Tuesday, 23 November 2010

Shock Horror: Patient at Staffordshire Left without 0xygen


These headlines do not surprise me at ALL.

Let me tell you a little story.

On my 34 bed medical ward many of the patient beds do not have oxygen ports at their beds or nearby.  Our trust can spend millions on management consultants. pointless IT schemes, and PR.  But they cannot seem to get oxygen ports in at every bed.  This is strange.  Every other patient getting admitted to a medical ward seems to have respiratory problems, a history of lung problems or medical problems that may cause the patient to require 02 at some point.

A few months ago I had a patient go into respiratory failure all of the sudden.  This was at 4:30 in the morning. There was one 02 port in her bay, 3 beds away.  It was being used by a patient with severe pneumonia.  I had to locate a bed space with 02 and locate it quickly. 

Every bed space that had 02 nearby had a patient using it. I found one in the bay on the other side of the ward.  Bed 2 in that bay had an 02 port.  The patient in that bed was a COPDer and he wasn't using is 02 for over two days. He was the healthiest guy on the ward. I had to wake him up.  I had to tell him we needed to move him to get another patient on his oxygen.  Lucky for me he was nice about it.  I don't know how I would have felt being woken up at 4 in the morning for someone to move me and use 02 that I might need at some point.  The patients next to him at 02 at their beds and could not be moved.  The distribution of 02 ports are uneven.

So we moved him  into the hallway on his bed.  Then we moved the crashing patient in respiratory failure into that bed space by moving her on her bed. We got her into the space with 02 and hooked her up. Then we moved the the stable man into the space without 02.

You are all welcome to be Monday morning quarterbacks here but the facts are this:  We had seconds to find a solution.  And this was the only one.  We have learned the hard way that begging the porters to get up off their assess and bring a portable o2 cylinder to the wards takes too much time.  And we have learned that using the o2 on the crash trolley is not a good solution either.  Murphy's law will ensue, and another patient will crash if the crash trolley is in use.

The only thing management cared about the next day was the fact that there was a female patient in a male bay.  The government doesn't want mixing of the sexes.  They weren't concerned about the lack of 02 ports, space etc that necessitated the move. 

The medical admissions unit is under a lot of pressure to get their patients onto the wards very quickly. They have A&E on the phone screaming "we are breaching we are breaching, we need to send you admissions, for the love of god get your goddamn patients to the wards and make us some beds".

Yes, medical admissions must get their patients shipped up to the medical wards very quickly.   They know that not all beds on the wards will have 02.  They know that the ward Nurse will not accept a patient that requires 02 if she doesn't have a bed to put him in. 

But they need the ward nurse to accept the patient so that A&E doesn't get fined for missing targets.

So what do they do?   They do not tell the ward nurse that the patient they are sending up is on 02.   They just send the patient up via the porter.  The porter doesn't know or doesn't care.  He just brings the patient to the ward and dumps them there. Half the time they cannot even be bothered to let the Nurse know that her new patient has arrived.  When the Nurse finds out that the patient needs 02 she has to scramble around trying to move beds etc in order to get the patient some 02.   She has to re-allocate beds.  Change all details on the computer, change paperwork around etc etc.  All these things must be sorted even if you simply swap bed 4 with bed 2. And it has to be done immediately.

Just another example of what gets dumped onto a ward Nurse who is  solely responsible for 19 patients.  It usually happens straight in the middle of meal time.  Or right in the middle of her drug round when she is trying to stay with and help confused patients with their medication. 

Meanwhile in another bay an old woman's 02 tubing has disconnected and her distraught relative is waiting for what seems like an eternity for the Nurse to come along and sort it out.


Nurse Anne said...

And guess what is even funnier than this.

They used to keep high flow 02 masks (used in an emergency on the ward). But thanks to financial cutbacks they want to cut back on stock.

We were informed that these masks will not be distributed to every ward but rather they will be 2 floors up in the emergency supply cupboard for the entire hospital. It does not get restocked over the weekend.

You also need a code and to fight with the door to be able to get in and look for what you need. Not really something you want to be messing around in an emergency when you have abandoned your 19 patients to head two floors up to a supply cupboard.

Especially when you are getting stopped by elderly people who need directions to the car park every two seconds on your way to and from.

But the public will just blame the "cruel nurses" for "not wanting to be bothered putting granny on 02" when people get hurt. So really, what does management care?

Anyway I think we shot them down on the high flow masks in the cupboard 2 floors up thing. It shows you how they are thinking.

Frustrated Fairy said...

Aww Anne...that really really sucks! I'm lucky my placement ward has plentiful O2 at every single bad and every nurse only has 6 patients to look after. They are recruiting here too, come work here!

Nurse Anne said...

Where FF where where?

Nurse Anne said...

I'd tell you to email me but I cannot get into my gmail account.

Community Matron said...

Come and work in the Community with us Nurse Ann, our "ward" has no boundaries and is not limited by bed spaces, we take everything that is thrown at us in increasing complexity and are expected to get on with it, when we can no longer cope with an individual because they are too sick to be cared for at home we admit them for them to be returned in a day or so worse than when we sent them in. Ontop of the invention of the forty hour day by our twat of a management team who like yours have largely forgotten what actually the job is about we have to attend a never ending and frequently growing amount of meaningless meetings to discuss more meetings and to make sure our service remains fit for the 16th century.... It's all great fun... The patients are great, the gps are great, the staff are great, but we can't carry on get g more and more complicated work with a decreasing and increasingly fragmented staff load.
As a Community Matron the future for Primary Care is terrifying!

Nurse Anne said...

I feel bad for you community matron. I know what kind of shit we are discharging into your care.

Patients are getting discharged way before they are ready.

They are closing down all the stepdown beds.

Community social services and district nurses cannot cope.

The wards are like bloody ITU.

The patients are unable to take care of themselves on discharge yet there are no services to help (that don't take 8 weeks to set up)

The hospital has no beds. We have to discharge people. Then they come right back in.

The families say"but you can't discharge gran because she cannot cope at home". Then they are yelling at us when we cannot get social services on board. WTF do they want me to do?


Dino-nurse said...

The more things change, the more thay stay the same. Unfortunately. I have friends who work in the community (mental health) who are currently being taken over by the private sector and it sounds dire.
I am shocked that any patient can be transferred to a ward from ED or MAU without a nurse escort. Do you get any sort of handover at all? Whoever is in charge of the shift (ED and MAU) needs reminding of their professional responsibilities as this has to be in breach of our code of conduct. In my own particular trust we have seen recent changes- porters would bring O2 if requested (ICU we always have loads anyway) and would usually attach the tubing for you and get you to check the settings before turning the canister on. As long as an RN had set the rate, if the tubing then came off, they could re-attach it. Attaching a piece of tubing is not rocket science afterall and they would not touch anything else. Plus the documentation for transfer indicates the rate so on arrival to, say xray, another RN had to tick that the rate was as stated. Now they are no longer allowed to attach the tubing (even if it pops off). HCAs are in the same boat- however in many cases it is HCAs and porters who transfer patients on general wards between departments (Xray etc)...so what are they supposed to do if O2 tubing pops off? I asked this at a senior staff meeting not so long ago and was told that wards would have to release RNs to transfer patients on O2 from now on. As far as I am aware, there have been no incidents concerning patient safety when HCAs and porters were allowed to reconnect tubing....the upshot is MAU now phoning ICU to see can they borrow an RN for a transfer. Ho hum. ICU seems to be everyones bitch at the moment.

Dino-nurse said...
This comment has been removed by the author.
Dino-nurse said...
This comment has been removed by the author.
Nurse Anne said...

Ha i am not surprised that you guys are everyone's bitch. You are the only unit that even has RNs LOL.

The porters and an HCA or 17 year old cadet do the transfers. They literally dump and run.

We get a handover but they never tell you half of what you need to know.

The whole world revolves around AAU you know.

Once I was suctioning a patient (in the middle of meal time) and it was emergency. AAu called to give a handover. The hca told them that the nurse (me) could not take a handover now. A. because I was dealing with a patient who was unwell and B. because it was mealtime and 4 of us were trying to hand out meals and feed 20 people.

They started screaming at her demanding to know excatly how many minutes it would be until I got to the phone to take the handover.

After I got off duty I walked down there and started laying into them. Felt good.

I got a NBM stroke patient with a low K up at midnight. The medical team had prescribed IV fluids around noon. Was not started until he arrived on the ward and I noted it.

Sue said...

@Dino nurse;

I work on an admissions unit as a HCA. The nurses call the ward to give handover. The porters, or us, then move the patient. The nurses only need to come if the patient is very unwell, on certain infusions, or a cardiac monitor.

Also, HCAs are allowed to start oxygen as long as it's prescribed. Is that even legal? The RN is responsible for checking the flow every 2 hours.

Admissions unit is a joke of nurisng care. I've even seen a patient being pushed to a ward in a bed with a tray of hot dinner on his lap, to "get that patient out before ED breeches". Disgusting. Oh, and the reason that things don't get done on those units? The bed manager sometimes takes the liberty of handing over to the ward (missing out half the stuff that is relevant) and then calling the porters, all without informing the RN's.

/rant over.

Anonymous said...

Right on Sue!

I remember when I was a student in ED it was the ultimate sin for a patient to breach the 4 hour target.

Even if you were quiet in the morning and MAU were still swamped from the night before, the ED matron and bed manager were screaming at you to get the patient out!

What has the NHS come to when targets take priority over patient safety!

As for the O2 discussion, I was always reconnecting tubing if it disconnected or mask came off patients face when I was a HCA/student. God knows if I was violating trust policy!

Matt said...

"Also, HCAs are allowed to start oxygen as long as it's prescribed. Is that even legal?"

unregistered staff can administer medication as long as the registered practitioner deems them competent. Have a look at the NMC standards for medication administration.

Anne, I know of wards where there are not enough flometers for all beds and they have big O2 cylinders to wheel up to patients who may reuire O2 in the situation like you have mentioned.

I've heard from other students when chatting that staffing is still poor at other trusts, another Stafford is inevitable. A close friend of mine ends up having to look after 27 acute medical patients with one other rn and 1 hca, the ther week she was on her own with 1 healthcare till midnight. I've sugested going to the press, but we all know what happens then. Margaret Haywood?

Dino-nurse said...

I suggest wikileaks.
Afterall, NHS IT is pretty sucky and I doubt it would be difficult to break into.
I remember when the 4 hour targets first came in. The original idea was not a bad one- recognising that patients were spending too long lying on trolleys in A&E. However, it is a prime example of what happens when no clinical input was sought. Its 4 hours regardless of the problem. All of a sudden we realised that the REAL problem was the lack of beds to put patients into...so most A&Es ended with a small bedded area (used to be the drunk tank where I worked) that low and behold became the admissions unit. Job done! Unfortunately this didn't solve the bed crisis and so admissions units became the gargantuan monsters that we loathe today. Having that number of acutely ill people coraled together was suddenly starting to be expensive- hence the gradual whittling away of RNs and replacing them with a hoarde of support workers. Problem is, we know that they were a mistake but its one that can't be undone. Even if the targets were taken away, ED would still have to find beds for patients and the beds are just not there. I read with interest about a failing trust in the south of the UK that was been bought by a private company. This is the way we are heading. Acute care is expensive.

Sue said...

Anne , have you seen the latest froth from the daily mail?:


Maybe they should campaign for better working conditions/more staff etc.

Nurse Anne said...

Oh god yes I did.

I still cannot believe it.There are people out there who believe that Nursing students don't work shifts on the ward anymore. Idiots.

I will stroke out if I read any more of those comments about Nurse training and the old days. People are so dumb.

Anonymous said...

Hi there,

Thanks for sharing this link - but unfortunately it seems to be down? Does anybody here at militantmedicalnurse.blogspot.com have a mirror or another source?


A scared hospital patient said...

This all sounds scarily familiar to me. I recently had the misfortune to end up in the A&E of a large central London hospital. For whatever reason I then became that 'breaching' patient and they all ran around like startled ants trying to decide who to blame if they couldn't shift me into the clinical decisions unit before the timer ran out.

A day later when they needed my CDU bed for the next breacher, I was pushed up to a top floor overflow ward which is basically a large room with no windows or phones and few equipment points on the walls, divided into bays by a few curtains. The porter then got cross with the ward nurse because they weren't ready for me and students were sent running to make up a bed.

A little while later all staff left, except one new nurse who seemed unfamiliar with her surroundings and didn't have a full grasp of the English language. She seemed a little overwhelmed to have been left alone in charge of 20-something patients for the night. I spent a scary night where I didn't receive my prescribed injections (although the vials sat in the cupboard by my bed), waited several hours for morphine and was kindly helped by the patient in the next bed (admitted for a Sickle Cell Crisis) who fetched me a bowl to vomit into when my call buzzer went (understandably) unanswered.

The next morning I told my doctor that I didn't feel safe spending another night there. My husband managed to arrange for us to take my treatment home and we managed to get me discharged before the following night.

Shortly before we left my husband had the misfortune of being the only non-patient in the room when a patient half a dozen beds away shouted out that the diabetic in the bed next to her had lost conciousness and begun fitting.

Patients are being mistreated because of financial cut backs causing a dangerous lack of staff and equipment and something must be done about this!

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