to understand how it is possible for a patient to starve on a NHS ward?

[GastonTheLadybird]

I don't have much experience of the NHS and I was shocked to read this blog:

here

If this is true, and I guess you have to assume it is, of course peoplemare going to starve on hospital wards. Logistically it just doesn't work.

Surely it could be arranged so that family member could feed the patients? I know I would be happy to do that if my Mum or Grandmother were in hospital. Although I guess it might not be possible for everyone.

I suppose it isn't that simple, but I was a bit as family members on tv last night where complaining about watching their relative starve to death and I was a little as surely if the hospital wasn't doing it you would make sure your family member had food. However I don't have all the facts and I wouldn't want to say.

You're not allowed to feed your relatives in a lot of cases. My dad wasn't allowed to eat for three days after a stroke because he hadn't had a swallow test. He could swallow but the practitioner was too busy to test him. In the end we conspired with a nurse and started secretly feeding him. His condition improved instantly. Even after he passed the test, technically a medic had to feed him because of the food diary that was part of his notes.

Unfortunately, I also discovered that a horrifying proportion of the elderly patients he was in with didn't get a single visit while he was there (around 10 weeks). They either had no family or their families just didn't visit.

The staff were, on the whole, fantastic, but there weren't enough of them and I really felt for them. We'd bring the nurses doughnuts and coffees when we visited every day because they were really overworked.

Not everyone has a family member to help.

I wouldn't want to speculate on individual cases but sometimes elderly people are treated very badly in hospital.

Dear God that is an amazing blog.

Sadly it is true. I could have written that post when I was working on a medical ward.
The idea that a family member could come in is a good one, but not always feasible.
I was nodding in recognition of the families that refuse to share information so end up ringing over and over to ask the same questions.
i don't know what the answer is, apart from avoiding the NHS which is not practical.

Having done agency in general hospitals I can totally see how patients can starve.
Meals get put on table in front of elderly patient, they may be confused, had a stroke, dementia etc, don't even realise it is there, then it gets taken away again as it's not been eaten.

I spend my whole shifts giving patients drinks, feeding them as the rest of the staff use this time to write notes etc.

It's just awful, lots of nurses have no training in dementia and mental health issues and don't have the time to sit and chat and encourage an elderly person to eat their food or even feed them it.

So sad to think of people in hospital with no visitors or advocates.

There is a dispatches on next week which looks at how older people are treated in hospital. If that blog reflects usual staffing levels how can the nurses be expected to provide adequate care levels? If there simply aren't enough of them, and of course amongst those there are some will be motivated superstars and some will be less bothered, how can it be done.

I guess the question for me is whether or not staff to patient ratios are good enough?

Oh god, the phone thing, that seems absolutely nuts. Can't they have an answer machine?

It just really seems like the whole organisation of it is failing people. I can't even imagine working in environment where my ability to do my job would be so restricted by other people.

I don't think the NHS is understaffed (speaking as one who works in it), it's more an issue of being being tied down by vast and unnecessary amounts of paperwork to 'cover their backs'.

If I were to have to go into hospital, I would take all my own food and drink.

The sad thing is that this issue has been explored and resolved in some hospitals, but the lessons have not been spread. It's a classic example of a problem that can be (and has been) addressed by Lean techniques - a combination of ineffective systems with lots of waste (running back and forward to the phone), some significant behavioural issues to address, and no useful information cues to help shape what happens. As ever, with Lean problems, throwing extra resources at the issue is an order of magnitude less helpful in fixing it than addressing the underlying issues and getting continuous improvement going - despite what it feels like to practitioners.

Nurses no longer nurse

nor are they responsible for cleanliness

they are responsible for paperwork it seems, reams and reams of it

they are overworked and understaffed and it is a crime

they are misdirected

and you know something - that is what there is for the end of our lives too

'As ever, with Lean problems, throwing extra resources at the issue is an order of magnitude less helpful in fixing it than addressing the underlying issues and getting continuous improvement going - despite what it feels like to practitioners.'

Absolutely. The 'extra resources' calls rarely solve these issues.

1 extra resource to concentrate on all the bureaucracy ?

My grandfather went into hospital for routine kidney dialysis one November and died two months later with a broken hip and a fractured disc in his spine. He was repeatedly given a mild sedative he responded badly to - it made him a bit woozy and unsteady on his feet so when he tried to get up he fell.

Whilst this is appalling in itself, my family have always felt that the food situation made everything much, much worse. His weight loss was astonishing to watch. We were not told that there was a small kitchen available for family to prepare food until the week he died. We were told he was to have the 'fortified' option from the daily menu but no one ever knew which that was. He was supposed to have protein shakes that were never opened for him (he was too weak to manage it) but just left at his bedside. Breakfast cereal often arrived with only a dribble of milk and was inedible. The hot food that was offered was disgusting, often cold and congealed by the time it reached him. If he was asleep at meal time, he was not woken up to eat, the food was simply taken away again. If we left him sandwiches etc, we would return the next day to find them in the bin by his bed (which was never emptied).

I can readily believe that patients die of starvation, despite daily visits from their family. My family and I watched it happen.

I've had similar experiences as herbietea when I was in for a gynie operation. I missed meals because I couldn't get out of bed to collect them, and the orderly(?) in charge of the food trolley was to busy/hassled to remember to bring it to me. I was off ward when the meal sheets were filled in so didn't get meals assigned. Luckily having seen how disorganised it can be when DH has been in and when I've had the DCs I took my own stash of food in there with me.

People who are admitted under emergency situations, or who don't have relatives/friends who can call in everyday don't have the resources to do that.

Regular meals are such an important part of the healing process, it really needs to get sorted out.

When my dad was in hospital my sister organised for family members/friends to feed him as the nurses never had time/inclination to do it. The nurses took the piss when we turned up to feed him and were v unhelpful. I complained to the hospital. The Chief Executive replied (eventually) and said that training would happen.

Upside of this is that my dad was again recently in hospital (same one) and the difference in 2 years was amazing. The nurses took the time to make sure that he was fed and showered/washed (which didn't happen before)and he felt that his dignity was restored.

My point is to complain when things aren't going right. If we hadn't ensured my dad was fed I doubt whether he'd still be here today.

That log was written nearly 3 years ago and I suspect nothing has changed
Management need to look at staffing levels and think seriously about how to make meal times easier instead of wittling on about increasing efficiency

Another thing to remember is the patients are ill. Seems obvious doesn't it. How many people feel like eating when ill?
In many cases the patients will have been malnourished before entering the wards.
In my mums case the sight and smell of food made her nauseous.
She'd been off her food and vomiting for a few days before even contacting a doctor, thinking it was a stomach upset, it was only the pain that made her seek medical help. (It turned out to be cancer, she died within 11 days of entering hospital )
My sister and I would bring in a variety of treats and drinks, what she could stomach at afternoon visitng would make her vomit by evening.
In spite of the meds given to counter act the nausea, toward the end she couldn't even keep water down.

My father has dementia.

Last year he was admitted to the stroke unit at Ipswich hospital. The food looked fine, but he needed to be helped to eat (effectively spoon fed.) So far as we could see, the nurses did their best, but he utterly refused to co-operate. After a couple of days, we got their agreement that Mum could go in at supper time each day, and help him eat (he would accept her help).

I am absolutely sure that if we hadn't arranged for Mum to come in and help out, Dad would have died. It would have been very easy then to blame it on inadequate nursing care, but in his case it would not have been fair, or true.

When my mum was in hospital there a old lady in the bed next to her unable to eat by herself. She said the nurse brought her food in, plonked it in front of her and walked off. Then she collected the food a little later untouched.

My mum did bring this up with the nurse (she said they were understaffed) and also told her family. My mum even had to give her water during the day as no-one else bothered so it really doesn't surprised me that so many people starve to death

very sad.
When I did my nurse training in the 1980's it was the nurse in charge who dished out the food and other staff would go around helping to feed etc.
Now it is ward orderlies so who does the feeding, checks the plates????
I had a 'discussion' with a student nurse who felt her role did not involve giving basic care such as feeding, cleaning dentures if required or even topping up water jugs. she said she wa working towards a degree not as an auxillary. Awful attitude, may be basic stuff but essential.

coccyx I come across quite a few student nurses with the same attitude, more interested in poncing around after the Dr's than looking after patients.
I have failed several students who were unable or unwilling to give patients basic care.

When my Grandad was in hospital recently, he was luckily able to feed himself. However, 2 of the other patients on his ward were not, and it seemed there was noone around to do it, so I fed them myself. They were very grateful but I did wonder what they did for the rest of their stay

i too have seen this happen - its awful.
fanny you are right - this is a basic human right and something the nurses should make one of their top priorities.unfortunately most of them don't.