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Family Interview with Jack Jack and his wife Doreen have two daughters, Michelle, 14 years and Allison, 11 years. Jack has his mother and sister in the city but his mother has dementia and is not able to help. His sister is a tremendous support. Doreen's family is all out east. They have support also from Jack's employers and their network of friends. Michelle was diagnosed with leukemia and received a stem cell transplant from her donor sister. Jack reflected on their health care experiences involving their daughter Michelle. Salient Themes: III Collaboration 1. Development of trusting and working relationship between health care professionals, patient and family b. honesty of health care professional VI Patient Safety 2. Medication administration medication experiences Learning Elements: Using patients and families as safety checks Dealing with errors and near miss incidents "We were more experienced with Michelle's medications. The nurse came in to give her the meds. I asked what she was doing. "I'm giving her meds." I replied, "No, you are too early." She said, "No it is the right time." I asked her what the dose was and she told me and I said the dose and the time of the medication was changed. "No, no, this is the right dose and time." I was insistent and asked her to please check. She didn't argue and she came back to assure me that it was the correct dose and time. Well I assured her it was not correct. I asked her to call the doctor because there was a mistake and to please not give it to her until the orders were clarified." "She came back and said, "I glad you pushed it because I would have given the wrong dose. Thanks for pointing that out." She was very open and honest. I appreciated that she respected and valued my opinion. It was not regarded as a mistake or an error but as a near miss. I had less angst over that incident than the "Oops and oh no" episode we previously experienced and not being given any explanation as to what had gone wrong." "This is something that all parents appreciate, open and honest communication and professionals listening to parents. We know we are not scientists, we are not nurses but we certainly know our kids. We know our meds and we know when they are given. Parents learn that pretty quickly. Give parents credit when credit is due and respect their concerns. If parents say something is wrong, than you need to respect it. We still do not know what happened for the first incident. We did not have a trusting relationship after that episode with the "Oops" nurse.
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I use "statins" often because they are well-tolerated, and somewhat effective. I prefer Pravachol pravastatin ; because of its safety record it is not known to cause muscle damage. Plus, there is good evidence that this medication is much more effective at preventing heart attacks than the other statins.24 These benefits may be due to the physical properties of this medication which prevent it from entering the cells its action is all outside of the body's cells. I do, however, prescribe most of the other statins, like Lipitor, Mevacor, Zocor, etc. usually because this is the one the patient's insurance company pays for. I also use niacin usually as an extended release form, like Niaspan often along with agents that bind cholesterol in the intestine and cause it to leave the body. These are called cholestyramine Questran ; and colestipol Colestid ; . See my February 2003 newsletter article: "Niacin - A Time Honored Treatment for Cholesterol and Triglycerides." ; My goal is to use sufficient medication to lower the cholesterol below 150 mg dl and the LDL-cholesterol below 80 mg dl ; . Learn more about this treatment from my June 2003 newsletter article, "Cleaning Out Your Arteries." Prevention of a Second Heart Attack: One baby aspirin 81 mg ; daily offers more benefits than risks in people with a history of serious heart disease bypass surgery, angioplasty, or heart attack ; .25 Those without this history of heart disease may suffer far more harm bleeding ; than benefit from taking aspirin. More than 81 mg of aspirin is less effective and has more side effects. I also use baby aspirin for people with a high risk for stroke. Blood Pressure Lowering Medications: I use beta blockers and or diuretics, because they are as effective as any other kind of medication used to lower blood pressure.18, 19 Mostly importantly, the slight reduction in the risk of strokes achieved by lowering blood pressure is as good with these simple drugs as that seen with the newer, more expensive, medications. Diuretics and beta-blockers cost pennies to buy as opposed to dollars for one dose for the others ; and because they have been used for more than 40 years, their side effects are very well-known. I use sufficient medication to keep the diastolic BP between 85 and 100 mmHg. BP lowered below 85 mmHg with medication increases the risk of heart attacks and strokes. See my July 2004 newsletter article: "Over-treat Your Blood Pressure and You Could Die Sooner." ; Blood sugar-lowering medications: For type-1 diabetics I use only insulin. For type-2 diabetics I use enough insulin to keep them from losing too much weight and to control symptoms of frequent urination and excessive thirst. With some reluctance I will use Glucophage. The evidence on the results of treating blood sugars for type-2 diabetics with medications shows much harm and little good is done. The risk of dying from heart disease appears to be increased and there is no convincing evidence that blindness and kidney disease are reduced. Furthermore, most treatments cause the patient to gain weight, which may aggravate their diabetes. See my February 2004 newsletter article: "Type-2 Diabetes the Expected Adaptation to Overnutrition." ; Pain Medications: I like aspirin and Tylenol. However, inexpensive over-the-counter NSAIDs, like Motrin and Advil, are also fine for occasional use. For severe pain, narcotics are useful, but addicting, over the long term. Relief of indigestion Gastritis ; Wafer antacids like Tums ; or liquids. Use of simple, over-the-counter antacid pills, like Tagamet or Zqntac used only as needed, not daily. Changing to a healthy diet and raising the head of the bed are of the most help. See my February and March 2002 lead newsletter articles. ; Colds and Flu: Pains and fever: aspirin not for children ; and Tylenol. Cough: Syrups with dextromethorphan DM ; . Nasal congestion: Nasalcrom spray, Afrin nasal spray, and Sudafed tablets. See my October 2003 newsletter article: "Surviving the Cold Season." ; Chronic allergies and asthma.
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See; it wouldn't even matter if it showered off n on. As long as it didn't pour, the hotel-people would be up on the roof and Vera's people would be out on the reach, all of em hopin there'd be just enough of a break in the cloud-cover to let em get a look at what wasn't gonna happen again in their lifetimes . not in Maine, anyhow. Hope's a powerful force in human nature, you know - no one knows that better'n me. As I remember, Vera ended up havin eighteen house guests that Friday night, but there were even more at the Saturdaymornin buffet - thirty or forty, I'd say. The rest of the people who'd be goin with her on the boat and they were island folk for the most part, not from away ; would start gatherin at the town dock around one o'clock, and the old Princess was due to set off around two. By the time the eclipse actually began four-thirty or so - the first two or three kegs of beer'd probably be empty. I expected to find Vera all nerved up and ready to fly out of her own skin, but I sometimes think she made a damn career outta surprisin me. She was wearin a billowy red-n-white thing that looked more like a cape than a dress - a caftan, I think they're called - and she'd pulled her hair back in a simple hosstail that was a long way from the fifty-buck hairdos she usually sported in those days. She went around and around the long buffet table that was set up on the back lawn near the rose garden, visitin and laughin with all her friends -most of em from Baltimore, judgin by the look n sound - but she was different that day than she had been durin the week leadin up to the eclipse. Remember me tellin you how she went zoomin back n forth like a jet plane? On the day of the eclipse, she was more like a butterfly visitin among a lot of plants, and her laugh wasn't so shrill or loud.
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The RiskLine began in response to a growing number of questions directed to the University of Utah School of Medicine's Division of Medical Genetics and various Utah Department of Health UDOH ; programs. Pregnant women, their health care providers, and their families and friends were anxious to find the most accurate and up-to-date information about the possible effects of medicines drugs, chemicals and maternal illnesses and other medical conditions on the unborn baby.
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