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
What Is an Arterial Blood Gas Test (ABG)?
You can check out last week’s question by clicking on the link here.
In this episode of “YOUR QUESTIONS ANSWERED” I want to answer a question from one of my clients Anna as part of my 1:1 consulting and advocacy service! Anna’s
dad is transferred to a peripheral bed with low visibility in the Respiratory Ward and Anna is concerned about the care her dad would get from the medical team.
My Dad Is Still Vulnerable And Needs A Higher Level Of Monitoring. Why Did They Put Him At A Spot Far From The Nurse’s Station?
Hi Anna,
Thank you for the update!
I’m sorry to hear that your Dad has gone backwards.
Don’t give up. Recovery after ICU is often two steps forward and one step back!
Please see some comments below.
Also, I’m not sure if I mentioned this to you Anna, I own and operate a home care nursing service INTENSIVE CARE AT HOME, where we basically send ICU nurses into the home for ventilated, tracheostomized and medically complex patients.
This is most likely not what your Dad will need going forward, but I also have lots of experience in home care and I can help guide you what level of care your Dad will need at home, including equipment.
Kind Regards
Patrik
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Hi Patrik
Many apologies for taking so long to reply.
Your email was so helpful as ever and gave me the information to challenge his care.
We fed back all our concerns (building in your advice) to the rehab ward matron and one of the ICU matrons, separately and together.
The ICU matron, who is very pleasant, just “talked the talk”. Her response was to say our feelings were “very understandable” and kept saying that we were going through what every family goes through when their loved one leaves ICU.
We politely reminded her that not every patient is Dad and hasn’t spent 3 months in ICU and battled sepsis, multiple organ failure, 7 cardiac arrests, delirium,
critical illness myopathy, weaning from a ventilator and tracheostomy.
That he still has respiratory issues – including preexisting COPD – and needs quality, intensive physio.
Patrik: Yes definitely, that is why he needs to stay on the Respiratory Ward.
That he is still vulnerable and needs a higher than basic level of monitoring. That he was not in a high visibility bed.
She didn’t really have an answer, apart from to direct us to the rehab ward matron.
To answer your question, ICU don’t have a formal liaison/outreach. It’s done “informally” we were told, which of course suits them and not the patient! The devil is always in the detail, as you have counselled me.
Patrik: That is concerning, but that is why it is good that he’s now on the respiratory ward.
Are you checking in with the rehab ward, we asked the ICU matron? “We have to be careful not to step on anyone’s toes” she told us. I said, but that doesn’t have to be an issue if done respectfully. Our concern is Dad, and that should be your universal concern too, we replied.
Patrik: What a ridiculous comment to make, this is about your Dad and not about their politics.
Fast forward to the day before yesterday. Dad ran a temp, was short of breath and said he had a violent coughing fit, bringing up a lot of mucus which he almost choked on. He said it frightened him. He asked the auxiliary to get the Doctor.
The Doctor reviewed him and phoned the respiratory ward, who said immediately to transfer him. He was transferred that night, placed in the high dependency respiratory part of the unit, put on higher oxygen and monitored all night. As he remained stable they moved him to the acute respiratory bay within the unit. They confirmed to us he had developed an infection and are treating with strong antibiotics.
Patrik: It sounds like this is a much better environment to begin with. At least they are allowing him to have a higher level of care when required. This means your wishes have not fallen on deaf ears. They are treating him with antibiotics and that is fine. He is in a much better environment there.
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Patrik, this is exactly what we worried would happen to Dad, based in part on what the ICU consultant had cautioned against but also based on our instincts of him being discharged from ICU too early to a general ward.
Patrik: Not only that, also having auxiliaries and not nurses on the ward probably got him to this point. There are nurses on the respiratory ward and not auxiliaries.
He needed time to consolidate his ‘wins’ and we felt it was likely he would have another setback, based on what we knew of his pattern – and that this could be supported effectively in an environment where he was monitored appropriately. We didn’t see it in a negative way, just that he needed to be in a space where they could act appropriately if needed.
Patrik: Absolutely. Make sure they keep him on the respiratory ward for as long as possible. This sounds more of what he needs.
This was not the rehab ward, where most of the time it was often 1 auxiliary to 6 patients!
It wasn’t fair on Dad or on the auxiliaries.
It concerned us that Dad was directly opposite the toilet – used frequently to empty commodes and by other patients. To be candid it often smelt, so we worried about the airborne bacteria and the wall dirty linen basket was against the wall near his bed – we felt this was far from ideal!
Patrik: Definitely an infection risk to be opposite the toilet.
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Dad de-saturated briefly in the respiratory unit after a mucus plug and the Ward sister told us he needs to stay there now. She said he will now be under the care of their unit and the respiratory consultant until he is discharged with physios visiting or to a community hospital also setting for further rehab.
She said the myopathy is important to treat but that his respiratory issues are the priority. They plan to do a CTPA scan to give an in-depth view of his lungs and to screen for any clots, which hasn’t been done before.
Patrik: That is a good sign that they are not giving up on him and do what is required.
They said he will get physio Monday – Friday and that they have a chest physio on call 24 hours
Patrik: Again, exactly what he needs.
The respiratory Doctor and sister told us they want to really move forward with dad eating and drinking so that the feeding tube can be removed.
Patrik: Way overdue. What about speech therapy and swallowing assessment to get the feeding tube removed?
They said if Dad ever deteriorated, they would escalate him to the HD part of the unit and get ICU in to review him.
Patrik: Again, a sign that the hospital listened to your wishes.
They were positive, saying they think this is the best place for him and that it shows his strength and capacity to live and recover.
Patrik: Excellent.
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One of the nurses yesterday mentioned to me that they are looking to wean Dad from the suction tool – that he is getting reliant on it now and that they want him to get used to coughing secretions into a tissue etc. As you know he has a strong cough. Does this sound ok to you Patrik?
Patrik: Yes, coughing into a tissue would be great rather than suctioning.
Best wishes!
Anna
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
