Health Literacy

Every hospital has a routine form for the discharge instructions that is given to the patients. It’s usually a printed form, with check marks that dictate allowances on activity, diet, wound care, a list of medications, and a printed copy of educational material. But, how do we, as health care providers really know that our patients are comprehending what we are telling them? That’s the tricky part. Sure, some of it is easy… don’t drive until the physician gives you the all clear… don’t shower today, but you may take one tomorrow… etc. But what about REALLY understanding their diagnosis and medications?

I was caring for a patient who coded at home, was revived by the paramedics, brought to the emergency room, and was currently intubated, unresponsive (on her own – we were not giving any sedation), and was frequently having episodes of Ventricular Tachycardia, meaning that her heart was quivering and not pumping blood to her vital organs. So, we were defibrillating (shocking) her heart about 5 times each day to keep her alive. Generally in patients who continue to have arrhythmias requiring them to be defibrillated, we would put in an AICD (automatic internal cardiac defibrillator) that would shock them from inside their chest at a much lower voltage. But, an ethical question came into play- the patient was unresponsive and her EEG (electroencephalogram – which is a study of the brain waves) was flat, meaning that she was brain dead. If we were to put in the AICD, she would live as a “vegetable” and have no quality of life. After a few days, the patient’s husbands eventually came to terms with the situation and let her pass on.

During my multiple days taking care of this patient, I had ample opportunity to talk to the husband about their life together, what his wife was like before all of this happened, and anything else he wanted to tell me. One of the things we talked about was her aversion to medications. She had been diagnosed with congestive heart failure a few years before and was on about 5 different daily medications, including Lasix (a diuretic, which pulls excess fluid from the body which removes some of the workload from the already weak heart). Lasix has a side effect of removing potassium along with the extra fluid, so most patients who take Lasix daily are also prescribed a potassium pill to prevent the potassium level from getting too low. In the body, potassium has many functions, one of the most important being its important role in muscle function, including the functioning of the heart muscle. From talking to the patient’s husband, I found out that she had been religiously taking her Lasix because she was told how important it was, but she was not taking her potassium supplements because it made her nauseated. At that moment, it all made sense… looking back at her lab work, her potassium level was at a critical low when she was brought into the emergency room, and the lack of potassium does not allow the heart muscle to squeeze appropriately.

I gave this information to the cardiologist when he came by that afternoon, but I didn’t have the heart to tell the husband myself that all of this most likely came about from his wife not taking a supplement that she was prescribed.

I can only assume that the doctor who prescribed the potassium supplements and/or the nurse who gave the discharge instructions (if it was prescribed when she was in a hospital) did not emphasize the importance of the potassium with the lasix.

To help elliviate this problem, I would love to see hospitals routinely make follow-up phone calls to patients discharged from the hospital. The hospital would inquire about their health since being discharged, if their pain is well controlled (if they had surgery), make sure they were able to get all prescriptions filled, and go over any questions that the former patient may have. Not only does this improve patient education (discharge is often an overwhelming time as the patient is getting many pieces of new information in a short period of time), but it will also improve the satisfaction that patients feel with the hospital, showing that they are cared for, even though they are not within the walls of our faciltiy.