- Some of this stuff is abuse - stealing wedding rings etc and hopefully those responsible will be prosecuted, my heart breaks for the families
- Some of it is lack of infrastructure- hospitals too small, not enough physical beds etc
- Some is poor design - modern hospitals with all individual rooms - absolutely no good if you don’t have the staff to check on everyone
- A nurse used to be able to nurse. Now they spend half of their time writing down what they have done and the justification in case they are sued. Far too few working computers means plenty of time is spent queuing to use a computer. Some places still using paper notes so everything has to be handwritten and then typed up for the discharge letters.
As an example of this absurdity- So much handwritten duplication. If you want to check a patients blood results- it’s not enough use a computer and check a patients blood results and then act on it.
No first you must wait until there is a free computer (four doctors to one computer in my last job) then you must log off the person on the computer -3min, then log yourself on 5min (data protection means can’t use each other’s log ons - sacking offence) then log onto antiqued results system clicking though a load of pop ups that tell you not to misuse the confidential information. Finally check results. Realise you want to compare them to old results to look for a change - that’s a different computer system so another 5mins gone. Then it’s not legally defendable to have just written “checked blood results - gave antibiotics for infection” you have to write out on paper exactly what the results were or a court will say you didn’t actually look at them.
“Date
dr Blogs GMC 12234556
Grade
Bleep/phone
Blood results date:
Fbc 123
Wcc….
……
….
(Probably about 10 lines of results)
Infection.
No allergies
Abx given in line with infection guidelines 1224.
Signed dr Bloggs”
And god forbid if you need to check if the patient has any allergies because of the patient can’t tell you then you need to check the summary care record which often dosent work so then you need to call the GP to find out and that takes ages (we call the same line patients do so can be on hold for hours)
And then you hand write the drug chart. Copying by hand the medications from the computer system/Gp print out/boxes of meds - this can be 3-4 pages of a4 handwritten
Then if you need to use extra strong antibiotics you need to get permission from the microbiology department so you have to call them and wait on hold for 10-20mins to get a code you handwrite into the notes.
The. You want to order some blood tests for tomorrow to make sure your patient is getting better. That needs a computer- so you have to go find one and repeat the log in rigmaroles. Then you find the printer is broken/missing/never installed so then as well as ordering online you have to go handwrite the blood forms and bottles. Copying by hand the nhs numbers onto multiple tiny bottles - one error means they are rejected so you have to be precise.
So a 5min job when I started medicine is now an hour long one.
And if after all of that your patient gets well enough to be discharged you need to write a discharge letter - again find a computer then type up a summary of the medical notes from the paper records. Transcribe the drug chart.
It all takes so so long and no actual patient care takes place.
- Still using pagers to communicate (at least the faxes have stopped). So you need to speak to Dr Jones - so he is paged and then needs to find a free telephone to reply (there is never a free telephone as the others are in use by people waiting for a response to their page). Some places have tried mobiles but the signal is often so bad you can’t get responses and wifi seems beyond the nhs.
- There is no where to discharge patients to. Care homes don’t want to take hospital patients as they might have covid (understandable after what happened wave 1). No one wants to be a commmunity home carer because the pay, hours and conditions are rubbish. So people stay in hospital and then get covid/flu/Noro/pneumonia and die
- sometimes stuff can’t be cured. Not anyones fault but the Disease. Maybe after stroke number three a 97yr old would prefer to stay at home. That would require someone to nurse them at home tho….