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.