, but they are very comfortable. Birkenstocks are also popular, as are the Dansko clogs, which seem to be worn more often by the OR nurses than the floor nurses.

-When I was in Ohio I met a nurse named Mary. She had the prettiest, whitest teeth, so I complimented her on them. She laughed and told me she used the Crest Whitening Strips. A week after I returned from my visit she sent me a package with a box of the advanced formula strips. I'm not sure if she sent them because she thought I needed them or just to be nice- maybe a little of both. I have been using them everyday for a month now, and I really do notice a difference.

-Once I was at lunch with some nurses in Dearborn, Michigan. Chris, the nurse next to me, asked how I was doing with all of the travel and work. I told her I was trying to step back from it all and that I hated leaving my family and that even when I was home I felt like I was working all the time. She suggested that I bake cookies when the children come home (it makes the house smell good and homey), put a flower next to the computer (so I could have something pretty to look at when I work), and to start using a crock pot (to save time on cooking healthy meals for my family). I did all of the things she told me to do, and I continue doing them- except for the crock pot thing. That never really worked out for me. Maybe I need to ask her for some good recipes.

-Sometimes when I am visiting hospitals there are medical terms I don't understand- like c. diff or BPOC. My nurse friends always give me a thorough, easy to understand explanation.

-Nurses have taught me how to deal with stress and difficult situations. Exercise and reflecting on what went well, what didn't go so well, and what can be done to make things better tomorrow are just two of the many recommendations they have shared with me over the years.

If I could do it all over again, I would like to join the ranks of this very noble group whom I greatly admire and who have taught me so much, not only about the health care industry, but also about life.

Thank you to all of the wonderful nurses who inspire us to be better, stronger, happier people. Thank you for all that you do for patients and their families. Thank you for your friendship to me and the Josie King Foundation. You are an honorable, humble, smart, wonderful, fun-to-be-with bunch and I am lucky to have met so many of you.

Happy Nurses Week.

Many thanks,

Sorrel

What to do with condolence letters?

2010-04-09T08:22:00.003-04:00

A few weeks ago a friend told me about a book called The Happiness Project by Gretchen Rubin. It was a clever little book with lots of tidbits on things that make us happy- one of which was doing something that you have been putting off for a long time, like putting together scrapbooks. Each of my children has a baby book except for Sam, who is now eight years old. His book was my first priority. So, feeling inspired by The Happiness Project and knowing how great I would feel if I completed this nagging task that I had been putting off for years, I gathered the boxes of pictures that had been sitting on a bookshelf. Then I went into every room in the house and gathered the stragglers- the pictures the children had snagged from the boxes over the years. I put them all in the dining room and started sorting and filing just as The Happiness Project suggested. After a little while Sam and Eva came to hep. Jack moved his homework into the dining room and we all started going through the pictures.

One of the boxes contained the condolence letters that people had written to us when Josie died. I had not looked at these letters in over eight years. Eva, who is now twelve, started looking through some of them. She was three when Josie died and I don't think she remembered much. I watched her as she read one and then another. I wanted to somehow casually take the letter from her without making a big deal. I didn't want her to read them. I didn't want her to know about all of that horrible, sad, grieving condolence letter stuff, but I didn't take them away. I let her read. After reading a few she dumped them all out and put them in a neat pile, and then went outside to play basketball with Sam.

I picked up the letter she had placed on top of the pile and began reading. It was as if the piece of paper had come to life. The words threw me right back to those awful weeks and months. It all came back- that horrible feeling of loss and helplessness. I put the letter down and looked at the pile and then I looked over at the fire burning in the fireplace. I wanted to lay them one by one in the flames and be forever done with all of that sadness. I decided that before I destroyed the letters I needed to think about it first.

I've been thinking and pondering for the past week and I still don't know what to do. I've even asked other people their thoughts on the subject. What happens to condolence letters? How long should we save them? A part of me wonders if it would be healthy to get rid of them, to close the door on that part of life. Why save something that brings back such sad memories? It's not like they are photographs- snapshots into a life that once existed. Those I would never throw away. The letters are just pieces of paper with sad, depressing words- words I don't want to read again.

But then a part of me thinks I should let them be, and I don't know why. Would my children ever want to read them? Would their children? I don't know. I decided I should ask my husband Tony. His response: "I never knew we still had them." In his mind they had been tossed years ago. Hmmm, this seemed like more of a reason to get rid of them.

I needed to ask another mother who lost a child. My friend's son died twenty years ago. She had kept the condolence letters in a box in the attic and never read them. Every few years, she would go to the box, take a handful out, and put them in the trash. Five minutes later, she would go back to the trash, pull them out and return them to the box in the attic. "I don't know why I do that," she said. "It just feels weird throwing them out."

I'm still sort of wondering what to do. The letters are upstairs in the hallway waiting to be placed back in the attic for another eight years. Or perhaps they will go into the trash. The Happiness Project does say to get rid of clutter, but maybe clutter is not the right word here. The letters are a different type of clutter which I can't quite explain. For now, I walk past the box of letters in the hallway and wonder what other people have done with theirs.

Visiting Excela Health

2010-03-29T10:36:00.005-04:00

A few days ago I went to Pennsylvania to speak at a patient safety event sponsored by Excela Health. It was a pretty drive- through Maryland, across the Appalachian Mountains, and then into the Allegheny Mountains heading through Southern Pennsylvania. As Tom the driver and I drove deeper into central Pennsylvania, we passed through little towns- Breezewood, Somerset, Ligonier. I imagined these were old mining towns that were once bustling with life and growth. I was sad to see so many empty storefronts with "For Rent" signs in the windows.

Latrobe, Pennsylvania, was my destination. Tom is a history buff and with every trip we go on he always does a little research and shares his interesting tidbits with me. Fred Rogers (of "Mr. Rogers' Neighborhood") grew up in Latrobe, and so did the golfer Arnold Palmer. Plus, the banana split was first created in Latrobe.

The great people of Excela Health organized a wonderful event: a reception at 5:30 pm with delicious food, my presentation at 6:30, and a book signing to follow.

There were a couple of things that made this event stand out for me:

-It was held in the Fred Rogers Center - a beautiful facility donated by Mr. Rogers' family. There were glass cases that held Mr. Rogers' famous red sweater and blue coat, his blue sneakers and loafers, and the puppets- King Friday and Lady Elaine. All of this notes- yellowing and faded- that he had written for the shows were displayed in the cases. I am 44 year old. I grew up with Mr. Rogers, so it was fun to see all of this.

-Excela did something that most hospitals- at least the ones at which I have been invited to speak- have not done before. They opened up the event to the entire community. It was nice that they recognized that this topic- patient safety- was not just for the health care industry. It was about getting the patient and the family involved. This was something that I had wanted to see for many years and it was a thrill to finally be able to speak to not only health care providers, but regular people just like me.

-The book signing began much like the others. I wrote notes and signed books for doctors, nurses, board members, administrators. Then I began seeing young (really young) faces- students who were in medical school, nursing school and even students who were in high school. A young boy with a baseball cap and jeans that hung low on his hips handed me the book and said, "I think I might want to be a doctor one day." I wrote a long note to him and handed him back the book. He read the note and then stuck his hand out to shake mine and said, "Thank you, Mrs. King."

It was great to meet these young, fresh, bright minds and I am honored that they took time out of their evenings when they could have been doing homework, playing sports, chatting on Facebook, or watching TV to come hear me speak and buy Josie's Story. They will read the book and I hope their dreams of becoming doctors and nurses will come true. I believe if they do, they will always remember Josie.

Thank you, Excela Health, for all of your great patient safety work. Thanks, too, for a wonderful evening. Most of all, thank you to all of the students who came to hear me. Study hard and become doctors and nurses. You are the next generation, the new culture. YOU will make a difference in the lives of many.

-Sorrel

Getting a Grip on My Fear of Flying

2010-03-24T07:53:00.003-04:00

I've never really liked flying. As I've gotten older, my fear and dread of flying the friendly skies has only gotten worse. I'm not sure why that is- maybe it's because my children have already suffered the loss of a sibling and I just don't want them to have to suffer another loss. Since my book Josie's Story was released a few months ago, my time spent on airplanes has increased dramatically. I've been to twenty-five cities in the past seven months. Any chance I can hop on a train (which is not too often) I take it.

The plane lifts off, and it's the same every time. My hands are sweaty. My mouth is dry. My stomach is in knots. As the plane continues to list itself further and further away from the ground I am certain that soon it will decide that the load of passengers, bags and highly flammable gas is too heavy and the only thing to do is to plop to the ground and explode into a ball of flames. Once the plane levels off and the stewardesses begin serving drinks, I settle down a little until I feel the slightest bump or hear the faintest out-of-the-ordinary sound- surely an engine malfunction- then my panic attack starts all over again. When the plane lands I always give the pilot a little smile and say thank you. I am grateful and I am exhausted and my trip has just begun.

Not long ago I told myself I was either going to give up the travel (which meant giving up the book tour and my work with the health care industry) or I had to get a grip on the situation and find a way to deal with it. I decided I would face the problem head on and try to fix it myself before I went the route of seeing a shrink (which I had no time for) or taking some sort of medication (which I didn't want to do).

So after seven months of frequent air travel, here is how I deal with my fear of flying:

-When I am buying magazines in the airport before my flight, I say to the cashier, "I hope my plane does not crash." If the plane were to crash, it would be too weird of a coincidence for the cashier lady. A coincidence like that must be highly unlikely, therefore I am decreasing the chances for the plan to crash. A few flights ago, I decided this strategy was a bit odd (particularly for the cashier at the Hudson News store at BWI), so I no longer use it.

-If I can't find someone to talk to during takeoff I read my "People Magazine". It is easy to read and entertaining enough to get your mind off of what is happening. I also chew two pieces of Orbit chewing gum.

-Leaving a little work undone that absolutely MUST be done before arriving at your final destination forces you to focus on something else.

-Listening to good music helps block out the scary noises of the engines.

The thing that really helps the most is the realization I came to thanks to the wise words of my English friend who flies often from London to the States. She mentioned that her most recent flight took eight hours longer than it should have. I asked her why. She proceeded to explain that two hours after take-off they had to return to Heathrow because of a high terrorist alert that had just gone into effect. After another few hours of searching the plane the passengers re-boarded and once again headed west across the Atlantic.

What struck me about her story was not just the story itself, but rather the way she told it. It was as if she were telling me about a trip to the grocery store.

"Weren't you scared?" I asked her.

"What is the point of being scared and getting worked up when you have absolutely no control over the situation. It is an absurd and ridiculous waste of precious energy," she said in her beautiful English accent. "When it is your time to go, it is your time to go. You can't control that, so why waste your energy worrying?"

What she said made sense. Getting worked up, being afraid does not prevent the plane from crashing. It IS pointless. It IS a waste of energy. She was right. When it is our time to go, we go and we can't control that. We might as well just relax.

So I read my "People Magazine", chew my gum, listen to my iPod, and do my work that absolutely must be done before I arrive at the next city. I don't mind sitting by the window anymore. Sometimes I even lean against it and look past the five inch-thick piece of metal and plastic that separates me from the 30,000-foot drop. I look down at all the little houses with the little swimming pools and the little, tiny cars that travel on the little, grey strips of road and I think how pretty it all is.

I am no longer exhausted by the flights. I am actually quite productive. I get my work done; sometimes I even get extra work done. I read the newspaper or books off of my beloved Kindle. I get geared up for the next city, the next group of amazing nurses and doctors- or better yet, back home to my family in Baltimore.

Care Journals Back in Stock

2010-03-17T10:37:00.003-04:00

Hello everybody-

I'm happy to report that Care Journals are back in stock. Anybody who requested a Care Journal and was put on the wait list will be mailed their Care Journals next week.

Email carejournal@josieking.org or awesol@josieking.org with any questions that you have about the Care Journal.

Thanks!

-Andrea

Indiana - Working Together to Eliminate Health Care Acquired Infections

2010-03-04T10:30:00.003-05:00

On Tuesday I spent the day with doctors, nurses and health care administrators from all around the state of Indiana. These health care providers had come to Indianapolis to attend a leadership conference put on by the Indiana State Department of Health.

The first ISDH leadership conference was in 2007. Seven hundred and twenty people came. This year, over 1,000 people participated. Preventing health care acquired infections was the focus of this meeting. It is a timely and important topic. Just last week, the Archives of Internal Medicine released a study showing that hospital acquired sepsis and pneumonia killed 48,000 people and cost $8.1 billion in extra health care costs in 2006. These are just two of the many hospital acquired infections that harm patients. The CDC estimates that there are 1.7 million health care acquired infections annually, and 99,000 patients die each year because of them.

This is a subject that means a great deal to me. A hospital acquired infection played a part in my daughter Josie's death. This was a conference I needed to be a part of.

I have always enjoyed statewide collaborations on patient safety. It is exciting to follow the journey of a group of health care professionals from different facilities coming together, sharing information, helping each other achieve a goal that they all have in common. I had seen this happen in Michigan, Tennessee, and North Carolina. Now I hoped to be able to watch Indiana- a state I had been to three times in the past seven months (with two more visits scheduled in the next two months), a state where I was meeting hundreds of amazing health care providers, a state I was becoming very fond of- tackle this problem.

My job was to kick off the meeting. My goal was to inspire these health care facilities to join in this statewide collaboration. It would mean hard, hard work for those that signed up. It would mean reporting every single, ugly, little hospital infection that occurred- full, scary transparency. The ISDH had funding for some of the facilities to partake in this 18-month effort to reduce health care associated infections. I wanted them all to sign up, and I hoped that if that happened that somewhere, somehow the ISDH could dig up the extra funding.

I made the most of my 45 minutes speaking to the group. I hope I did a good job. I think I might have, but I won't feel satisfied with what I did until I know that the collaboration is in full swing with a full load of facilities signed up and chomping at the bit to fix this problem.

Thank you, Indiana, for letting me be a part of such an important day. Keep up the good work. I'll be rooting for you.

-Sorrel

P.S.- The ISHD had copies of my book on hand during the lunch break. I enjoyed meeting so many wonderful people (mostly nurses) and I enjoyed having the honor of writing notes to them in the front pages of Josie's Story. I am glad that there is a memory of Josie left behind in Indiana because I know her story will help push them the extra mile. Unfortunately the books sold out. To those who stood in line and did not receive a book, you can learn how to get a signed copy on our website. Thank you.

"Josie's Story" a National MS Society Books for a Better Life Winner

2010-02-23T06:14:00.004-05:00

Last night, the National MS Society chose Sorrel's book Josie's Story as the winner in the "First Book" category of their Books for a Better Life Award. Many thanks to the New York City - Southern New York Chapter of the National MS Society for this honor. The recognition came on a particularly poignant day, as yesterday was the ninth anniversary of Josie's death. Thanks again to the National MS Society, and everybody who has read and shared the book.

For more information on the Books for a Better Life Award and the National MS Society, visit their website.

Care Journal on Back Order

2010-02-03T10:32:00.003-05:00

Hello everybody-

The Care Journals are currently on back order. We hope to have Care Journals back in stock in late February. We are adding requests for Care Journals to a wait list, and will ship Care Journals as soon as we can.

Please continue to email your questions or requests to carejournal@josieking.org during this time.

Thank you for understanding.

-Andrea

50 Influential Women

2010-01-11T07:42:00.002-05:00

Hello everybody-

Sorrel has been named one of 50 influential women who are changing the world by Woman's Day magazine.

Read Sorrel's story and see the entire list here.

Thanks to Woman's Day for this honor!

-Andrea

Shipment Notice for 2009

2009-12-10T07:50:00.003-05:00

Hello everybody-

The last shipment of 2009 will be mailed on Thursday, December 17. Requests received by 4:00 pm EST on Wednesday, December 16 will be included in the shipment. Requests received after 4:00 pm EST on Wednesday, December 16 will be shipped in January 2010.

Affected items include:

"The Josie King Story" DVD
Signed copies of Josie's Story
Care Journal (small quantities only)
Nursing Journal (small quantities only)

We may be able to facilitate bulk orders of the Care Journal and Nursing Journal through the end of December. Please email Andrea at awesol@josieking.org if you are interested in learning more details.

Thanks for understanding!

-Andrea

"Josie's Story" named a top health book in 2009

2009-12-08T14:37:00.005-05:00

Hello everybody-

Josie's Story has been chosen as one of the top health books in 2009 by the Wall Street Journal's Laura Landro!

Her description of Josie's Story plus the other books honored can be found online: http://tinyurl.com/yfu6xgu.

We'll be reading some of Laura's other interesting choices.

Thanks for the acknowledgement!

-Andrea

Sorrel's Visit to Richmond, VA

2009-10-26T10:48:00.003-04:00

Hello everybody-

On Tuesday, October 27, Sorrel is visiting her home town of Richmond, VA, for a book event:

St. Stephen's Parish Hall
6000 Grove Avenue

6:30 pm - 8:00 pm

Sorrel will discuss her book Josie's Story, and the medical errors that led to her daughter Josie's death.

If you are interested in attending, please RSVP to awesol@josieking.org.

Thanks!

-Andrea

Josie's Story Excerpt on Oprah.com

2009-10-21T12:18:00.003-04:00

Hi everybody-

Just wanted to share some exciting news: there is an excerpt from Sorrel's book Josie's Story now up on Oprah.com. Please click to read it, and share the link with anybody you think might be interested.

Thanks!

-Andrea

At the Ivy Bookshop

2009-09-23T15:07:00.003-04:00

Last week I had a book signing at the local Ivy Bookshop in my hometown of Baltimore. The Ivy- wedged between a Blockbuster and a men's clothing store just a mile from my house- has been a part of my book journey from the very beginning.

I had fallen into a good routine with the writing- after dropping the children off at school I would sit down in front of my laptop and start to write. It took about four hours of writing before the silence would start to bother me and the loneliness would set in. It was then that I knew I needed to head to the Ivy. It felt good to be surrounded by the books that covered every possible inch of the little store. I would usually buy a book, but the real reason I was there was because of Bonnie, Shirley, Alice and Greg. Every time I walked into the store they would ask me how the book was coming and they would say, "One day we will have a book signing party for you."

For a long time no one knew I was writing a book. But my friends at the Ivy did, and for two years they encouraged me and pushed me along. I never thought the day would come when my book would be lining the Ivy shelves, much less find a place in the front window, but it did. As Josie's Story tiptoed into the world, the book events began to fill my calendar- with the Ivy event set for Sunday, September 13.

I wasn't sure what would be worse: standing in front of 1,000 health care professionals- total strangers- or standing in front of the community in which I lived. What if no one showed up? What if they hated the book?

The Sunday afternoon was beautiful- not too hot. The sun had lowered itself behind the building just enough to provide the perfect amount of shade for the guests who sat outside in chairs that were lined up amphitheater-style. Tables of food surrounded the edges.

Dr. Peter Pronovost- a doctor from Hopkins who over the years had not only become a partner in my quest to improve patient safety, but had become my friend- introduced me to the guests. As I had seen so many times before, Peter captivated the audience with his brilliance, his charisma and his humility.

I had jotted down some notes on what I was going to say, but as I stood behind the podium I realized that I didn't need my notes. These were my friends, my family. I've learned that sometimes- actually, always- it is best just to speak from the heart. It does not matter who is in the audience- whether it is a large group of nurses and doctors or a small group of family and friends. All that matters is the message. If you have a message that you are passionate about, it will just sort of find its way from your head, through your heart, and right on out into the world.

I signed books with Sam my seven-year-old by my side. Friends would ask him to sign his name next to mine. With a black Sharpie pen gripped tightly between his little fingers, he concentrated hard and signed his name in perfect Calvert script. It became a book signing not just for me, but for my entire family with Jack, Relly and Eva filling requests to sign their names alongside Sam's. This was not just my journey. This was their journey, their story.

Thank you to Darielle Linehan and the Ivy Bookshop for getting so behind Josie's Story. Not only did they put on a beautiful event, but they also agreed to donate a portion of their proceeds to the Josie King Foundation. The little Ivy Bookshop is truly a bookstore with a heart- a BIG heart- and a desire to make a difference in people's lives.

Thank you to Peter Pronovost, whose work continues to transform health care for us all.

Most of all, thank you to my family and friends for coming out to support Josie's Story.

Watch Sorrel on NBC's TODAY Show

2009-09-21T11:08:00.003-04:00

This morning, Sorrel appeared on NBC's TODAY Show with Matt Lauer and Dr. Nancy Snyderman. They discussed the problem of medical errors, and Josie's Story.

Click to watch a clip of the interview.

Thanks!

September 8th - Official Book Release of "Josie's Story"

2009-09-08T04:06:00.004-04:00

My book Josie's Story has been in stores for a number of weeks, however today- September 8th- is the official publication date. It is now in stores nationwide- 20,000 hardback copies in Barnes and Nobles, Borders, Amazon.com and book stores in little towns and big cities all across America and Canada.

September 8th has been on my mind for many months. Will I regret having written the book? Will I regret having Josie's story- my family's story- out there for everyone to read? Did I do a good job? Will people like it? What if they hate it? I have decided that I cannot worry about those things anymore because they are now out of my hands. I will simply cross my fingers and hope that people will like the book and hope, hope, hope that the book will perhaps make a difference in someone's life- a mother who has lost a child, a nurse who is finding a way to speaking up and prevent a medical error, a patient who is in the hospital bed and is not sure about the medication that is about to be administered.

It took me four years off and on to write the book. When I signed the book deal with Grove/Atlantic two years ago it was no longer off and on. I learned that deadlines are good things. It was a long, sometimes lonely, two years of writing with some ups and downs along the way. When my editor told me the whole thing needed to be restructured, I wasn't sure how I would do it. But I trudged along, knowing that I had to do the work. I had to get to September 8th and I had to do a good job.

In a few days I will pack my bag and leave my family, whom I have never left for more than a day, for an entire week. This will be the beginning of a Fall book tour. I will travel to hospitals around the country and do my best to inspire doctors, nurses, pharmacists, risk managers, and CEOs, to continue their essential work on the patient safety front. At each event Josie's Story will be available. I look forward to spending time with the many great health care providers I will be meeting.

I am ready for the second part of the book journey. I hope this part of the journey will further raise awareness about medical errors and patient safety, further inspire health care providers and further educate patients and their families. But most of all I hope people just like Josie's Story.

I look forward to reporting in after my travels.

From the Institute for Family-Centered Care Conference

2009-09-04T04:51:00.005-04:00

Hi there-

In August, Sorrel had the opportunity to attend the Institute for Family-Centered Care's 4th International Conference in Philadelphia. The Institute for Family-Centered Care (IFCC) is a non-profit working with patient advocates and health care providers to improve care delivery. Sorrel was honored to deliver the closing plenary address. IFCC hosted two book signings in support of Josie's Story. Sorrel loved meeting with the dedicated conference attendees, who are going back to hospitals all around the country and work to strengthen productive partnerships between families and health care providers. Thank you to everybody who stopped by the book table.

Here are two pictures from Philly:

Photo Credit: Institute for Family Centered Care

Thanks to the entire IFCC's team- with a special nod to Bev Johnson and Julie Ginn Moretz- for their hard work in creating a meaningful, successful conference!

-Andrea

P.S.- Come back next week for a special note from Sorrel.

Parents the "Missing Link" in Patient Safety Efforts

2009-08-04T04:42:00.004-04:00

Hello everybody-

A fascinating new report on the role of parents in pediatric patient safety efforts is published in the July 30 issue of Journal of Hospital Medicine (paid registration required). A summary of the article is available through the University of Michigan.

Beth A. Tarini, MD, MS, assistant professor of pediatrics at the University of Michigan Medical School, and her co-authors Paula Lozano, MD, MPH, and Dimitri A. Christakis, MD, MPH, of the Seattle Children's Hospital Research Institute, looked into parents' perceptions of medical errors, patient safety, and communication. They found that nearly two-thirds of parents felt that they had to closely oversee their children's hospital care to prevent a medical error from happening.

Interestingly, parents who reported a higher level of confidence in communicating with the medical team were less likely to be worried by the potential for medical errors.

Dr. Tarini draws an important conclusion: "We need to address parents' concerns about errors and find ways to make them feel comfortable talking to us about their child's care. Parents are an underutilized resource in our efforts to prevent medical errors."

I can't echo Dr. Tarini's sentiment enough. While some parents are trained medical professionals, most are not. But parents- because of their close relationships with their children- are often able to sense important but subtle changes in their children's conditions. Parents are more than visitors. They have the potential to meaningfully contribute to their children's medical care. Time has come to harness that potential.

-Andrea

JKF now on Facebook!

2009-08-04T04:27:00.004-04:00

Hello everybody-

First Twitter, now Facebook!

The Josie King Foundation now has a presence on Facebook. Please check us out and link to us.

Thanks for your support!

-Andrea

Summer Shipping Details

2009-07-20T08:49:00.004-04:00

Hello everybody-

Just a quick note to let you know that there will be a shipment of "The Josie King Story" DVDs and single copies of the Care Journal going out on Wednesday, July 22. If you would like a copy of either the DVD or the Care Journal soon, please email awesol@josieking.org by 5 pm EST on Tuesday, July 21.

Requests received after Tuesday at 5 pm will be shipped the week of August 14th.

We will still be able to process bulk Care Journal requests during this time.

Thanks for understanding!

-Andrea

"The Josie King Story" DVD is back in stock

2009-07-13T08:50:00.002-04:00

Hello everybody-

Just a note to let you know that "The Josie King Story" DVD is back in stock. Email dvd@josieking.org to order a copy. Thanks for your patience!

-Andrea

Josie King Foundation now on Twitter

2009-07-01T10:59:00.002-04:00

Hello everybody-

I'm happy to report that the Josie King Foundation is now on Twitter! You can follow us at www.twitter.com/jkfaw.

We're looking forward to connecting with the patient safety community here.

How do you use Twitter?

-Andrea

More Great Advice from Nurses

2009-04-16T11:36:00.004-04:00

Hello again-

The rejuvenating tips from nurses on how to cope with work-related stress keep rolling in. I just wanted to share the latest bits of advice with you.

Keep 'em coming! Keep spreading the word about this project!

-Sorrel

"I de-stress by dancing at least once or twice a week. I love dancing - it is something that helps keep me sane and gives me something to look forward to outside of work. One tip for work stress: Don't take things personally. If a patient/colleague/family member/MD snaps at you, it's not you - they are stressed out too. I find laughing defuses the situation - it helps them relax. It also prevents me from getting angry - which would just escalate the situation. Yeah, don't take things personally is the best advice I've been given. I also vent to my nursing colleagues - it helps to know that other people are sharing your pain." - C. Rae

"Take a moment everyday to reflect on what went well, what didn't go so well, and what you can do better tomorrow.

Always take a moment to take a deep breath when the world is moving quickly by you and you can't keep up. Who knows your speed might be what everyone should be moving at throughout the day.

Baking fresh treats for your co-workers is the best medicine and always makes a nurse's day brighter." - Sheryl C., RN, MSN, Washington, DC

"I find that in order to care well for others, I must first take care of myself. Without my health, I wouldn't have the strength to perform the hard work nursing requires. Daily exercise and good nutrition are essential to helping me cope with stress. I love group fitness classes, weightlifting, and 'clean' eating!

I also set aside one night a week to relax and have a date night with my husband." - Kathryn A., BSN, RN, South Lyon, MI

"As a NP I try to remember to always thank everyone for helping me to help my patients. It really is a group effort. And thanking people is a great way to defuse stress as it makes people feel appreciated. Surprising the staff every once in awhile with cookies or another treat goes a long way to making people feel appreciated. Praying with patients and staff is a great way to lessen stress." - Kimberly B., MSN, CRNP, Pittsburgh, PA

"I know that it sounds sappy but...I try to appreciate all the good things, my family, my health, my job, etc. I don't want to be in the position (like some of my patients and families) of having regrets (the could of, should have syndrome) in life. I am not waiting for retirement to care for myself, to tell my husband or children that I love them, or to just be in the moment. Life will probably always be too short but my glass is more than 1/2 full." - Maureen

"I find good friends to be the best stress relief. I love my coworkers and we go out regularly to debrief about work and personal lives. I also value my non-nurse friends that I don't talk about work with. They help me remember there is more to life." - Anonymous

"We go through so much each day. I have been a nurse for many years, most in the Baltimore area. What really helps me is thinking about how the families and patients feel, particularly after losing a child. Sometimes we get so wrapped up in the technology and what we have to get done each shift. However, when I start feeling that way, I think, if this was my family, how would I feel and what can I do to make it better. That is how I cope." - Joanne M., RN, MSN, NE-BC, FABC, Newark, DE

Nursing Project Update

2009-03-28T04:30:00.007-04:00

Thank you to all of the nurses who sent us their words of wisdom on how they deal with work-related stress. We are compiling these tips into a toolkit specifically for nurses. This project is under development.

Below this note are some of the great comments we have received. Please take a look. I hope you find them as helpful and inspirational as I do. Please, please keep the comments coming and spread the word to other nurses who many have a helpful tip they want to share. Remember, you can post your advice directly on the blog, or you can send an email to nursing@josieking.org.

Thanks, too, to everybody who has helped us spread the word about this project. Your efforts are really making a difference!

-Sorrel

"Having spent most of my nursing career working in Adult ICU, I find that staying 'grounded' literally helps keep me sane! I like to spend time outdoors - whether trout fishing on a beautiful stream or lake, working in my yard or garden, or just taking a walk really helps puts things in perspective. I especially find sharing time and talking with my family helps maintain balance." - Tamma

"I think my staff is just the greatest. When our work life becomes very challenging I like to have lunch with the staff and catch up on what is happening in their home life. It does help maintain balance. We have mini "Lunch and Learns"; we lunch and learn that life does not have to be all serious." - Mary Ann, Pittsburgh, PA

"One of the things that I feel has the most impact on helping nurses to cope with the everyday stress is the fact that we are a team of professionals and when push comes to shove, stand together and help each other - basically we are each other's counselors. We openly discuss our feelings with our co-workers and cry together while giving each other hugs and letting each other know we are here and that we all understand what each other is going through. That kind of support is not felt in many other professions. We are a team of support and care for all!" - Tracy N., RN, BSN, MSN, Pittsburgh, PA

"Learning to de-stress, by spending time with my daughters or just me by reading a good book or going for a run with my dog. In my dream world every healthcare facility would have a gym and a massage parlor to help encourage all healthcare workers to take a moment to de-stress so we can think clearly." - Kimberley S., RN, Ontario, Canada

"I try to look for the humor in an otherwise difficult situation, to make myself laugh and others laugh, and to remind us all to not take ourselves TOO seriously. Laughter IS the best medicine and a unifying force in the midst of stress." - Sue

"I'm an optimist and try to maintain that optimism while working in a 'negative' or stressful environment. I like little quotes that I can hold onto. Sir Winston Leonard Spenser Churchill states, 'A pessimist sees the difficulties in every opportunity, an optimist sees the opportunity in every difficulty.' Thoughts like Churchill's keep me going. Here is another one: 'In order to succeed, your desire for success should be greater than your fear of failure,' from Bill Cosby." - Laura S., Lewes, DE

"I love to sew- especially baby quilts or crafts. While I'm sewing, I'm thinking about the new baby- and am always amazed by the miracle of new life and I know I have the opportunity to touch 'life' while I work. I am filled with wonder!" - Anonymous

"As a pediatric nurse, some days are definitely better than others. When the stress seems like it has taken over my life some strategies I use to cope include; having a good hearty belly laugh in the company of good friends, taking a trip to the playroom for some BINGO with the kids during a break, and remembering to step back for a minute to remember WHY I am a nurse and what my purpose is." - Alicia

"I recently started beading and I love to see what my imagination can create. I also have done scrapbooking for many years. I love to recall the memories of the event. I have recently been asked to teach scrapbooking to middle school age children who attend after school activities programs." - Lori

"I started exercising. Now to burn off stress, I run. In fact, I am running my first 5k this spring. I am also a bit (45 lbs) lighter, which is great, too. I feel so much better now that I have consciously taken my stressors off of me." - Elizabeth, Michigan

"Exercise always makes me feel best - I love riding my bicycle and get together with a co-worker that lives close by. We'll get together and chat and ride at the same time. I belong to a hiking/biking group. If I can get to a hike or ride once a week, I'm happy. The rest of the time is spent walking my dog when I have time to get out." - Dorothee K., Pittsburgh, PA

"I think stress relief depends on the energy needed to be expelled or reversed.

When I need to de-stress and calm down, walks in the forest and on the beach of Lake Michigan can be the best (especially with the dog). Other calming activities have included yoga, reading a novel by the fireplace, and cooking with family/friends.

The other spectrum, of energy "release" needs, can be best met by a workout at the gym, working in the yard, cleaning the car or the garage, and my favorite of all, is going out after work with a fun group of friends for munchies and cocktails (try to do that every couple months!)." - Todd K., RN, Holland, MI

"As a pediatric nurse working in ICU and the Peds ER for over 25 years I have seen more than a lifetime's share of tragedy and sadness when children are severely injured or killed. I have found peace in the ability to return to work to face another day only through the faith I have in God. I try to pray every day. I especially pray during a code - for the doctors and nurses administering care to the child, and for the parents. I found taking a walk or a drive and being quiet with God allows him to minister to my heart and heal me." - Ann D., RN, Copiague, NY

"My faith has carried my through my nursing career for 30 years and it has never failed me. Surrounding myself with my family and a few close friends has also been very important in coping." - Sandy

"I cope by listening to those who trust me enough to share their pain. Just by having someone open their heart to share the pure emotion, all of my stress seems to melt, and I find myself feeling very thankful and at peace with my life." - Anonymous

"Personally, I make sure I stay in contact with those I love the most during the week. My children and grandchildren all live out of town. A phone call to any one of my grandchildren always lifts my spirits. Their energy is contagious, even over the phone." - Kathy, Harper University Hospital

"I take my dog on a long walk and then once home drink a large glass of ice water to flush out any remaining stress hormones." - Shelley, RN, Pittsburgh, PA

Needed: Advice from Nurses

2009-03-10T13:19:00.008-04:00

I need your help. We've been struggling with something here at the Josie King Foundation. Here's the deal: we are creating a toolkit for nurses, something that will help nurses cope with the stresses of the job, something that will make their days a little better, something that will let them know how much we appreciate them. I know lots and lots of nurses. I've seen them at work in hospitals around the country. I'd like to think that I sort of have a notion as to what it must be like to be a nurse, but the truth of the matter is- I don't REALLY know.

So, I am asking all of you wonderful nurses to help. Here's what I'm looking for: quick tips on how to cope with the challenges of being a nurse. What do you do that helps you do your job well? What have you discovered that helps you deal with stress? It could be anything like:

"Once a week I buy fresh flowers to put in the nurses' snack room." - Sandy K., RN, Grand Rapids, MI

"When I come home after a long day on the job, I like to bake cookies with my eight-year-old." - Sue S., RN, BSN, Tampa, FL

"I just started walking for forty minutes every day with my neighbor. It really helps clear my head, and my jeans fit a little better." - Tamara M., RN, Houston, TX

Please post your tried and true tips below. You can also email your tips to nursing@josieking.org. We want to collect and share your great ideas with other nurses. If you would like to, please include your city and state, too.

I'll be sure to share updates on this project as it progresses, but right now we need as many tips as possible from nurses. Spread the word to your nursing friends and colleagues, and have them post their tips, too.

Thanks so much for your help with this, and for all of your hard work with patients,

Sorrel

Patient Safety Week

2009-03-09T12:46:00.005-04:00

It's Patient Safety Week- a time to reflect on all of the great patient safety projects and initiatives that have been under way. So many people have done so much to make our hospitals safer and for that I am forever grateful. But this is also a week to look ahead towards an even safer, better health care system. From what I can see, we have come a long way, but the journey is not over yet. There is work to be done.

I've heard from nurses and doctors all around the country who are planning on commemorating Patient Safety Week. There will be speeches announcing new safety programs, and ceremonies honoring caregivers who have done remarkable safety work. Patient safety is front and center, and I am excited about that.

Let's stay invigorated. A few quick hopes of mine:

If you are a caregiver, keep focusing on improving how you communicate with your co-workers and patients. Even if your team communicates well, the nature of team work is one of continual change, and it helps to check in every now and then to make sure everything is still working well.

If you are a student, keep learning about patient safety and preventing medical errors. Ask your professor or mentor about the changes they have seen with regard to medical errors since they started practicing.

If you are a patient or family member, thank your health care team for incorporating patient safety techniques into their daily routine.

I'll be commemorating Patient Safety Week with a few groups around the country this week. I hope that everybody is able to support Patient Safety Week in a way that is helpful and meaningful for them.

Keep up the good work!

-Sorrel

Update: IHI On Call Transcript and Audio Download Now Available

2009-03-04T05:07:00.003-05:00

Hi everybody-

Just wanted to spread the word that the transcript and audio download of Sorrel's IHI On Call session are now available at IHI's Open School website.

We hope that you enjoy the conversation. Feel free to comment on the session here, or at IHI's Open School blog.

Thanks,

Andrea

IHI On Call: Talking with Nursing and Medical Students

2009-02-26T08:13:00.004-05:00

The first time that I ever spoke to a room full of medical students was a few years ago at Johns Hopkins. I told them Josie's story and at the end of the talk I asked them if they had ever head of the Institute of Medicine's report "To Err is Human". No one raised their hand. I remember feeling shocked that these students- who were taught how to cure diseases, deliver babies and mend broken bones- were not being told about one of the leading causes of death in our country- medical errors. The more medical and nursing students to whom I talked, the more I realized that it was indeed a rarely discussed topic. I found this frustrating and confusing. Since then I have tried to talk to as many medical and nursing students as I can. These young minds are the next generation, and if I could make a tiny difference in how they would care for their patients by sharing Josie's story then I was going to do it.

I am grateful to the Institute for Healthcare Improvement (IHI) for creating the Open School (www.ihi.org/openschool). The Open School is a great resource for medical and nursing students to round out their patient safety education. They offer free courses in patient safety and quality improvement, sponsor essay contests, and host safety conferences for students of the health professions. Each month the Open School offers an On Call teleconference lecture, in which a guest speaking talks about a topic related to patient safety. Students from all over the country listen in and learn. I don't believe anything can take the place of a classroom with a professor, however this may be the next best thing.

On Tuesday- with the help of modern technology- I sat at my desk in my home in Baltimore and had the honor of talking to a few hundred students from around the country. The session was called "Channeling Grief into Action". Simon Mathews, a medical student at Johns Hopkins, moderated the hour-long session. I shared Josie's story. I explained that Josie didn't die because of one misplaced decimal point, because of one doctor or nurse. She died because of a lack of communication. After I spoke, Simon opened the lines to take questions from callers. I loved hearing from the students and I could tell that they had been moved.

For me it had been an hour well spent. It was my chance to make an impression on these brilliant minds that will take healthcare into the future. It was my chance to remind them of the importance of good communication and the need to create a culture in which reporting errors is considered heroic; a culture where doctors and nurses work as a team to prevent medical errors; a culture where the patient is heard and when a mother says, "Something is not right..." she is listened to. I hope I succeeded in delivering that message.

Thank you to IHI for realizing the importance of getting this information to students. Thank you Deepa Ranganathan for pulling the program together, and thank you Simon Mathews for being a great moderator.

For more information, check out the links below:

-An audio recording and a transcript of the session will be available at www.ihi.org/openschool at the end of the month. This link is also the gateway to all of the information about IHI's Open School.

-IHI's Open School blog (www.ihiopenschool.blogspot.com) has an open conversation about the session where you can post comments/questions. I'll be checking in on the comments and responding to them.

-Want to take IHI's educational programming wherever you go for free? You can subscribe to their informative podcasts at the Apple iTunes Store. Just go to the iTunes Store, search for "Institute for Healthcare Improvement" and click "Subscribe" to download IHI's podcasts.

Book News

2009-02-04T12:00:00.007-05:00

When Josie was first in the hospital, I kept a journal. It helped me remember everything that was happening, everything we had to do. It helped me release some of the stress. When she died I continued to write. I wrote and I wrote and I wrote. I had to get my sadness, my anger out. It was one of the things that really helped me.

As I ventured into the health care industry, I continued to write off and on. One day I realized that I had what looked to be a book in the making and so I showed it to a few people. They told me to find a book agent, so I did. My agent told me I could get a book deal, and I did. Two years ago I signed with Grove/Atlantic, a publisher in New York. Since then I have been working on the book pretty much full time.

The book is called Josie's Story. It is about how our family once was. It is about Josie's death and how we struggled to survive. It is about making the decision to either let the grief and anger destroy me or do something positive, something for Josie. It is about the search for religion, the search for understanding what it means to forgive and the search for the reason why. The book is about my journey into a world I knew nothing about, the health care industry. It is about the wonderful doctors, nurses and other health care providers I have met along the way and the amazing hospitals that have invited me - in my small way - to help them become safer. But most importantly the book is about all of the wonderful things that have come from Josie's death. Josie's Story will be in bookstores in September 2009.

I continue to accept speaking invitations. Starting in early September, we will be able to have book signings after the speeches. If you are interested in learning more about speeches and book signings, click here. Of course, you can always email any questions about speaking requests to speaking@josieking.org. We will get right back to you.

As we get closer to our publishing date we will have more details to share.

One final note- a portion of the proceeds from the book will go to support the Josie King Foundation.

Thanks- as always- for your interest and support.

"Questions Patients Need to Ask"

2009-02-04T10:53:00.003-05:00

There is a great new book out there for patients and their families. It is called Questions Patients Need to Ask. Dr. David Shulkin, CEO of Beth Israel Medical Center in New York City, wrote it with the hopes that it would help patients and their families get safe care and be as informed as possible when in the hospital. Dr. Shulkin has been on the front lines of the patient safety movement for years now, and is truly passionate about patient safety.

It's important to ask questions when in the hospital, or in any health care setting. We developed our Care Journal with that very thought in mind. Dr. Shulkin's book is a great tool for empowering patients and their families. His book is informative and a must-read for anyone who is going into the hospital or who knows someone who is.

For more information, visit Dr. Shulkin's website at www.questionspatientsask.com.

Thank you, LeanBlog!

2009-01-19T09:53:00.003-05:00

Happy New Year!

The charity auction organized by Lean Hospitals author and LeanBlog editor Mark Graban has ended. Thanks to the winner, whose support will help us continue our grassroots patient safety work in 2009. Of course, thanks to Mark for his time and great idea!

We wish you a healthy, safe 2009.

Charity Online Auction to Benefit JKF

2008-12-10T15:05:00.006-05:00

Thanks to the generosity of Mark Graban, the Josie King Foundation is the charity beneficiary of an online auction.

Mark Graban is a quality consultant who recently wrote Lean Hospitals, a book that applies the "lean" techniques of quality improvement and employee satisfaction to the healthcare setting. Mark is also the founder of LeanBlog and LeanPodcast.

The item for auction is a 4-CD podcast of Mark speaking with lean expert Norman Bodek and one of Mr. Bodek's books, autographed by the author himself.

Please check out Mark's blog and consider making a bid to support the Josie King Foundation. The auction ends Friday, December 19th.

Thanks again, Mark!

Josie King Foundation and the Johns Hopkins Hospital Department of Nursing Patient Safety Heroes

2008-09-25T13:35:00.012-04:00

On Wednesday the Josie King Foundation and the Johns Hopkins Hospital Department of Nursing recognized nine nurses, one clinical technician and one support associate for their work in patient safety at Hopkins Hospital. These professionals were nominated by peers in their unit for their outstanding work and are true patient safety heroes. I'd like to introduce them:

Maxine Bell-Trusty, Support Associate - Neurosciences

Maxine has taken a special interest in preventing hospital-acquired infections. She is what the literature calls a "positive deviant"- someone who does the right thing and is an agent for good. She single handedly advocated for two new practices in the Neuro Critical Care Unit: 1) using a fresh rag to clean each separate piece of equipment in isolation rooms and 2) requiring terminal cleaning of the patient's room once they were taken out of isolation. We know from lab cultures that Bell-Trusty has reduced the prevalence of multi-drug resistant organisms on her unit. While we often worry that the "bugs" are winning, Maxine has won the battle in her unit.

Kelly Creighton, BS, RN - Medicine

After a serious event involving a monitor alarm in 2006, Kelly's unit set out to improve the safety of patients on physiologic monitors. They determined that 27,000 alarms were set off on their 15-bed unit every 24 hours- that's one alarm every three seconds. Creighton worked with her committee and the Clinical Engineering team to improve the situation, reducing "nuisance alarms" by 26%. Kelly literally took the noise out of the system, so that nurses could respond more quickly to patients in trouble.

Catriona Henderson, RN - Oncology

As part of her night shift routine as a charge nurse, Cat reviews all lab values for the patients on

her unit. She found inexplicable changes in a number of patients' sodium values. So she followed her instincts (and her intellect) that something was wrong with the laboratory findings being reported in a large series of patients. Working with the lab, an investigation found that more than forty patients in the Cancer Center had incorrect sodium calculations made. But thanks to Henderson's astute observation and quick action, only one patient was treated for the incorrect results (without any adverse effects).

Vicki Jackson, Clinical Technician - Emergency Department

Vicki championed doing "re-vitals"- that is reassessing patients in the emergency department. In the past two years, she identified significant changes in patients. One was having a heart attack, and the other a stroke. Because of Vicki, these two patients received the required treatment from the heart attack team and the brain attack team earlier than they would have. When minutes count, Jackson's vigilance was life-saving.

Sara Nakamoto, RN - Gynecology and Obstetrics

Sara is a new graduate who joined Hopkins in March 2008 and she has already demonstrated an
aptitude for promoting the safety and well-being of the very ill patients under her care. For
example, Nakamoto discovered that a pre-mixed IV solution had one medication label applied
over another label. The IV bag actually contained the solution noted on the hidden label, and this
drug was contraindicated for the patient. Nakamoto's patient had impaired renal funcation with
only one kidney, and could have suffered significant complications had the drug been
administered. For this patient, Sara was a hero.

Liza Raymundo, BSN, RN - Ophthalmology

Working the tail end of the night shift, Liza was preparing a surgical patient as the first case for the operating room one morning. The patient complained of not feeling well. Liza assessed the patient, whom she identified as having symptoms indicative of an impending stroke. She organized the ophthalmology team and facilitated the patient's transfer to the Emergency Department where the required treatment was rendered in a timely fashion. Her quick assessment and critical thinking provided an immediate intervention so that the patient with an impending stroke was managed in a controlled environment.

Kathleen (Kathy) Robertson, MSN, RN - Surgery

The Hospital has been implementing an electronic provider order-entry system requiring all physicians to enter their orders online, and all nurses to document administration of medications in an electronic record. While the system was designed to be safer than paper-and-pencil versions, it was not fail safe. Robertson orchestrated the collaboration between physicians and nurses that was needed to develop the order sets, and implemented the change across the Department of Surgery. Many safety issues have arisen during this process. Robertson monitors these, and drives safety issues to the top of the priority list for system modifications. While many of our safety heroes have prevented individual patients from being harmed, Robertson is working to make the whole system safer.

Gloria Scott, BSN, RN - Pediatrics

On a unit where children and adolescents are treated for psychiatric illnesses that cannot be
managed safely out of the hospital, security is a critical concern. Gloria Scott worked with the
Pediatric Safety Team to add a security officer to the unit. The lay security officer could maintain
a presence at the front door; identify visitors to determine if they are authorized; check visitors'
belongings; and lock away valuable or unacceptable items. However, the security officer was also
needed to help with patients in a clinically appropriate manner. Scott explained the unit to the
officer, taught the officer how to handle patients, and otherwise implement this new role.
Because of Scott, the environment is secure and the patients are safer.

Melinda Walker, RN - Psychiatry

The stories about Melinda are legion. In summary, she "sees" problems and fixes them. To give
one example, Walker recognized a set of safety concerns in the electroconvulsive therapy (ECT)
suite. She subsequently prepared a 30-minute educational program covering how to prepare
patients for ECT; transport anesthetized patients safely; and maintain a smooth flow of patients
through the recovery phase. Her educational program has been incorporated into the annual
review that all RNs must complete. Walker is a safety hero for preventing harm from befalling
her patients.

As you can see, their work covers the gamut from actually saving a life to improving the systems

so that errors can be caught before it is too late. Each had a different story to tell, but one thing

that they all had in common was that in going the extra mile, in going beyond the call of duty

they often faced push-back. They each persevered and fought for what they truly believed needed

fixing. Some of these system changes have been adopted in other units, some will be published

in medical journals, and I believe that all of them will make care safer for the patients of Johns

Hopkins.

It was an honor to acknowledge the work that they did- not to receive awards- but because they

were simply compelled to do what they felt was right. I know that Karen Haller, Vice President

of Nursing and Patient Care Services at Hopkins, joins me in sincerely thanking them for their

commitment to patient safety.

(Thanks to Hopkins for providing the safety heroes' stories!)

Boston Part 2: Health Care's Holy Grail

2008-09-23T10:00:00.003-04:00

Energized from the previous night's meeting with the HCA folks, I took a cab to the John F. Kennedy Library to a conference put on by Blue Cross Blue Shield of Massachusetts (BCBSMA). The conference was titled "In Pursuit of Health Care's Holy Grail: The Quality Movement That is Transforming Health Care".

The conference room was beautiful with a wall of windows as the backdrop of the stage, overlooking pretty Dorchester Bay. The audience consisted of doctors, nurses, health care leaders and public policy people all from the state of Massachusetts. These people had come together to celebrate the movement and to more importantly be inspired to continue on in the improvement of health care delivery at their hospitals. The centerpiece of the event was Charlie Kenney's new book The Best Practice: How the New Quality Movement is Transforming Medicine.

The morning began with a welcome by Cleve Killingsworth, the Chairman and CEO of BCBSMA. It was apparent to me as I listened to him that he and his organization were committed to patient safety. It seemed that BCBSMA was going beyond the call of duty. BCBSMA isn't sitting in the back of the room, merely observing the quality movement, but its leaders are committed to leading the way and I am grateful for that.

After Cleve's opening remarks, I shared Josie's story and my thoughts on Charlie's great book. I recommend this book to anybody interested in learning more about the history of the patient safety movement that is truly changing health care for the better. I hope that the book can raise awareness on the reality of medical errors and inspire people to continue their work to improve patient safety or even to take up the cause.

I could go on and on about the interesting ideas of Charlie and other safety leaders like Don Berwick of IHI, Louise Liang of Kaiser Permanente, Uma Kotagal of Cincinnati Children's Hospital, and Goran Henriks of the Qulturum in Jonkoping, Sweden, but instead I'd like to send you to Paul Levy's blog "Running a Hospital". In addition to being the President and CEO of Beth Israel Deaconess Medical Center in Boston, Paul is an amazing blogger. He was at the conference, and has done an excellent job on writing about the days events. Take a peek.

Boston Part 1: The Grassroots of a First-of-Its-Kind Law

2008-09-22T14:19:00.005-04:00

I flew to Boston on Monday, September 16, for a conference put on by Blue Cross Blue Shield of Massachusetts, which was to be held the next morning. Earlier in the week Jim Conway from the Institute for Healthcare Improvement contacted me and told me about a group in Boston that was doing some interesting things in the patient safety advocacy vein. He suggested that we meet.

And so Monday night I had dinner with five people from Health Care for All (HCA). HCA is a Massachusetts-based non-profit organization that is working to- among other things- create greater quality health care throughout the state. You can read all about them on their website. HCA sponsors the Consumer Health Quality Council- a very active and renowned coalition of health care consumers who have been personally affected by medical errors. The Council was created in 2006 and currently has about 40 members who are doing some impressive things: sharing their medical error stories with the public, advocating for improved health care, and meeting with legislators to introduce health care improvements into law.

A recent success included their year and a half-long work in the development and signing of a groundbreaking state law that includes:

mandatory reporting of all hospital-acquired infections
mandatory reporting of all "never events"
creation of rapid response methods at all hospitals
creation of patient/family councils at hospitals.

This was an interesting group. I urge those of you reading this who want to make changes within your state to check them out.

I'll be back tomorrow with more from my trip to Boston, including the Blue Cross Blue Shield of Massachusetts' patient safety event.

"Don't think that you are more safe in a place just because they don't talk about their errors. "

2008-08-29T03:54:00.009-04:00

With Labor Day right around the corner, I'm catching up on some healthcare blog reading that I've missed out on while enjoying the summer. Earlier this month on "Running a Hospital" Beth Israel Deaconess Medical Center CEO Paul Levy discusses transparency in the patient safety realm. BIDMC took the bold step to report the incidence of preventable harm events on their very public website. You can take a look at the report here.

For each of the Joint Commission's preventable harm events, BIDMC lists the number of times such an event happened at the hospital within a quarter. Levy's discussion on the motivation and concerns surrounding such a public forum is insightful. The emphasis on reporting the raw number of harm events- and not obscuring them by reporting them as percentages of total patient population- shows a real understanding that patients are people whose lives are truly impacted by preventable errors.

It also sets up a clear standard of comparison; the goal is to have zero preventable events, and anything above zero signals continued room for improvement. What's the bottom line? Big thinking in a simple framework that patients, nurses, doctors and hospital administrators alike can use to chart progress and identify ways to change the status quo and improve patient safety.

The line from Levy's post that struck me the most is the quote used for the title of this post: "Don't think that you are more safe in a place just because they don't talk about their errors." I think this succinctly sums up an important aspect of patient safety today. For years, it was commonly assumed that there was an acceptable threshold for errors in medicine. Then came the realization that harm events could be prevented by analyzing and reworking broken systems. It's a huge change in philosophy, and the exciting part is that as patients and healthcare providers, we are all in the middle of a true zeitgeist shift. The language and tools to move medicine into a new, safer phase are right now being developed at a quick clip, and it will take some time and thought to figure out how we can best use these new resources to improve patient safety.

Surprising news about the incidence of harm events at one institution doesn't necessarily mean that a hospital isn't safe or actively trying to become safer; instead, it's a new way to bring healthcare providers and consumers on the same safety page.

Thanks,

Andrea

Condition H Networking

2008-07-22T08:29:00.006-04:00

Every now and then, I get emails from people who are in the middle of implementing Condition H, and would like to talk with other healthcare professionals who have participated in a Condition H implementation.

For example, here are some good questions we recently received from Wisconsin:

1) What barriers, if any, did you experience from physicians and staff when implementing Condition H? How did you overcome them?

2) How do the nurses and medical staff react when the family or patient calls Condition H? Were there any feelings of guilt (i.e., "I failed the patient") or resentment? What resources are available for staff to debrief after a Condition H call?

3) How many calls do you get from patients or families per month? How many have been appropriate vs. inappropriate?

4) How willing were the physicians to do this? If there were any negative attitudes, how were they overcome?

5) If you have both staff-activated rapid response teams and patient- and family-activated rapid response teams, are the teams the same or do you have unique teams for both?

Are there any Condition H veterans out there who would be open to talking to colleagues in the early stages of implementation?

If you are interested, I encourage you to post below or email me at awesol@josieking.org to volunteer.

I will also set up a discussion page on our forum "Connecting with Others". Click here to enter the forum.

Thanks,

Andrea

UPMC Releases Good News on Condition H

2008-07-21T10:35:00.007-04:00

Good news from Pittsburgh. UPMC is reporting results from the first two years of its implementation of Condition H, the patient- and family-activated rapid response team program that is gaining good traction in patient safety circles throughout the country.

From September 2005 to August 2007, there were 42 calls to Condition H. All of the calls were instigated by breakdowns in communication between caregivers and the patient or the patient's family. As the patient safety movement continues to make great strides and develop new techniques to prevent medical errors, it's clear that basic communication skills remain key resources for both caregivers and patients.

These and other successes are discussed in detail in the May/June 2008 issue of the Journal of Healthcare Quality.

As a Condition H partner, we at the Josie King Foundation are so proud of their success and hope that their impressive results inspire even more hospitals to implement Condition H. As a healthcare consumer, I'm relieved to know that more and more fellow patients have access to these rapid response teams.

Condition H consistently ranks among the top of the inquiries that we receive. It's encouraging to hear from so many institutions in varying stages of implementing patient- and family-activated rapid response teams of their own. For those of you who are associated with hospitals that have active programs, consider sharing any successes or lessons from your experience that could help your patient safety colleagues.

If you are in the early stages of planning, or are just considering starting a similar program at your institution, you can find helpful information on our website. Background material on Condition H is available here. This page also contains program support materials developed by UPMC for their program, like educational brochures and evaluation tools. These materials are all available for download, for you to learn from, amend and use at your institution. Big thanks to our friends at UPMC for sharing their good work with the community.

Please send us your questions and share your stories by leaving a comment below or emailing me at awesol@josieking.org.

Thanks, and more soon,

Andrea

JKF Blog 2.0

2008-07-14T13:47:00.004-04:00

Summer! It's time for baseball and barbecues and vacations, but here at the Josie King Foundation it's also time to refresh our blog. We want www.josieking.org to be a continually useful resource for you, filled with new, helpful information and various ways to connect to the patient safety community. To better serve your needs, we've decided to add a second blogger to the mix.

This is where I enter the picture.

My name is Andrea Wesol, and I've been working with Sorrel and Tony for almost four years now. It's been a true pleasure to help them grow the Foundation and expand the scope of the work done in Josie's name. It's also been rewarding to communicate with you- the patients, families and medical professionals who write to us. I am most often the first point of human contact that most people have with the Josie King Foundation, and it's a role that I enjoy tremendously. I'll still be the one responding to your inquiries and ideas about the DVD of Sorrel's speech, Care Journals, Condition H, etc., so keep those emails coming. I do look forward to having the new medium of the blog to interact with you and generate public discussions about the patient safety topics that make this work so interesting.

Fear not- Sorrel will still be contributing to the JKF Blog. For you sports fans out there, think of me as the play by play announcer, and Sorrel as providing color commentary.

You can expect to find more frequent blog posts, so please bookmark this site and come back regularly to check out or contribute to the conversations. I encourage you to leave comments and questions about the blog after each entry, and you can always email me on any patient safety topic at awesol@josieking.org.

More soon,

Andrea

With the Medical Students

2007-10-12T09:38:00.001-04:00

A few nights ago I spent the evening with 27 Post-Baccalaureate students from Johns Hopkins University. I had been asked by the director to join the students for dinner and then speak to them for an hour or so. I was to be joined by Rick Kidwell, who had been the lead attorney at Hopkins when Josie died and was now at UPMC, University of Pittsburgh Medical Center.

The Hopkins Post-Baccalaureate program is a year long program that prepares students for medical school. Hundreds of students from all over the country apply to this program, with only 42 acceptances for 27 positions. These students have earned their undergraduate degrees with an average of a 3.7 or above. More impressive than their high academic standings are the things they have done after college on the humanitarian level. Each one had an amazing story to tell. Some had spent time teaching in impoverished areas overseas. One spent a year with Dr. Paul Farmer, who is known throughout the world for his work and dedication in the poor towns of Haiti. Another student worked with the world renowned Dr. Benjamin Carson, a Hopkins pediatric neurosurgeon. One student worked as a teacher in the Mississippi Delta and then went on to teach children with AIDS in Africa. These life experiences shaped their young minds and led them to discover what it was that they truly wanted to become. Doctors. It is this dedication to public service, this humility and this selflessness that set these students apart from all others and landed them in the prestigious Hopkins Post-Bac program.

I always find it invigorating to be with medical students. They are so young and eager with bright minds that can be shaped. I can see the future in their eyes, and as I sat at my computer the day before and read all that they had accomplished and all that they had contributed to society and at such a young age, I knew that it was going to be a memorable evening.

Rick and I sat on folding chairs on stage and began our presentation. I started by sharing Josie's story. I broke it down as if it were a case study and watched them as they began to put the pieces together, realizing that a little girl had died at one of the best hospitals in the world, not because of a misdiagnosis or a medication error. It was something far simpler: communicaton, or rather, a lack of communication. I continued to talk about the importance of disclosure, and what it means to a family to be told the truth, to have questions answered and to know that the problem will be fixed. Rick shared the hospital's side of the story. He talked about how doctors and nurses are affected by medical errors. He told the students that when they become doctors, and if they make a mistake always to tell the family. "Don't worry about a potential lawsuit," he said. "That is the job of the risk manager." The discussion led to error reporting systems, family involved root-cause analysis and more. They asked interesting questions, and they shared their thoughts.

Soon these students will be in medical school. They will be inundated with Biology, Chemistry, Physiology. The importance of communication might not be woven into their curriculum. This was my chance to sink a story into their hearts and hope that when they become doctors that they will remember how to listen and communicate. These students are going places. These are the ones who are going to win Nobel prizes and find cures for our diseases. They are going to save lives. I am sure of it. I was honored to be with them I wish them all luck, and I thank them for listening.

It All Comes Back to Communication

2007-06-07T14:11:00.001-04:00

In the nearly five years that I have been participating in this patient safety movement, I have met thousands of wonderful healthcare providers. I have visited hospitals all over the country. I have sat and listened to dozens of patient safety conferences and grand rounds. I have learned big words like nosocomial infections.

Through it all I have told Josie's story and every step of the way I have tried my best to inspire caregivers to incorporate patient safety best practices into their everyday experience on the job. I have looked and listened, and have been amazed at all of the good I see, while also being confused as to why things can't happen faster and why 98,000 people still continue to die from medical errors every year.

The thing that really continues to amaze me is the communication issue. Josie died because people didn't listen. They didn't listen to me, and they didn't listen to each other. I can't tell you how many stories I have on my computer from families who have been affected by medical errors, and there always seems to be a common thread, "They didn't listen."

Correct me if I'm wrong. Doesn't the Joint Commission report that over 60% of all sentinel events are due to a breakdown in communication? I am not a doctor or a nurse. I am not at the bedside, and I am not an expert in the field of patient safety; however it seems to me that if people communicated better we'd all be safer. I believe in high tech solutions. It is where we are heading, but wouldn't we get more bang for our buck if we communicated better?

I was in Pennsylvania a few months ago at a wonderful hospital by the name Abington Memorial. I was presenting at their Grand Rounds. After the presentation, I was lucky enough to join them on their Patient Safety rounds. The team consisted of two nurses, a doctor, and a board member. I was struck by two things:

The first was the presence of the board member. There is a lot of talk these days about getting board members involved, especially when it comes to safety and quality. It was so great to see first hand a hospital that was doing just that.

The second thing that struck me- Every unit we went to, the patient safety officer would ask the nursing team on the floor a question:

"If you could have anything you wanted on your floor to keep patients safe what would it be?"

Each floor had variations on the same response:

"I wish we could get into the doctors' heads."
"I wish we were more like a team."
"I wish we communicated better."

That is what they wanted. They did not ask for fancy equipment or the latest in technology. They wanted to understand what the doctors were thinking. They wanted better communication between the nurses and the doctors. The thing that amazes me even more is that I hear this everywhere I go. Communication- and it is not just between the doctors and the nurses. It is between the patients, their families and those who are caring for them.

It seems so simple, but I am learning that changing behavior is not an easy thing to do. I don't know what it takes, maybe time, maybe another generation, hopefully not more deaths.

I will tell you one thing. The board member that day heard that message loud and clear and I bet she shared what she learned with her fellow board members, at least I hope she did.

Introducing the Care Journal

2007-05-29T14:00:00.001-04:00

Have you ever been a patient or had a loved one who was a patient in a hospital? Did you feel overwhelmed and scared? Was a lot of information thrown at you? I am guessing that your answers to the above might be yes. I know that I felt that way when Josie was in the hospital. I was in a new environment and I was scared out of my mind.

One thing I did that really helped was to write. I kept a journal. I kept track of everything from my parking space number to the names of the nurses on duty. I documented the medications she received and I wrote down questions and concerns I had for the doctor. Writing gave me a sense of control in a situation in which I had none. It helped me stay organized and on top of what was going on each day.

In my conversations with other patients and families over the years I have learned that they too often found comfort in writing. I decided that the Josie King Foundation needed to offer a journal that would help patients and their families manage their hospital stays. Each page would represent a day of health care, whether the patient is in the hospital or after they have been discharged. We call it the Care Journal.

It was time to take the Care Journal out for a spin in the healthcare industry. What I learned shocked me. I was having dinner with a wonderful group of nurses. I excitedly unveiled the Care Journal campaign and as I waited for them to tell me how great of an idea it was. All I saw were blank faces.

They told me what it felt like to them and their colleagues when they see a patient or family member writing. It makes them feel threatened. Healthcare providers think that patients are creating documentation so that they can later sue. However, they all agreed that when they or their loved one was in the hospital that, absolutely, the one thing they did was to write. I asked other healthcare providers if they felt threatened in the same way, and the majority of them did.

I had no idea that nurses and doctors felt this way. The last thing I wanted to do was to further alienate the nurses from the patients, but I felt so strongly that patients should have this tool. My nurse friends and I came up with the perfect solution. The Care Journal needed to come from the hospital. It needed to be a gift from the nurse to the patient or family member.

This made great sense. We could offer a handy tool AND we could help bridge the gap of mistrust between the healthcare provider and the patient. Now, instead of a nurse looking at a patient and feeling threatened that nurse can say, "Oh, I see you are writing in your Care Journal. That is great and don't forget to write down your questions for the doctor when he makes his rounds."

Right now, we're working on the final touches of the Care Journal. We expect to have them in one month. If you work at a hospital interested in partnering with the Josie King Foundation to distribute Care Journals to your patients, I will send your hospital however many you would like. You can write up a personal note to your patients telling them that you encourage them to partner with you in their care and attach it to the inside of the Journal. All I ask is that your organization make a donation to JKF. Just contact me and we'll get you started.

If you are a patient, the Journals will be available from our website in a few weeks. All the money from the Care Journal project will go back into this patient safety movement, funding great new ideas to improve the culture of healthcare.

I hope you like this project. Please email me at sking@josieking.org to learn how to partner with us, learn more about the Care Journal, or- very importantly- let me know your thoughts on the project.

Welcome to Our New Website

2007-05-24T15:23:00.002-04:00

Thanks for visiting us at the Josie King Foundation's new and improved home on the web. I encourage you explore the various areas of the site, and also to send us your opinions on the site. As we worked to create this website, we were guided by the hundreds and hundreds of e-mails that I have received from patients, families, doctors, nurses, hospital administrators, medical students, and nursing students.

These e-mails came from all corners of the world and covered an enormous range of thought and emotion, but all had one thing in common- a passionate interest in and commitment to improving patient safety. These e-mails come from people like me who have been affected by medical errors in one form or another and are looking for ways to make their hospital safer.

This new website responds to your needs. It is a place that provides help and information. A place where people can learn from experts in the field. A place to find the latest and most helpful websites, books, and articles about issues related to patient safety.

The new website also fulfills a vital need of the Foundation- to share information about the successful patient safety programs that we have supported. Good things are happening in patient safety all over the country. We want to help spread the word so that these good things take root and replicate in new places where the need is dire.

We also wanted the site to be a place where people could connect with others. Why should the interesting, wonderful, and sometimes heartbreaking e-mails come just to my inbox? Wouldn't it be great to pass them along so that thousands of others can read, react and connect? Maybe by creating this online community, doctors, nurses, and families can come together and solve problems or help each other.

I think this website will achieve some of those goals. It will continue to evolve as we react to your ideas and the progress shaping patient safety as a field. We would really love your feedback- good or bad. It all helps.