Saturday, 3 November 2012

Mealtimes USA.......

........Fucking love it.

My older readers will certainly remember an old post of mine regarding hospital mealtimes in the UK.

In short that post explained why patients are not assisted at mealtime in UK hospitals. It should also help readers to understand that that NHS RNs have ZERO control over this situation. 

Let's talk mealtimes USA.

Keep in mind that even though my hospital is large, number one in the region and absolutely groundbreaking that we are also non profit and  that the majority of our patients are poor, chronically ill medical patients. Around 60% of our reimbursement comes from medicare and state programs. My floor specialises in kidney patients and Americans with renal failure are covered by the government.  In other words no one dies because they cannot afford dialysis.  They kill themselves quite often by refusing to be compliant with dialysis, renal diets, medication, diabetes education and fluid restrictions but that is a whole 'nother post.

Anyway . Mealtimes. 

In the UK I was one RN to 12 to 25 patients. Some kitchen troll dumped a food cart onto the ward at 6PM and took the damn thing and all the food away 15 minutes later.  Kitchen troll didn't give a fuck if staff were able to get that food out or not.

Ahhh rather than write about it all again here is the link  again.

In the USA I have 6 medical patients. I also have a certified nurse's aid and a charge nurse. The charge nurse has no patient assignment (if we are short she may get two patients as well as be charge but it's still manageable). We have multiple multiple kitchen staff from 6 AM until 10PM.   In short, I have help.

The patients each have their own free phone and are able to order their meals from kitchen who brings the tray to the patient. If a patient is on a renal diet, fluid restriction, or is Nil by mouth an order would have been entered into the computer system for that and it would have been seen by the kitchen staff.  They are meticulous about monitoring for diet orders.  If a patient is too sick to order their own meal, I do it for them.

The beauty of this system is that not all of my patients are getting their tray at the same time. And with 6 patients in my assignment I am usually able to assist.  If not then the certified nurse's aid probably can. Say 3 of my patients can order their meals and feed themselves, and 1 patient is nil by mouth .  That leaves only two patients for me to feed and not at the same time.  Very manageable.

Sure, the shit hits the fan here too, and drugs, medical emergencies, admissions,  psychopath schizophrenic weirdo relatives, and stat doctors' orders slam me to death at mealtimes regularly.  Usually all at once, as such is the nature of a medical ward. But still, it is manageable.

The kitchen staff here are trained. They know not to do anything FUCKING STUPID like leave a tray in front of and in reach of a demented elderly patient. That would OBVIOUSLY cause choking and burns.  They will tell the nurse or the tech that they are bringing the tray.  Then we can get there and feed the patient while the food is hot.  If we can't get there the tray is kept warm and ready for when we can.  It is kept this way by the kitchen staff. 

In the UK the nursing staff leave trays out of reach of patients to avoid choking and burning of their elderly patients. ....unfortunately they are too short staffed to get back and feed before NHS kitchen troll takes the food away.    Three NHS staff have 35 meals to dish up and hand out in 15 minutes over there.  It's not like they can bring a tray to a patient and then stay there and feed them. If they did that, then no one else would get their tray at all!!!

So yeah, patients and families here are sometimes whiny temper tantrum throwing crackhead dilaudid addicts but hey, mealtime is great. No one goes hungry unless they are ordered by the physician to be Nil by Mouth for a test. Nothing I can do about that as a Nurse unfortunately.  Feeling hungry is preferable to dying on the operating table of aspiration because you pigged out before surgery.

Off the subject but one thing I have found comical about the United States is that the uninsured patients who are getting free care throw the biggest tantrums.  They are often very noncompliant with their free dialysis, renal diets, diabetes diet.  We are talking about people who weigh 25 stone with a blood sugar of 30, creatinine of 6, and potassium of 5.9 going nuts and putting in official complaints because the Nurse wouldn't go and get them a big mac and 36 ounce coke.

They throw things because there is no dvd player in the room, or they want the doctor to prescribe 6mg of dilaudid IV fast bolus every hour and he won't (because it might kill them on top of making them high). They bitch about the free ice cream, the comfort of the beds (they get the same beds and facilities as everyone else), the lack of HD on their TV screens and the fact that the kitchen cafe is closed between 11PM and 6 AM.   We had a patient who was an illegal immigrant from the caribbean punch a doctor in the stomach when he came to see her because she wanted " bigger apartment from rich America" i.e. a bigger hospital room..  She had a life saving (and free) OP at my hospital.

Meanwhile the working family guy who works 80 hours a week and HAS to pay $1100 dollars a month plus co-pays to insure his family plus anything that the insurance company won't pay for is nice, understanding and grateful for care.   Because he is so nice we take the good stuff out of his room to give the government assistance patients so that they don't beat us up.  You think I'm kidding?  Okay not all government assistance patients are ghetto thugs.  We are all one unplanned step away from being on state assistance, especially in this economy.  But many of them are thugs and druggies, and they are usually regulars and they are seriously entitled and abusive. They are also insanely sick usually due to life style choices.

Have had two patients with guns on them so far.  Also  I worked an extra shift in trauma just to see what it was like. All gang members. The whole unit is on lockdown bigtime with security "in case whoever put the patient in hospital comes in to finish him off".  Yeah I will stick with my kidney unit. Thanks.

Whadda country.

Anyway hope you all are well!!!

I am very sad to read about the way certain journalists are presenting the liverpool care pathway. That pathway is what I would want for myself and my family if terminally ill or quality of life was gone.  I wish we were better at palliative care in the USA. We suck at palliative care here. We have had 98 year olds begging to be allowed to die with dignity put through big operations, intubations ICU stays and months of suffering for NO reason.  So sad.

Well I suppose that's all for now. Take Care.


the a&e charge nurse said...

Great to hear that your professional life is much better for you - even so I would take the NHS over the system in the US every time (warts and all).

The US spends "more than any other country in the world. In 2005, our per capita -- so, per person -- spending was $6,697. The next highest in the study was Canada, at $3,326. And remember -- that's "mean" spending, so it's the amount we spend divided by our population. But unlike in Canada, about 16 percent of our population doesn't have insurance, and so often can't use the system. These facts should set the stage for all numbers that come after: Every time you see a data point in which were dead last, or not leading the pack, remember that we spend twice as much as any of our competitors".
(10 reasons why American health care is so bad).

Z3r00n3 said...

Great to hear from you again, Anne!

I'm doing a piece on the LCP over on Not So Big Society soon ;-)

Katie said...

Good to see you again.

Our NHS hospital has introduced a new system for mealtimes. They come up as microwave meals and they get heated on the ward. In theory, this means that patients who are off the ward or need feeding can still get fed as we can heat one at a time.

What is happening on our NHS ward? The HCA's who can not be bothered to feed patients will slope off for a cigarette when they see the domestic putting an apron on, leaving one HCA to hand out all the meals and feed all the patients.

The domestic gets pissy if the lone HCA asks to leave a few meals till the end so they can feed the patients one at a time. They insist on cooking them all at once. They also insist on starting at 5.00 or earlier instead of 6pm, so the nurses rush around trying to give the meds and do the vital signs and blood sugars. They will not tell you they want to start, they will just cook them and come and demand someone hands them out.

Meanwhile, an admission comes up and starts creating that the shepherds pie meal they ordered is not here and they have to have fish and chips. The admissions units won't send up the damn meals with them. We have to go hunting around the hospital.

Anonymous said...

God I feel for you Katie. I hated the NHS kitchen trolls. They won't work with the Nurses at all. They don't give a shit if you have a code blue on the ward or if you are getting an admission or if someone has died and you are tied up with the family. They just want to get their shit done as half assed as possible and then get him.

The kitchen staff here are pretty on the ball and very respectful of the Nurses. If they weren't they would be fired. They get the best free health insurance in the region for free working fulltime at my hospital even though their wages are low. They wouldn't risk being fired.

Militant Medical Nurse

Top 5 US States For Registered Nurses said...

Yes i remember that old post regarding hospital mealtimes in the UK. I can never forgot it.

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