Unsafe discharge.. I need help

[ItsLeviooosar]

Hi I work in icu so this is a bit of a new field for me. Could I ask any ward nurses to answer a few questions for me?

My grandad has Covid, and was very very unwell a week ago, he’s kind of stabilised but obviously very unwell. His wife has tested positive so this morning they rang my mum and said he’ll be coming home tomorrow because you’re there to look after him and nana is positive anyway.. but there are social issues at home as she has severe dementia and can’t look after herself so mum asked if he could stay there until we got my nana assessed by social services.

2 hours later she gets a call ‘he’s on patient transport now, he’ll be home soon’ he’s so weak he’s not able to walk upstairs unaided, he can’t speak he’s so breathless and he’s confused. Is this normal? As i said my experience of discharging is to a ward!!

He was sent home with no ttos (drugs to take home) instead a list for the community pharmacy that no one in his house can get for him so I'll be driving to wales from England and back again tomorrow just to go to the pharmacy. He's so listless, I'm concerned.

I've told my mum to ring 999 ASAP if anything happens over night at all. She told me his temp was 35 and he had cold hands at 9 which is a sign of sepsis so I said to call the ooh or 999 but she said he was refusing: if it was me I wouldn't hesitate call the ambulance but mum isn't medical at all and is a bit hesitant.

I'll be there to sort out the pharmacy thing tomorrow, however I need a plan;

PALS?
Community matron
Social workers?

Firstly I need help for him and secondly I need to complain that this even happened in the first place. He still has Covid and is incredibly unwell so shouldn't be at home.

[Juke1]

You know yourself this is all wrong. So breathless he can’t speak, and confused? I’m afraid he needs an ambulance! Best case scenario is his numbers are all fine, but he needs a step up bed. I don’t think there’s a safe alternative. The complete lack of planning re TTOs/safety at home would suggest the whole thing hasn’t been thought through and he perhaps isn’t even medically fit.

[Juke1]

Worry about PALS later.

[ItsLeviooosar]

I completely agree, but you know when you overthink things? I've told mum if I haven't heard anything from her in 30 mins I'm calling an ambulance from England.

[Juke1]

It’s so easy to be objective when you’re not emotionally involved! I would get them to call now, he sounds like he needs it.

[Bridecilla]

I'd call the ambulance

[Zillaindie]

Im an overnight DN. See if you can get them out to run obs cause of him refusing to go to A+E and just being discharged.
OOH Gp will prob refuse to visit due to them being positive.

[ItsLeviooosar]

Thank you!

[kazza446]

1st point of call, ambulance get him returned to hospital, secondly ring the local authority and ask for help through the emergency duty team, thirdly report the hospital to cqc as an unsafe discharge.

[Inituntiltheend]

Sorry to hear he isn’t well. Must be so scary being far away. Ring an ambulance for sure. Then when things settle check what ward he is on tomorrow and ask for referrals to the ward ot and physio it is them who will complete the assessments and either rehab him there or transfer to rehab ward/hospital.

Hope everything is ok an elderly person certainly does not need this,poor discharge

[Famousinlove]

A relative works at a carehome that's just been hit with covid and one of the residents just went to hospital with sepsis, she couldn't swallow and could hardly speak so definitely keep an eye out for that

[Di11y]

I'm sure a local volunteer group would get the meds for you. Their local council website will have a number you can call.

[JacobReesMogadishu]

I’d call an ambulance now and complain like hell later. If he’s so breathless he can’t speak surely he should be on oxygen, his SAtS can’t be normal?

[ItsLeviooosar]

I called an ambulance, he's in hospital again. His sats were 84 which even with Covid and shitty lungs is horrendous!! I'm so angry. I hope he's looked after properly now.

[Ginfordinner]

This sounds horrendous. What were they thinking? I hope he makes a full recovery

[Juke1]

Sorry to hear that You want to give them benefit of the doubt and think it’s this rapid deterioration on day 10 that you hear about, but all a mess from the sounds of it. Lucky that you were on hand!

[Sparticuscaticus]

The hospital has an incident report system for unsafe discharges. You can do that in time.
Ask the ward to refer dad to adult services there will be a social work team on site if it's a big acute hospital. Follow up by ringing them so they involve you

[Griselda1]

If your Dad had been in a nursing home they'd have done the same thing.This is why so many older people have died.
You need to complain and do so vociferously but don't waste your energy on that at present.Best wishes to you and your family.

[Turquoisesea]

My mum is in a nursing home and was in hospital with Covid and they discharged her back to the care home saying she was fine. The staff couldn’t believe how poorly she was when she returned, worse than when she went in. Came back on a stretcher and practically unconscious. She was pretty much asleep for 2 or 3 days and then I get a call from a Dr who hadn’t been to visit her but had spoken to the care home and said her oxygen levels were really low and to prepare myself for the worst, they took her off all her regular medication and basically were preparing for her to die. I couldn’t fault the staff at the care home and they went in regularly in full PPE and helped her to eat and drink and amazingly she pulled through and is now fully recovered (she’s 85). The staff were annoyed at how poorly she was to be sent back to them as she was clearly really ill still. It was obvious that she hadn’t eaten in hospital either and no one helped her. I think it’s an all too common occurrence with elderly people. They are effectively written off. I hope your dad improves now he’s back in hospital.

[Tolleshunt]

This is appalling. I hope he’s in safe hands now.

I don’t know specifically about Covid, but my experience of hospital admissions with my very elderly grandparents is that it seems absolutely standard for them to attempt to discharge as soon as humanly possible, regardless of the actual physical condition of the patient, regardless of whether they will be safe at home, and regardless of whether suitable rehab or home care has been arranged.

Every single time we had to put a stop to a discharge until suitable arrangements were in place. Each time, they tried to get them out before visiting hours (in an attempt to stop us preventing it? IDK), and then when we arrived and found that the previous day’s plans had changed entirely and they were now judged fit to go home, we had to insist proper care was in place first. They’d have happily just sent them home to fend for themselves while living alone and unable to mobilise. One physio had stated that my grandmother could walk the length of the corridor unaided, when she had to be supported to get to the loo 3 or 4 metres from her bed. I ended up filming her trying to walk by herself as evidence they were lying.

I have no idea why this happens - presumably there’s a culture of massive pressure to get patients out of beds ASAP as though the sheets are on fire - but how do staff do this in all conscience? I shudder to think what happens with elderly people who have no family. They’re just dropped off at home and left to sink or swim, I imagine.

[Tolleshunt]

I think it’s an all too common occurrence with elderly people. They are effectively written off.

I agree entirely. And it’s all too often an ‘on paper’ decision that doesn’t take into account the unique person, but just the data ‘oh, he’s X age, with A, B, C condition. Nah, nothing we can do’.

[NotEverythingIsBlackandWhite]

This is one thread I hope the Daily Mail pick up on and report in their paper. Utterly shameful of a hospital to discharge someone in your GF's condition.

Well done for calling the ambulance yourself. You did the right thing. As your GF was confused and breathless, he wasn't in the right state of mind to make the decision.

I hope your GF recovers.

[ColdOopNorth]

I am not at all surprised by this story - hospitals are chucking people out and have, since the COVID pandemic, put all responsibility on community staff. It is terrible but happening a lot. Just for future reference I think a call to the community nursing team and also adult social services is the best thing to do in these circumstances (if he was medically fit but requiring care). They can sort out carers and any aids and adaptations required for the home as well as other support. Hope he is ok hun

[ButtonMoonLoon]

So sorry to hear this.
This definitely warrants a complaint- it sounds like the very last thing he needed, and I’m guessing it’s also put your Mum at risk of exposure too!

I hope he is now getting the good care he deserves and that he makes a smooth recovery.

[PatricksRum]

This is horrible!
I'm so sorry OP.
How on earth did they discharge him?!!
Thankfully you called the ambulance (granddaughterly instinct?)
Hope he recovers soon

[Inituntiltheend]

I am glad you rang the ambulance ans hope he gets the care,input and rehab for the occupational and physio therapists this time and a safe discharge home is facilitated