Monday, 6 December 2010

Scheming...

I've come up with the best plan to show that what I'm saying about patient care is true.

The trouble is, I can't tell you readers without giving the game away.

All I can say is that I've thought of a brilliant way to separate the emotions of patient care from the facts.

You all feel so much like real-life friends, (some of you are more "real-life" than friends who live just down the road, lol) that all I want to do is sit down with you all and gossip over a cuppa.

Sadly, you'll just have to wait like everyone else. If I go quiet for a while, don't fret, I'll just be working on my scheme. Mwahahahaha.

If at any time I get too ill to post, Dave will give updates, so you don't need to worry about me!

***********************

As a general update, I'm back home with my wonderful family. It feels incredible. Every bed seems softer, every colour brighter, every baby kiss a privilege. 

Even on discharge it was a shambles. The consultant told me I'd get the registrar's pager number and the direct ward number. I got neither. The pharmacist offered some kind of chart to help me keep track of the copious medications I have to take. I didn't get that either.

When my drugs came up from pharmacy to take home, they had dispensed anti-sickness tablets instead of injections and perhaps most worryingly of all, a drug I'm supposed to take 6.25 mg of was dispensed in 25mg ampoules. When I phoned the ward to query it, the nurse told me they only draw up 6.25 mg of the 25mg and throw the rest away. I'd had no idea about that and only realised before I had the injection because the volume seemed much greater than before.

Even if we ignore the ridiculous waste of throwing three quarters of a particular drug away every time you use it, we can't ignore how dangerous it could have been. I've never had to draw up anything in an ampoule that I've then had to go on and either discard or save. I would image very few patients would have ever even noticed the mistake. And well, well, well, look what I found when I looked it up on t'internet to check I couldn't have overdosed! http://www.netdoctor.co.uk/medicines/100001886.html I particularly like this bit, don't you?

" For this reason you should tell your doctor immediately if you experience any of the following symptoms while taking this medicine: unexplained bruising or bleeding, 

They had prescribed it for me to treat nausea but no-one even mentioned that you should only draw up a quarter of the ampoule. It could have been a dangerous mistake. She didn't even apologise.

They only dispensed enough of my painkillers to last until 5am on Monday morning, meaning the first thing I had to arrange when I woke up was getting a new prescription and sending someone out to collect them for me.

If they can make this many mistakes over a simple discharge, I dread to think of the implications.


35 comments:

  1. Sue,


    Great that you are home! We await with great interest your plan! Sending hugs for the four of you!

    :) :) :)

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  2. Believe me Sue, it is even worse than you realise. I blog about it on Militant Medical Nurse.

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  3. That is great news indeed you are home sue and hope your feeling a little better:)

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  4. If your new scheme works may be you could call it sickileaks!

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  5. Have just spent a hour or so scrolling through your blog. It makes me angry that the NHS is treating people like this. When I did my training, we were always having lectures on the "unpopular patient" which was a way of saying that yes, you are human and yes, there will be patients that you find harder to deal with. A sounding board if you like, with strategies to cope with your own prejudices. No-one is perfect but you should never take it out on the patients.
    Most current issues are around staffing levels and skill mixes- not enough RNs impacts on things like pain meds and the countless things that HCAs cannot do. If we want to shout about something then this should be it...1RN to no more than 6 patients on general wards. (4 patients on acute admissions wards and 1 in the ICU please). Improved communication would be a plus- surely not beyond the realms of possibility?
    Just a few comments that spring to mind
    1) Pain meds- CDs as patient led analgesia is never going to wash in the NHS. This is true of other countries as well. Just a thought, does oromorph work? Its recently been declassified. Also the anti-emetic. Several are actually antipsycotics so I wouldn't read too much into it. With your problems many of the others would probably not work...most ICU patients get a dopamine type of antiemetic.
    2) Your tale of the epidural- do you have a fentanyl allergy? Its not the only drug they can use (we have fentanyl plus bupivicaine or just bupivicaine alone). Epidurals are a bit of a nightmare- here on the ICU we can titrate them and also have docs around all the time if top ups are needed. On acute wards this is not usually the case. When they work they are fantastic but when they don't they are worse than useless.
    3) The tale of the jej tube. This isn't a criticism of anyone, just an observation/comment. My own hospital also has a secret garden...there are no crash buzzers and I would dread to think how long it would take to get there. Jej tubes are pretty specialist. Was the nurse who found you familiar with them? If yes then I am disgusted. If not then she did what she probably thought the safest option- get you to a clinical area. I have had patients collapse outside ED around a corner whilst smoking and its no joke.
    4) Privatisation of healthcare would be a disaster for anyone with a chronic disease. I've seen it happen in the US and France (refusal of insurance or procedures).
    5) 24/7 MRIs...again, not in my lifetime. Its not just the running costs for the machine, its increased service costs (maintenence increases)the staff costs (in real terms most departments would have to double staff numbers to cope with this). At the moment a private MRI costs between £500 and £800. Thats for a 36 hour week.
    6) Acute care has improved alot in the NHS over the years- I see patients every day on the ICU that would have died 10 years ago. Unfortunately chronic conditions are less well treated. Its not just the UK either. Most drug companies just aren't interested in the cost implications of developing new drugs, as they know that the biggest markets (USA and the NHS) are unlikely to want to spend the money...new acute drugs are a different matter.
    7) Being sent home inbetween scans and operations. The unending problem of beds! Medical patients blocking surgical beds and vice versa. This is something that is also not going to go away. Again, not just in the UK.
    8) Finally, I have little experience of dealing with the DSS, other than the misery of sitting through MDT meetings trying to get care packages set up so that people can go home. Soul destroying. Problem of limited resources and nobody wanting to pay. I await with interest to see where they new ConDem alliance will go on this one. I trained under Thatcher- and its what drove me to the US....hmmmm.

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  6. Thanks everyone.

    Haha Crispin!!! That's genius.

    Dino-nurse - Brilliant post, very very much to think about.

    Nurse Anne - I'm off to take a look at Militant Medical Nurse right now.....

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  7. Oh, and Dino-Nurse, just a couple of things:
    I was inside again in a toilet when there was no panic cord.

    I am horribly allergic to morphine. Fentanyl and oromorph are both morphine based I'm afraid.

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  8. Sue - I am so pleased to see health professionals posting here. They report what I hear from mental health nurses ... they're put through the mill, too few nurses on the ward and too many agency nurses. No or little back-up from line managers.

    The truth is that it is probably surprising how few nurses behave badly, are incompetent or make mistakes... but unfortunately one is too many for a vulnerable patient.... and which patient isn't vulnerable!

    PS Glad to see that you're surviving. Take care Syzygy Sue x

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  9. I trust that you have seen the DLA consultation up at http://www.dwp.gov.uk/consultations/2010/dla-reform.shtml

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  10. Having an allergy to morphine will rule out many CDs, as there are few that are not opiate-based. Our CD cupboard rarely has anything else (tablets and infusions/injections.)
    As for panic/crash cords-many hospitals took them out of non-clinical areas because, lets face it, without clinical staff around there is no real point. How many visitors would know what to do or where to find help. Again this is the same in most other countries. Instead they have defibs scattered around and phones to connect with switchboard so you can get the crash team.

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  11. Hi Sue....It's good to see a couple of front line staff, Nurse Anne, and Dino-nurse, contributing to your blog, and don't they come across well....grounded and pragmatic, as you would expect. Their comments are enlightening in that they recognise, acknowledge, and in some instances, explain, your unfortunate treatment at the hands of their professional colleagues. Their situation of course, is a common one in a multi-tiered bureaurocracy, in theory, everyone is focused on the same objective, in reality, since the practical measures of success are not client based but statistical, the process takes over, and reflects the top down culture, which of necessity, is brutal. It takes a very strong character to resist the influences of a strongly statistically, focused management culture, the humanity of that culture is determined by its ultimate goal. In a politicised organisation statistics speak louder than words since they can be presented in way that suits the argument, people aren't the priority.

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  12. Ken - it's wonderful isn't it?

    I'm going to write a post on nurses soon, in case they think I'm putting all the blame on them, lol.
    Far from it.
    If all else fails, a patient is usually told the ward is short staffed. That's undoubtedly true, but not the patient's fault in any way.

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  13. Sue......Ultimately, it's a management problem, and that of course means that the buck stops at the top, in the case of a politicised organisation, the realpolitik determines the culture. What drives the top politician? Glory, power, ambition, greed....or, the humane treatment of the ultimate user of government services? On a daily basis I think of profit for my company, the only way I can achieve that is by treating my clients with respect and consideration. Politicians think of their majority. Who would you prefer to run a health service, someone who understood the need for excellence, or a political chancer ?

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  14. Sue, It isn't the Nurses fault that the ward is short staffed either. I think that patients should know. Things will not change unless the public starts demanding safe staffing levels. If you want undivided attention from your Nurse you need to let managment know that 2 nurses and 2 hca's for a 30 bed ward is ridiculous.

    Management isn't listening to the Nurses on this issue. At all. And they get away with it because the patients just direct their anger at the Nurses.

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  15. Nurse Anne....Management isn't listening to patients because it is listening to politicians.
    I bang on about the difference between public and private delivery of service, but in the private sector the client comes first, in the public sector the client comes last. If we don't privatise, then we should at least, de-politicise services.

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  16. agreed Ken.

    My dad was the president of a large financial institution and he would have agreed with you as well. He worked the shop floor along with tellers, receptionists and everyone else so he could see what the issues were and give them what they needed to do their jobs. He took care of his clients and staff and his organisation was very successful.

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  17. Dear Sue,

    Logged onto to do my daily pop in to your blog and noticed some new contributors of a very high calibre. I feel silly with nothing useful to say, but I do love reading their contributions. I hope you don't mind us contributing good will messages of support, as opposed to contructive messages, such as Dino Nurse's

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  18. Haha, just took a break from writing my next post and saw your comment about staffing!!

    I thought you'd never believe me, so look, here's the first few paragraphs

    Nurses. "I probably should have written this ages ago, so I apologise that it always kept getting pushed aside by other issues.


    Before I say any more, I want to make it absolutely clear that I've known some wonderful nurses over the years. In my experience, there are many more examples of the good ones than the bad. I owe them my life and I could never find the words to thank them enough.

    Over nearly two decades, the only time I experienced wards that weren't short staffed was in 2009.**

    However, if I had suggested 50 years ago that a tiny percentage of priests went into the church for unfettered access to small children, it would probably have been me that got locked up.

    If I'd suggested 50 years ago that a tiny percentage of nursery nurses chose a career in childcare for the same reason, surely I would have been considered the insane one?

    Could it not therefore also be possible that a tiny percentage of nurses go into nursing for the absolute power it allows them over helpless patients?

    We've all heard of the Harold Shipmans http://news.bbc.co.uk/1/hi/in_depth/uk/2000/the_shipman_murders/news_and_reaction/default.stm

    and the Vanessa Georges.
    http://news.bbc.co.uk/1/hi/england/8345756.stm

    But is it not even worth considering that other, less extreme cases go undetected every single day?

    Nurses are always the first line for blame. If a ward is badly run, it's the nurses......

    What a coincidence eh?

    Anyway, it should be up soon xx

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  19. Eoin - I'm honoured that you do post. I don't think you've missed a single day and your encouragement was one of the factors that gave me the confidence to even set up the blog in the first place.

    Nurse Ann - By the way, I loved your Militant Medical nurse blog. I've read nearly all of it already. I think you're very brave to write like that and I'm unspeakably grateful on behalf of all the spoonies and sickies out there.

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  20. Sorry Ann, forgot the link, doh!

    http://militantmedicalnurse.blogspot.com/

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  21. Nurse Ann...The NHS would be a better place if your dad, and people of the same calibre, were given the freedom to run it.

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  22. In my work, I meet people from all sorts of jobs and of all of them nurses are unquestionably the worst managed and least protected ... teachers come a close second, and the police generally are amongst the best.

    The rubbish just seems to get passed down through the line managers and accumulates, with the frontline nurses bearing the brunt. In my experience, they are expected to do far too much and failure to complete the tasks, means that the vulnerable patient suffers.

    I believe that the vast majority of nurses do an extraordinary job in the face of enormous pressure, but it is inevitable that some will 'burn out' and some will just not be saints. In my experience, treating employees badly, inevitably results in some of the staff treating the customer/pupil/patient badly.

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  23. Having worked in several different countries, including the US and Switzerland, I do not think that private hospitals have any more interest in patient care than state run ones- they want to make a profit. You make a profit doing elective surgeries, you do not make a profit running ERs and general medical wards (chronic conditions and rehab.) Look at the current campaigns in Oz and Minnesota over safe staff ratios- it makes very gloomy reading. This is where we are heading.
    As for nurses being "grounded and pragmatic" well, you are of course entitled to your opinion. May I ask if you have any background in healthcare? In the UK, the only real opportunity for employment for RNs is the NHS. Whistleblowers in the NHS get sacked and character asassinated. Stick up for yourself and you get branded a bitch or worse. I have worked as a nurse for nearly 30 years now and have seen standards slip to the point where if I had other options I would quit. No other industry would get away with treating employees and clients the way that the NHS does.
    Here is a little story. Its a busy night on the admissions unit. They have 40 patients and 3 RNs and 3 HCAs. One bay has an elderly confused gent along with a diabetic lady admitted with a DKA ( life treatening). The elderly gent keeps getting out of bed and wandering. The HCAs are trying to monitor him and keep him in bed. An hour into the shift and 2 of the RNs are redeployed to other wards that only have 1 RN and so are all the HCAs. This leaves 2RNs. They are only halfway through the IV round let alone anything else. One RN is getting a bedpan for another patient when the crash buzzer goes off. For the next hour both RNs are tied up with the crashing patient. Meanwhile the elderly gent has fallen out of bed, the DKA lady has not had her insulin IV titrated...the gent is unconcious on the floor and the DKA lady eventually ends up in the ICU. As for the lady on the bedpan and the 37 other patients....happening in a teaching hospital near you on a daily basis. What would you do?

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  24. Once again Dino hits the nail on the head.

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  25. Dino-nurse, you make my point for me, after the biggest uncontrolled, unfunded, spending spree in history, the NHS is still delivering the service you describe. Private sector delivery, based on patient satisfaction, would change the culture. I believe that the private sector would be flexible enough to address the problems the NHS is creating. From your description of the service, it sounds as though the NHS is failing miserably.
    My experience of the NHS is through horror stories from friends and relatives, the constant stream of negative revelations revealed in various reports, and now, your story and Sue's experience. Why are you defending this disaster ?

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  26. The enormous flaw in your plan is that there is nothing inherently "better" about care in a private hospital. If service is so good in these private hossies of which you speak, why couldn't THEY pass their management style on to the NHS rather than expecting the NHS to be privatised? All you end up doing is making sure that public money goes into making a wedge of profit that could have been spent on more nurses or scanners.
    Just because the NHS is state controlled, there's no inherent need for the service to be poor. You don't buy sympathy or compassion or trust.

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  27. See Ken? What the rest of these guys still haven't realised is that we are evolved souls.
    We have reached a zen of agreeing on the fundamental matters whilst disagreeing on the solutions.

    Not "Red" or "Blue" but a much more enlightened orang?

    Haha, even the name of our creed sounds credible - KenSu

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  28. KenSu.....SuKen, looks even better. Having agreed on fundamentals, I'm sure that we could construct a sensible solution. It's only a question of enlightenment, I'm prepared to be convinced, I always look for the best solutions, based on the best information....but of course you and I have the advantage of our zen, we're halfway there. :-)

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  29. I lived in a different part of the US from Dino, and every state over there is different. The state I lived in provided much better care for the poor via non profit private hospitals....better than the NHS. Sorry.

    My friend had a preemie and the march of dimes paid her entire bill for the SCBU. My friend would have insurance via her employer if she got off her butt and worked full time. But her band is more important.

    My 35 year old Uncle has a chronic condition/disability as well as autism and has no problems on medicaid.

    I had fabulous fabulous insurance coverage through my employer. As long as I worked full time. They paid for everything for my spouse and kids (one is autistic). I didnt have to contribute a penny towards anything.

    For Me, the NHS is a hell of a lot more expensive. Or should I say that healthcare is more expensive for me here in the UK. Nurse's pay is crap, taxes and cost of living is much higher and I have to work a lot of unpaid hours. No insurance through my job and no money means I have to rely on the NHS.

    In America all 50 states are completely different. They have different economies different kinds of government and different kinds of taxation. This is why you will never hear the same story about USA healthcare from any two people living in America.

    The 50 States are what makes it so hard to have an NHS type of system. America already fought a long and bloody civil war that killed over 600,000 Americans over States rights vs big government and each state government has a different view. Some states want federal money for health care (which the feds would steal from other States). Other States (like Vermont) have their own state government run universal system and if they feds taxed the shite out of them to inject money into other states it would ruin vermont and provide a shittier service to the people of vermont.


    If they are ever going to make universal government run health care work over there it is going to have to be done STATE BY STATE.

    President Ovomita and the feds need to stay the hell out of it.

    I just thought that since people are talking private vs government healthcare that it would invariably lead to a discussion of US healthcare. I thought I would get first dibs here before someone starts saying crap like only rich americans get healthcare and Obama should sort that out with the federal government.

    It is a much more complicated issue than people in the UK realise and unless you understand US history and government you won't really understand why they resist having the same healthcare system as the UK.....a system where it is all controlled by the central government. Their constitution doesn't allow the feds to kick around the states like that...it isn't how the country was designed. For good reason.

    Just my 2p.

    Sorry about my typing but my keyboard is going ape.

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  30. Yoy are right Anne. I worked in several different hospitals in the US ( several different states as well) including County hospitals and all singing, all dancing Trauma Centres. The differences were astounding. My salary was way better than the UK and on the whole my working conditions were no worse ( county hospital ER was a bit of a nightmare). The problem I have will the idea of privatising the NHS is that you can already see where things will end up. PFI hospitals are already in a hell of alot of debt. The rush to allow all hospitals to become foundation trusts (even those who are practically bankrupt) will compound this. The only way to make money is through elective surgeries. This will mean that teaching hospitals will start to claw away most of the money (we already see this with the so-called easier elective surgeries being done in private clinics). This will mean even fewer treatments will be offered nationally. Competition in healthcare does not work. My experience in the US and Switzerland showed me that insurance companies were able to dictate treatments rather than the clinicians (US) and that a system that looks good on the surface (Swiss) couldn't cope with chronic conditions and an aging population.
    Ken, I am saying the same thing that sue is saying...the problems in the NHS will not be solved by privatisation. The problems will be solved by adequate staffing levels. Private hospitals in the UK do not deal with trauma or chronic conditions (on the whole) as the costs can be astronomical. I work in the ICU- every patient costs on average £3000-£5000 a day, depending on level of treatment. We have patients with us for an average of 10 days- some for as long as 6 months. Most have chronic conditions ( lung disease, kidney diasease, liver disease, heart problems). Some are elective patients who the private sector wouldn't touch. Most are trauma victims or victims of violence. Many are also alcoholics or drug addicts. On the whole, few would get insurance. Under the NHS all people get the same chances for treatment ( lets not get into the NICE drugs debate- I'm talking about needing an ICU bed).

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  31. Yes ER's at county trauma centres are hellholes in the US.

    In my old state we had non for profit private hospitals. Any millions that they made were plowed back into the community. They just built a brand new all singing all dancing private hospital for the amish community to get care with that money. Amish people are not insured, cannot pay and refuse to use state funded programs. Yet they are going to get care. They also offered free flu shots to the whole community. They get huge donations from charity organisations and businesses for doing stuff like this for the community. A friend of mine had a bad car accident shortly after she was made redundant and lost her health insurance. The hospital organised charities and businesses to donate to pay for a large portion of her care. And they have her paying the rest back at $1.00 a month.

    The private hospitals that we will get in the UK will all be for profit private hospitals rather than non profit hospitals. This means that they won't deal with medical elderly patients, chronic conditions etc etc. And they certainly won't be plowing any of their profits back into the community.

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  32. So it is very true that the kind of private sector hospitals that we are going to get in England will not touch your average patient because it is not cost effective to do so. They will only deal with healthy people having operations basically.

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  33. Ladies, I can't tell you how I appreciate your comments! I can bang on for years (and have done!) but until my site becomes a forum for patients, nurses, doctors even managers and politicians, nothing will change.
    At a stroke, you transform me from demanding, neurotic moaner, to articulate patient with grievances.
    PLEASE do keep commenting here whenever you can. I learnt so much from your discussions about private care in the US.
    As an aside, my neighbour is from the US and came here as a radiographer. She gets amazing pay and benefits (through an agency) but left her first role as she couldn't believe how useless and demeaning the local hospital was. She even experienced racism.
    Now she works in London.

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  34. One of the mosr ludicrous wastes of money in the NHS is on agency payments. Most Trusts intentionally understaff at all levels of clinical staff. If someone calls in sick, first option is for the nurse in charge to round robin all those who are on a day off work, to either get them to swap a shift (making another future shift short) or to do an extra shift. If this doesn't work he/she contacts the duty manager to try and shift staff from another area. If this isn't possible then usually you are told to just get on with it. Occasionally you will be authorised to use the hospital bank- now for ICU and ED this is usually of little value because they cannot supply the right calibre of staff. Our final option is agency...so you get a (usually) pretty competent nurse at a very expensive rate (or is that just that agencies recognise our true worth?). He/she will work alongside the RNs getting paid double, if not triple what they are getting. Due to hospital rules agency nurses cannot do a range of tasks, including giving IV meds (big pain in the ICU as most meds are IV). Doctors can also work as locums and get paid stackloads. When I was younger, I used to regularly work for a specialist ICU agency that covered London and the Home Counties. I could double my monthly salary by working a few extra nights (not in my own hospital). Many London hospitals run on agency staff as they cannot get Band 5 nurses to stay...and why would they- salaries mean you cannot live in central london (unless you want to live in a redlight or very dodgy area) so you have a long commute, lots of agency staff increases your workload and they are getting paid more than you...its a viscious circle. End result is patients suffer. I worked in the ED of a large London Teaching Hospital for a year as a sister and it was the worst year of my life. Double my salary and I would still not go back.
    As a reality check, I doubt any politicians will be open enough to debate on any sites. There are some interesting medical oriented blogs around (as well as Annes!)- try The Ferret Fancier, The Jobbing Doctor and Mental Nurse (as a starter). Also Devils Kitchen and Tory Lies as general sites.

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