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surrounding feeding without consent remain about as clear as mud?the a&e charge nursenoreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-43516565373940371592010-08-06T08:49:13.031-07:002010-08-06T08:49:13.031-07:00"What am I missing here"- well the first..."What am I missing here"- well the first bit is easy. <br />It sounds like your ward needs to establish a more effective referral mechanism?<br /><br />Most hospital based services usually require a medic (or nurse) to ACCEPT a GP referral first before deciding if a ward area (rather than A&E) is the most appropriate setting to begin investigating a new patient.<br /><br />It simply beggars belief that a cohort of patients are being sent to an acute medical setting even though none of them have an actual physical problem.<br />What next - sending patients with unstable angina to a forensic psychiatric setting?<br /><br />The decision to impose treatment on any patient refusing intervention MUST be judged on the individual set of circumstances in each case.<br />At least two factors must be ALWAYS be kept in mind;<br />[1] does the patient have capacity?<br />[2] the likely consequences of NOT treating a particular problem - for example, a young person who has starved themselves and now has a potassium of 8.3, say.<br /><br />In other words, once a life threatening problem has been identified staff would be entitled, and in fact required, to act in the patient's 'best interest' in order to save their life (assuming they were lacking in capacity).<br /><br />The MHA can be used on a medical ward (or other in-patient areas) to detain somebody - by applying either the nurses holding power, Section 5(4) or a medics holding power Section 5(2) - although these sections DO NOT permit enforced treatment (rather their function is to enable more detailed psychiatric assessment).<br /><br />As mentioned above 'common law' must be used to treat a physical emergency, providing there is evidence that a patient lacks capacity, and the consequences of not treating the problem are likely to be significant.the a&e charge nursenoreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-38505956442268001272010-08-02T06:09:10.193-07:002010-08-02T06:09:10.193-07:00You know dino every time I try to tell people abou...You know dino every time I try to tell people about what is going on they say the same thing<br /><br />"Well dear have you bothered to call the union"<br /><br />"Have you bothered to put in incident forms"<br /><br />"Have you bothered to contact the NMC/RCN"<br /><br />"Have you bothered to contact the newspapers"<br /><br />"Have you bothered to whistleblow, it is the nurse's responsibility you know"<br /><br />Um. OF COURSE WE FUCKING HAVE DONE ALL OF THE ABOVE AND MORE. And everything that Joe Public can think of we have already thought of, everything he can suggest we have DONE. And we have done all the things that Joe Public is to fucking ignorant to think of on his own.<br /><br />Why are people so dumb?Nurse Annehttps://www.blogger.com/profile/05400048448105519082noreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-71270877240541116842010-08-02T05:21:27.514-07:002010-08-02T05:21:27.514-07:00It sucks to be old and frail at the best of times ...It sucks to be old and frail at the best of times but to be old and frail on an NHS ward....:0(<br />This story is repeated on medical wards across the country and is only going to get worse. Our CCOT nurses are constantly being called to review patients who are on 80% fiO2 and desaturating due to being old, frail and not able to cope with a resp rate of 40 due to a HAI. What can they do? Most often they argue with a doctor over whether a DNAR might be more appropriate as there is no way ICU will take them....most will not tolerate the tight mask needed for NIV and if they get tubed they usually die on the ventilator. Most often the DNAR is not done and low and behold they manage to bypass the review by the medical SpR (a requirement for admission to the HDU for NIV) and a snotty consultant will browbeat an anaesthetic SpR to admit to the ICU (time and time again this happens as they know damn well that getting hold of the ICU consultant will=no admission). The medical SpRs manage to hold their ground because (a)they can get hold of the consultant easily and (b) she is well known for eating other consultants for breakfast. Most of the time our SpRs are on their own as getting hold of the ICU consultant is alot harder as they have a bigger patch to cover ( theatres, ED plus the rest of the hospital). This is why they are pushing for CPAP and NIV to be available on general medical wards. Can you imagine it? Who will do the ABGs? Who will make sure that all NIV patients keep their masks on, are not accidentally being fully ventilated ( it happens alot on HDU due to the safety settings on some of the NIPPY machines)and have NG tubes so that they can be fed? We can use mittens as a firstline and sedation as aback-up but this is because we have one or two patients to look after. It beggers belief how anyone thinks that this is a good idea. I have contacted the RCN and the NMC with no luck or back-up. Big fat suprise.Dino-nursehttps://www.blogger.com/profile/06032700219601293612noreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-61675323422463618672010-08-02T04:50:54.958-07:002010-08-02T04:50:54.958-07:00Oh and then there was all the paperwork I had to c...Oh and then there was all the paperwork I had to complete and send off to get her discharged and under the care of SS.<br /><br />She is still on the ward today with a lovely hospital acquired chest infection...on IV antibiotics. An hour after we started the IV antibiotics the rehab place rang and said that they will accept her and will have a bed in two days. I told them she was no longer fit for discharge because of her chest infection and IV drugs. <br /><br /> If she is once again declared medically stable we will have to go through the whole process again. Eventually she will die on the ward.Nurse Annehttps://www.blogger.com/profile/05400048448105519082noreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-56950945301929036802010-08-02T04:47:56.690-07:002010-08-02T04:47:56.690-07:00They are slashing community beds for elderly as we...They are slashing community beds for elderly as well. We already are overwhelmed with delayed discharges anyway. There is no place for these people to go.<br /><br />Management has told the RN's that "we had better get off our asses and get these people discharged".<br /><br />The consultants don't seem to understand the situation. I had one screaming at me the other day. On Friday he had medically discharged a patient to a stepdwon facility. She is 99 and cannot take care of herself. And it will take about 8 weeks to get a NH. <br /><br />On friday I busted my ass to make 100 phone calls to find a rehab type place to actually accept her. I started on this as soon as the consultant said she was medically stable for discharge from our hospital ward. If you want to know why your nurse is ignoring your call bell it's because we are doing this kind of stuff for 22 patients.<br /><br /> Rehab facility said they will assess her on Tuesday and then it will be a 3 week wait at least because they have no beds. So we won't even know if they will accept her until at least Tuesday. And that was the only place I could get to come and assess her.<br /><br />Monday morning her consultant was on the ward screaming and cursing at me because "I hadn't bothered to discharge that lady" "Why the fuck is she still here" "these goddamn nurses don't know what they are doing" "How hard is it to handover a patient to the nurses at a rehab facility".<br /><br />I really wish these consultants would either get to grips with the situation or shut the fuck up.Nurse Annehttps://www.blogger.com/profile/05400048448105519082noreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-83570664163275316972010-08-02T02:23:36.837-07:002010-08-02T02:23:36.837-07:00In my part of the uk that would be because mental ...In my part of the uk that would be because mental health staffing and beds are being cut and are the psychiatric ward equivalent of what you so regularly describe happening to your ward, Anne.<br /><br />I'm a mental health nurse, and of all the blogs I've looked at, yours most accurately reflects what I see going on in mental health.<br /><br />Despite occupancies of 133%+ over several years now (achieved by juggling beds, sending folk out on leave to use their bed and sleeping new admissions on a sofa, borrowing beds on other wards) there is now talk of cutting more beds.<br /><br />Community support, rather than being increased to compensate for the lack of inpatient care, is being chipped away at.<br /><br />No wonder more folk are shipping up at your wards.<br /><br />It is a sick system.<br /><br />Stressed RMNAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-59378340989910907722010-08-02T02:02:17.557-07:002010-08-02T02:02:17.557-07:00Anne, I thought you might find this interesting, s...Anne, I thought you might find this interesting, shocking, disappointing, disgusting... the list goes on. <br /><br />http://www.channel4.com/news/articles/uk/nhs+whistleblowers+apospaid+to+keep+mouth+shutapos/3731277Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-69701901124729390652010-08-02T00:57:15.232-07:002010-08-02T00:57:15.232-07:00They won't self discharge.
And apparantly if ...They won't self discharge.<br /><br />And apparantly if we discharge them without feeding/sorting them we are in deep trouble.<br /><br />I am repeating to you what I have been told. I think it's all a load of rubbish really.Nurse Annehttps://www.blogger.com/profile/05400048448105519082noreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-24178088661258775492010-08-01T17:33:06.994-07:002010-08-01T17:33:06.994-07:00If they're not a section surely most of them s...If they're not a section surely most of them self discharge? Who wants to be on a general medical ward? Why hang around, for no treatment?<br /><br />Or am I missing the point.<br /><br /> CN<br />xXxAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-341795132296269092010-08-01T13:38:01.251-07:002010-08-01T13:38:01.251-07:00Yep, it's BS. Nothing in the Mental Health Act...Yep, it's BS. Nothing in the Mental Health Act about how if they've been sectioned in one place they can only be sectioned in that place.Spirit of 1976https://www.blogger.com/profile/10314554889217669727noreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-90898045632722673682010-08-01T12:42:34.011-07:002010-08-01T12:42:34.011-07:00That is definitely BS.That is definitely BS.pjhttps://www.blogger.com/profile/06832177812057826894noreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-53733794749375281782010-08-01T11:48:19.739-07:002010-08-01T11:48:19.739-07:00Z, We were told that if they were sectioned somewh...Z, We were told that if they were sectioned somewhere else in the past then they have to go back to that place to be sectioned again?<br /><br />Sounds like a lot of BS to me.Nurse Annehttps://www.blogger.com/profile/05400048448105519082noreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-38662473655958747932010-08-01T10:59:10.992-07:002010-08-01T10:59:10.992-07:00In the new era, GP will be charged with the help o...In the new era, GP will be charged with the help of private companies of course and suddenly the psychs will fight to have the patient. If they do not get better....wow.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-69299264797509151932010-08-01T10:09:23.417-07:002010-08-01T10:09:23.417-07:00I'm pretty sure you can section a patient with...I'm pretty sure you can section a patient with anorexia for force feeding in a general hospital (section would need to be done by a psych though). It is pretty much the only way you can force feed an anorexic patient since they will usually retain capacity.<br /><br />Medical consultants often have little familiarity with the mental capacity and mental health acts so it is often worth getting an expert opinion. That said there is no way the psychs can threaten the general hospital for not treating the patients - as you say - to force feed without section would be assault - it is up to the psychs to arrange sectioning for the purposes of treatment.pjhttps://www.blogger.com/profile/06832177812057826894noreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-88815611182365025472010-08-01T09:28:32.668-07:002010-08-01T09:28:32.668-07:00In the old days, a Psych. consult will do the tric...In the old days, a Psych. consult will do the trick. Now, it is the future: GP commissioning is here.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-49840907423808167862010-08-01T09:24:21.364-07:002010-08-01T09:24:21.364-07:00General Medicine is the long stop for everything. ...General Medicine is the long stop for everything. It has always been like that. If somebody has social problems that cannot be managed by social services they are sent to hospital and passed on to general physicians to sort them out. It is the same with psychiatric problems. If the mental health services cannot cope the patients get sent to the general hospital and the general physicians have to do their best. Or the patient is left with the GP.<br /><br />With the coalition cuts this sort of problem is only going to get worse.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-51102944131705808582010-08-01T09:22:45.337-07:002010-08-01T09:22:45.337-07:00Anonymous: Yes, you can be committed to hospital f...Anonymous: Yes, you can be committed to hospital for compulsory treatment. However, what I believe MMN is saying is that the particular ward that they are working on is not legally allowed to compel patients to accept treatment (vs. some other wards which can).Sarah Quailhttps://www.blogger.com/profile/02976974626905690974noreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-12377199074644832242010-08-01T09:18:43.117-07:002010-08-01T09:18:43.117-07:00Send them home. They do not necessarily die.Send them home. They do not necessarily die.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6277229251527832949.post-40539294111952524342010-08-01T09:11:50.497-07:002010-08-01T09:11:50.497-07:00http://www.nhs.uk/Conditions/Anorexia-nervosa/Page...http://www.nhs.uk/Conditions/Anorexia-nervosa/Pages/Treatment.aspx<br /><br />Compulsory treatment<br />Occasionally, someone with anorexia may refuse treatment even though they are severely ill and their life is at risk.<br />In such a situation, doctors may decide to admit the person to hospital for compulsory treatment under the Mental Health Act. This is sometimes called ‘sectioning’ or being ‘sectioned’.Anonymousnoreply@blogger.com