Why so many hospital admittance questions?

As I have posted before my Mom is in latter stages of terminal Lung Cancer. Saturday night she had actute breathing difficulties so we brought her to the hospital emergency room. They got the breathing under control and admitted her to a regular room. By the time they got her to the room it was four in the morning and my mom desperately wanted and badly needed some sleep. Instead they hit her with a barrage of questions, the likes of which I have never seen. I do not blame the nurse who felt bad and said she was required to do so. Some I understand such as do you have an allergies, what medicines you are currently taking, etc although these questions were previously asked in the emergency room. Some I thoght could probably wait. How much alcohol to you take, how many cigarettes do you smoke etc. But some I thought were plain rediculous and I could not see the point of asking them at that time or any time unless the patient requested such. My mom had admitted that yes when healthier she liked to enjoy a few beers each day although that had largely been eliminated the past couple of weeks due to declining health. They were asking her, would she like some information on alcohol and smoking cessation, has any family members ever told her she had a problem with alcohol etc. I thought it was totally inappropriate at the time, given the circumstances. She was being admitted to hopefully stablize a cancer related breathing problem, not a patient in a drug or alcohol rehab center. I wonder what are the reasons the powers to be felt the need for these questions should be asked. Any medical insight on this?

This sounds like cookie-cutter medicine to me. I probably would've pressed the nurse for some details about why she was required to ask those questions and who demanded that she badger this poor patient at such an inappropriate time. I've seen far too much of this nonsense firsthand and I'm fed up with this kind of treatment myself.

It's just to keep the lawyers away.

This sounds like cookie-cutter medicine to me

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No, just cookie cutter administration

Actually, it can be vitally important to know if she's a habitual smoker or a drinker. The condition of her lungs from smoking or whatever is VERY important is she's there for a breathing problem, if they have to intubate her or do anything like that they will adjust those settings given some of that information. Once she is intubated (which could happen at any moment if she's in bad shape) she can't talk anymore to tell them. So you go home an hour later after refusing to answer all these things and she gets transfered to the ICU, gets intubated and it takes them hours of playing around and several very painful arterial blood gas sticks to get it setup right, or they could be a lot closer on the first try if they know.

As far as booze and drugs, thats vital to know too as it affects the dosage and use of other medications. If she's on drugs then they can't give her some things, or if she's a habitual drinker then it may take more than the normal dose of a pain killer to get her some relief. Again, an hour after you leave she gets taken to the ICU and they give her an inadequate dose of pain killer, but she's been put on a vent and is in horrible pain but can;t tell anybody?

No, I think it's better answer some unnecessary questions at 3am than to end up in any of those positions.

James S said:

No, just cookie cutter administration

Actually, it can be vitally important to know if she's a habitual smoker or a drinker. The condition of her lungs from smoking or whatever is VERY important is she's there for a breathing problem, if they have to intubate her or do anything like that they will adjust those settings given some of that information. Once she is intubated (which could happen at any moment if she's in bad shape) she can't talk anymore to tell them. So you go home an hour later after refusing to answer all these things and she gets transfered to the ICU, gets intubated and it takes them hours of playing around and several very painful arterial blood gas sticks to get it setup right, or they could be a lot closer on the first try if they know.

As far as booze and drugs, thats vital to know too as it affects the dosage and use of other medications. If she's on drugs then they can't give her some things, or if she's a habitual drinker then it may take more than the normal dose of a pain killer to get her some relief. Again, an hour after you leave she gets taken to the ICU and they give her an inadequate dose of pain killer, but she's been put on a vent and is in horrible pain but can;t tell anybody?

No, I think it's better answer some unnecessary questions at 3am than to end up in any of those positions.

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bingo!
was about to post essentially the same thing but you beat me to it.

James, I agree with the asked questions you stated but at that point what is the point of asking if you want smoking cessation information or whether a family member has ever suggested you might have a problem with smoking or drinking?

Just a guess, but some health care workers do double duty as social workers. I understand that in some cases it's required (child and spouse abuse) and others may be local policy.

It sort of makes sense for an HMO owned hospital to try to avert the problems from smoking and drinking. Cessation clinics are a lot cheaper than transplants.

I always figure that they have reasons for their questions and I always answer completely and correctly. The last thing I want is to have a doctor make a decision with incorrect information. Besides, the better you treat the staff the better they treat you.

James, I agree with the asked questions you stated but at that point what is the point of asking if you want smoking cessation information or whether a family member has ever suggested you might have a problem with smoking or drinking?

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Cause it's cookie cutter administration

If they were going to leave out those specific questions, then that would be the responsibility of the individual doing the question asking and is that person really qualified in the eyes of the hospital administration board to be making decisions about what questions are likely to be applicable to an individual at any given moment? It's more than her job's worth if she starts actually THINKING while following the checklist. And it's probably some anti-discrimination thing too. everybody gets the same stupid questions all the time so that nobody can say you asked them how much they drank and how much they smoke and how much they have unprotected sex, because they were black/white/red/short/stupid/inbred/funny looking/poor/shirtless/pantless/etc

And then, once you decide to have this platform that you read to the patient, and once you have a board whos most important function on that level is to hire the pr firm to design a public relations commercial and catch phrase for the hospital, they are going to keep adding more and more garbage to the presentation. Cause after thats done they wont have a better opportunity to talk to you again...

The only place more beurocraticly constipated than the lower echelons of hospital administration would be the DMV

What JamesS said.

You'd always prefer to know one bit more than one too less, especially in critical conditions.

In addition to that you'd need standardized information aquiring procedures to allow for the follwing:
- to avoid forgetting the important questions in the hurry
- to allow "lesser" personnel (a nurse in this case) to do the job instead of a doctor ... money talking
- to keep the lawyers away just in case you discover something important for the illness at hand
- to allow the patient to be treated optimally in all aspects, not just the emmergency reasons why she is here
- to double check the info from the ER which might not be as complete as you'd want as the new situation is that the patient will stay longer and you'd need more info than what was needed for the decision making in the ER

In the end ... I wouldn't bother about a pack of questions if it is just this ... questions and nothing more ... and let the staff do their work. After all, it is them who should be knowing what they are doing. And you'd want the best treatment given to your relative, and this best treatment is most likely the one the hospital staff is working out since they are the specialists that you called for to help your relative.

bernie

One word or acronym I should say

HIPPA

Health and information personal privacy act.

What James and Bernie said also. My wife has been and ER nurse and is now a fertility and Neo-natal nurse. She often talks about Hippa and how it is so funny that each form has to be filled out by each unit to protect your privacy. So if she has a patient that is trying to get pregnant and then has a baby the same info has to be gathered again to fulfill these privacy acts.

And it is as James suggested they are told to ask ALL the questions to EVERYONE no matter if they apply or not so everyone is treated the same whether they should be or not, it's all just plain goofy if you ask me.

Also hospitals can not share records as they once did. So each hospital or medical group has to attain their information through the patient, not from your doctor or from your last hospital visit.

One of the things this really causes problems with is from drug seekers. It used to be that the 4 hospital in our area would inform the others if they had a "patient" that came in complain of pain and the staff suspected they were just trying to get narcotics. Well now it is illegal for one ER to share that information with another, or even share that information with a unit if that patient is admitted. I understand the need for privacy, but it seems to have gone over the deep end.

James S said:

Cause it's cookie cutter administration

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Exactly. HIPPA, JACHO, lawyers, administration, so-called nursing experts...take your pick, it's all about CYA.

I hate filling in all the blanks at 0300 with a patient who just came up from the ER and hasn't had anything to eat since breakfast, but I have to. If I don't, I open up the entire hospital to the wrath of god. Not the real God, but the gods of accountability

If I don't ask you a specific question, for any reason, and it comes back to bite me later in the shift or some other nurse days later, who's fault is it. Will I get in trouble, you bet. Could it hurt the patient, good chance. Will it go to court, possibly. Will it hurt the hospital in the long run, yes. All because I didn't ask you a simple question--what I am required to do.


I love patient care--it's why I got into nursing. I just can't stand the paperwork. I can't stand the paperwork audits. I really can't stand the audits of the audits.


We have a JACHO inspection in two weeks. And I'm charge of the ICU that week on nightshift for three days of it. GARGH! I'm not stressed out, I'm just pissed that everyone else around me will be and I hate that.