The wisdom that is out there… Patients spot the simple things that can make SUCH a difference…
Tomorrow I am attending a high level meeting in London with Patient Engagement Leads from the NHS and people responsible for quality and improvement. Here is a story that I hope will contribute…
Sometimes I spot a tweet – or in this case a series of tweets – where I know there is a story worth telling. Here Delia Stearnes (@vivdora) came out with a barrage of tweets that suggested she knew a thing or two about hospital stays…
Delia’s tweets struck a chord. I had just collected my best friend from hospital after an acute admission. I was depressed after the tales she had told me. I want the ‘in my shoes’ series to make a difference, by highlighting good and bad practice, particularly where simple things can make a big difference to patient experience. I asked Delia to tell us her story. She initially protested that she could only write in 140 character tweets, but then the flood-gates opened. Given a bit of encouragement, most people are keen to tell their stories if they think people are listening….
Delia started with her personal story. A fascinating viewpoint as a health professional, carer, patient, widow, mother and (as so many of us) multi-faceted perspective… However, I have moved this to the end of the blog as I wanted to focus on Delia’s sharp observation of life on a hospital ward…
The ward I was treated on was a ward I had worked on in 1976. I was a student and my husband-to-be was working as a houseman. In those days, it was a 32 bedded orthopaedic ward where fractured shaft of femurs were treated with skeletal traction.
The ward is now divided in to a 16 bedded trauma unit and a 24 bedded hip unit. Each side has a Matron and a Sister.
My last two stays were in the trauma side and that’s where I did a lot of observing, got told off for Tweeting ( check #talesfromhospbed) and wanted the nurses and HCAs to be able to spend more time with the patients and less with the paper ( and computer) work.
I have seen the problem with the pressure to admit patients from A&E so they’re not “breaching” whilst patients are stuck on the ward because they’re not ready to go to a rehabilitation hospital yet or their nursing home staff are not ready to take them back. This led me to think that another ward could be opened which they could move to, have the nursing and Physio they need but move out of what is an acute trauma ward.
As I said, this ward has 16 beds which doesn’t sound like many but it’s really more like 26 as there is such a high turn over of patients and a great deal of work goes in to discharge planning. There are also some elective operations. An empty bed never stays empty for long. (In the hip unit patients are sometimes transferred to the rehabilitation hospitals at odd hours like 8.30pm, a bit of a shock to the system of a 90 year old.)
The nurses often work 12 hour shifts, some agency nurses 14. They don’t drink enough and they’re on the go all the time.
I wrote to my MP about the use of agency and he sent me a copy of a letter from Jeremy Hunt in which he admitted that pay for an agency nurse could be 50-100% more than the ward staff get! I have seen an agency nurse take an hour to dispense the drugs for 8 patients ( she was not interrupted) when asked to do various things she said she didn’t know how. So the ward staff had to work harder knowing they were being paid a lot less.
A lot of the ward staff do bank shifts to earn some extra money. Despite working so hard they always smile and work well with each other.
They are so good but they have to battle things that are very annoying. The bed curtains for example, don’t draw properly ( despite some silicone spray a man came and sprayed on the rails). There are holes without hooks and the hooks are flimsy. This looks shoddy in a ward that is kept very clean and tidy. ( I have written to the hospital about it. In the rest of the email I praised everybody I came in to contact with.)
So much time is devoted to ticking boxes, back covering, worrying about being sued and adhering to trust policy such as taking the blood pressures of patients who are waiting for a place elsewhere.
Why take a 98 year old lady’s blood pressure when it hurts her? Change the policy!
Are 4 hourly observations strictly necessary? We’ve stuck to those forever as nurses. Decide which patients need that frequency! Why 4 anyway? Not done at night. Look at the patient, you can see if they look well. Nurse in charge should decide who needs to have regular observations.
We’re still not good at working with social services, local authorities or whoever is holding the budget outside the hospital.
A lady who was due to be discharged was unable to go because of squabbling about the cost of a care alarm! Utterly ridiculous.
Going back to box ticking – on admission I was asked if I took the contraceptive pill. I pointed out that I’m a 61 year old widow and I was told “I’m sorry, I have to ask.” No, you do not! You cross it off or write N/A surely? A similar thing happened at home when a district nurse decided to check my bottom and to perform a dementia screen on me. In my job I’m brave enough to decide what’s appropriate, it’s my PIN, but nurses are diligent people and will always endeavor to complete a form if given one. There are too many!!
Patient’s notes should be filleted so that all the old treatment and TPR charts are kept elsewhere.
This admission I took a laminated paper with my history written on one side and my drugs on the other. I asked that it be put in my notes. Previously I have given my history to so many people, each writes it down, never reads it and nor does the next person. This means people say “it’s your left knee isn’t it? ” the day you’re going home after surgery on your right hip. That’s just irritating and careless. That was after the scrub-out operation, it was a Dr I hadn’t seen before and he was pushing a trolley with the notes in!
Once I was presented with a form that asked for date of death. I put “to be arranged.”
Computer use is half hearted at the moment, the ward seems to be at that awkward stage where things are written on paper and put on the computer, it will probably improve but the nurses and the amazing HCAs have so much paperwork that they have to leave the patients to catch up with it. I’ve seen a staff nurse stay on another 2 hours after a 12 hour shift because he wanted to get his paperwork up to date.
Yes, a patient should be able to reach their call bell but does this mean that a box must be checked to say they can reach it? The whole culture has changed, no one is trusted any more. Since Stafford there’s a difference, nurses can be a bit edgy about visitors who in turn are on the look out for faults.
I expect it’s standard in hospitals now that patients who need help with feeding have red trays and red lids on their water jugs. Wards have protected meal times.
Food – some things are nice but if, like me, you don’t eat meat, do eat fish and have a properly diagnosed lactose intolerance the daily choice is not good. The vegetarian options are cheese on cheese with a cheese sauce. I was allowed a meal from the canteen once a day because of this but the use of cheese as an essential ingredient for vegetarian meals tended to happen there too. The menu is the same every day which is not good if you’re there for 4 weeks.
I always put on weight in hospital as there is so much carbohydrate on offer and not much protein or fruit and vegetables.
Years ago we had an ex-army chap as catering manager at a hospital, he took the job on as a challenge. His budget was the same as the other hospitals in the group yet he managed to provide lovely meals and arranged for a fresh omelette to be cooked should a patient miss a meal or not fancy anything heavier.
I tweeted the chief executive and I asked her if she would go to the ward and tell the staff that they were a credit to the hospital and to the NHS and to see if perhaps she could grant them a wish, like new curtains or a reduction in form filling for example. She replied but I don’t know if she went.
I asked on Twitter if anyone could go and see their hospital chief executives and use first name terms. I believe some can. How good if you have an idea or a question and you can do that!
I love the NHS , I’ve worked in her for more than half her life in admin first and then nursing. There are lots of things we can do to keep her going.
Remember, without the patients none of us would have jobs. Listen to patients, they know their bodies best – and ‘do as you would be done by’.
Some interesting photos here… all will be explained in Delia’s personal story below 😉
Delia’s personal story is very moving. It also highlights the challenges faced when people who are themselves unwell are called upon to care for a partner or dependent…..
“This is a long ramble to show that I consider myself eminently suitable to comment on hospital care…”
I’m a 61 year old widow of a GP whom I used to work with as his Practice Nurse. We both retired in 2007 but sadly, less than two years later and just after his 57th birthday, he succumbed to pancreatic cancer and died in a wonderful hospice having benefitted from the Liverpool Care Pathway.
Prior to being admitted to the hospice he had had pretty awful treatment ( rather lack of treatment from our local hospital) and loving care from our two daughters and my brother in law but nothing much from me as you will see.
In 2003 I had a Birmingham Hip resurfacing of my right hip as I had avascular necrosis. A friend later pointed out that this was probably caused by old school nursing, ( I started my training in 1975) when we lifted patients and beds and anything else that required lifting.
I always had backache after this operation and started to yo-yo between the hip surgeon and the pain specialist who each thought that the pain was coming different places as in “it’s your back”, “it’s your hip”. It was probably a bit of both. I was able to work as a Practice Nurse and to ride my pony so it wasn’t too terrible but walking was a pain. I would have to keep stopping and sitting down for a few minutes and then I could walk a bit further.
This hip lasted until 2009 when I had a vascular necrosis again. By this time my husband was ill and we asked the surgeon if there was an alternative to surgery. It was agreed that I would try walking with crutches for 6 weeks. A few days later I was given a date for surgery which was very soon but I had to decline because of what had been agreed. It was during this time we went to our outpatient hospital for an ultra sound scan for my husband to see if it was his gallbladder. He was in the room a long time and when he came out he said his gall bladder was OK and he’d tell me the rest in the car. Lesions on liver and lungs, pancreas not visualised.
My hip was so painful I rang to see if I could get another date but was told I’d had my chance and was now routine so I stuck it out for the six weeks and went back to see the surgeon. He said that I was, in effect, walking on a broken leg and that he’d take me in as trauma, which was very kind of him. An amazing man.
So I had a total hip replacement (conserving the acetabular cup) on April Fools Day and was making such a good recovery that I had a quick sit on my pony at 4 weeks.
At five weeks I dislocated the hip when my husband, who couldn’t breathe well, asked me to take our beloved Springer Spaniel out of our bedroom ( yes he shared our bed).I was carted off to A&E where they had two attempts to reduce the hip under sedation with no success so I was admitted.
What I didn’t know was that my husband was admitted the same morning. Our treatment couldn’t have been more different. I kept telling my daughters how wonderful everyone was on my ward which made them cross because my husband was being treated very badly. That’s another story which my youngest may write up one day.
One amusing interlude – I was bed bound but I really wanted to see him because I thought I might never do so again so the lovely staff pushed my bed all the way to the private ward where my husband had been magnanimously granted a bed for the night on the NHS ( so that his daughters could continue to tend to him in the absence of any nurses I understand).
He took one look at me and said “I don’t think that’s a good idea”- I think he thought they were going to try and fit us in together! Made me sad as although I knew what he meant I felt a bit unwanted but that’s just me, I’m a bit like that.
So then I had two general anaesthetics to attempt to get the hip back in but it wouldn’t oblige so I had the hip taken out and another put in. My previous surgeries were done under spinal with no sedation ( chatting to the surgeon was fun although I don’t know if he thought so, he teases me about it.) I told the anaesthetist that that was what I wanted but she decided I should have sedation and have me Ketamine which gave me hallucinations.
It was the first time I’d had substandard treatment as in not listening to me **Listen To The Patient**.
The care in recovery was not nearly as good as before and when I said I felt sick I wasn’t given a bowl. Consequently I was very sick on the way back to the ward. The lovely kind porter ran onto a ward and grabbed bowls ( he came to the ward the next day to ask how I was, how nice is that?)
I wanted to get home so I was allowed out the next day with a plaster hip brace. This gave me cellulitis which gave me a temperature and caused me to be a bit do-lally, so I got taken to A&E, they let me go about 1.am in a taxi.
We got back to the hospice and the driver said “have a nice night” or some such. A hospice, 1am? A rave perhaps?
After my husband died, I got a letter from the NMC offering me my registration back without retraining as they were worried about swine flu. I went back to work at a friend’s surgery just doing a few blood pressures but then, a year after the last operation it turned out I had an infection called staph epidermidis so I had to have my hip scrubbed out, and a PICC line to deliver antibiotics for 6 weeks. This meant I couldn’t go on a cruise with my girls.
I went back to work and got in to full blown practice nursing again and went to help out at my husband’s old surgery for a few hours a week too.
Last year I was fine, mucking out and riding my two ponies and looking forward to Christmas in Iceland with my youngest ( it’s an amazing place). Two days before we were due to go, I fell off one of my ponies in walk and sustained a periprosthetic spiral fracture of my femur. No riding an Icelandic horse to see the Northern Lights then.
Another hip was inserted and I spent Christmas and New Year in hospital. I was close to having the hip removed in case the infection was there but a part didn’t come and it was decided to take lots of swabs and a frozen section and proceed. All went well but then a week later everything came back with the bug in so another PICC line and eight weeks of vancomycin. I was ok till that finished, even managed to sit on one of my ponies but had a hell of a job getting off! Hadn’t worked that out!
I wasn’t getting better, Physio said do less, unheard of for a Physio,the surgeon said do less, eventually one evening, having accepted an invitation to visit the Houses of Parliament ( theme here, don’t book things) I suddenly just couldn’t walk and it was more painful than the fracture.
This time the hip was removed, a cement spacer full of antibiotic was put in instead and another PICC line was put in. I had my birthday in hospital.
After three months I had another hip put in and I’ve only got three weeks to go until I can drive and work and maybe start riding again.