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Advance Directives



To prevent health care errors, patients are urged to .. Speak UP!


EVERYONE has a role in making health care safe. That includes doctors, health care

executives, nurses and many health care technicians. Health care organizations all across

the country are working to make health care safe.  As a patient, you can make your care safer by being an active, involved and informed member of your health care team.

An Institute of Medicine report says that medical mistakes are a serious problem in the health care system. The IOM says that public awareness of the problem is an important step in making things better. The Speak Up™ program is sponsored by The Joint Commission. They agree that patients should be involved in their own health care. These efforts to increase patient awareness and involvement are also supported by the Centers for Medicare & Medicaid Services.

This program gives simple advice on how you can help make health care a good experience. Research shows that patients who take part in decisions about their own health care are more likely to get better faster. To help prevent health care mistakes, patients are urged to “Speak Up.”


SPEAK UP if you have questions or concerns. If you still do not understand, ask again. It is your body and you have a right to know.

  • Your health is very important. Do not worry about being embarrassed if you do not understand something that your doctor, nurse or other health care professional tells you. If you do not understand because you speak another language, ask for someone who speaks your language. You have the right to get free help from someone who speaks your language.

  • Do not be afraid to ask about safety. If you are having surgery, ask the doctor to mark the area that is to be operated on.

  • Do not be afraid to tell the nurse or the doctor if you think you are about to get the wrong medicine.

  • Do not be afraid to tell a health care professional if you think he or she has confused you with another patient.

PAY ATTENTION to the care you get. Always make sure you are getting the right treatments and medicines by the right health care professionals. Do not assume anything.

  • Tell your nurse or doctor if something does not seem right.

  • Expect health care workers to introduce themselves. Look for their identification (ID) badges. A new mother should know the person who she hands her baby to. If you do not know who the person is, ask for their ID.

  • Notice whether your caregivers have washed their hands. Hand washing is the most important way to prevent infections. Do not be afraid to remind a doctor or nurse to do this.

  • Know what time of the day you normally get medicine. If you do not get it, tell your nurse or doctor.

  • Make sure your nurse or doctor checks your ID. Make sure he or she checks your wristband and asks your name before he or she gives you your medicine or treatment.


EDUCATE yourself about your illness. Learn about the medical tests you get, and your treatment plan.

  • Ask your doctor about the special training and experience that qualifies him or her to treat your illness. The goal of the Speak Up™ program is to help patients and their advocates become more informed and involved in their health care.

  • Look for information about your condition. Good places to get that information are from your doctor, your library, support groups, and respected Web sites, like the Centers for Disease Control & Prevention (CDC) Web site.

  • Write down important facts your doctor tells you. Ask your doctor if he or she has any written information you can keep.

  • Read all medical forms and make sure you understand them before you sign anything. If you do not understand, ask your doctor or nurse to explain them.

  • Make sure you know how to work any equipment that is being used in your care. If you use oxygen at home, do not smoke or let anyone smoke near you.

ASK a trusted family member or friend to be your advocate (adviser or supporter).

  • Your advocate can ask questions that you may not think about when you are stressed. Your advocate can also help remember answers to questions you have asked or write down information being discussed.

  • Ask this person to stay with you, even overnight, when you are hospitalized. You may be able to rest better. Your advocate can help make sure you get the correct medicines and treatments.

  • Your advocate should be someone who can communicate well and work cooperatively with medical staff for your best care.

  • Make sure this person understands the kind of care you want and respects your decisions.

  • Your advocate should know who your health care proxy decision-maker is; a proxy is a person you choose to sign a legal document so he or she can make decisions about your health care when you are unable to make your own decisions. Your advocate may also be your proxy under these circumstances. They should know this ahead oftime.

  • Go over the consents for treatment with your advocate and health care proxy, if your proxy is available, before you sign them. Make sure you all understand exactly what you are about to agree to.

  • Make sure your advocate understands the type of care you will need when you get home. Your advocate should know what to look for if your condition is getting worse. He or she should also know who to call for help.

KNOW what medicines you take and why you take them. Medicine errors are the most common health care mistakes.

  • Ask about why you should take the medicine. Ask for written information about it, including its brand and generic names. Also ask about the side effects of all medicines.

  • If you do not recognize a medicine, double-check that it is for you. Ask about medicines that you are to take by mouth before you swallow them. Read the contents of the bags of intravenous (IV) fluids. If you are not well enough to do this, ask your advocate to do it.

  • If you are given an IV, ask the nurse how long it should take for the liquid to run out. Tell the nurse if it does not seem to be dripping right (too fast or too slow).

  • Whenever you get a new medicine, tell your doctors and nurses about allergies you have, or negative reactions you have had to other medicines.

  • If you are taking a lot of medicines, be sure to ask your doctor or pharmacist if it is safe to take those medicines together. Do the same thing with vitamins, herbs and over-the-counter drugs.

  • Make sure you can read the handwriting on prescriptions written by your doctor. If you cannot read it, the pharmacist may not be able to either. Ask somebody at the doctor’s office to print the prescription, if necessary.

  • Carry an up-to-date list of the medicines you are taking in your purse or wallet. Write down how much you take and when you take it. Go over the list with your doctor and other caregivers.


USE a hospital, clinic, surgery center, or other type of health care organization that has been carefully checked out. For example, The Joint Commission visits hospitals to see if they are meeting The Joint Commission’s quality standards.

  • Ask about the health care organization’s experience in taking care of people with your type of illness. How often do they perform the procedure you need? What special care do they provide to help patients get well?

  • If you have more than one hospital to choose from, ask your doctor which one has the best care for your condition.

  • Before you leave the hospital or other facility, ask about follow-up care and make sure that you understand all the instructions.

  • Go to Quality Check at to find out whether your hospital or other health care organization is “accredited.” Accredited means that the hospital or health care organization works by rules that make sure that patient safety and quality standards are followed.


PARTICIPATE in all decisions about your treatment. You are the center of the health care team.

  • You and your doctor should agree on exactly what will be done during each step of your care.

  • Know who will be taking care of you. Know how long the treatment will last. Know how you should feel.

  • Understand that more tests or medications may not always be better for you. Ask your doctor how a new test or medication will help.

  • Keep copies of your medical records from previous hospital stays and share them with your health care team. This will give them better information about your health history.

  • Do not be afraid to ask for a second opinion. If you are unsure about the best treatment for your illness, talk with one or two additional doctors. The more information you have about all the kinds of treatment available to you, the better you will feel about the decisions made.

  • Ask your doctor to recommend a support group you can join to help deal with your condition. People in these groups may help you prepare for the days and weeks ahead. They may be able to tell you what to expect and what worked best for them.

  • Talk to your doctor and your family about your wishes regarding resuscitation and other life-saving actions.


The goal of the Speak Up™ program is to help patients and their advocates become more informed and involved in their health care.

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