Wards

I'm not happy with wards.

Well, to be blunt, I'm not happy with the standards of care on acute medical and surgical wards.

I'm not in the habit of bashing colleagues, so I won't. There may well be understandable reasons for why care has been poor. I honestly don't imagine that staff got up in the morning and thought, "I know, I'll go to work today and do a rubbish job!" I trust that the instituationalisation of the ward staff and the management structure's edicts have significantly contributed to (if not generated) this state of affairs.

But, understandable or not, nurses fault or not, the consequence is still that care has been poor. Unacceptably so.

I have to travel to the acute district general hospital to see their patients, doing the liaison psychiatry work for them. Visiting patients has become a more frustrating process, of late. Parking is a nightmare, so how can I even get to see their patients? But when I do finally get to the ward, it's mostly empty. Usually I just wander on, look for a qualified nurse, can't find one, find if the patient's on the ward by looking on the whiteboard on the wall (no confidentiality here, you see), go to the notes trolley by the door then rummage around and pull out notes (odd that these notes are openly kept in a public area, without supervision, and I've never never been challenged on picking up a set of notes) and get the measure of what's going on. I then find anyone (really, anyone) who can tell me something about the patient's course of late, whilst on their in-patient unit. Once it was a lady pouring tea, who could say my patient had got worse and left her drinks now (had done since last Tuesday), left her meals too come to think of it, and just lay in bed (because the nurse in that bay "was off" and no qualified or unqualified nurse on the ward on that shift knew anything about the patient).

So I drive to their hospital, park up eventually, get to the ward, find notes, find some information, then finally get to see their patient for them.

Recently I saw on lady on the ward who I've been looking after in the community. She has Alzheimer's disease (F00.112) and was getting frailer and more confused, but deficits weren't typical. I thought she'd an acute confusional state so arranged investigations which found her to have pancytopaenia, she was admitted and clever haematologists did genuinely clever things, improving her significantly. They were unsure if she could return home and if her drug regimen was adding to lethargy so asked for advice. When I saw her on the ward, she was lying in urine. She'd been incontinent (because she is). I went to find someone to sort this out, who attended and sighed, scolded her for "not pushing the buzzer" and blamed the patient. The patient has severe dementia. She has no idea what the buzzer is or what it achieves and certainly wouldn't be inclined to push buttons and coloured lights on dashboards on an acute medical ward. The healthcare assistant had no idea that her patient was demented, or what that meant. Folk with dementia really get woeful care on that acute ward, persistently, staff simply have no notion of how dementia affects patients.

Another ward, another patient. Again, someone I know. He's had major surgey and is on a high dependency unit with 1 : 1 nursing. Fabulous. I have a sense of deja vu here as, once again, I see the same thing as has happened before.

My patient's face lights up as he sees me (no idea why, it's the CPNs who've done the most for him, but I guess he's genuinely happy to see a familiar face). I enquire how he's been today, he says he's bored because he can't do anything. He gestures to one arm strapped up (from his orthopaedic surgery) with tubes coming out of it. He nods to the newspaper in front of him which his son had brought in, but he can't ready today. Why not? The nurses haven't got his glasses, he's bedbound and can't get them, the nurse is too busy and chided him for wanting a drink earlier so he daren't ask her for his spectacles. His bag's right behind his bed, I reach down, pull them out, hand them to him. He beams. I'm seeing him at lunchtime (the only time through the day I can, since it's only between morning and afternoon out-patient clinics that I can find parking) and his lunch is on a tray in front of him. He's lying in a bed, with the head end tipped up a little. The tray is across his chest. On it is a shepherd's pie and carton of juice and a cake. The juice and cake are sealed. He has just one usable hand. I look at the food, look at him, look at the food, look at him and he bursts out and laughs, knowing exactly what I'm thinking. "One hand, yes doc, clever isn't it?" He gestures at the foil lid and the cellaphane wrapped muffin knowing he's got no chance.

My third patient is sitting in bloody diarrhoea.

My fourth patient is being taken home by family, against medical advice, despite being an incapacitated vulnerable adult and having nursing and medical and OT and social workers formal written statements and assessments detailing her needs and how these could only be meet within a 24 hour nursing care home. But it's easier to let her go and have no care than argue with the vocal and critical family. So it goes.

My fifth patient isn't there any more. She was admitted with confusion on top of her bipolar mood disorder, was found to have had a heart attack, and had died 2 days later (may she always rest in peace). I wonder what her last few days were like. She was often bewildered and afraid in unfamiliar settings. If my kith or kin had to die in hospital, I truly hope their last days are in a better place than this, with folk who really are in a position to give care.