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 Vulnerable And Needs A Higher Level Of Monitoring. Why Did They Put Him At A Spot Far From The Nurse’s
Station?
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 is
unhappy with her dad’s transfer from ICU to the ward and she is asking if it is the right place for him to continuously recover.
Is My Dad At The Right Hospital Ward For His Needs? He Seems To Be Getting Less Care Here. Help!
Hi Anna,
I’m not surprised by what you are currently experiencing.
ICU is such a highly specialized area that you would have noticed the drop in skill and expertise with your Dad going to a regular ward! Your observations are absolutely correct that the nurses there would be overwhelmed to look after your Dad during such a critical phase of his recovery!
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The good news is that to this point he seems to be holding his own, either through determination, a little bit of skill from the nurses and probably through your and your family’s presence and guidance!
One of my biggest concerns from what you are describing is definitely that ICU is not really keeping an eye on him. You may remember that I mentioned some ICU’s in the bigger metropolitan hospitals have an ICU outreach or ICU liaison team to keep an eye on patients who are at risk of ICU readmissions.
Without having all the clinical information, I would assume your Dad fits that criteria after such a long and arduous ICU stay. It doesn’t sound to me like he’s out of the woods yet, although please also keep looking at the positives and see how far he has come with all of those unbelievable challenges he had to overcome to get to this point!
One pattern that emerged throughout your and your Dad’s challenges is that whenever there was an obstacle or issue, you were never afraid to speak up and seek guidance from a professional like myself. You used what you learned in the process and you applied it with much success. One challenge that my clients often have is that they are too scared, timid and intimidated to implement the strategies and you clearly have run with all of the advice with much success
and results!
Therefore don’t change a winning formula! If you are finding something that works, do more of it and not less!
All of your observations on the ward are incredibly concerning, what I’m not 100% clear on is if your Dad has improved since discharge to the ward or not? Do you think he’s going forward or backwards?
Also, who is the current treating doctor and what input does this person have?
Please also see comments and questions below to your specific questions.
Kind Regards
Patrik
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Dear Patrik,
Hope you’re well.
I wanted to update you on Dad’s situation and seek your advice as ever, please.
Overall we have sought to keep an open mind but increasingly we are unhappy with his placement on the new ward. It’s a mixed neuro and acute elderly ward – 6 beds for neuro cases, the rest is acute elderly.
It’s not 1 step down from ICU, it’s more like 10 steps down!
It’s basically auxiliaries on the ward. In theory a nurse is at the desk, but the reality is of course different. A nurse is around but often stressed and rushed from our observations.
Patrik: They probably have a heavy workload with 1 nurse to 6 or even 8 or 10 Patients and they don’t have the specialized training than an ICU went through.
We were told he would be in a high visibility bed – well, it depends on the interpretation! He is in the corner of the room. If the curtain is pulled on the bed next to him and left that way – which of course it is at times during the day and night – he is not high visibility!
Patrik: Keep holding them accountable for what they told you. High visibility means high visibility, he should be as close to a nurse as possible if that’s what they promised you! I’m sure he’s higher risk than most other patients on this particular ward, however they may also look after patients with stroke if it’s a neuro ward, therefore they may have other sick patients there. In order to work out how your Dad fits their risk or acuity profile just ask what other “high risk” patients they have.
Dad doesn’t have the ability to shout because his voice is still quiet, and we often find his aid call is out of reach for him – i.e. it has slipped to the floor or is tucked behind him etc. He needs time to get used to having one too, after 3 months of 1-1 care with no need to think to press a nurse call button!
Patrik: Again, that’s why he needs to be close to the nurses, so they can see him and attend to him when needed.
He needed his suction tool and I found it had slipped down behind the bed and was on the floor – which I could see was dusty. It then needed cleaning of course.
Patrik: In a situation like this it won’t need cleaning, it needs replacing with a new tool, full stop!
What if he had pulled it up without realizing and put it straight in his mouth? This is a man who has been in ICU for 3 months with compromised immunity and is vulnerable.
Patrik: Again, it comes down to being visible to the nurses so they can help him when he needs it. Compromised immunity is just one factor that makes your Dad vulnerable, there are many other factors and they should know this and manage it accordingly.
When the Sister came to top up his water through the nasal feed, I politely asked what his care plan is. “What do you mean?” She said, in a fairly passive-aggressive tone. I said, I’d be really grateful to know what the plan of care and treatment is for Dad now he is on this ward. “I don’t know, I will have to go and look.” Why doesn’t she know, my sister asked discreetly?
Patrik: She should know the details about your Dad’s care forward. There is no excuse here.
She came back and said briefly “So he is waiting here until a bed in the offsite rehab unit becomes available. They’re going to do another swallow test next week.” That was it.
Patrik: Is the swallow test necessary for him to go to rehab? It sounds to me like the sooner he can leave the better. Also, if your Dad has private health cover, have you considered going private?
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I asked about his physio. “They try to come Monday – Friday but can’t guarantee every day. “
Patrik: That’s terrible, he will need to keep moving and get out of bed every day. He can’t stop mobilizing! Again, private hospital/private rehab might be an option if your Dad has private health cover.
I asked how the microbiology service works, if and when required (the ICU matron told us microbiology do visit the ward and that this would be the case for Dad if needed). “Why would microbiology visit? Is there an issue?” I simply replied that of course we were mindful of Dad developing another chest infection, as ICU had told us he was at high risk. “Well, they don’t visit here, I’m not aware of them visiting any wards. It might be different on ICU, but we
don’t have the service here”.
Patrik: That sounds strange. Surely, they would have to test patients’ microbiology if needed. That’s a standard hospital service. If one of their patients develops an infection, it would be standard procedure to check microbiology.
ICU told us how important physio is for Dad’s recovery, but he is actually having less physio on this ward. For example, the plan is to mobilize him every day, but he didn’t sit in the chair at all yesterday and was in bed all day.
Patrik: Yes, absolutely. As you would have seen by now, mobilization, stimulation, Physio etc., is what got him to this point. Not keeping up the frequency of mobilization would be detrimental for your Dad’s recovery. Again, the sooner he can go on to specialized rehab, the better, it sounds like currently he’s stuck somewhere he doesn’t belong to.
On Friday he was put in a chair by the bed. A friend came to visit him and found he was getting uncomfortable after being in it an hour. Eventually she went to tell them as Dad’s legs were extremely painful. She was told the physios were at lunch and that the wait would be 30 mins at least. She pointed out that’s a long time for someone in pain to wait. They came at the 2-hour mark, by which time Dad was worn out from the pain.
Patrik: That’s incredibly concerning. Have you brought that up with the team there? They need to know about your concerns and frustrations.
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His breathing seems to be fine, thank goodness; he’s got a nasal cannula with oxygen.
Patrik: Do you know how much oxygen he’s still on?
He is still very weak and vulnerable in our view.
Patrik: Yes, he certainly would be after all this time in ICU. Again, maybe private rehab might be the way to go if he has private health cover?
As you know by the time, I found out about the plan to discharge Dad, it was too late to halt it – even though I tried.
Patrik: They moved swiftly once they made up their mind. Given that he’s been in this environment now for a week, he must be doing something right in order to be there. So, with all of the challenges don’t lose sight either and see how far he’s come in all of this.
We have sought to keep any open mind but after 6 days of being on the ward, we think we’ve seen enough. I ask Dad what he thinks about the care and he replies, “it’s so-so, not all that good”.
Patrik: It’s not good compared to ICU, no doubt. There is currently a mismatch between what he was used to in ICU, what he now needs and what they can provide for him in order to keep moving forward!
We are worried that Dad’s recovery will stagnate, that the reduced physio will undermine all his hard work and that he is at risk of not improving.
Patrik: Yes, absolutely, if he’s not moving forward, he will go backwards! Therefore, the sooner they can move him into an environment where they can cater to his needs the better!
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Our instincts are telling us that the level of monitoring and care is too much of a step down for Dad. You will recall that just 3 weeks ago the consultant and matron on duty in ICU told us that Dad was at high risk if transferred to the ward, that Dad was vulnerable and weak, with no reserves to draw on, and that they were concerned he could contract an infection, deteriorate and even die there!!
Patrik: The level of monitoring would be non-existent compared to ICU. Do you think your Dad has no reserves to draw on? Do you think since discharge he has moved forward or gone backwards? And yet two weeks later they discharged him to the very same ward.
We wonder if he is even on the right ward for his needs?? It’s a neuro and acute elderly Ward. We appreciate he has critical illness myopathy but a large part of the involvement of the neurologist was over his delay in waking up from the coma and the ICU acquired delirium. He is out of delirium now, so is this the right place for Dad as he is now? We just don’t have the knowledge to question it effectively.
Patrik: The most important questions for me at the moment would be, do you think he has improved or deteriorated since discharge from ICU? This will answer the question if he’s in the right environment or not? Just because the care is not as good as in ICU, the question remains, can he move forward within current circumstances???
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ICU told us they would keep an informal connection with the ward to see how Dad is doing.
I am tempted to call ICU and tell them my concerns and put the responsibility back to them.
Patrik: Yes, keep them in the loop and share your concerns. Hopefully, they come to the party and take back some ownership!
We would welcome your help as always in navigating this next challenge!!!!
Very best wishes
Anna
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
