Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where
we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from our readers and the question was
My Dad is still in a coma after bypass surgery what could be the reason for him not waking up? (PART
2)
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“ I want to answer the next questions from one of my clients Natasha stating that her dad’s pressure
sore got worse and ICU nurses have not documented it in their nurse’s notes.
TITLE: My Dad’s Pressure
Sores Worsened In The ICU. How Come The Nurses Didn’t Prevent Them?
“You can also check out previous 1:1 consulting and advocacy sessions with me and Natasha here.”
PART 1
PART 2
PART 3
PART 4
PART 5
PART 6
PART 7
Natasha: Because, Patrik, I really went in on them. I told them, “I’m definitely going to complain about this place. I really, I cursed them out to the point … It got really bad, and then when you tell people that you’re going to do that and do this, and then that phone call, they know that maybe that, “Oh, my God. I hope she doesn’t do something like complain,” or, “We should just be ready to cover our asses,” or something. I don’t know.
Okay.
Patrik: Yes, so that’s what I would do, to ask them, “Oh, there must be some nursing notes?”
Natasha: Yes, be polite.
Patrik: Yes, polite, and I’m just trying to find out … I’m just trying to think.
Natasha: Never run into this problem?
Patrik: Yes, yes, because I’m almost certain that they’re trying to hide this from you.
Natasha: I know, yes.
Patrik: For whatever
reason.
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Natasha: Yes, and there was just so much going on, and the thing is that there really was so much going on all the time. It really was, like my dad was … I mean, like I told you in that CCU, Patrik,
I’ve never been in … They’re usually supposed to be busy, right? They always want you to … From what I … They want to kick people out basically, because there’s not enough beds. But literally, for the most part, there was only like three or four people for the most part. It wasn’t until the end when they started getting three new admissions. There were so many open beds. They had time to do all that.
Patrik: Yes,
well, and again, the nurses, and I’m not saying that they didn’t do their notes. I’m sure they have done their notes, but where are they?
Natasha: Where are they? Yes.
Patrik: Doctors are well aware of covering what … Their work.
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Natasha: It’s so unfortunate.
Patrik: I can’t believe … There’s this saying, there’s this saying in the nursing and doctor profession, “What’s not documented is not
done.”
Natasha: I think my sister, she said something similar.
Patrik: Yes, yes, I’m sure she has. I’m sure she has.
Natasha: Because, she said, “How come …” Because, she skimmed through it. She made a comment about the respiratory therapist. She said, “It’s not
consistent.” She made that comment about that, she said that there should’ve been more, especially since he was so unstable all the time. She didn’t notice …
She just thought it was odd.
Patrik: Yes, and okay, here is another thing, here is another thing that I think is why this is important: I do know you mentioned early on that he had a pressure sore. Now that, when
I skimmed through the notes, he had a stage two, stage three pressure sore.
Natasha: It turned into a stage three and it became unstageable, and it got bigger.
Patrik: Right, right, okay. So, this is … Usually, pressure sores are nursing issues, okay? So, especially in light of that, there must be some nursing notes.
Okay, one thing that’s not in the notes either, so let’s just use the pressure sore as an example. When patients have pressures sores or any other, let’s say, surgical wound. They might have had surgery and they have a surgical wound, there must be a wound care plan. There must be.
Natasha: Oh, they did. No, they wrote it. So, they wrote it down but it wasn’t like
that … They had notes, the ostomy nurse, the wound ostomy nurse came. She literally came, my dad was admitted Friday, she came on that Monday to first observe my dad. Yes.
Patrik: Right, so but again-
Natasha: She did make notes, the nurses made notes, but they made notes …
So, they kind
of fibbed. They just kind of put the … It’s almost like a template. They wrote … If you look … It’s almost like at template, where it’s like, “Okay, what measures are you taking? Measures taken for pressure sore,” and then it has a list. Then, they put “debridement”.
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Patrik: Debridement, yes.
Natasha: Yes, he never got debridement at all. When I asked them, “Are you going to do that?”
they were like, “No, he doesn’t need that,” but it’s listed there.
It’s almost like a template, you know, “Moisture control, blah, blah, blah.” They just kind of quick, check off boxes, yes, but they didn’t do it.
Patrik: Right, and you’ve seen that within those 1,200 pages?
Natasha:
Yes, I saw that. Yes, yes. It’s, yes, but I mean-
Patrik: Okay, so it’s there. Okay.
Natasha: They didn’t actually do that, though, and then they made comments about, “Despite trying to take all the necessary precautions, we’re still not able to manage pressure sore,” or something, but that’s not true, Patrik. They didn’t take all the
necessary precautions, because I was watching them, and they were not doing all the things that they said that they did for his pressure sore, including turning him. They would turn him, they would actually … Let me tell you, Patrik, they would put the pillow underneath so it was on the coccyx, is that how you say it?
Patrik: Yes, yes, yes, yes.
Natasha: Yes, they would actually put the pillow right there and keep him on his back. They were supposed to tilt him kind of 45 degrees to the right and to the left, right, putting the pillows to the side. They would do it maybe like 20 degrees, so he’s still on his lower back and his butt. He’s still on there, until I started to really complain. “That’s not how you do it,” and the ostomy nurse was like, “Oh no, they’re not …” Like, she thought that
I was telling them that he has to be in a foetal position. I’m like, “No, you’re not understanding me. They’re not doing it the way you’re saying to do it. The ICU nurses, they’re not doing it the way they’re supposed to do it. So, anyway, yes, moisture control too, they took off his catheter for two days. He wet the whole bed, it was bullshit.
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Patrik: Right. You see, this-
Natasha: But, they didn’t document that either. They made it seem like his Texas/Condom catheter was on the whole time, but for two days it was off.
Patrik: Right, right, and do you know why?
Natasha: Because, there was a male nurse, and it fell off, and he didn’t bother to put another one back in. There was a nurse named Michelle, during the day she told me that,
and so she put a towel on top of my dad’s penis. Then, I thought that … I was like, “This is wrong, this is weird,” right? And they put a diaper on him, and then there that night … No, the next day or whatever, another nurse put a soft cloth inside his diaper, but he still wet the whole bed. Then finally, I spoke up and I told the charge nurse, “He’s supposed to have Texas/Condom catheter, why is it not on?” And then they finally put it back on, like, “Oh yes, he had an order, blah, blah, blah.”
But, they didn’t document any of this stuff.
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Patrik: Well, well, they may have documented it, but you might not have those notes yet. You see, one thing, again, I was only glancing over it, but one thing that I couldn’t find, and that could be because it’s not there or because I haven’t looked properly, is you mentioned about lying your dad on his side and turning him every two
hours again. I have not seen any of that documentation, but I’m also certain that documentation must be somewhere, must be somewhere.
Natasha: Well, no, they wrote in a template form. Okay, so how can I explain?
No, it’s just, you know what it seems like? It seems like they just kind of checked of something and then it was form, but they didn’t type it in themselves.
You know what I’m saying?
Patrik: Yes, yes.
Natasha: So, it’s in there but it’s not like they wrote it in themselves. Do you get what I’m saying?
Patrik: Yes, okay, so are you saying this is in those 1,200 pages?
Natasha: Yes.
Patrik: Okay, okay, good, good, good. That’s fine, that’s enough information. I agree that they probably ticked some boxes, but again, then we have to go by what boxes they’ve ticked, whether right or wrong, you know, I mean that’s what’s documented, and then we can say, “Does that make sense or does it not make sense?”
Natasha: Because, I made a big stink about that as well. Yes, and they lied about that too. You know, even a doctor had documented that it got worse when he was in hospital. But then, they were saying how in the nursing notes, one of the nurses wrote that, “Despite taking all the precautionary measures, being that he has a feeding tube and his nutrition, that it’s not healing,” or whatever. But no, you’re not taking all the necessary precautions. So, even though those other things can exasperate, like a pressure ulcer, the thing is that they were not taking all the necessary precautions, with the moisture control, and the turning, and all that kind of
stuff.
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Patrik: Yes, yes. Okay. Well, this is another question, so you’re talking
about moisturiser and pressure area care’s extremely important, you know? Okay, when they turned your dad on your side, you know whether they, for example, gave your dad’s back a wash, did they moisturise his back? Do you know whether any of that happened?
Natasha: You mean when they turned his back?
Patrik: Yes, when they turned him
on his side. So, when I do a shift in ICU and I turn a patient, I take that opportunity usually to give their back a wash and put some moisturiser on their back. Because, imagine you’re lying, you’re immobile, you’re lying in bed, and you’re lying on one spot for three hours, and you can’t move because you’re either unconscious because of an induced coma or whatever. Bringing some circulation back is very important.
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Natasha: No, they wouldn’t massage him. No, the only time they put … I mean, I never saw them put lotion when they just turned him. I don’t know what they do when they gave him a bath, because I would leave the room when they would give him a bath. But, when they would just do the regular turning, they just would take the pillows out and just do that. I never saw them put lotion.
Patrik: That’s terrible, that’s really bad.
Natasha: Okay, so then, just so that I should ask, so the patient relations. God, I’m trying to think how I’m going to … Maybe I’ll have my sister do it.
Patrik: Yes, I think that might be a smart idea.
Natasha: Not me, I don’t think it’s good for me to communicate with them.
They’re probably more likely to give it to her. Alright, so then, alright, and then I’ll get back to you, then we’ll-
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Patrik: Yes, yes, and then we’ll do everything from there.
Natasha: Yes.
Patrik: Yes, once you either have the rest of the documents, or number two, once you’re certain there are no more documents. It could be either/or, but
I’m 99.9% certain there must be some nursing notes. There must be some nursing notes somewhere.
Natasha: There has to be.
Patrik: There has to be.
Natasha: Yes, I was shocked, especially towards the end. I cannot believe there was absolutely nothing, nothing. No
nurses notes, nothing.
Patrik: What we can do, if you want to, we can start with what we’ve got. We can start reviewing now, if you want to, with what we have. I’ve spoken to the person who’s going to the do the review, and we can start relatively quickly, or we can wait until you’ve got everything you want.
Natasha: When do you think you can
start, like as early as tomorrow or what?
No.
Patrik: I’d say as early as this week, for sure.
Natasha: Oh, okay. Yes, okay, okay.
Patrik: I mean, we can probably start probably by Wednesday. We can do that, no doubt
about that.
Natasha: Okay, okay. So, you can actually start early. Okay.
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Patrik: Yes.
Natasha: Alright, well, so that’s
good to know. No, I thought you meant like tonight, I was thinking, “Oh, it’s kind of late.”
Patrik: Look, I spoke to the person on Friday, and he signalled to me, “Yes.” This is usually my go-to person for that type of work, and he said, “Yes, we can start next week.”
Natasha: Okay, and so he does this all the time, he does it
…
Patrik: He still works in ICU.
Natasha: Good, good.
Patrik: When I have complex cases to review, I would usually give it to him, because he has lots of experience, and I’ve worked with this guy many years ago, and I know he’s very good. He pays a lot
of attention to detail, which is what is needed.
Natasha: Okay, and that’s … Okay, okay. So, in terms of payment, so do you accept … Do you want the payment all upfront, or do you like …
Patrik: I would need to. I would need to.
Natasha:
Okay.
Patrik: What I can do is I can send you a link, a PayPal link. That’s what would need to … Yes, what I do.
Natasha: I think it’s on your website, too. I don’t know.
Patrik: There are PayPal links on the website, but it’s mainly for … What I do in this
case, because when we review notes, depending on the volume, there is no PayPal button on the website for reviewing notes, because it’s always an individual quote.
Natasha: Oh, okay.
Patrik: Right, so but I have done that in … I create a PayPal button in five minutes because I know what to do and how to go about it, you know? I can send
that to you very quickly. Yes.
Natasha: Okay, alright, so then alright, so let me see what’s going to happen tomorrow. Let’s see if they’re going to give me … Well, I might tell my sister to do it. I’m not going to bother calling them.
Patrik: Right, yes.
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Natasha: Alright, so that’s good. Alright, so this was good. Alright, thank you Patrik for letting me know finally.
Patrik: Thank you, thank you. Yes, look, I just have to … Need to look, and we’ll see what happens next. I’ll wait for you, I’ll probably send you a PayPal button.
We can start quickly with what we’ve got and I’ll wait to hear back from you.
Natasha: Yes, alright. Very good, very good. Alright, thank you. Alright, so I think, yes, alright, so I’ll let you go now, because it’s like 8:50. I don’t want to keep you.
Patrik: Alright, okay. Look, I’ll
send you a PayPal button, and once you have more documents or more information to even find out where those documents are or if they exist at all, let me know.
Natasha: Yes, no, I’m going to. I’m going to have my sister do it tomorrow. I’ll let you know. Alright, thank you Patrick.
Patrik: Okay, thank you. Have a good
night.
Natasha: I appreciate so much, thanks. You too, thank you. Alright.
Patrik: Okay, thank you. Bye bye.
Natasha: Bye.
Kind Regards
Patrik
