To wonder how many elderly people in hospital die of neglect?

[Gone2far]

My poor elderly dad is in hospital. Whenever we visit, we're sorting out something. This morning, nobody had made sure he'd taken his medication and, when I pointed it out, they whisked it away. But then told my mother that he had had it.
The hospital is enormous, and you never seem to see the same member of staff twice.
I think it would be very easy for an elderly patient, who didn't have family or friends coming in, to be forgotten, apart from the absolute minimum of care.
Anyway,perhaps i'm feeling this because i'm worrying about my dad. But I know we can't be there all the time and feel helpless

A trained qualified doctor, often a specialist in pain relief, decides and it's all thoroughly documented. Where do people get these ridiculous ideas from?

I appreciate its a fine line and im not saying whats right or wrong. Im just wondering whether in this modern era, there should be some form of informed consent?

End of life care is getting much better. Patients are not euthanised at all and it is simply idiotic to continue harbouring that sort of nonsense opinion.

Palliative care plans are made in advance and include the patients' wishes. End of life analgesia is based upon the best available evidence and regimes worked out by experts in their field. You'll also find the amount of terminally ill cancer patients dying in hospital has reduced massively.

Euthanasia would be much kinder. And most people do not die of cancer.

Didnt they used to have drivers with a clicker so that patients could self administer? Did they have safeguards programmed in or could a patient self administer a high or fatal dose by desire or accidentally?

DM begged for more pain relief for five months; DB and I begged for it on her behalf for five months. Nothing ever happened... one of the biggest problems in elderly care IMO is the lack of a holistic approach. So: old must equal dementia; broken bone must equal orthopaedic; incontintent must equal urinary care. No one ever seemed to take an overview and treat her as a whole person. If end of life analgesia is that bloody good, why could they not sort out my DM's pain from a broken shoulder?

I am shocked by the awful care I have witnessed in hospitals. When my dad had a heart attack the elderly men opposite and either sides of him were unable to feed themselves, they were literally starving in front of my dad. Their food whisked away before anyone would help them.

One was sick on himself, no one cleared it up despite my dad buzzing for someone on his behalf. My sister then cleared this poor old man up.

I know not all nurses will be useless but the many I have encountered from my dads stays and my mum dying in hospital have been awful. Almost every nurse that has helped my parents have been utterly shit. They have time to sit in their nurses station eating crisps and chatting and pissing about, but not actually getting off their arse and helping the patients.

Didnt they used to have drivers with a clicker so that patients could self administer? Did they have safeguards programmed in or could a patient self administer a high or fatal dose by desire or accidentally?

No patient controlled anaegesia (PCA) hasn't been around for more than... 10 years? It's introduction was before my time I'm afraid. But yes when in use it does have an automatic cutoff.

When my dad died in a hospice he was only there for 12 hours, they didn't have chance to fit a syringe driver as he deteriorated really quickly. He became agitated so they gave him IM midazolam. He then "settled and passed away peacefully". Did it hasten his death? I'll never know but im bloody grateful he didn't die in distress£

clairemcnam. The correct term for what you are suggesting as a kinder option is murder.

PCAs were used for loads of patients. I even had one when I had my appendix removed. There was no way one could OD on it. It was programmed to only be able to release a specific dose after a certain amount of time.

People need to talk about dying more. And people really need to make plans and decisions about what they want to happen as they approach the end of their life. I know exactly what my parents want and I will make sure they get it.

They have time to sit in their nurses station eating crisps and chatting and pissing about, but not actually getting off their arse and helping the patients.

Ah yes this is my experience of nursing. It's surprising there are 40,000 nursing vacancies really with all the opportunities the 'piss about' and 'eat crisps'

Nurse bashing go ahead. Teaching bashing on here OMG you are all
Wrong how very dare you etc. The nhs is in crisis. Pay more and help
Look after your relative.

I have just given up nursing after 30 years - the final shift that broke me was horrendous, a 12 hour nightshift with multiple agitated terminally ill patients at risk of falling and not enough staff to keep them safe. I handed my notice in at the end of the shift. we were one of the better staffed care facilities ( hospice) but still struggled to recruit and retain staff. The vast majority of staff were caring , and conscientious but at times the workload was just too high to keep people safe.

Didnt they used to have drivers with a clicker so that patients could self administer? Did they have safeguards programmed in or could a patient self administer a high or fatal dose by desire or accidentally?

I can see why you would get confused, but syringe drivers and patient controlled analgesia pumps (which are definitely still used in the hospital that I work in) are similiar but different.

Patient controlled analgesia (PCAs) pumps are usually used for pain relief just after surgery, the patient has a clicker to administer a dose of pain killer, which goes directly into their vein. They can't overdose on it as it has maximum dose settings, and there has to be a certain amount of time from the last dose until it will let you deliver another dose.

A syringe driver is usually used for end of life care (though they are also used to manage patients symptoms before they are nearing end of life), and constantly deliver meds 24 hours a day subcutaneously (it goes into the tissue just under the skin, rather than into the vein like a PCA does). Usally syringe drivers have a mixture of medications, which usually include pain relief, anti sickness, something to relax the patient, and something to help ease secretions that can build up in the patients lungs towards the very end of life.

When people say the nurse/HCA was “too busy” to assist their loved one, what do you imagine they were doing? Painting their nails? Booking a holiday? Chatting about their weekend? No, they were assisting another person, equally in need. Every shift, details are entered of patient acuity (an estimate of how many staff hours they are likely to need) and actual staff present, so we can have evidence to ask for more staff. Of course, the correct number of staff are not usually/always available.
Volunteers are very helpful and some wards have one or two that are trained to feed patients but they only do a couple of hours a week usually. It needs to be more public knowledge that very ill/dependant patients can definitely benefit from their relatives or friends helping if they can. Even sitting with them at mealtimes and helping them to drink/ eat a little. Ask their nurse if there’s anything you can do to help- this happens quite rarely I’m sad to say.

Thanks Popcom,,, as i say, im here to learn and explore. Im not in helathcare. Its all about openess and honesty. So if a terminal patient is fitted with a driver as you say, is there an informed consent discussion about what is happening and is it documented?

So if a terminal patient is fitted with a driver as you say, is there an informed consent discussion about what is happening and is it documented?

Before any procedure is carried out mental capacity is assessed, and patient consent is gained. If a patient is not able to consent due to various reasons then a decision is made in their best interests, this will usually take relatives and carers views into account. All such discussions are documented, as is every intervention.

So if a terminal patient is fitted with a driver as you say, is there an informed consent discussion about what is happening and is it documented?

This is an interesting question which has made me think about how consent for various procedures/treatments differs. It should be explained to the patient what the syringe driver is for, but I wouldn't say that the actual discussion to obtain consent from the patient is usually formally documented. The doctors would probably write in the medical notes that the syringe driver has been prescribed and they have had a discussion with the patient and their family, but the patient wouldn't be required to sign a formal consent form; it would be verbal consent. An adult patient is assumed to have capacity to make decisions about their care unless there is a reason to believe that their thinking might be impaired, such as they may have dementia or be very drunk. If there is a reason to doubt that they have capacity then their capacity is formally assessed, and decisions are made in their best interests and formally documented.

Syringe drivers are prescribed by senior doctors, usually by ones who specialise in end of life care, and then made up by a pharmacist who will question it if they are not happy with the dose. It is then checked by two registered nurses and a record of the dose and when it was administered to the patient is kept in the controlled drugs book, and checked by two registered nurses every few hours to ensure it is still delivering the correct dose and has got battery life left (it's usually locked in a clear plastic box so it can't be tampered with).

Before Harold Shipman I think doctors had more "freedom" around administering controlled drugs like diamorphine to terminally ill patients, but now everything is scrutinized and double checked. One of my mum's friends told me once that when her father was dying at home from terminal cancer (back in the 80s I think, maybe earlier) and in the last stages of life, as in barely conscious but distressed, the district nurse asked her and her mother in a roundabout way if they wanted her to give him something to help him 'go'. They said yes, they felt he was suffering and had had enough, the nurse gave him an injection and a few hours later he died peacefully. That just wouldn't happen nowadays, but my friend said she and her mother were glad that he went peacefully.

Thanks popcorn and fruit cider. Ive not read chapter and vrse on harold shipman but i guess he just thought he was doing what was best and others judged it in the cold light of day and pointed the finger at him. I guess we go full circle back to the law which prevents assisted dying and HC professionals are compelled to teeter around the edges for fear of ending up being accused of something. The whole thing needs addressing in an open and honest way.

He murdered over 200 people, many of whom had wills leaving him a legacy. Sure he thought what he was doing was for the best - for him. He’was the most prolific killer in history.

Ive not read chapter and vrse on harold shipman but i guess he just thought he was doing what was best and others judged it in the cold light of day and pointed the finger at him

No he did not do what he thought was best. He murdered them, mainly for their money.

Ive not read chapter and vrse on harold shipman but i guess he just thought he was doing what was best and others judged it in the cold light of day and pointed the finger at him.

I suggest you educate yourself even a little bit.

My dad is on a specialist dementia ward at the moment, the qualified staff seem busy, rushing around doing meds and writing notes - the HCAs are the laziest most ignorant bunch I have ever had the misfortune to meet. They sit around, not speaking to the patients at and only occasionally to each other! eye rolling if someone needs the the toilet or a drink - you couldn't make it up!

I hate NHS bashing, but this experience has shocked me to the core.

Shipman was a serial killer who abused his patients trust in him, didn't act in their best interests at all, murdered vulnerable people in order to gain financially from their wills sometimes, and other times for reasons unknown.

However other doctors have admitted playing a part in assisting patients die (who asked for his help) in the past, like Dr Iain Kerr:
www.heraldscotland.com/news/14524312.obituary-iain-kerr-gp-and-passionate-supporter-of-the-right-to-die/

Not saying it's right or wrong, but it used to happen.

Shipman wasn't doing palliative care with a little extra morphine to help a peaceful death, he was injecting people who weren't dying with lethal doses and profiting from their wills.