Geriatric discharges from a hell: A patient experience story.

30 August 2013

Ron Murphy is a software designer, he blogs at ronmurp.netlady  Discharging frail older patients can be complicated and requires multi-disciplinary input and co-ordination between doctors, nurses, therapists, pharmacists and social workers - not to mention the patient and their family. When it goes wrong, it can turn a positive patient experience into a harrowing story of failure and incompetency, Ron Murphy whose, mum was recently admitted to hospital, recounts some episodes of hospital discharges going amiss. Not for the faint-hearted. Discharge 1 I called and was informed “She's ready for discharge. Pick her up at 4pm.” Bad traffic, hospital parking: I was walking onto the ward at 5pm, ready to apologise for the delay. But who should pass me by as I walk in? My mum, in a wheelchair on her way for a scan. What? Had I been on time we'd have gone, and the scan would have been put off to the dreaded outpatient service. No explanation. No doctor was available. Well, that gave some time for the medication check. The meds were not all there. The patient returns exhausted from the scan, ready for home and a sleep. There was no time to wait for a doctor, or the missing meds. I decided to see the GP. Discharge 2 Someone calls me the day before. We agree I'll pick up the patient at 2pm on the day of discharge. All seems ready, with the patient's belongings in a bag. But where's the medication? "Isn't it there?" They check, "Oh, it’s with pharmacy." Call to pharmacy. Then, to me, "Can you hold on for a while?" No, "We have to be home for the re-enablement team at four. And for the district nurse at five, to administer the insulin." "Can't she [the patient] do the insulin herself?"  Didn’t they know this while she was on the ward? "No. She has cataracts, can't see well enough for the blood tester or the insulin pen." "OK. We'll send it out by taxi." "You'll pay for a taxi rather than hurry pharmacy along? Will it arrive by 5pm, when the nurse is due?" "Yes; and yes. No Problem. We often use a taxi." Often? Really? The waste! Guess what? At home, 4:30 arrived, but no medication. I phoned the ward, "Sorry, pharmacy won't approve a taxi. We have to wait until 6pm, when we are authorised to order one." "But, the district nurse... You couldn’t have let me know earlier?" I rang the main reception and asked for someone to complain to. "Sorry, they do have the authority to send taxis. Let me speak to them..." Within minutes someone from the ward sheepishly called back, grovelling an apology for the error. The meds, including insulin, arrived an hour after the district nurse left. I checked the meds: 28 days of most pills, but 12 of that one, and 8 of another. Different pills due to run out on different days? Why would such an odd lot be dispensed, or prescribed? How do patients with no next of kin manage? Discharge 3 Ha! They won’t get me with the old meds run-around again. I called and made sure the patient and all the meds were ready. I arrive, and we’re about to go. Patient, “They took the catheter out this morning.” What? I told a nurse, “It’s supposed to be long term; atonic bladder; retention; infection risk? Why?” Nothing in the records, nobody has any idea. Someone on the previous shift? Often the case. The doctor is summoned, and arrives half hour later, “Yes, so, your mother is back on Warfarin.” “Sorry? Warfarin? Her discharge pharmacy list clearly states: off Warfarin, on aspirin.” – I’ll get back to the catheter. “We started her Warfarin again today.” A quick check – no, none dispensed. “Ah, … Can you wait for pharmacy?”. Keep calm I explained what happens with pharmacy. Embarrassed hushed urgency is something you get used to seeing: phone calls are made. I get back on track: the catheter? “Well, she’s doing well without it.” I explain, again, why it’s needed, and why going to the toilet isn’t a sign the bladder is emptying.  More embarrassment as it dawns this removal wasn’t the active decision the doctor implied it was. She too discovers no one knows why it was removed. The doctor ponders, and then, authoritatively (do they teach this in med school?), “I think we’ll have it put back.” The nurse is told what the doctor has decided. A swish of curtains, some cheerful nurse-patient banter, and the catheter is back. We wait for pharmacy. Make conversation with other patients. Twiddle thumbs. A pharmacist arrives with Warfarin; and for good measure double checks all the meds. Well, that was only a couple of hours in the end. We arrived home with all the meds we needed. Or did we? I check the details and see the dosage, count the days: 28 days for this, 10 days for that. Meds out of sync again. GP and pharmacy again. Doh! They got me again. What fun we have on discharge.

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