George Eliot Hospital - No pharmacist=no medications

[concerneddaughter]

My mother was admitted to George Eliot hospital last night following a fall. She is 89, post stroke with vascular dementia, plus she has atrial fibrillation. To compound the problem I am in the USA. I called the ward this morning, was told that she was somewhat confused (hardly surprising) but the thing they were most concerned about was her lack of medications. They had been given a list (a diuretic, 2 BP meds, ant-seizure meds plus an anti-depressant) by her carer, but they had not been able to provide them. When asked why, I was told the hospital pharmacy had been closed all day. I realise this is a holiday weekend but to be unable to provide prescribed medication seems to me to be appalling. I was, fortunately, able to contact her carer who took in my mother's home supply of meds, but I am stunned that it is possible for a hospital to not only not provide these meds, but not even try to obtain them. The carer had visited in the morning, asked if there was anything else that was needed and had been told everything was fine.

I will be formally complaining, although I doubt it will do any good. From what I gather, the pharmacy was supposed to be open so I suppose that someone failed to turn up for work.

[craigwalsh]

Hi ---

Thank you for your posting. It was awful to read that a hospital in the Midlands doesn't even have a pharmacist over the week-end, but (alas) not all that surprising. Another member of this forum, turnthetables, has a blog (http://medinthemist.blogspot.com/) where he talks about his problems in getting medication, etc. He seems to often get the wrong medication, medication that's out of date, etc. Pretty sad stuff.

Most importantly, how's your mother doing now?

[concerneddaughter]

To say I was surprised was an understatement. I have been told, subsequently, that GE is part of a program whereby patients are supposed to bring their own medications with them. Unfortunately, if the patients don't know and neither do the ambulance staff, the chances of them bringing the meds with them are small. However.

It's been 3 days, and we're on our third diagnosis (fracture, infection) - probable stroke, which is what I suspected in the first place. Apparently, I'm a better diagnostician from 3500 miles away than the A & E. I find it extremely difficult to ensure that the ward staff have the information about my mother's condition and behaviour - I assume that as part of the cutbacks they have removed writing implements from the wards: nothing seems to get written down or passed on. I have no real expectation that she will improve, all I can hope to do is get her out of what is a very distressing situation as quickly as possible. A hospital is no place for a confused 89 year old.

Thank you for your concern.

[craigwalsh]

Wow, been there --- done that.

My father had a stroke in the U.K. while I was in Hawaii. I had the same frustrating experiences when calling the hospital. I never spoke with the same person twice. The doctors were never, ever available to speak with me. Nobody seemed willing to simply get my father's chart and let me know what it said.

I didn't want to be too "grumpy" on the telephone because I didn't want them to become polemic and take their frustration out on my father.

Life is often not orderly, with sons and daughters physically able to be by their parent's hospital bed. I frequently wondered how the hospital staff would have liked to have been in my position, trying to get information from recalcitrant staff about their parent's medical condition.

I hope you're starting to get some answers now.

[concerneddaughter]

I just wanted to update this. My mother, is now thankfully out of the hospital, although in worse condition than when she went in - she has essentially stopped eating. We (her care manager and I) have been unable to get a diagnosis - the discharge papers said "UTI? Stroke?" I have no idea whether this is refers to another stroke, or simply the fact that she has had strokes in the past. As for the UTI, this was the first time either of us had heard this mentioned, although it's not uncommon in the elderly. The medication dabacle continues however - she was sent home in an ambulance without her medication, which subsequently came in a taxi. However, as she is cared for by paid carers, medications need to be a pre-measured dosages - these were simply provided in boxes. When the care manager called to point this out, and that she had been quite clear about the requirements, and anyway, the hospital had my mother's own pre-packaged medications she was told "Oh yes, we've got them here" at which point they were sent in another taxi! Added to that, they tried initially to discharge this 89 year old after 8 pm. They are have been unable to grasp the fact that although her home (flat) is in the grounds of a nursing home, she is not a resident IN the nursing home - at 8 pm all the domicilliary care staff have gone off duty.

Irritatingly, she was kept in hospital for approximately 5 extra days (3 of them "working" days) because there were no OT or PT's available to assess her. If the NHS wants to cut hospital stays, they should ensure that there are sufficient numbers of these people to perform their duties in a timely manner. Finally, a system which seems to encourage everyone to pass the buck is never going to work efficiently, or catch problems before they occur.

Sadly, I suspect that this is not the last I shall see of this hospital. There is talk of closing it, and I, for one, will be delighted, although I fully appreciate that these problems can and do occur all through the system.

Jennifer

[Farmer Geddon]

The diagnosis was obvious. Your mother fell over - you said so yourself in your first post. Why is another diagnosis required?

This of course is not an indication to be admitted to Hospital but as we are all aware the level of support for the elderly frail in the community is non-existent, especially out of hours and at weekends. So inevitably people like your mother end up in an acute medical bed being looked after by people who are not trained to manage the chronically unwell and demented but who in fact are trained to manage acute emergencies.

Why didn't her carer ensure her drugs were sent with her in the ambulance in the first place? Was the carer even around??

You see the criticism of the Hospital may or may not be valid but you say in one of your posts that ' a hospital is no place for a confused 89 year old' - perhaps the ambulance staff should have left her on the floor at home instead? I expect you would be complaining if they had done that.

This elderly confused person fell at home. Someone called the ambulance. The assessment was that she was not in a fit state to stay at home and in the absence of any other support she was taken to hospital. In hospital she was fed, kept warm, given drugs (eventually) and finally discharged. Sounds perfectly humane to me but of course i only work in a hospital every day and have to deal with this sort of problem so what do i know?

[craigwalsh]

Hi, Farmer Geddon ---

Welcome to the NHS Sucks forum. Thank you for taking the time to register, and thank you for your first posting. I look forward to reading more in the weeks and months ahead.

When I started to read your posting, I thought you were being incredibly harsh. At one point I thought you were actually being sarcastic. But when I read:
Sounds perfectly humane to me but of course i only work in a hospital every day and have to deal with this sort of problem so what do i know?
I felt quite sad. I would have expected a more thoughtful, considerate attitude from someone employed by the NHS. Silly me.

You indicated:
The diagnosis was obvious. Your mother fell over - you said so yourself in your first post. Why is another diagnosis required?

I'm not aware that "falling over" is a diagnosis or medical condition. I "fell over" last May and was told by A&E (after 11 or so hours, x-rays and a CAT scan) that I'd just bruised myself. "Go home, remain active, take paracetamol." In fact, I'd fractured my back at T11, but this was missed by the folks at the NHS. I was also "kept warm, given drugs (eventually) and finally discharged." With an undiagnosed fractured spine.

The postings by concerneddaughter are, at least in my view, quite heartbreaking. Your posting makes me (I hate to say it) a bit angry. I expect more from the NHS. I'm probably wrong to do so.

[Farmer Geddon]

In hospital she was fed, kept warm, given drugs (eventually) and finally discharged.

Well i call that humane treatment - i'm not sure what you expect from the NHS but this at least is basic care.

I'm not aware that "falling over" is a diagnosis or medical condition

Well i think it is a perfectly adequate diagnosis and is referred to these days as a 'mechanical fall' i.e. due to the patients overall frail condition and is the reason for admission as quoted by concerneddaughter.

Unfortunately we are no longer allowed to use commonsense terms such as 'old age and general frailty' which the vast majority of people would understand, and that is why the (probably) spurious diagnoses of ?UTI?Stroke were offered. If one writes something such as 'Mechanical fall' on the discharge summary, the Commisars at the Department of Health don't know how to deal with it.

I'll reiterate it again but spell it out even easier this time. This elderly lady was admitted to hospital totally innappropriately because of lack of adequate social care. Her carer did not provide the appropriate drugs at the time of admission. During her stay she was assessed by the OT and Physio (apparently this was disgraceful as it prolonged her unnecessary stay) and then discharged home.

Until someone tells me that the preferred option was to leave her on the floor at home, i will continue to defend the care she received in hospital as humane.

[concerneddaughter]

Hmm. Much of what you said in your first post has merit. It was entirely appropriate for her to have been taken to hospital after a fall, particularly as she was unable to put her foot to the gound. Nine days in hospital seems a trifle excessive without a CT scan for a patient you feel may have had a stroke, but actually I accept that with or without a scan, treatment in the UK for a stroke in an 89 year old would be unlikely to vary. I assume they did find a UTI - they prescribed antibiotics at any rate. As to being fed - she has lost 7 lbs in 9 days, so I have my doubts about that.

You feel the need to support your colleagues in the NHS and that I can understand. I was not aware that I had blamed the OT or PT for taking their time to get around to assessing my mother - I assume that they had other cases to deal with. My issue is with a system, be it hospital managment, or more likely further up the line, that fails to provide a hospital with adequate resources, yet blames them for not discharging patients as quickly as possible.

As my initial post indicated however, I do blame the pharmacist who failed to turn up for their alloted shift in the hospital pharmacy: I am sure that my mother was not the only patient who was affected by this.

I take issue, however, with the characterisations of my mother's carers who have, quite frankly, been wonderful throughout this entire situation. Her carer followed the ambulance, and stayed with her through x-rays until she was admitted, without, I might point out, being paid for it. She provided a printed list of medications and dosages, which has been the standard practice for admissions to this hospital. As you may or may not be aware, domicillary care workers can administer medication provided they are in pharmacy pre-packs. Unfortunately such pre-packs can take anything from several days to several weeks (if you're dealing with Boots) to prepare, which is why it has not been standard practice to send them with the patient, as it can cause problems if they are not returned. As it was, the hospital ended up sending 2 taxis - hardly a wise use of scarce resources.

As for inadequate social care: we do the best that we can. My mother has not received a social services assessment because she is self-funded. She lives in an extra care apartment in the grounds of a nursing home. The alternative is residential/nursing care but she is vociferously opposed to this, and at 89, she is entitled to her autonomy, no matter how much this situation might worry me. We are fortunate that she has always been of a "saving nature" and that her savings allow her to have modicum of choice (I do not subscibe to the belief that it is in some way "unfair" that she should use her savings to pay for care - you save for a rainy day, and this rain is torrential).

In closing i have one thought. "Humane" - well yes, but I expect humane treatment for my pets when I take them to the vet. Should not the NHS aspire to something higher?

[zubzubes]

Wonderful, wonderful.

The "concerned daughter" - so concerned she is thousands of miles away "caring " by phone expecting everyone else to do the hands on.

[zippyRN]

My mother was admitted to George Eliot hospital last night following a fall. She is 89, post stroke with vascular dementia, plus she has atrial fibrillation. To compound the problem I am in the USA. I called the ward this morning, was told that she was somewhat confused (hardly surprising) but the thing they were most concerned about was her lack of medications. They had been given a list (a diuretic, 2 BP meds, ant-seizure meds plus an anti-depressant) by her carer, but they had not been able to provide them. When asked why, I was told the hospital pharmacy had been closed all day. I realise this is a holiday weekend but to be unable to provide prescribed medication seems to me to be appalling. I was, fortunately, able to contact her carer who took in my mother's home supply of meds, but I am stunned that it is possible for a hospital to not only not provide these meds, but not even try to obtain them. The carer had visited in the morning, asked if there was anything else that was needed and had been told everything was fine.

I will be formally complaining, although I doubt it will do any good. From what I gather, the pharmacy was supposed to be open so I suppose that someone failed to turn up for work.

Here's the simple reality

there is no way that a Hospital pharmacy, never mind an assessment unit can keep every conceivable medication on the unit ...

depending o nthe meds in question ( and the presentation) many common medications are held on assessment units in tablet form , but not all doses ...

we allready have a room full of drug cupboards to hold our limited tablet stock and further room full of drug cupboards to hold the injectables and fluids

there are a limited number of pharmacists funded for hospitals and unfortuantely out of hours provision from pharmacy is is on an 'on call' basis, the pharamcists who work on call are among the more experienced pharmacists ( therefore more expensive to call in ) because they have to be able to provide the initial service across all areas ...

THIS IS WHY WE ASK PEOPLE TO BRING THEIR MEDICATION IN IF THEY ARE ADMITTED AS A NONE ELECTIVE CASE

there is a clinical cost / benefit decision to be made in terms of calling the on call pharmacist in, or would you rather see life saving treatment delayed becasue they've used the allowance of on call for the weekend sorting out mrs miggin's tablets - some of which will probably be discontinued anyway - particularly as a significant cause of falls and collapses in the elderly is polypharmacy and/or inadequate review of the need for medication by primary care

[zippyRN]

In hospital she was fed, kept warm, given drugs (eventually) and finally discharged.

Well i call that humane treatment - i'm not sure what you expect from the NHS but this at least is basic care.

I'm not aware that "falling over" is a diagnosis or medical condition

Well i think it is a perfectly adequate diagnosis and is referred to these days as a 'mechanical fall' i.e. due to the patients overall frail condition and is the reason for admission as quoted by concerneddaughter.

snip


mechanical falls are extremely common in the elderly as is drug related postural hypotension leading to collapses / falls

add in a chest or urinary tract infection and it's an almost certainty that sooner or later the call will go up of 'nan down!'

[Happy1]

I am a A&E nurse. Our department once received a scathing complaint from an oversees relative regarding the fact that the blood from a (mechanical) fall injury had been left on the floor at home - not cleaned up.

Sorry?!?!?