Louise Batz RSS Feed

Celebrating National Patient Safety Awareness Week!

spearson — Wed, 07 Mar 2012 18:33:49 GMT

We are proud to join forces with the Improvement Science Research Network to raise awareness about safe care. Be Aware for Safe Care. Learn more www.npsf.org for what you can do to help celebrate this important week.

We Celebrate Patient-Centered Care Awareness Month!

molly heinsler — Wed, 12 Oct 2011 09:23:31 GMT

We are proud to celebrate Patient-Centered Care Awareness Month. To learn more about patient-centered approaches visit Planetree's Website.

Dr. Val Jones Launches "Healthy Vision" radio show

molly heinsler — Tue, 14 Jun 2011 10:38:25 GMT

The Batz Foundation is a guest blogger on Get Better Health, and we are proud to support Dr. Val Jones and her "Healthy Vision" radio show!

ACUVUE^� BRAND CONTACT LENSES LAUNCHES "HEALTHY VISIONT WITH DR. VAL JONES"

Popular medical blogger hosts new online radio program focusing on eye health

JACKSONVILLE, Fla. (June 15, 2011) - VISTAKON^�, Division of Johnson & Johnson Vision Care, Inc., today announced the launch of Healthy Vision^TM with Dr. Val Jones, a new radio program devoted to educating and improving the eye health of Americans.

"Americans spend surprisingly little time thinking about their eyes, even though they're critical to their quality of life," says program host Val Jones, M.D., CEO of Better Health, LLC, a network of popular health bloggers, and author of, "Dr. Val and the Voice of Reason," which won The Best New Medical Blog award in 2007. "Research shows that many people share the misguided belief that seeing well translates to good eye health. As a result, they often don't see an eye care professional regularly, or take the necessary steps to protect their eyes from things like UV (ultraviolet) damage. Eye care professionals are a critical part of a primary care medical team."

Healthy Vision^TM with Dr. Val Jones seeks to close the gap between vision care attitudes and behaviors by providing consumers with timely and relevant information and helpful resources to help them manage eye health for themselves and their families. The program is supported by ACUVUE^� Brand Contact Lenses.

On the inaugural show, Dr. Jones is joined by leading experts from around the country to take a close look at three areas vital to maintaining eye health and wellness.

�       What's in an Eye Exam? - Learn why an eye exam is important beginning in infancy and how eye care professionals can identify some medical conditions, such as diabetes and high blood pressure, just by looking in your eyes.

�       Are You Contact Lens Compliant? - Research shows that many contact lens wearers are significantly non-compliant when it comes to taking care of their contacts. Hear from the author of a recently published study that looked at the wear and care habits of contact lens wearers, learn the risks associated with not following your eye doctor's instructions, and find out about a free tool to help you remember when to change your lenses on time.

�       Protecting Your Eyes from the Sun - Did you know it's just as important to protect your eyes from the sun's harmful rays as it is to shield your skin from the sun? Learn about the risks of not protecting your eyes from ultraviolet (UV) rays, beginning in childhood, and how you can get added protection to your sunglasses.

Free podcasts of Healthy Vision^TM with Dr. Val Jones can be found in the iTunes Store (for best results, search for the show by its complete title. You will find it in LifeMinute.TV Health), BlogTalk Radio (www.blogtalkradio.com/healthyvision) and on http://getbetterhealth.com/healthy-vision. A link to the show also can be found at. www.acuvue.com/healthyvision. You can listen to the show in its entirety (Approximate Running time: 23 minutes) or via individual segments.
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Doctor Dos and Don'ts in Communicating with Afib Patients from Mellanie True Hills

molly heinsler — Tue, 07 Jun 2011 12:22:25 GMT

As the founder of StopAfib.org, I have heard from thousands of atrial fibrillation patients who have shared their afib experiences with me. For so many of us, the diagnosis and treatment of afib is confusing and scary.

To improve communication between patients and their health-care providers, and ultimately, provide better care, I recently shared with doctors at the Western Atrial Fibrillation Symposium some "dos" and "don'ts" that afib patients have shared with me. While these comments are from atrial fibrillation patients, they are likely to apply to all patients.

Tips that medical professionals can incorporate when seeing afib patients:

Think: What if it were me? When dealing with afib patients, keeping the physical, emotional and financial impact of the condition in mind can lead to more empathetic care.
Adjust to patients. Especially when afib patients are initially diagnosed, they may not be up to speed with the risks posed by the condition. Health-care providers may need to slow the pace of information to ensure the messages are received. Specifically, the elderly, those with hearing loss, or those on beta blockers with "brain fog" have difficulty with speed or accents, so adjust speaking speed to the patient.
Decrease medical jargon. Health-care providers work in the world of abbreviations and medical terminology, but patients don't understand this jargon. Be prepared to offer explanations instead of waiting for questions, because many won't even ask.
Write down medical terms. Patients can gain a greater understanding of their condition and do additional research when they know the precise language used to describe their condition.
Set realistic expectations. Describing the potential outcomes of treatments and medications allows patients to know what to expect and allows them to adjust accordingly. Be honest and don't hide the truth. For example, some patients are not told that they might need more than one catheter ablation.
Say "I don't know." If there is a topic or patient question that health-care providers don't have all the information about, let patients know. Patients know that afib is complex and that health-care providers may not have all the answers, and that's OK. Exploring such answers together creates a team atmosphere.
Provide credible resources. As patients look to research their condition, point them to reputable organizations and reliable sources. Look for resources with the Health On the Net Foundation (HON code) seal, which means that the sites attribute research and are trustworthy.
Refer patients to StopAfib.org. Through the organization's support network, patients can learn about the condition and share their experiences.
Request StopAfib.org patient cards. These handy cards allow patients to immediately connect to afib information.

DON'T

Here are a few phrases patients wish health-care providers wouldn't say when talking with them:

"Afib won't kill you." When first diagnosed, patients are in shock and can't process the deluge of information. Saying "it won't kill you" gets in the way of the real message - that blood clots and stroke can kill.
"Just get on with your life." Afib has hijacked the lives of those who have it, and saying that devalues the patient's experience. It's not something that can be ignored.
"Stay off the Internet and only listen to me." Patients need support from those who have been there. Be open to patients bearing printouts and web research. When patients do such research, they feel empowered.
"I'll choose your treatment, not you." Instead, incorporate patients as part of the decision. Let patients feel in control, because the condition often takes that away from them. They have to live with the end results of treatment.
"You're just a hysterical female." Women are open about feelings, which are often dismissed and thus they don't get treated for afib as quickly. Remember, afib is different for women, especially related to hormonal cycles. And often women's symptoms are dismissed as stress, lack of sleep, or panic attacks.

Adapted from: Bridging the Afib Communications Gap: Afib Patient Perspectives from the Fourth Annual Western AF Symposium, by Mellanie True Hills, EP Lab Digest, April 2011, pgs. 28-32. PDF Reprint Available

Two Years Ago

molly heinsler — Tue, 26 Apr 2011 09:10:26 GMT

Two years ago was the last time my Mom told me,� "Good Night, and I love you!" I gave her a big hug before I left the hospital room and told her how well she had done through the surgery, and I was so proud of her.� I never thought in a million years that this would be the last time we would ever be able to talk to one another. That I would be able to hear her voice, share stories, laugh, get loving advice and words of comfort.

On April 14, 2009 my Mom went to have routine knee surgery. Her surgery was successful, but then after a series oversights and medication errors on the General Floor, my Mom went into respiratory depression and suffered anoxia to the brain. 11 days later she passed away.�My brother and I lost the best Mom in the world. Our children lost an amazing grandmother. My aunts and uncles lost their sister, her friends lost a devoted and loyal confidant, and my Dad lost the love of his life.

I want to thank everyone for all of the love and support these past two years. My Mom's death was tragic and so sad for all of us. My little girl, Ella who is 6, loved her so much and misses her all the time. It has been very hard for her to understand what happened and it crushes me to see her struggle to make sense of it all.� The other day, she was helping me stuff and seal envelopes for a mail out for the Foundation. She told me, "Mommy, it is so sad that Grandmother had to die like she did, but I know that she is saving lives.� When I grow up I want to work for Grandmother's Foundation."� My heart swelled with pride and love.� Through great tragedy, there is great hope.

We founded the Louise H. Batz Patient Safety Foundation in honor of my Mom's life, with the mission to help prevent medical errors by ensuring that patients and families have the knowledge they need to promote a safe hospital experience for their loved ones, and to support innovative advancements in patient safety. Our greatest hope is that families, patients, and caregivers will work together as a TEAM to improve safety in our hospitals. �

It has help to heal our family and celebrate my Mom's life by working on improving patient safety to save lives. We have an amazing staff, Board of Directors, Medical Advisory Board, and Foundation Advisory Board that have joined forces with us on our mission. We have been moving at lightning speed and have accomplished so much in such a short time.

Thank you to everyone for your support, love and guidance for the last two years!�

Bringing Patient Monitoring into the 21st Century from Dr. Lynn

molly heinsler — Thu, 10 Mar 2011 13:47:05 GMT

At the Sleep and Breathing Research Institute we are focused on trying to move themonitoring industry away from the utterly simplistic 30 year old "firealarm" concept of patient monitoring which has proven ineffective in manyRandomized Prospective Controlled (class A) trials.

However we are just beginning to realize why they don't work when it seemed, in thepast, so obvious that they must work.

We now know that unexpected death on the hospital general floor usually proceedsby one of three basic patterns over time. These have been called the patternsof evolving death(PED) and conventional hospital monitors cannot identify ordetect them.

In just one recent example, a 63 year old sleep doctor colleague of mine diedabout 2 months ago. He had a elective surgery for colon polyp removal. He wenthome and then was developed with a fever then he developed shortness of breath.They thought he was OK and didn't need ICU, but then his condition worsened onthe general floor, still they thought he was OK. Finally, he was urgentlytransferred to ICU and died shortly after due to septic shock.

This is a type 3 pattern of evolving death. A simple threshold pulse oximetry alarmsystem provides a false sense of security with this pattern and I have seen somany delays in treatment due to this I had a annual lecture at my hospitalwarning of this pitfall of threshold pulse oximetry as an alarm system on thegeneral floor.

Since it is not possible to know in advance which PED (if any) will occur in anygiven patient, the simple threshold monitor may provide early warning with onepattern of death or may provide a false sense of security (delaying action)with another pattern of death so this is why these devices have provenineffective when studied prospective. The monitors are simply not smart enoughto tell the nurse that a potential pattern of death is evolving and which typeit is.

It is ironic that a physician may die in his own hospital connected to a pulseoximeter with an utterly simplistic 20+ year old threshold alarm processorwhich cannot identify a single pattern of evolving death and, as he dies, hehas an iphone in his pocket which can identify a song just by listening to it.

We need a new vision and new standards for hospital monitoring which require thatmonitors used on the general floor have a minimum ability to detect, andidentify quantify and track the various patterns of evolving death.

This need is analogous to the past need for other standards (such as in theautomotive and aircraft design) which simulate the real world adverse events(like a dynamic front end skid) and then design systems which timely detect,identify, and quantify various adverse events (like dynamic skids) to allowtimely correction.

Universal skid identification, quantification, and correction is estimated to save over10,000 lives annually. Universal timely Pattern of Evolving Deathidentification and quantification might save 10 times that many annually.

There is no need to mandate how the relational skid is detected, only that this beaccomplished with a minimum sensitivity and specificity by say 2015. As in theauto industry this begins the safety race and the public benefits much soonerthan 2015.

This is a wonderful opportunity and we are standing at a time similar to that forthe early mandating process of automotive safety.

How many young children and babies are alive because those people stepped up againstindustry pressure and against the scientists who were comfortable with thestatus quo and made it happen.

We need the public to know that the space age looking monitors used their familieson the general floor today are the same simple "fire alarm" conceptfrom the 1970s before the PC was introduced.

A 2009 meta analysis published in Oct. indicates (after review of 22,000patients) that the long tried 30 year old idea of threshold alarm does notwork.

Its time for the public to say that since these simplistic devices (designed beforethe PC) do not provide enough information to health care workers, we demandinnovation.

Dr.Larry Lynn- CEO Of Lyntek Medical Technologies, Columbus, Ohio

�

Preventing Hospital Acquired Infections by Dr. Julia Hallisy

Molly Heinsler — Tue, 08 Mar 2011 09:23:02 GMT

Serious infections are becoming more prevalent and morevirulent both in our hospitals and in our communities. The numbers arestaggering:��1.7 million people will sufferfrom a hospital acquired infection each year and almost 100,000 will die as a result.

�

When our late daughter, Kate was diagnosed with anaggressive eye cancer in 1989 at five months of age our life became consumed bydoctor visits, MRI scans, radiation treatments, chemotherapy and fear. Myhusband and I assumed that our fight was against the ravages of cancer but almosteight years later we faced another life-threatening challenge we never countedon - hospital-acquired infection. In 1997, Kate was infected with Staph aureusin the operating room during a "routine" 30 minute biopsy procedure to confirmthe reoccurrence of her cancer.

�

Kate's hospital infection led to seven weeks in thePediatric Intensive Care Unit on life support, the amputation of her right leg,kidney damage and the loss of 70% of her lung capacity. While most infectionsare not this serious, the ones that are often lead to permanent loss offunction and life long disabilities. In the years since Kate's Staph infection,resistant strains of the bacteria have emerged and now pose even more of athreat since they can be impossible to treat with our existing arsenal ofantibiotics.

�

Those patients afflicted with resistant Staph, or MRSA(Methicillin resistant Staphylococcus aureus) will often have to contend withthe threat of recurrent infections for the rest of their life.��Patients live in constant fear ofre-infection and often struggle with feelings of vulnerability andhelplessness. Family members, friends and co-workers may not fully understandthe facts and have nowhere to turn for education about risks and prevention.Loved ones may worry unnecessarily for their own safety, which can cause themto distance themselves from someone who desperately needs their presence andsupport.

�

The truth is that we have the knowledge and the ability toprevent a great number of these frightening infections, but the busy andfragmented system in which care is delivered does not encourage adequateinfection control measures and patients continue to be placed at risk. Asignificant part of the problem is that the public doesn't receive timely andaccurate information about the detection and prevention of MRSA and otherdangerous organisms and they are not engaged as "safety partners" in the questto eliminate infections.

�

Once I knew that Kate would survive her infection, I embarkedon a different journey as I began to research the causes and the solutions tohospital-acquired infections and preventable medical errors. The information Iobtained was both alarming and disheartening. The system that we all rely uponand the one that I trusted to care for my precious daughter was failing tens ofthousands of patients every year. Our situation was not unique - in fact, itwas all too common.

�

In 1999 the Institute of Medicine released a groundbreakingreport on the dangers in our health care system that validated what I had cometo learn during my quest for answers. In the decade since the Institute ofMedicine publication, little progress has been made in implementing the safetyrecommendations detailed in the report. The reality is that patients and theirloved ones must step up to the plate and have a positive influence on thesafety and the quality of the health care they receive by seeking information,doing their own research and being actively engaged as active partners withtheir health care providers.

�

Consumers can help prevent many infections and potentialerrors and studies show that patients who are involved in their care oftenexperience better outcomes. Patients who are involved in their medical careunderstand the rationale behind their plan for care, have realisticexpectations and set attainable goals and are generally more compliant withtheir treatment strategies. All the major patient safety organizations agreethat patients need to assume a greater role in their healthcare and to enlistfriends or family members as advocates.

�

It's true that the days of squirting Bactine on a cut andnot giving it another thought are over. But even though we must be more awareand vigilant, we must not allow fear to stop us from taking steps to protectourselves. I'm often asked if consumers can really have an impact on preventinghospital infections and medical errors and my answer is always an emphatic "Yes"because I consider patients and their advocates to be untapped safety resources.

�

This fervent belief led me to spend eight years researchingand writing a book entitled�The EmpoweredPatient: Hundreds of life-saving facts, action steps and strategies you need toknow.�I believe that the hard-won information I learned during our tenyears immersed in the system fighting for Kate's life was meant to be sharedwith others.

While the book details hundreds of basic "action steps" forpatients to utilize, the following is a good start for those interested instaying safe from infection:

�

Don't insist on antibiotics for every illness. Many respiratory illnesses, fevers and ear aches are viral infections and antibiotics�have no effect�on viruses.
Finish your entire dose of antibiotics to ensure that the bacteria have been completely eliminated from your system. If you stop taking antibiotics as soon as you feel better, you may be helping the bacteria become resistant, because you may only wound the bacteria and not kill it.
Wash your hands and insist that your health care providers do the same. Simply state�before�anyone touches you, "I know that infections are a problem in hospitals and I routinely ask all my providers to wash their hands and wear gloves." No one will object to this logic or feel offended.
Health care workers should wash their hands and wear gloves for all vascular (or blood related) procedures, such as starting an IV line.
Ask if you need a pre-operative antibiotic one hour before your surgery and remind the staff to administer it.
Ask your surgeon if you should wash with an antibacterial body wash containing chlorhexidine before surgery and don't shave your surgical site, which can cause small cuts in your skin and allow bacteria to enter your system.
Realize that California has adverse event and a hospital infection reporting law. If you experience an error or an infection, ask that your hospital report it to the Department of Public Health. If you encounter resistance, you can personally report the situation to your local health department.

�

Can you prevent every error, mishap or infection? Absolutelynot. Caring for the human body will always be inherently risky. That fact isundeniable. But don't let the fact that you can't eliminate every error or riskmake you give up or not even try at all. The reality is that patients and theiradvocates are only a part of the solution - but they are a vital part.

�

Those of us who have lost so much could have turned awayfrom the system that hurt our loved ones and never looked back. Instead, I workwith hundreds of other advocates from all over the country who devote endlesstime and energy to working with the system to make meaningful improvements. Wedo this because we still believe, even after losing those we love and stillmourn every day, that this country has the desire and the ability to make ourhealthcare system a beacon of safety and excellence.

�

Because at the end of the day, we still envision a systemthat puts patients and advocates at the center of the healthcare team. A systemwhere patients work with their doctors and not at odds with them. A system thattracks, monitors and reports hospital infections and medical errors so that wecan compile the data we need to save lives. A system that is safe andcompassionate, but never complacent. A system that is constantly seeking waysto improve, setting higher goals and welcoming of a more educated and involvedpublic.

�

Dr. Julia Hallisy is a private practice dentist in San Francisco, California and a patient safety advocate.

Why Knowing Your Blood Type is Important

molly heinsler — Wed, 26 Jan 2011 14:31:44 GMT

Last week Laura Townsend was visiting with one of the Medical Advisory Board Members. They were talking about an incident where a family member noticed that the nurse was about to give the wrong type of blood to the patient. She thought to herself that the family member was being a really informed and an active participant in his mother's healthcare. Then she began thinking she didn't know her own blood type or her children's and she should figure that out for just these types of situations. She made a chart at home that listed the entire (including the extended) families' blood types. You'll never know when a situation will occur that you will need to provide that information quickly to a doctor or nurse.

Blood types are based on the antigens you receive from your parents. You can either have A, B, both A and B or neither, which result in types A, B, AB and O, respectively.� Which antigens you have dictate which type you can donate or receive blood from. �This chart explains:

RELATIONSHIPS BETWEEN BLOOD TYPES AND ANTIBODIES
Blood Type	Antigens on Red Blood Cell	Can Donate Blood To	Antibodies in Serum	Can Receive Blood From
A	A	A, AB	Anti-B	A, O
B	B	B, AB	Anti-A	B, O
AB	A and B	AB	None	AB, O
O	None	A, B, AB, O	Anti-A and anti-B	O

�

Chart from: http://www.answers.com/topic/blood-type#ixzz1C9vjmb1O

�

In an emergency, you may need to receive a blood transfusion.The hospital will check to make sure that you receive a compatible blood type (most likely the universal donor, O), but it's still good to know your blood type in case type O is unavailable.

�

If you are having a planned surgery, a family member or friend may be able to donate to you should you need a blood transfusion during surgery. Because they will donate in advance, you won't need to worry about receiving the wrong blood type or that there will be a shortage of blood.

�

January is National Blood Donor Month. Please consider donating to your local hospital or Red Cross, especially if you are blood type O. If youdon't know your blood type, you'll find out when you donate!

�

Thoughts by Dr. Paul Curry on the direction of Patient Safety in regards to monitoring patients on the general floor.

Molly Heinsler — Fri, 14 Jan 2011 16:45:00 GMT

I was inspired when I lost my best friend 15 years ago to a preventable medical error. Losing Mark altered my entire career in medicine and started me ona long journey trying to understand and fix how this particular problemhappens. The journey has been eye opening for many reasons, and probably mostimportant is learning to understand how the human brain can deceive itself intobelieving thoughtful, rational, goal directed tactics are always the solutionto finding the answers to highly complex enigmas.

Inactuality the block busting solutions that change the course of our culture(how we do things) are most often totally unpredictable and discovered byaccident by disruptive innovators such as Larry Lynn, willing to tinker ontheir own and against the grain of thousands of smart people who dismiss thiskind of outlier work as fantasy. To get just how often this happens and why,I'd invite those unfamiliar with Nassim Taleb's work to read, "The BlackSwan", and other books of his. This is what we're up against today.

I wasoperated on a week ago today, having a multilevel, significant back surgery atone of the outstanding university spine programs in the country, supported withone of the elite anesthesia programs. I was told by the resident that I'd begoing to the general care floor following my surgery where I'd be checked onregularly. This was a given because I'm a fitness fanatic, but the residentwasn't prepared for my follow-up questions. As I probed for more detail, itbecame apparent that no one in that organization had an inkling that nursingchecks every 4 or 8 hrs, on a patient, fresh off a surgery on controllednarcotics was less than standard of care. I told them I wanted at minimum pulseoximetry, that I had mild sleep apnea, and had to be upgraded to telemetry toget it. What's more interesting is that there was so little understanding ofthis problem, that they put me on pulse oximetry in my room where the only onethat could watch it was me, the patient.

Thepoint to all this is that mistakes and errors are preventable and avoidablebecause there is knowledge out there that predetermines the right thing to do,and for whatever reasons it doesn't get done. In this case there isn't theknowledge out there to begin with. Even the progressive monitoring industry ismaking incremental strides in trying to advance and change the culture, buttheir work today is based on what they think they know, not what they don'tknow for sure, which is considerably behind the thinking in Larry Lynn'smessage. Larry, Franks, and my frustration is rooted not in harm fromcarelessness, but rather continuing harm occurring from lack of a critical mass(number) of people needing to know the unknown and accept what Larry has beentalking about to actually drive postoperative care to totally transformedentity...A Black Swan.

There'sbeen a lot of work done on human behavior and how best to motivate these kindsof megachanges. Appreciative Inquiry (AI) has been very successful, based onmuch evidence that while people can learn from mistakes if we're able to unearththem since many assume (especially us yanks) bad consequences must be theresult of carelessness, that we learn much better from looking at and learningfrom our successes. That's why I've made the reading recommendations and hopeto continue thru candor to add value to our work as a family.

Dr.Paul Curry - Immediate Past Chief of Staff, Hoag Memorial HospitalPresbyterian, Newport Beach, California

Goals for 2011

Molly Heinsler — Fri, 03 Dec 2010 11:00:00 GMT

2011 Areas of Funding

We are proud of our work this past year, however, there is still so much to be done. We continually ask ourselves, "What more can we do? How do we prevent more medical errors from happening and raise awareness of this terrible issue?" We plan to continue our involvement with the SASC and we will continually update the website with news and information. In addition, we are planning the following research and outreach activities for 2011:

The Batz Guide

The Batz Guide was published in October 2010. It was a collaborative effort with our medical advisory board, volunteers and community partners. Several copies have been distributed and the feedback has been extremely positive. Along with the research project in the facility, the Foundation is eager to get these guides in the hands of the patients and their advocates. We are interested in talking with medical professionals on the frontlines to help distribute them to people at their time of need and when they can be most impactful. The printing, distribution and promotion of the guide require funding. We know that this guide will save lives as we have already heard from our users that it has been instrumental in identifying errors and empowering its readers. While people can locate the guide online, we do not want to be reactive. We do not want to wait for people to find us after it is too late. Our mission is to PREVENT medical errors and reduce deaths related to medical errors. This requires us to proactively promote the solutions that are available.

Educational and Awareness Campaign

By giving to the year-end appeal, the Foundation will be able to raise awareness of this critical issue. It is imperative that we reach people prior to entering the hospital and we need to develop and execute an outreach strategy to have maximum impact. We also need to make sure that the general public and those interacting most with our healthcare system are aware of the statistics so they can be more prepared for their own medical interactions. Along with educating the patients and their loved ones, the Foundation will leverage our relationships with medical facilities and professionals to impact our mission. We believe in creating a team effort to improve patient safety and we will include all audiences in our outreach efforts.

2011 Research Project in San Antonio

The Louise H. Batz Patient Safety Foundation is collaborating with the Baptist Healthcare System and University of Texas Health Science Center in San Antonio (UTHSCSA) to implement a six-month pilot-study at Northeast Baptist Hospital's Orthopedic Unit. Together, we will provide our educational materials to patients and families in hopes of effectively integrating our patient safety model into the hospital's culture. UTHSCSA's Academic Center for Evidence-Based Practice will systematically evaluate the effectiveness of The Batz Guide (print and online), teamwork concept, and communication improvements including patients, families, nurses and doctors working together to improve patient safety.� The study includes training by nurses to joint surgery patients and their families during pre-surgery meetings. Training will include an overview of the Foundation's educational materials. The study will also include professional education provided by the Foundation's staff and board of advisors.

�

The pilot-study will be based on the principles of Team STEPPS, developed by the Department of Defense Patient Safety Program, in collaboration with the Agency for Healthcare Research and Quality. According to the Team STEPPS approach:

"Human Factors research has shown that even highly skilled, motivated professionals are vulnerable to error due to inherent human limitation. HROs, such as those found in military operations, aviation, community emergency response services, and nuclear power industries, have learned that TEAMS of individuals who communicate effectively- and back each other up-compensate for individual fallibility and dramatically reduce the consequences of inevitable human error-resulting in enhanced safety and improved performance."

�

We are anxious to begin the study and plan to replicate the recommended outcomes throughout San Antonio. We are also saddened that this is an issue that affects millions of people every day throughout Texas and the entire U.S. We are hopeful that our research and educational tools will be implemented throughout the country and more lives will be saved because our efforts.

Patient Protection smart phone applications

The Louise H. Batz Patient Safety Foundation has partnered with Ringful Health to develop two mobile applications for the iPhone and iPad. The applications allow patients and their loved ones to electronically record medication information and have immediate access to The Batz Guide. Use of this technology ensures that everyone will have easy access to the information needed to work with hospital staff and family members to prevent medical errors. The availability of these applications on iTunes also provides an efficient and cost-effective way to distribute this vital information.

What we've done in 2010

Molly Heinsler — Fri, 03 Dec 2010 10:07:52 GMT

2010 Accomplishments

This past year has been filled with new relationships, innovations, infrastructure and a very focused mission. Because of our generous donors, we were able to achieve many milestones for the Foundation. Below is a snapshot of our 2010 activities:

Development of the Louise H. Batz Patient Safety Foundation logo, identity mark and website in collaboration with Gray Web Technology and Design.�

Medical professionals and patients can find resources and join a community of individuals that care about preventing medical errors online at www.louisebatz.org. The logo design is based on one of my mom's favorite traditional Oaxacan Mexican dresses. Our family has called San Antonio home since the 1800's and she loved to celebrate the city's history and passion for life. The dress always symbolized happiness and love and now we hope that our logo will provide that same feeling for others.

Creation of our Medical Advisory Board, Foundation Advisory Board, and the Board of Directors.�

Our advisory boards consist of doctors, nurses, professors, Chief Medical and Nursing Officers with many years of experience in their respective fields. Our leaders share a passion and conviction for improving patient safety and were instrumental in the development of The Batz Guide. Our Board of Directors is an outstanding group of individuals from San Antonio and across the country and we are honored to work with them to accomplish our mission.�

Publishing The Batz Guide for Bedside Advocacy "Teaming Up for the Patient".��

Medical terminology is often times very difficult to understand. The guide is meant to help patients and their loved ones ask potentially life-saving questions in a language that they and their medical teams can all understand. The purpose of the guide is to keep patients safe. It is filled with over 70 pages of questions, tips and worksheets and is available on our website for download.

Presentation of the Health 2.0 Challenge Award.�

Over the past year, our foundation has been working closely with Ringful Health and Dr. Vishal Kancheria of the North Austin Medical Center. We have developed a pain care mobile application that helps chronic pain patients to better manage their symptoms and medications; and better communicate with their physicians in hopes of properly treating patients and reducing the risk of medical errors. Health 2.0 (a group focused on highlighting technology advances in medicine) announced this fall that Ringful Health's Pain Care application won the "Project HealthDesign" developer challenge sponsored by the Robert Wood Johnson Foundation and California Healthcare Foundation.

Formation of the San Antonio Safety Collaborative (SASC).�

The catalyst for this movement was the tragic death of Louise H. Batz, who suffered a medication error while on Patient Controlled Analgesia (PCA). The Louise H. Batz Patient Safety Foundation met with San Antonio hospital systems to present research on the risks of PCA and the need for improving PCA safety in our community. After these meeting, the group was formed in late 2009 and includes a multidisciplinary group of representatives from several San Antonio hospital systems. Meetings included a review of all PCA literature, resource sharing, and discussions about risk reduction strategies. In October of 2010, the SASC released guidelines surrounding the use of PCA. This collaboration demonstrates that if we can all work together as a team, we can reduce preventable medical errors. It is a great feeling to know that patients will be so much safer now because of the adoption of the PCA safety collaborative guidelines. The Foundation is very proud of this accomplishment.�

Ringful Health's Pain Care application has won the "Project HealthDesign" developer challenge

mizaguirre — Thu, 07 Oct 2010 15:23:00 GMT

Great News! Health 2.0 announced today that Ringful Health's Pain Care application has won the "Project HealthDesign" developer challenge sponsored by the Robert Wood Johnson Foundation and California HealthCare Foundation. We are honored to win this national challenge! The winning application is a collaborative effort between Ringful Health, Dr. Vishal Kancherla of the North Austin Medical Center, and the Louise H. Batz Patient Safety Foundation. We are so excited about this news!

Please take a look at Rinful's Video Submission on the Pain Care App- http://vimeo.com/15048551 and password is Health2

The following is Michael Yuan of Ringful's press release:

Health 2.0 announced today that Ringful Health's Pain Care application has won the "Project HealthDesign" developer challenge sponsored by the Robert Wood Johnson Foundation and California HealthCare Foundation. We are honored to win this national challenge!

The winning application is a collaborative effort between Ringful Health, Dr. Vishal Kancherla of the North Austin Medical Center, and the Louise H. Batz Patient Safety Foundation. By having practicing pain management physician and patient safety experts on the team, we have developed an application that benefits patients and physicians alike.

An early version of the Pain Care application is already available on the iPhone App Store. An update and the Android version of the app will soon follow next week.

Pain Care is a consumer mobile application that helps chronic pain patients to better manage their symptoms, medications, and better communicate with their physicians. It is based on one of the video scenarios in Project HealthDesign. Building on the HealthDesign story board, we work with pain management specialist Dr. Vishal Kancherla to enhance the design to include decision support analytics that are integral to physician's workflows.

So, why do we choose pain management? According to the National Institutes of Health, pain is one of our most important national health problems, costing the American public more than $100 billion each year in health care, compensation and litigation. Pain management is also plagued by substance abuse, overdosing, and medical errors. Yet, a recent study (1) shows that many patients receive insufficient pain management. There is clearly something wrong here, but what is it? Can technology help?

Well, as it turns out, pain management is one of the therapeutic areas that really need personalized medicine. According to a study (2), today's prescription pain medications are only 80% effective. People have different lifestyles, environments, and even genetic makeups. The one-size-fit-all solution does not work well for pain treatments.

In our view, a key aspect of a better and more cost effective pain management solution is to provide better information for physicians and patients to help personalize the treatment options for the most efficacy. That is exactly what our Pain Care application does.

At its core, the Pain Care application is an electronic pain journal for patients. Pain journals are well established tools to help patients manage chronic pain. Many studies have shown that electronic journals far outperform paper journals in both response rate and accuracy (3). In the pain care application, the patient report pain episodes, triggers, and medications. It then correlates all those data to give the patient insight into exactly what causes the pain and what medication / therapy is effective.

With PHR integration, the patient can share data with physicians. Our application provides an automatic natural language summary of the patient history together with analytics charts - they are all designed to fit into pain specialists' existing decision making workflow, and make it easier for the doctors to come up with personalized treatment options.

We look forward to your feedback. If you are a healthcare provider or insurer in the pain management space, we'd also love to explore opportunities for us to work together!

Links- www.ringful.com

Video Submission on the Pain Care App- http://vimeo.com/15048551 and password is Health2

References

1. American Society for Therapeutic Radiology and Oncology (2008, September 10). Many Cancer Patients Receive Insufficient Pain Management Therapy. ScienceDaily. Retrieved September 9, 2010, from http://www.sciencedaily.com/releases/2008/09/080909122753.htm

2. Brian B. Spear, Margo Heath-Chiozzi and Jeffrey Huff. Clinical application of pharmacogenetics. Trends in Molecular Medicine Volume 7, Issue 5, 1 May 2001, Pages 201-204

3. Tonya M Palermo, Duar� Valenzuela, Paul P Stork. A randomized trial of electronic versus paper pain diaries in children: impact on compliance, accuracy, and acceptability. Pain. Vol 107, Issue 3, Pages 213-219 (February 2004)

New Mobile Apps for Patient Protection

mizaguirre — Tue, 05 Oct 2010 15:20:08 GMT

The Louise H. Batz Patient Safety Foundation has collaborated with Ringful Health and, Dr. Vishal Kancherla of the North Austin Medical Center to develop a pain care mobile application that helps chronic pain patients to better manage their symptoms, medications, and better communicate with their physicians in hopes of properly treating patients and reducing the risk of medical errors.

The Foundation and Ringful Health are currently working to develop two mobile healthcare applications (apps) for the smart phone, particularly the iPhone and the iPad. The apps will allow you to electronically record medication information and access our information in the Batz Guide for bedside advocacy. By using these apps, everyone will be able to readily access the information needed to work with hospital staff to protect you or your family members against preventable medical errors. The availability of the apps on the iTunes store will give much greater access to our tools and resources.

Go to www.rinfgul.com or the itunes store and check out the Pain Care App and some others they have already developed. Some of their most popular apps are the Pollen Journal and Asthma Journal. They have been featured in The Wall Street Journal, New York Times, Los Angeles Times. Dr. Michael Yuan, the CEO, is a recognized expert in mobile and Internet software development. He published 5 books and over 40 articles in this area. His book "Enterprise J2ME", originally published by Prentice Hall in 2003, is considered a pioneering work on end-to-end enterprise mobile computing, and it is a best seller on Amazon.com after being adapted as textbook in several universities. With his vast experience in mobile healthcare application technology we are very excited to have them as our partners.

We will let you know as soon as they are available for download at the iTunes store!

My Mom's Story

admin — Wed, 24 Mar 2010 11:27:37 GMT

In April of last year, I was sitting with my Mom during a visit to my parents. We were in the family room watching TV. It was a Monday night, so we were watching Jack Bauer save the world on 24. We loved that show. It was a nightly ritual of ours when I came to San Antonio to visit. With my dad asleep and my two daughters tucked in, Mom and I had time to relax and just catch up. I always cherished those moments and even now they are some of my fondest memories. On this night in particular, while we were chatting and watching our shows, Mom was looking over all her paperwork for the hospital, getting ready for her knee replacement surgery the next day. She was so calm. Mom was so ready to have her surgery; she timed it just right so that she would have enough time to heal and be ready to welcome the arrival of her fourth grandchild, Riley Bruce Hamilton Batz.

We went to the hospital the next morning. My Dad, my aunt Joanne, and I were all with her in the Pre-operative room. She was still so calm and strong. I was so proud of her. The nurses came and got her and I gave her a kiss and told her I would see her in a few hours. Dad, Joanne, and I sat in the waiting room nervously for a couple of hours. I always thought that this was the scary part, the surgery. The doctor came out and told us everything went great and the surgery was a success. I cannot tell you how relieved we all were, especially my Dad. He had been a nervous wreck. The hard part was over now. Mom was on the road to recovery and focused on getting her new knee in shape.

After the surgery, my Mom was taken down to her hospital room. Mom had asked me to go get her night jacket because she was cold. I picked that up and my daughters -Ella and Mary Louise. They came back with me and brought her flowers and balloons. They loved her so much. Ella was four years old at the time. They had such a special relationship. Mom would take care of Ella at least once or twice a week. Their favorite thing to do was sit in the kitchen, color and play with baby dolls. When Ella was a baby, I think my Mom would change her clothes three times a day - each time a new dress and bonnet. Mom helped me so much. She was such a strong presence in my life and the life of her granddaughter. Our youngest daughter, Mary Louise, had just turned one. In that short time, their bond was already becoming very strong as well. Every time she saw my Mom she would kick her legs and reach her arms out trying to spring out of my arms to get to her. She had such joy in her eyes every time she saw Mom. Looking back, I am so glad they had one last time to see her.

I took the girls home and came back to sit with my Mom at the hospital. We were trying to decide if one of us should stay with my Mom overnight in the hospital. The nurse told us to go home because Mom really needed her rest. She had to get up at 5:00 A.M. to go to her first physical therapy session. At 10:00 P.M., I gave my Mom a kiss and told her she was doing great and that I loved her. I never imagined that would be the last time she got to talk to me or tell me goodnight and that she loved me. I will forever wish that I had not listened to the nurse. I will forever wish I had stayed with her.

I came home and my Dad arrived about an hour later. He was so relieved that everything had gone well that day. He was not excited about going to bed without Mom. They were always together; they never spent time away from each other. Mom and Dad had been together for almost 50 years. Dad and I sat up and visited until around midnight and then decided to go to bed.

The phone rang around 4:00 A.M. It was the hospital. The hospital staff informed Dad that Mom was having trouble breathing and that we should come down to the hospital. We immediately got dressed and raced to the hospital. On the way, I called my uncle Charlie, who is a doctor, and he was trying to assure me that everything was going to be okay. The nurses probably just had her on some oxygen. I was feeling a little bit better, but I couldn't get this panic out of my stomach. I wouldn't relax until I saw her for myself.

We got to the hospital and I ran to her room. As I turned down the hall, I saw a security guard outside her door. My chest tightened and my heart sank. Something was really wrong. Why would they have a security guard outside her door? I raced into her room, and at that moment I felt a pain that I have never experienced in my life. I thought my Mom was already dead. She was so white and lying still on the bed. The nurse was pumping oxygen into her. She could not breathe on her own. Now I know why they had a security guard. I started yelling and screaming, and it took every ounce of me not to start throwing things at them. How could this have happened to my sweet wonderful Mother? It is so hard to describe the emotions that I felt at that moment. It was like a thousand knives going straight through my body. Those first moments were filled with anguish and pain like I have never felt in my life. They told us my Mom had suffered from respiratory depression. I immediately called our dear friend Dr. Scott Campbell who was also an ER doctor. He was at the hospital within fifteen minutes and was the one responsible for rounding up the team of doctors that would try and save my Mom. For the rest of my life, I will be forever grateful for Scott. He tried desperately to save my mom and tried to help her so that our family and friends might have had the opportunity to be with her one last time.

My Mom was on life support for ten days. During those ten days in the hospital, we asked a million questions about how this could have happened to my Mom. It didn't take long to realize that she was in this condition because of a preventable medical mistake. I felt like my Mom had just gotten hit by a drunk driver. It was all so sudden and could have been avoided. How could this have happened? My Mom's father, brother, son, daughter-in-law and sister-in-law were all doctors. I started doing some research and quickly realized what a huge problem patient safety is in this country. I had no idea so many people died each year from preventable medical mistakes. The few hours each day that I was not at the hospital with my Mom, I kept diving into research and learning as much as I could about patient safety. entire life that Mom was too sick to take care of us and even then it was only for a day. So, I sat with her during the days and nights. I held her hand, massaged her feet, and would put ice packs on her forehead when her fever would get high. I just wanted to try to take care of her the way she always cared for me. Yet, I knew that I could never come close. I told her over and over again how much I loved her and what a wonderful mother she was. I kept hoping for a miracle. Hoping that she would wake up and just look at me and tell me everything was going to be ok. But, the damage to Mom's brain was too massive, and eight days later we were told that she would never be able to recover.

On April 26th we made the terrible decision to take her off the breathing machine. I held my Mom's hand and stroked her head while she was fighting, unconsciously, to breathe. I begged her to stop struggling; I wanted her to stop suffering. I told her that we would be okay. I told her that it was time for her to go to heaven and that she could take care of us from up there. My aunt Joanne was holding her other hand and telling her the same thing. My brother paced the halls. He couldn't bear to see her struggling to breathe. My brother's wife, Ginger, sat at the corner of the bed her head down and crying. My husband Michael was in the room standing behind me rubbing my shoulders. He never left my side. My Dad was sitting in the chair next to her in shock. His eyes were glazed over. He was a man with a broken heart. I looked up at the monitors. Her oxygen finally read zero and the heart monitor had "flat-lined". My Mom finally passed away. I went to the hallway and sat on the floor, crying. I was terrified because I couldn't feel my Mom anymore. We always had a very special connection, and for the first time I couldn't feel it. I was so scared that I wouldn't get it back..

I went home to tell Ella that Grandmother went to heaven. She cried and couldn't understand. She asked if she was coming back. I told her no, but she would always be with us no matter where we go. After asking if she would be at school, in the car and various other places, Ella asked, "Will she be with us even if we go to Mexico?" . I laughed through my tears. Children are wonderful and they are an eternal sense of joy. I realized that was how my Mom felt about us. I was blessed by her love for 35 years. I will always have those memories and moments in my heart. Even though Ella only had four years with Mom, she will be able to carry those blessed memories in her heart as well. She talks about her all the time. She will laugh and smile at something funny they did together and she cries a lot too. I asked Ella one day what one of her favorite memories was about Mom. She said, "I loved coloring with her. She always colored with me when I asked. Now there is no one to sit with me and color in the kitchen and it is lonely." This is when my heart breaks into little pieces. At least she has those memories. The greatest tragedy is that Mary Louise won't remember Mom. I will have to tell her how excited she was to see her, but she won't have the memories that Ella and I have. That is when I think to myself over and over again, how could this happen? She didn't die from a terminal illness or serious medical condition; she died from a preventable mistake. Why?

From that moment on, I had a new sense of purpose and focus. My life took a new direction that night. I got up the next morning and wrote the mission and objectives of the Louise H. Batz Patient Safety Foundation. I was not going to let my Mom's death go unnoticed. I couldn't imagine other families having to experience this pain. My Mom would never want other families to suffer the way we have. Over the past year, with the help of so many amazing people, we have established and laid the groundwork for my Mom's foundation.

In just a few months, we have accomplished so much. I can feel Mom with me. I know that Mom and God have been guiding me through this journey. I try to think what she would have done. She always believed there was a solution. When friends called to tell her they were sick or having a problem she would immediately get to work calling our doctor friends, researching the internet, or referring back to interesting articles she had read that seemed helpful. I recently discovered that she kept index card files labeled with helpful tips just filled with information for those moments when someone needed to know things would be okay. It is amazing. I feel that I am merely working on her behalf. I am doing what she would have done.

I am thrilled that the website is going to launch this April. We have developed patient care packets for families and advocates to use while their loved ones are in the hospital. I know that if I had known the RIGHT questions to ask, my Mom would be with me today. If we could have all worked together with the nurses and doctors as a team, the outcome could have been different. We would be having our quality time together watching Jack Bauer save the world one more time. She helped and supported so many people during her time with us. I hope that her foundation will leave a legacy of helping families for many years to come.