Staying safe in hospital: what patients can actually do

Hospitals are safer than they have ever been and still carry risk.

Patients and families catch a meaningful share of errors, which makes speaking up part of the system rather than an intrusion into it.

Identity checks

• Expect to be asked your name and date of birth repeatedly.
• Answer fully every time.
• Check your identification band is correct and legible.
• Ask staff to check the band before anything is given.
• Report immediately if it is removed or damaged.

Medicines

• Ask what each new medicine is and what it is for.
• Say so if a tablet looks different from yesterday.
• Do not take your own supply without telling staff.
• Repeat your allergies whenever anything new is prescribed.
• Ask what side effects to report.
• Most medication errors are caught by someone asking a question.

Infection prevention

• Clean your own hands before eating and after the toilet.
• It is acceptable to ask staff whether they have cleaned theirs.
• Ask visitors to clean their hands on entering.
• Ask unwell visitors to stay away.
• Report redness, swelling or discharge around any line or wound.

Lines, drains and catheters

• Ask why each device is in place.
• Ask when it can be removed.
• Ask again daily if it stays in.
• The longer a device remains, the higher the infection risk.
• Report pain, leakage or redness at the site.

Ask about your own observations

• Ask what your blood pressure and temperature are.
• Ask whether any reading is causing concern.
• Ask what the plan is if a reading worsens.
• Knowing your own numbers helps you notice change.

Preventing falls

• Use the call bell rather than getting up alone.
• Ask for help the first time you stand after a procedure.
• Wear non-slip footwear, not loose slippers.
• Keep water, glasses and phone within reach.
• Sit on the edge of the bed before standing.
• Report dizziness rather than pushing through it.

Skin and pressure areas

• Change position regularly if you are in bed a long time.
• Ask for help if you cannot move yourself.
• Report any area that becomes red or sore.
• Ask whether a special mattress or cushion is appropriate.
• Pressure damage develops faster than most people expect.

Blood clots

• Ask whether you have been assessed for clot risk.
• Ask what is being done to reduce it.
• Move your legs and walk as permitted.
• Report calf pain, swelling, breathlessness or chest pain immediately.
• These symptoms are always urgent.

Eating and drinking

• Poor intake slows recovery considerably.
• Tell staff if you cannot manage the food provided.
• Ask for help if you cannot feed yourself.
• Report difficulty swallowing straight away.
• Ask whether family may bring suitable food.

Speaking up effectively

• Be specific rather than general.
• Say what changed and when.
• Say plainly that you are worried.
• Ask for the nurse in charge if you are not heard.
• Ask for the responsible consultant after that.
• Stay calm and factual; it works better.

The role of family

• They notice changes the patient may not report.
• They can keep notes when the patient is too unwell.
• They can prompt the questions that were prepared.
• They should raise concerns rather than waiting politely.
• Confusion or drowsiness that is new is always worth reporting.

Pain control

• Report pain rather than enduring it quietly.
• Uncontrolled pain delays movement and recovery.
• Describe severity and what it prevents you doing.
• Ask what the plan is if the current approach is not working.
• Report side effects rather than stopping medicines yourself.

Confusion and delirium

• New confusion in hospital is common and always significant.
• Family should report it immediately.
• Familiar objects, glasses and hearing aids help.
• Daylight and a normal day-night pattern help.
• It is often reversible when the cause is found.

Handovers are the risk points

• Shift changes and transfers between wards are where information is lost.
• Repeat key facts to the new team.
• Restate allergies each time.
• Mention anything outstanding, such as an awaited result.
• Your own notes are valuable here.

Consent for each new step

• Consent is not a single signature at admission.
• Ask what any new procedure involves before agreeing.
• Ask what the alternatives are.
• You may ask for time to consider unless it is emergency care.
• Ask for an interpreter if the explanation is unclear.

Tests and results

• Ask what each test is for.
• Ask when the result is expected.
• Ask again if the date passes.
• Do not assume silence means normal.
• Ask for the result before you are discharged.

Bring your own glasses and hearing aids

• Being unable to see or hear increases confusion and falls.
• Label cases with your name.
• Tell staff where they are kept.
• Ask for them before any discussion about your care.

If something goes wrong

• Ask for an explanation at the time.
• Write down what happened with dates and names.
• Ask what is being done about it.
• Use the patient liaison or complaints service.
• Reporting improves systems as well as your own care.

The point to remember

Three things:

1. Ask what each new medicine is — questions catch most medication errors.
2. Use the call bell rather than getting up alone.
3. Repeat allergies and key facts at every handover.

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