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.

[springbokdoc]

KittaKatta - where abouts in the country do/did you work? I noticed a huge difference between the north/south. Oop north (where I was a houseman) we had a matron who held sway, made sure things happen and chose her staff (proper ortho nurses thank you very much :)). There wasn't a divide between docs and nurses - I believed them when they said obs fine but there's just something wrong (and for a few of them I would haul ass no matter what if they said they were worried).

Down south, I get more of the divide between us and more of a by the book kind of thing where people aren't interested in going the extra mile.

(ah, I'm getting all nostalgic - hang on I'm not even that old)

aged knees I love the outpatients comments :)

[KittaKatta]

agedknees, just read your comment of 20:48 , no I'm not I'm just an pissed off angry cow. Who used to love say I'm a Nurse proudly and now feels like I'm saying I'm a Nurse is the same as saying I'm a BNP member

[coinoperatedgirl]

I have to say that I worked on a medical ward as a HCA and every shift I worked on (can't vouch for others) every patient was fed. I do agree that nurses (including student ones) don't on the whole provide basic care, more likely on a night shift when it's less busy, but pretty rare.

Honestly some of the nurses do take the proverbial. The lot of an HCA is not a happy one ime. I could not do that job again if my life depended on it. It's in, bed changing/bathing/washing then obs then breakfast, then obs again (maybe a break) lunch, obs, changing, obs dinner, obs, changing etc you get the idea. All with the added stress of buzzers buzzing, cleaning to be done, stocking to be done, running around to pharmacy, x-ray etc, a million different requests from nurses/doctors, which they expect to be completed this instant. Patients need to be turned every 4 hours, some fully fed, others encouraged.

It is an absofuckinglute nightmare of a job, 13 hours on your feet straight, literally running around like a blue arsed fly.

Plus we had paperwork too, we had to fill in food/liquid charts, plus charts which assessed the overall condition of a patient, others I can't remember.

On some days I literally did the giving out and delivering of meals on my own, not an insignificant task, faced with the discharge/admittance problem (30 bed ward), hence the running up and down to the kitchen.

Nurses are brilliant, but honestly they use the paperwork excuse to sit the fuck down and not get up again. I felt like a fucking slave to be honest, I actually was a slave. I was called from the other end of a very long ward by the sister to fetch a file from the other end of the very long ward, I'm assuming because her delicate footsies could not endure the walk .

I have no idea what job I will do when I return, it won't be on a ward though, it's demoralising and dehumanising.

[coinoperatedgirl]

Although some patients would refuse food/medication. Obviously we were not allowed to force the issue, we could try and encourage, but a few refused, not sur if relatives could force the issue, but nothing hospital staff can do when a patient flat out refuses.

[KittaKatta]

Coinoperatedgirl I do really really get where you?re coming from,
I was you.
I was the Aux Nurse and later the HCA doing all the running and washing and toileting and feeding.
And I really really thought WHF,all s/he does as Staff Nurse is do the drug round FFS I could do that after all it?s just reading a chart ain?t .

And then I did my nurse training, and discovered why everyone jumped up and down if the fluid balance chart showed that the patient with the catheter hadn?t passed more than 15mls in an hour.

Or my patient with the blood transfusion, when their resp?s went from 17 a minute to 26 a minute.

Or my patient who thought they?d pulled their shoulder, but their BP in their ® arm was 163/102 and their bp in their (l) arm was 91/52 .

Or why even though the doc has prescribed 100 mg of morphine and the pharmacy has supplied that volume of morphine as a staff nurse you should go about giving 100mg of morphine to , well anyone really, unless you really hated them

[KittaKatta]

And as nasty as it sounds as a HCA you can?t be sued, it?s the hospital/trust responsibility.

As a qualified Nurse if you do the most minor of things that is not in your remit as a RGN/RN, you can and will get sued, and its personal responsibility/ liability.

Something like as simple as zap some soup in the staff microwave for the little old lady who hasn?t drunk/ate in days but really fancies some of her DILS homemade soup and she some how manages to burn her mouth and her (shitty shitty git of a son who has never bothered to bothered to visit, in fact you didn?t even know that she had more than one son, ?cause it?s only the one son/DIL that visits;) decides to sue because clearly it wasn?t the cancer that was in pretty much every organ didn?t kill her.
It was me as the RGN allowing her to drink/eat hot home made soup.

Sounds silly I know, but I have been there.

[exhaustednurse]

Kitta - I am there, in it, living it everyday. I wholeheartedly agree with everything you have posted.

I have been nursing since 1993. For some reason, I took the hard route, and have always worked in acute medicine/elderly care.

I am on leave this week and the thought of going back fills me with dread.

WIthout doubt, I am physically and mentally exhausted and burnt out.

The saddest thing is is that my love of nursing is over. God, I used to be so proud.

[cory]

My MIL is convinced that my FIL starved to death. He was blind and hard of hearing and she saw the nurses plonk down the food on his table without even making any attempt to let him know it was there; she's convinced that's what they did when she wasn't there too (she tried to speak to them, but they wouldn't listen). MIL was not able to come in and sit with him for meals, as she was herself elderly, had cancer, lived in a village and was unable to drive. I don't think it was laziness or lack of time- how long would it take to guide somebody's hand to let them feel that the food is there? - just sheer idiocy; it didn't occur to them that if you can't see you won't know the food is there and they didn't like relatives trying to tell them their job.

She decided not to make a formal complaint because FIL was probably on the way out anyway, and she was too ill and upset herself to want to put herself through that process.

[moondog]

ory, that's a crucial point.
Families themselves are using at thier lowest ebb at a time like this when tp put forward a complaint means being very tough and organised.

I put a major complaint through a PCT a few years back and it basically took over my life for a year and nearly drove me to a nervous breakdown and I am a very tough disciplined and organised person.

[Newjobthankgod]

I wrote that blog post 3 years ago and yes, things got worse since then. I left the NHS in early 2011 for the USA.

I work in a non for profit hospital in the USA now and over 60% of our patients are uninsured and cannnot /do not pay and/ or are covered by the government programs of medicare and medicaid. So our hospital is not rich by any means. BUT the staffing is good. We have one RN and one carer to 4 patients. Kitchen sends up food all day long and unless multiple simultaneous emergencies are going on we can check in with the patients when they get their tray delivered. Kitchen also sends up staff to get the trays delivered. It makes a huge difference to patient care having that kind of resourcing.

They are telling us that when Obama care goes in the first thing they are going to have to cut is that high level of resourcing and staffing and the amount of realtime online documentation that we have to do is going to increase dramatically so it is a bit worrying. I believe it because I saw it in the NHS.

[GabbyLoggon]

GASTON Good question, in theory it should not happen. I rare cases I suspect you get badly run hospital wards (especially in the night,) Bkess

[Driftwood999]

Just a thought, when a detainee or prisoner in custody does not eat a meal provided, it is noted and documented.

[hiddenhome]

This is the reason why I don't work in the NHS

The care home is difficult enough, but I simply cannot imagine the levels of stress that these staff have to cope with.

We often struggle to ensure that everyone is fed, but at least we don't have the highly pressurised environment of a hospital ward to deal with.

Personally, I think that the RNs should be left to deal with the clinical side and there should be more HCAs on the wards. When I was training, we had both students and HCAs to ensure that basic care standards were maintained and I can't say that we ever struggled.

Nurses who plonk food down in front of someone and then just walk away without checking that person's capabilities should not be a nurse They are totally in the wrong profession. Basic observations like that are what nursing is all about. You can't teach common sense to some people.

[lesley33]

A friend has just come out of hospital. She was in a private hospital courtesy of the NHS so was in a single room. The nurses came in and routinely left drinks and food out of her reach when she was asleep.

Buit she had just had major surgery so she couldn't physically stretch to reach them. She rang her buzzer but no-one ever came. And because she was in a single room she couldn't see anyone to ask them to move her drinks/food nearer.

She was out soon and had visitors to help her. But anyone elderly copuld have starved.

[lesley33]

And herexperience wasn't about staffing ratios, but just staff who don't think about a patient being unable to stretch and reach.

[zipzap]

There was something in the paper the other day about a ward that had introduced a scheme where the patients that couldnt feed themselves for whatever reason got served their food on a red tray.

When trays were collected if a red tray hadnt been touched then it wasn't collected but someone could help the person eat something. Made a big difference to the health of the patients, recovery rates etc. So was rolled out to rest of hospital and now is in the process of being rolled out elsewhere.

Such a simple thing and needing minimal cost outlay or time to train on how it works. Brilliant. Scary thing is how long it seems to be taking to roll it out everywhere

[ilovewaldorfandstatler]

i've just finished a placement on a medical ward and tbh i can see how things like this can happen. while the staff were great, there just weren't enough of them. for a 16 bed ward there were many days where there was 2 RNs 1 HCA and 1 student (me). which meant that the HCA and i did all the personal hygiene while the RNs did the drug round and IV antibiotics. thankfully as a final year student i was able to help out with things like taking bloods or IV fluids or else we would have still be updating the patients notes during evening report.

the ward i was on was fantastic about sorting out car parking passes for the relatives who came in to help with meal times as well as having volunteers who would help out. the thing i found hardest was the patients who would absolutely refuse to open their mouths or spit out what we were giving them. that and dealing with the visitors who would see a patient asking for water and try to give them water despite a big nil by mouth sign. shouting at me after i have told you that the patient is not allowed anything will still not make me tell you why (other than that's doctors orders). and spending the whole shift trying to explain to a patient with dementia (and their family) that they have to fast for a procedure and yes we are aware that they were told 2pm and it is now 6pm but we have no control over the theatre list. and yes you lovely JHO when i wrote in the Drs book that X needed IV fluids, i did mean for you to do them while you were copying our notes taking the patient history as they had v+d, hadn't eaten or drunk for 24+hrs due to this and had only passed 200mls since they came to the ward the previous night....not 8hrs later when your SHO has asked why the fluids weren't up.

[Newjobthankgod]

Okay I see a lot of misinformation in the last few posts.

First of all, very few staff on the wards are nurses. THE PERSON YOU SAW WHO PLONKED DOWN THAT TRAY OF FOOD WAS PROBABLY NOT A NURSE. Unless of course the one nurse on duty to 15 patients left clinical work that cannot be left to hand out trays.

I dont know what to make of a nurse who leaves a bleeder and a chest pain and all the stat orders that are occuring for those people undone because it is mealtime and trays need to go out. That kind of behaviour could kill the bleeder and the chest pain patient. It was either an untrained carer or a kitchen assistant who handed out the food when it arrived.

Second of all, you don't seem to understand why the staff have to dump the tray out of reach and run. Let me explain it to you.

The food trolly arrives on the ward. Three staff have 15 minutes to hand it out to 30 patients before kitchen takes the trays away. It is kitchen staff who takes trays away. So anyone who is saying that "the nurse took the untouched tray away" is full of shit. The kitchen staff took the untouched tray away. Kitchen staff doesn't care if people eat.

The staff have 15 minutes to get those trays out. They grab three trays at once(that is all that they can carry). Give each one out to three patients and then run back to the trolley and grab three more.

So they have to get the trays out to as many people possible and then go back and feed them. You cannot just bring a tray over to someone and then stay there and assist them with it. if you do that then the rest of the ward would not get their trays at all.

Leaving that tray where a patient with poor coordination, dementia, delirium etc can reach it would be a very bad thing. Remember that you have to leave the tray there, run back to the trolley and hand all the other trays out and then go back and feed after all the trays are out. If you leave the tray within reach many of the patients I am describing will pour food all over themselves, the floor, the patient in the next bed and get burned. It really is best too leave it out of reach until you can get back. Unfortunately it is an ongoing battle to get back there before a clueless kitchen assistant who wants to get the dishes washed and get home on time takes the tray away. A patient seeing the kitchen assistant collecting trays in assume that she is a nurse. Older people especially are convinced that all members of staff that they see are nurses. I really don't think that the RN, who has 30 patients waiting for blood transfusions, labs, stat meds, regularly scheduled meds, their airways suctioned, their breathlessness and pain dealt with, is going to be abandoning those things to collect trays.

On a general medical ward something like 75% of the patients are suffering from some kind of confusion or disorientation. This may be due to dementia or it may be due to the kind of delirium that people get when they have an infection, a kidney problem, a liver problem, hypoxia etc. Sometimes people without delirium or dementia just get disoriented in the hospital environment. People who like they alcohol and go without it in hospital also become very disorientated. It is very hard to determine who is disorientated and who us not when you only have a couple of fleeting seconds with each one during the course of your shift.

It makes me angry that people don't understand this stuff and then accuse nurses of leaving trays out of reach out of pure malice and lack of caring.

[Newjobthankgod]

we had red trays and it wasn't making a bit of difference. The kitchen staff still takes them away. The nurses have complained about this repeatedly but no one really gives a shit. The kitchen assistants want to get home on time so the 3 ward staff had damn well better get everyone fed before she collects in the trays. That is what we were told.

[Newjobthankgod]

forget to put the @lesley in front of those posts.

[alistron1]

My grandfather is on a geriatric ward. The staff are lovely and the HCA's who do the meals are very caring and kind.

My grandfather is so plausible, if he said to you 'I've already had my dinner' you'd believe him. As do some of the HCA's.

It's tough for the staff, I've been with him, watched him have lunch and then seen him swear blind that he's being starved and not fed for days! And if I hadn't seen him eat I'd believe him!!

I've witnessed HCA's trying their very best to get other patients to eat, when they can't/won't feed themselves.

It's not a job I could do TBH.

[threadsoffeeling]

possibly a naive thought, but there are a lot of 16-17 year olds around with nothing to do. Cant there be some sort of thing where they come in and help feed the elderly patients? scouts or guides could do badges or duke of edinburgh type stuff.
there are a lot of good people in the world. why cant they be allowed to help?

[Newjobthankgod]

Alistron- you make a very good point.

Threads-- terrible idea. It's good in theory but bad in practice. The last time I let a 17 year old volunteer carer feed my patient he died. It isn't as simple as spooning food into a person.

If we start allowing untrained people on the wards to help they will be more of a hinderance than a help. As they would be visible to patients the patients would be assuming that they are nurses and shouting out to them.

The volunteers will stop the staff constantly to tell them things we already know but cannot get to. If I constantly have volunteers up my backside telling me that "bed 5 asked for the toilet" "Bed 8 is asking for pain meds" "bed 9 wants you to come and tell him when he is going home" and expecting me to stop what I am doing and go to those people a lot of errors are going to happen.

I know that bed 5 needs the toilet but I cannot go to her because my DKA patient pulled out her central line and is now going hypoglycemic. I know that bed 8 needs pain meds but the pharmacy hasn't delivered them yet and won't take my phone calls. I know that bed 9 wants to know when he can go home but as I have told him 100 times we have no way of knowing that and I am not going to him yet again right now because I have 16 IV meds to do and have been trying to get to them for the last 3 hours.

I wouldn't be able to deal with all those interruptions from volunteers and not make some kind of fatal error.

Someone else made a good point about members of the public who have no formal nursing training making up their own minds about things and being very non compliant with the instructions that they are given. Both family members and volunteers/carers fall into this category. We tell them that gran is Nil by mouth for a procedure or has an impaired swallowing reflex and they feed her anyway whilst telling anyone who will listen that the Nurse is starving gran.

We tell them that someone is hyponatremic ( a sodium/Na level that is low) is on a fluid restriction and cannot have water because it could kill them and they ignore us and run around saying that we are denying gran water and they give it to her anyway.

Same again with people who are on fluid restrictions for heart failure. Same again with people who are on renal diets where high potassium food will harm them, same again with people who are on diabetic diets.

They ignore what the nurses are telling them. They want to make out that patients are being denied things out of malice. Then they give the patient something that they should not have and the patient has a very bad outcome.

If you are a visitor on a ward you should NEVER feed a stranger or even give them a drink of water without speaking to an RN first (not a carer, or a domestic, or a secretary). I have had to sort out so many shitstorms because visitors assume that the nurses are just being mean and neglectful and assist the patients themselves thinking they are helping.

[happy2bhomely]

I phoned my local hospital yesterday looking for volunteer work. I said I'd be happy to help with anything and they said they didn't have the resources to offer an induction so couldn't accept my offer.

[threadsoffeeling]

good point. not about the lack of induction, but the volunteers being a hindrance...

what about university students then? as part of their degree in sciences, they could volunteer at a meal time a week for a term. If they are doing a degree in biochemistry or something, then they will understand about sodium and potassium balances and the need to follow instructions. It would require initial inductions and resources, but if managemet wanted to, then they could make it work.