Help with NHS and hiw to be moved wards

No you're wrong, just because a patient is confused it doesn't mean they are distressed.
Are you a HCP?

Sorry, I thought I had been clear, apologies if not. I had accepted the risks of sedation several posts back, as soon as you pointed them out. Poor people that they can’t be helped to have a good night’s sleep or to feel calmer and less anxious 😢 .

I’ve been talking about two things, primarily. 1) the unalleviated distress of dementia patients and those with delirium when in hospital, leaving them in a frightening and confusing situation; and 2) the effect that their behaviour (not that they can help it) has on everyone else they share a ward with.

It may be for number 1 we are at a situation medically where current treatments are either too dangerous or too rudimentary to be able to provide efficacious relief, so there’s no way of assuaging their distress and they just have to suffer. Which is really heartbreaking, frankly, and personally I would rather book myself a one way ticket to Switzerland than ever risk getting to this stage and just being left to suffer because there are no worthwhile effective treatments.

For number 2, it won’t be beyond the wit of man to provide some sort of separation between these patients and others, so that other patients’ wellbeing and rights can also be prioritised. I accept that it might be beyond the wit of the current set up in terms of how the NHS and social care are currently run and funded, however.

Surely you’re not saying the current situation is wonderful? Even if you can’t see any solutions at present within the current issues facing the NHS.

Bunfight
Don't work with dementia patients? What are these current protocols you are not day with?
We don't sedate people as urs dangerous and unsafe unless the danger of agitation outweighs the danger if the sedation.
We do do 1:1 care, frailty care , nursing care, psych rv if low mood, behaviour difficulties, station etc with other meds options ...

Is he on oxygen or likely to be well enough to get home under a virtual ward pathway ( telemedicine and monitoring at home with visit from nurses if he still needs iV's?).

Unfortunately if a bed did come up, he's likely to be with the exact same standard of people. The last couple of times I've been in hospital, it's been the same, no sleep, patients with complex needs (dementia / mh).

I now refuse to go into hospital which has had a severe impact on my health,meant to be going in for TPN and other tests but instead spend my days malnourished and vomiting constantly because the thought of going into hospital and put on a ward with these people have a huge impact on me.

I know they can't help it but after a week of no sleep and all the chaos, really isn't worth it. I hope your partner gets sorted.

www.gov.uk/government/publications/older-peoples-hospital-admissions-in-the-last-year-of-life/older-peoples-hospital-admissions-in-the-last-year-of-life

Some stats for those interested

What we need to do is get better at identifying when someone over 75 and especially with underlying dementia is in the last year of life and stop repeatedly admitting them in a futile fashion.

That will require a better acceptance of people dying and dying at home and better community medicine for that to happen. Only if that happens would we be able to keep hospital admission for those who will actually benefit from it.

When my mum had terminal cancer I moved heaven and earth to keep her out of hospital knowing that whatever was done there would only prolong her distress and be a horrible experience. I had to persuade my dad of that view as despite knowing her wishes it was hard to resist just doing that bit more. She was offered admission and she declined it with support of her family, MacMillan and the hospice. She probably died sooner than she would have if she'd been admitted and accepted various symptom relief stuff that would not affect the underlying process but that time was very poor quality and when she died she was ready to go.

The default is admitting people to hospital and I don't know if this society is ready to change that.

Try PALS. My dm had a horrendous experience on a similar sounding ward. I’m sorry to say but the nurses were absolutely awful. They kept on telling me that she wouldn’t be discharged until social services had assessed her needs, but also that social services wouldn’t be assessing her. One afternoon I noticed a lady having a seizure. I told the nurse and she said “Okay, thanks” then went back to her PC. I’m afraid I got assertive and said “No - now. She’s having a seizure now. Get up and help her.”

There were multiple dementia patients on that ward and she simply wasn’t safe.

Within 24 hours of emailing PALS a discharge plan was in place, and had been actioned another 24 hours later.

It'd be more like you need a specialist ward for young people! Elderly confused people are the majority clientele of most hospital wards whatever the specialty

All hospital wards are like this
If he gets moved to resp it will be exactly the same.
Elderly confused people are the main people being admitted to hospital so it's rather unavoidable
Many do not have dementia they have delirium which is temporary confusion due to infections etc but looks the same in terms of behaviour
It's not so simple as just give them a sleeping pill. This is very rarely effective for people with dementia or delirium apart from being dangerous. Mostly it just makes them more unsteady and prone to fall rather than actually putting them to sleep
What can be done? Stop admitting most of these people. Get a lot better at community medicine and treating people in their own homes or care homes but that would require quite a cultural shift in society which is conditioned to see hospital admission as the answer to most things rather than a last resort

Not sure why you’re getting hostile/defensive? To be clear, I’m not having a go at you or any staff. I get it’s a tricky issue.

Surely you can see the current protocols are unhelpful - and actually harmful often - to these patients and those forced to be with them?

It might be that nothing can be done currently with the NHS in the state it is. But if nothing can be done medically to help these poor people then at a minimum there should be specialist wards to accommodate them, where they can get specialist care and others won’t be prevented from sleeping or left frightened and stressed when they should be able to be in peace to recover. And prompt discharge to social care where medically they are fit to leave. That’s a big set of issues fo solve, I know. But meanwhile they and the poor buggers around them suffer. It’s ok not to like that and to want better.

@BunfightBetty I’m not saying sedation is the answer btw, you’ll see that if you go back to my previous post. But current protocols are not helping these patients or the other people subject to their behaviour

Okay, so sedation is out for obvious reasons, what are these protocols you would like introduced to manage this? It’s not like people cbf currently, it’s deemed a pretty impossible situation, so very interested in what you believe should be implemented for management of this demographic and the gap as it stands.

I've just had 2 weeks in hospital and I got moved 5 times, 3 different wards, 2 private rooms, they will just move patients where they can fit them even if it's not the right ward.

I had a night on my last ward where a lady bled excessively over the toilet, on the floor, support handles, outside basin and it took me 4 times to complain and them 5 hours to clean. In the same afternoon & night there was a lady next to me who kept defecating herself and it absolutely stunk, I couldn't even eat my dinner.

A lady opposite me was vomiting excessively and had buckets of sick just sat in the room.

I sat out in the ward reception in protest until they did something about it or demanded to be discharged or moved wards. They did eventually sort all out. Luckily I was full up with meds because only a few hours prior I'd been immobile so thankfully I was in a position I was able to walk down the hallway.

The next night the lady opposite with Alzheimer's started shouting for about 2 hours on, 30 minutes off, all night, so loud I couldnt hear my music and my head was pounding. I ended up sitting downstairs where the canteen was just to get some quiet.

On my last night in this ward before I went home, a lady was parked right in the middle, with no privacy, no curtains, table or anything because they had no room for her. She ended up back in the corridor later. I really felt for her.

I wasn't ready to be discharged, but the hospital sent me home with no diagnosis and nearly 2 weeks after leaving I'm still quite unwell. I think they just wanted the space back. It's a mess in hospital. I feel for your husband I do.

I’m not saying wakefulness is distress in itself, I am referring to other types of confusion and the fact that people who are confused because of dementia ARE often upset and distressed.

Like the elderly people who think they’re little again and are crying for their mum and confused as to why she’s not there. I’ve seen that more than once and it was heartbreaking. It’s cruel not to help people suffering this, and that’s before we get on to issues of balancing the rights and wellbeing of all patients, including those whose mental and physical health and recovery from sometimes serious illness and surgery is negatively impacted by being prevented from sleeping and being scared.

I’m not saying sedation is the answer btw, you’ll see that if you go back to my previous post. But current protocols are not helping these patients or the other people subject to their behaviour

I was admitted to hospital after collapsing while walking my dog, I had a horrible stomach upset, which had gone on for over a week, but I seemed to be on the mend, and felt it was safe to go out. It was dehydration which caused extremely low blood pressure, and I was taken to A&E, where I was immediately put on a drip, unfortunately I was on a corridor for 2 days, and even more unfortunately the diarrhea returned! Although on a drip, I was not routinely given anything to drink, and had to keep asking the already overworked staff for water.

It was quite frightening in A&E over a bank holiday weekend. It was impossible to sleep, with traffic up and down the corridor, security and police being called to deal with drunks, and of course the frequent dashes to the single toilet. As I was discharged they found I had compylabacter, so for 10 minutes before leaving I was isolated, to safeguard others!
I had spent 2 days without having anywhere to change my clothes or have a shower, or any privacy at all, on a corridor, sort of luckily near a toilet!
I can't believe our NHS has come to this.

No short term memory is just part of dementia it's not an indication for sedation!!

Well it's behaviour that may impact others but no - wakefulness and shouting for things and wanting to wander is not distress just difficult to manage on a ward, wrt other patients and falls risk.
I mean you don't sedate people to the point if drowsiness!! It just calms people a little. They will not be asleep in bed just calmer but at greater risk of respiratory suppression, falls and death. If they are a danger to themselves and others then sedation can reduce that. But you can't just sedate people for a quiet night, it's not safe or ethical better to use other measures most of the time.

No idea why you think the respiratory ward would be any different in terms of demographics? Hospital wards are hell, no one gets rest.

One of the problems with sedating the elderly confused is that they are then drowsy and confused and you get lots of falls - which is then the fault of the staff and a big problem . I stopped nursing in 2014/15 and it was exactly the same then , this is nothing new

Does that not count as distress? Being agitated is not a comfortable experience. Confusion as to night and day and memory problems of such severity you don’t remember using a bedpan minutes ago - or clock that you no longer need the loo - seem like a nightmare to be experiencing to me.

Ah, I see the ethical dilemma if it could make their condition deteriorate, though if I were in this state I would want to be helped to be less distressed and would not want to have my life preserved at all costs when this was the quality of it. We need a much more grown up conversation about end of life options, including euthanasia, in this country. Also, of course, much better social care provision too.

I guess it’s the problem of having wards instead of all private rooms in hospital. No thought is given to creating an environment conducive to recovery or healing when the hospitals are designed. And I guess they’re running at a level of fullness often that precludes designating certain wards to dementia patients so they can be cared for in one area. It’s a shit show all round for everyone.

I'm very sorry to hear of your husband's health and hope he gets better soon. I have recent and significant experience of NHS wards. sadly this has been my experience of the 8 different wards my wife has been on since April. I'm sure the staff want him to be on the correct Ward but they just can't get him onto one because of the bed problems. My only advice to you would be to keep pushing and pushing and pushing for your husband as nobody else will. If a bed becomes available they might be more likely to move him in order to get rid of you sad but this is the way things are. On every Ward we've been on though the staff have been wonderful.

As others have pointed out pretty much all wards these days. Awful places to be when you're sick. they're noisy with people making noise continuously throughout the night you might find the correct Ward isn't actually any better.

Many people these days seem to find it acceptable to play music on their phones without headphones on hospital wards.

Chances are if you move wards it’ll be the same on the next ward

practically every ward had dementia patients

Sorry Op. As pp have said you just need to support as much as possible until a bed becomes available elsewhere or he's ready to go home. Unfortunately he may not be considered ill enough in the pecking order of others needing to be on the respiratory ward so may go straight home from where he is.
You'll exhaust yourself focusing on actioning this. The process will be happening but due to demand you may be stuck.

What!!?? Speeding death? For elderly patients in a trauma ward?

Trauma wards have always been like this. Those patients will mainly be elderly who have fallen and broken hips. They could be your grandad who was doing his own shopping and plodding on last week but has now had a major life event. Surgery and hospital stay can cause delirium which may and usually dies lessen as they progress. Hospital admissions are horrific for older people due to the complex impact of being in hospital as well as the medical impact of post surgery.
They're in the right ward. Younger patients and boarders from other specialities have always been horrified. As have many nurses who used to end up working on the ward from bank or other areas (in the days when that happened).I worked on trauma wards and ortho wards for 30 years. This is normal often for periods at a time.

Respiratory is usually full of nursing home patients who have developed LRTIs and pneumonias or elderly people who have come in from home but are no longer able to return due to their declining health and are now stuck on the ward while waiting for Social Services to sort out nursing homes or care packages for them.

That's just the nature of hospitals unfortunately. They're noisy, busy places.