PICC line clotted. His mother called the home care nurse. When the nurse arrived, she found that the mother was about to use a syringe of ginger ale to clear the PICC line and prevented a serious error. Having been taught to clear the child’s feeding tube with ginger ale, the mother thought the same could be done with the PICC line. She is just one example of the many caretakers who do not receive adequate discharge counseling (Cohen, 2000).

A middle-aged man with newly developed asthma was prescribed an inhaler, but was not responding to treatment. During a follow-up visit, he described how he was using the inhaler. He would squirt two puffs in the air and breathe deeply for 15 minutes. He said he’d been instructed to do this by his doctor, who had picked up an inhaler, held it in the air, and released two puffs to demonstrate its use. The doctor had given the man no further instructions. The man had not read the instructions on the package because he was functionally illiterate. He is an example of the millions of Americans who do not receive adequate medication instructions and have difficulty with basic reading and writing (Cohen, 2000).

Each of the above cases illustrates the potentially lethal consequences of inadequate and ineffective interactions between consumers (patients or surrogates) and providers. The cases underscore the most common complaint about providers—they fail to take the time to listen and to explain. Some communication problems have been attributed to the fact that many health care providers focus on diseases and their management rather than on people, their lives, and their health issues (Lewin at al., 2005). Other issues concern the lack of understanding and respect for patients’ rights to be informed and to play an active role in their and their family members’ care. Unfortunately, such circumstances are commonplace (Annas, 2004; KFF, 2004; CMWF, 2005). Care delivered without good communication and follow-through on patient rights is provider-centric when in truth, consumers want and increasingly expect care that is patient-centered (Cleary, 1993). The Institute for Healthcare Improvement’s program on Patient and Family Voices has identified key aspects of patient-centered care desired by consumers (see Box 4-1).

FOUNDATION FOR IMPROVEMENT

Improving safety and quality in the medication-use system requires a shift from the conventional approach to care toward a patient-centered model based on consumer–provider partnership and communication. The foundation for this change has several elements discussed in this chapter. First, all participants in the health care delivery system need to acquire a thorough understanding of what patient-centered care really entails in terms of both the consumer–provider relationship and the culture of the health



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