So last night I had a night shift. I start at 2045 and finish eleven and a quarter hours later at 0800. It's not a long shift, but it is exhausting.
I happened to be on a Care of the Elderly ward which are notorious for being particularly heavy. There is a growing problem in hospitals of bed-blocking Grannys. They come into hospital for a reasonably straight-forward problem, falls or confusion are common as are dehydration and chest infections. However once in the hospital, getting them home becomes a real problem.
Let's look at a case study...
Granny Smith lives on her own. When her daughter visits her she seems a little confused today. Her daughter is concerned and calls the GP out. GP visits and diagnoses a chest infection. Nothing to serious but as Granny Smith is living alone it's probably a good idea to get her admitted to hospital so that she can be monitored while she recovers. Granny Smith is referred to the hospital and transport arranged. So far, so good.
The nice ambulance men come to her house, pick up all her things and then take her the short distance to the local hospital. When she arrives she bypasses A&E and goes straight to the Medical Assessment Unit (MAU). Here she is sat on a trolley while she waits for the MAU doctors to assess her and decide whether she needs to be admitted while her chest infection is treated. Some observations are done (Blood pressure, oxygen saturation's, temperature, heart rate and respiration rate), bloods are taken and a chest x-ray done. After being seen, the decision is made to admit her. Due to the chest infection she is having some problems with her oxygen levels.
A few hours after arriving in the hospital she is sent to the respiratory ward. Antibiotics are started and she is given some fluids as she was slightly dehydrated.
Fast forward a week and Granny Smith is still on the respiratory ward. She has been in a six-bedded bay for a week and her chest infection is clearing. The antibiotics have been working. However because they have been working, Granny Smith has now not opened her bowels for 4 days now (constipation is a common side effect of antibiotics). Also because she has been sitting or lying in her bed for most of the last week she is not very steady on her feet. When the laxatives she was given start to work she tries to make it to the bathroom on her own. Unfortunately on the way her legs give out and she slips.
She is hoisted back into bed, cleaned up and declared "unsafe to transfer." This means that until she has been reviewed by the physio therapists she should not be allowed out of her bed in case she slips. So far everything has been straight forward. Unfortunately today is a Friday. Physiotherapists do not work over the weekend so over the next two days Granny Smith will have to stay in bed...still worse things could have happened...
On Sunday the nursing staff notice that Granny Smith's bottom is looking a little red. They apply some sudocream as they pop her onto her 4th bedpan of the morning. When they remove the bedpan, 15 mins later, some of it's contents spill onto the sheets. They are short staffed but go to get a fresh set of sheets. On the way back to the bed they get waylaid by several other patients before finally getting round to changing the wet sheet under Granny Smith.
By now Granny Smith has been in hospital for 9 days. Her chest infection has nearly cleared up. She has been assessed by physiotherapists who have referred her to the occupational therapists for a kitchen, bathroom and stair assessment before she can be discharged. She also has a bit of a sore on her bottom but a dressing has been applied and it should start to heal once she's out of her bed.
Granny Smith manages to pass the occupational therapists' assessment and the nursing staff can begin to think about discharging her. When they tell her daughter the good news, she is concerned. Who will look after the dressing on her mother's bottom?
The hospital liaise with the district nurses to arrange a daily visit to redress her sore and it is decided that Granny Smith will go home tomorrow.
Overnight Granny Smith develops a temperature. In line with Trust protocol blood cultures are taken and paracetamol given to try and lower her temperature. A UTI (Urinary Tract Infection) is suspected and a urine sample is sent to the labs for confirmation. She will not be going home today.
It is a known fact that the longer a patient is in hospital, the more at risk they are of contracting hospital acquired infections. These will include MRSA, C diff, Winter Vomiting Virus, UTI's, Chest Infections and many others. They are also at risk of pressure sores. With staffing levels at an all time low, we don't have the time to get people as mobile as they could/should be. When there are three members of staff looking after 30 patients it's just not possible to spend 40 mins walking each patient round the corridors of the hospital. Pressure sores are so easy to contract (especially in older people where the skin quality is not very good) but they are so hard to clear up, partly because of their location (usually on the bottom) and also because the patients that get them tend to be incontinent which makes the problem worse.
This is not an actual case-study, more a combination of many different patients that I have seen in the hospital. Sometimes they get passed from ward to ward, speciality to speciality spreading different infectious diseases as they go before finally ending up on a "Care of the Elderly" ward where we try desperately to get patients into a position where they can go home.
I happened to be on a Care of the Elderly ward which are notorious for being particularly heavy. There is a growing problem in hospitals of bed-blocking Grannys. They come into hospital for a reasonably straight-forward problem, falls or confusion are common as are dehydration and chest infections. However once in the hospital, getting them home becomes a real problem.
Let's look at a case study...
Granny Smith lives on her own. When her daughter visits her she seems a little confused today. Her daughter is concerned and calls the GP out. GP visits and diagnoses a chest infection. Nothing to serious but as Granny Smith is living alone it's probably a good idea to get her admitted to hospital so that she can be monitored while she recovers. Granny Smith is referred to the hospital and transport arranged. So far, so good.
The nice ambulance men come to her house, pick up all her things and then take her the short distance to the local hospital. When she arrives she bypasses A&E and goes straight to the Medical Assessment Unit (MAU). Here she is sat on a trolley while she waits for the MAU doctors to assess her and decide whether she needs to be admitted while her chest infection is treated. Some observations are done (Blood pressure, oxygen saturation's, temperature, heart rate and respiration rate), bloods are taken and a chest x-ray done. After being seen, the decision is made to admit her. Due to the chest infection she is having some problems with her oxygen levels.
A few hours after arriving in the hospital she is sent to the respiratory ward. Antibiotics are started and she is given some fluids as she was slightly dehydrated.
Fast forward a week and Granny Smith is still on the respiratory ward. She has been in a six-bedded bay for a week and her chest infection is clearing. The antibiotics have been working. However because they have been working, Granny Smith has now not opened her bowels for 4 days now (constipation is a common side effect of antibiotics). Also because she has been sitting or lying in her bed for most of the last week she is not very steady on her feet. When the laxatives she was given start to work she tries to make it to the bathroom on her own. Unfortunately on the way her legs give out and she slips.
She is hoisted back into bed, cleaned up and declared "unsafe to transfer." This means that until she has been reviewed by the physio therapists she should not be allowed out of her bed in case she slips. So far everything has been straight forward. Unfortunately today is a Friday. Physiotherapists do not work over the weekend so over the next two days Granny Smith will have to stay in bed...still worse things could have happened...
On Sunday the nursing staff notice that Granny Smith's bottom is looking a little red. They apply some sudocream as they pop her onto her 4th bedpan of the morning. When they remove the bedpan, 15 mins later, some of it's contents spill onto the sheets. They are short staffed but go to get a fresh set of sheets. On the way back to the bed they get waylaid by several other patients before finally getting round to changing the wet sheet under Granny Smith.
By now Granny Smith has been in hospital for 9 days. Her chest infection has nearly cleared up. She has been assessed by physiotherapists who have referred her to the occupational therapists for a kitchen, bathroom and stair assessment before she can be discharged. She also has a bit of a sore on her bottom but a dressing has been applied and it should start to heal once she's out of her bed.
Granny Smith manages to pass the occupational therapists' assessment and the nursing staff can begin to think about discharging her. When they tell her daughter the good news, she is concerned. Who will look after the dressing on her mother's bottom?
The hospital liaise with the district nurses to arrange a daily visit to redress her sore and it is decided that Granny Smith will go home tomorrow.
Overnight Granny Smith develops a temperature. In line with Trust protocol blood cultures are taken and paracetamol given to try and lower her temperature. A UTI (Urinary Tract Infection) is suspected and a urine sample is sent to the labs for confirmation. She will not be going home today.
It is a known fact that the longer a patient is in hospital, the more at risk they are of contracting hospital acquired infections. These will include MRSA, C diff, Winter Vomiting Virus, UTI's, Chest Infections and many others. They are also at risk of pressure sores. With staffing levels at an all time low, we don't have the time to get people as mobile as they could/should be. When there are three members of staff looking after 30 patients it's just not possible to spend 40 mins walking each patient round the corridors of the hospital. Pressure sores are so easy to contract (especially in older people where the skin quality is not very good) but they are so hard to clear up, partly because of their location (usually on the bottom) and also because the patients that get them tend to be incontinent which makes the problem worse.
This is not an actual case-study, more a combination of many different patients that I have seen in the hospital. Sometimes they get passed from ward to ward, speciality to speciality spreading different infectious diseases as they go before finally ending up on a "Care of the Elderly" ward where we try desperately to get patients into a position where they can go home.
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