NHS issues - urgent advice appreciated please.

[OldQueen1969]

Hi there all,

Would appreciate some advice for a friend of mine who is currently in hospital and seems to be at some risk from some sort of system cock up.

I'll start by saying this is not about bashing the frontline staff who are obviously doing their best under pressure and with poor resources.

So my friend L who I saw yesterday evening had the beginnings of a tooth abcess and planned on sorting it with the dentist today - he's had them before and knows the drill so to speak, and would have done the usual routine except by this morning his face had swelled dangerously and his eye was closing, so he rang 111 and they advised A&E.

He and my other friend M for support went to one A&E (we have two on opposite sides of our town) at around 1.00pm. After three hours there it was concluded that no-one there was insured to go near teeth so they had to drive across to the other where they have been since. The swelling has got worse and L is actually crying with pain (chap in his early 30s and not a wuss by any means).

It was decided he should be admitted as he now has a fever and high temperature, but they didn't have any male beds available for a while so they had to wait in A&E. No meds could be administered until he was admitted.

He has now been given a bed, but apparently he can't be given any meds because his admission is nit showing on the system yet and until this happens they can't prescribe etc because they need to know where to "bill the meds to". It's nothing to do with cross referencing for allergies or anything. I have asked all the logical things and M is messaging me as time goes on. They are both really worried as he is now "ill" with this infected abcess and treatment is being withheld, and his pain is unbearable.

A nurse tried to get a canula in in preparation, but that went wrong as the vein was missed and has caused further distress. I guess that happens but it's not helped the situation.

My main question is whether this system failure is a common thing? And what should they do now? L has been seen by doctors etc but all say no system confirmation, no meds. Surely that can't be right as he is getting visibly worse - I've seen pictures and he looks terrible.

Any advice / opinions gratefully received.

[RUOKHUN]

I work frontline NHS and I have never heard of not being able to give medication to patients who aren’t being admitted?

That’s very strange.

[cannotmakemymindup]

Goodness no advice but didn't want to read and run. This is very serious and can lead to all sorts of complications if they do not sort soon. If the infection takes hold in his body it could wreck absolute havoc. This article highlights the reality. Your friend M needs to keep bugging Dr.s etc to sort this as it is silly to leave.
www.cornwalllive.com/news/cornwall-news/cornish-firefighter-needed-heart-surgery-3709259?_ga=2.100875393.1213800750.1578412296-969474081.1578412295

[katee90]

Hi, nurse here. Have never ever heard of this either?

[tjk10]

Where are you in the UK? I've never heard of that before and I also worked for the NHS.

[PatMullins]

I’m also NHS and never heard of this...any more info OP?

[OldQueen1969]

@RUOKHUN

I know - I can't get my head round it. Unless it's a new thing.

@cannotmakemymindup

Yes that's exactly what I'm worried about. They are staying put but every minute that passes may be crucial at this stage.

[OldQueen1969]

Thanks for all the replies.

I will try and get more info but this is what L & M have been told.

[onanothertrain]

Another one who works for the NHS and has never heard of this. Are they maybe waiting for max fax to see him? Not sure why they'd delay analgesia and antibiotics though.

[HappyHammy]

Is this the UK NHS, we dont charge for emergency care, what do you mean they dont know who to bill meds to? I can understand not being given medication until he has seen a doctor and been clerked in and having a drug chart written up but that's not the same thing as being admitted to the ward. Has he actually seen a doctor yet . Does he have a name band on and medical notes. Usually in a&E the reception staff admit patients on the system.

[MsMarvel]

Been in and out of a and e a lot these last few weeks and this is not a thing...

Do was given cannula and meds while sitting in the waiting room because they were so busy he needed to wait for a room. But he still got the meds because he couldnt wait for them.

[The3Ls]

My child was given pain relief immediately on arrival. In a and E having seen a traige nurse because there was a 3 hour wait for doctors. E wee just sat in a waiting room. Miserable experience but no one left her in pain

[AnchorDownDeepBreath]

I work frontline NHS and I have never heard of not being able to give medication to patients who aren’t being admitted?

Me neither. OP can they check that they've understood correctly; and ask for it to be written down for them if they believe that this is what they are told again? It'd be a bizarre policy and if anywhere had bought it in, I would have expected it to be big news!

[GeraldineFangedVagine]

I’ve never heard of this either, although I have had cock how regularly with drugs, it’s usually because a nurse can’t find a doc to prescribe. Ask to speak to the nurse in charge and ask what the problem is. Failing that escalate to the matron or site manager.

[Suze1621]

Have never heard of this. On a number of occasions I have spent many hours in A&E with my mum waiting for a bed. Never had an issue with her not being given medication whilst in A&E.

[GeraldineFangedVagine]

Cock ups!

[katee90]

OP clearly they've got the wrong end of the stick

[GoodnightJude1]

I’m in and out of a&e frequently for a chronic pain condition and I’ve never heard of this....
Was only in last week and I was given morphine before I’d even been admitted. He would have been given pain relief etc if he’d have been taken in via ambulance so no different really?

[OldQueen1969]

He has a bed and has been seen by doctors so must have been admitted on paper as it were. Am double checking about wrist band now.

It is UK - South coast not rural or anything.

The billing for meds things sounds so bonkers x I have queried that but that's what was said. He still hasn't been given anything.

[1FootInTheRave]

Are they waiting for it on epr (electronic system).

Can only prescribe and subsequently administer if the patient is on there.

Its a ballache tbh. Not your pals fault obviously and they need to sort asap.

[HappyHammy]

If he has been sent to a ward without a doctors file and drug chart then the nurse needs to contact the site manager and admissions so that he is on the system, hope your friend is ok.

[WhoWants2Know]

I used to encounter this years and years ago working in hospital administration. It literally was a computer glitch where the patient's info wasn't showing up in their assigned bed, and doctors/nurses couldn't input their orders as a result. It was A BAD THING and there would be system experts racing around trying to fix it.

I would have hoped that it was a thing of the past now.

[Serin]

This is ludicrous, he could develop sepsis.
Ask to speak to the manager.

[OldQueen1969]

@1FootInTheRave

That sounds like it. M has just said a doc has said he can be prescribed when "ECA" has updated - think it may be what they meant. M has just said L won't be going for surgery tonight but will tomorrow morning - nil by mouth after 12. Didn't realise it had got that far - am quite worried!

Very worrying that if computer says not yet everything is on hold though - what about emergencies? And can't help thinking if he'd had anti-biotics a few hours ago it might not be this bad !!

[independentfriend]

Maybe try:

*asking for a referral to the pain team - normally contains anaethetists, who might be good at handling this.
*asking for EMLA (or equivalent) cream to numb the skin and then someone else to try inserting a cannula - sometimes they go wrong, but if he's that ill, he's going to need one.
*an email to PALS - a contemporaneous record of the situation as it develops [bearing in mind he needs to be explicit in the email how long it takes him to write it whilst in pain, to avoid the retort - "your pain couldn't have been that bad or you wouldn't have been able to email"] - so he can follow up with a complaint later
*maybe explicitly asking the treating team if they think he's drug seeking. [it all sounds bizarre to me - why would clinicians be happy making an obviously distressed patient wait for pain relief?]
*talking around the issue with staff - if he's not showing as admitted on the computer system, does that mean they've breached their A&E waiting time targets? Does this happen often? How long does it normally take the computer system to update? How is it safe for him to be on the ward if he's not properly showing in the computer system [they might have a good answer to this]? What do they do with people who collapse in cardiac arrest who aren't on the computer system? Is there some sort of equivalent for him?
*Keep taking pictures - more contemporaneous evidence of his deterioration. Maybe some video of him trying to talk if he's willing?
*Some sort of distraction might help - a warm shower, if he's up for it?

[HappyHammy]

I would ask to speak to the nurse in charge or the site manager. He must be on the system somewhere and not having his details transferred from a&e to the ward is no excuse for not having any treatment.