Friday 24 May 2013

Three weeks - four wards - five moves - is this the way to treat a patient with dementia?

Mum went into hospital at the end of October 2012, with a UTI. She was to spend three weeks there, before coming home again. For a dementia patient, was this a good or bad experience?

Mum was admitted, under the recommendation of an out-of-hours doctor (Harmoni), he organised the admission via A&E. As far as A&E were concerned, she was expected. However, on arrival, we first had to wait fifteen minutes, for a free cubicle.

Next, a four hour wait, for a bed. Mum was severely dehydrated, and drifting in and out of consciousness. During that time, all she was offered was one glass of water, in order to take some Paracetamol.

Eventually, a bed became available, on a ward where she was to spend just one night. She had both a cannula inserted, for a drip, and a catheter. Once she was settled, and on the drip, I made my way home - still very concerned. I had no idea how she would be the following day. Incidentally, the room on the ward had eight beds - only two were occupied.

Prior to my visit the following day, I received a phone call to let me know Mum had been moved to another ward. Such calls, were to prove to be very rare events during her stay, even though she was to be moved several times.

On my first visit, Mum had visibly improved. Yet, in front of me, was a frail elderly little lady, who had no idea why she was there, and just wanted to be nice, kind and polite to everyone. In many of the wards, she became the "baby", as far as the patients were concerned. They looked out for her, and expressed any concerns to me.

One of the wards she was to find herself on, was excellent. A volunteer came in several times a week, and sat with Mum to discuss various aspects of her life. A more able patient sat with Mum at meal times, and helped and encouraged her to eat.

On other wards however, she was left to fend for herself - meals and drinks were provided, and then removed, unfinished, or not consumed at all. As a result of this poor oral intake, she was prescribed nutritional supplements, unfortunately, these would also often go untouched. By comparison, when visiting, I was able to encourage Mum to eat and drink quite successfully.

The worst experience, from my point of view, and already described in an earlier post, was when, on another visit, I discovered that Mum had been moved, again. The day before, she had been in the Acute Stroke Ward (the only bed available), but was moved, after midnight, to another ward. I received no phone call about this, and during my visit the next day, went to the stroke ward, and the bed that Mum had been occupying.

The curtains around the bed were drawn. In the bed, was a little old lady - very similar to Mum - with a doctor checking her responses. The board at the nurses station, still had Mum's name displayed for that bed. Fortunately, after the initial shock, I was able to make out that the lady in the bed, was not Mum. I eventually found out which ward she had been moved to - no thanks to the staff, as I had to stand and wait until they eventually acknowledged my presence, and finally gave me the answer.

As so often happens, some of Mum's patient notes were wrong. For a number of days, Mum's skin risk was recorded on the board by her bed as "Red" high risk. Yet in her notes, there was an "Amber" medium risk card. Why? It took a conscientious nurse to realise a serious mistake had been made, and to correct that mistake. Previous note checks, had failed to notice the mistake.

On another occasion, whilst visiting, Mum needed a bed pan. A nurse was duly called, and confirmed that one would be arranged. Twenty minutes later, still no bed pan. I had to ask a passing nurse to arrange for one, which she did. The first nurse eventually returned, and explained that he had been carrying out a hand-over/take-over. Sorry, but where do the priorities lie?

At other times Mum's bedding was stained as a result of drink and food spillages - more food and drink probably ended up that way, than was actually consumed. The worst staining was as a result of her spilling Fortisip, which left a large hard sticky patch, the bedding remained unchanged throughout the duration of the visit.

She was often cold, and even though I had provided a fleecy shawl for her to wear around her arms and shoulders - I had to put this on her virtually every time I visited. After, that is, I had managed to find it.

As a result of long stays in bed, she developed a sore on one of her heels - this should have been avoidable. It was treated, and a foam heel cup placed over the sore, to protect it. A clear case of ignoring the "prevention is better than cure" principle.

Mum would frequently refuse medication, but little or no effort was made to encourage her to take it. By encourage, I mean a gentle, softly, softly approach to persuade, not to coerce.

Sometimes she would become agitated and shout at staff, and would very occasionally, lash out. This would undoubtedly have been due to the fear and confusion caused by her dementia - and clearly illustrated a lack of understanding when treating patients with dementia.

Needless to say, these incidents were recorded as "patient being difficult" or "patient being aggressive".

When Mum was eventually declared fit for discharge, she still had to endure another seven days in hospital, whilst arrangements were made for equipment to be put in place, to enable her to return home. In other words, seven days of "bed-blocking".

Whilst the Occupational Therapists and Hospital Social Workers were very helpful, it was clear that Mum was no longer receiving anything other than minimal nursing care, just routine medical checks and medication. Physiotherapists made just two attempts to get her to mobilise. She was now just a little old lady who no longer needed to be there. Needless to say, during this time, she was moved yet again.

The day before Mum came home, the Discharge Nurse at least made some effort to improve Mum's appearance. Her hair had become very matted at the back, and the nurse supplied a shampoo cap, so that I could wash her hair, and then, as best I could, tease out the matted hair.

Her nails were filthy, and the skin on her legs, very dry and flaky. No cream had been applied, and no effort had been made to clean her nails. This, fortunately, was all to change, once she returned home.

Even on the day Mum was discharged, there were problems. The air mattress, which only arrived that day, was faulty. This was replaced with another, which also proved to be faulty, but which at least inflated to a degree. The engineer was called out again.

The first Regaining Independence Service carer arrived just before Mum came home, but said she could only stay for half and hour. I had to spend some time on the phone to her supervisor, begging that she be allowed to stay longer, as the hospital would not discharge Mum, if the carer was not there. Fortunately, the carer was able to stay.

When the ambulance finally brought Mum home, we still had the faulty air mattress. I just kept my fingers crossed that no-one noticed - fortunately no-one did. Mum was home, but her ordeal still wasn't over. No sooner had she arrived, than she had to be hoisted on to a chair, so that the mattress could be replaced. All credit to the engineer, who stayed until he was satisfied that the latest one was fully functioning.

At last, Mum was in bed, and comfortable in her own home.

Three weeks, four wards and five moves - is this really the way a patient with dementia should be treated? Somehow, I don't think so.

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