Help with NHS and hiw to be moved wards

[Tiredohsotiredandabitmoretired]

Posting here for traffic.

Can anybody advise re the above? Partner was admitted on Thursday due to low oxygen. They've stuck him on a ward which is supposedly a surgical trauma unit. (Why not respiratory? ) the other patients all have dementia or other cognitive difficulties. One patient sleeps all day then shouts/screams all night so he hasn't slept. There's a chap who keeps getting up and getting in bed with other patients. One chap urinated at the end of my partners bed and another chap just decided to defecate on the floor. Can anyone help he's never going to get better on this ward. Is this just how it is now in hospital? What can I do to help him

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.

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

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

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 short term memory is just part of dementia it's not an indication for sedation!!

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.

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'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.

@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.

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.

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

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

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.

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.

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.

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?).

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 ...

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.

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

And there are already many measures in place which work very well.
I'm not going to say it all again.

Of course there are specialist wards for COTE and Frailty. Patients generally do very well once settled on the ward. There are many measures we use from reassurance, interpersonal skills, routine etc to medication if needed. That need usually reduces once on the ward for a few days as the staff are trained to care for these patients.
Of course we used aids for nights sleep but we try to go with melatonin etc to reverse the dementia pattern of night for day.

Yes, I'm a mental health professional, though I don't work with the elderly.

The trouble is that the alternative is them being in massive distress. I honestly can't believe that maintaining them in a terrified state is a better option. In reality which of us would choose this before we became ill?

If someone was in pain with, say, cancer we'd mitigate their distress with sedation, even if it had a physical consequence. Why is mental distress any better?

Yes, to be clear, I am not saying that all patients who are confused are also distressed. What I am saying is that people with dementia who are confused can very often also be distressed. As an example, I mentioned upthread issues where people don't realise they are, say, 91, and think they are a little girl and are crying for their Mummy, very upset and frightened. I've seen this more than once and it was heartbreaking. I would like to see those patients' distress alleviated.

I'm not a HCP either but I have been in hospital where dementia patients are wailing and screaming and it certainly sounds like distress rather than confusion. How can you tell the difference?