Oregon’s success with its one-page Physician Orders for Life-Sustaining Treatment (POLST) has been remarkable (for details, refer to Improving Care for the End of Life, pages 125-127). In one study, 180 nursing home patients who had a POLST and who were later admitted to hospitals did not receive CPR and were not put on ventilators. This excellent system did not work in the recent case of an elderly woman admitted to an OHSU hospital. Although she had a POLST on record at the nursing home where she was a resident, it did not come in with her when an EMS team brought her to the hospital. She wound up intubated and with all the usual array of life-support. She died after a tour in the intensive care unit, with plenty of suffering all around. Progress indeed.
But then, something remarkable happened! People were outraged. Hospital workers viewed this case as a serious medical error. Reports were filed, participants were questioned, root causes were assessed. In short, people were agitated! And instead of rationalizing outrage away, they used it to note a problem in the system and how to prevent it from happening again. Even more striking is that there have been only three cases in which the POLST system has failed to prevent unwanted resuscitation--and it was the first breakdown at the OHSU hospital. And still, no one brushed it off!
What a marvelous turn of events. Such cases are still so routine in my hospital that they would raise no particular ire or interest. Such cases are still so routine in the nation that anything else probably raises eyebrows. But at least one major hospital has been doing things so well for so long that this banal wrongdoing was seen to be what it really must be seen to be – outrageous! As a result of this error, Dr. Tolle gave grand rounds, and the emergency department now contacts the nursing home to confirm the DNR status of patients.
All us Sisyphus look-alikes must kick up our heels. It can be done! Good care can become routine enough that mistakes stick out as threats to patient safety. Good care can become so expected that anything else kicks in the same corrective actions that good care settings have used for years for other mistakes. In short, good care can be commonplace.
And together, we can do it!
| For a Good Cause : Donate to ABCD Through the Combined Federal Campaign, Fall 2001 |
| ABCD will participate in the Fall 2001 Combined Federal Campaign (CFC). Through the CFC, federal employees are able to make charitable contributions through payroll deductions. ABCD relies on such donations to fund programs and projects nationwide: the CFC is a great way for you (and your family and friends) to help us. Please mark #4498 in the fall campaign, and help us in our work to ensure that all Americans can count on good end of life care. |
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