Advice on patient being discharged from hospital, when I don't think they should be!

[Orangeinmybluelightcup]

Hello, after some quick ish advice if anyone has experience of this. My mums husband who is 71 was admitted to hospital on Sat with severe diverticulitis. Stomach cramps started on the Wednesday, on Thursday the doctor diagnosed and prescribed oral antibiotics and wait. By Sat he was in severe pain and vomiting blood hourly. He is also a diabetic so not eating messed up his blood sugars and led to heart irregularities. 111 advised they'd send a paramedic, 10hrs later they ended up taking him to hospital by ambulance. He spent the weekend in A&E majors. He was taken to a ward Monday and put on IV anti-biotics, insulin drip, anti-sickness meds, and tramadol. CT scans flagged a second issue of a mass on his kidney. The consultant urologist hasn't yet looked at the scans. The ward he is on are now saying that they have treated the diverticulitis for now and are discharging him in the next few hours with oral anti-biotics. He hasn't eaten or kept water down since Weds. The longest he's gone without vomiting is a few hours. He is still in severe pain and not fully lucid. They say he'll be more comfortable at home and they won't take further action until the consultant urologist advises on the kidney scan. Luckily my mum is 10yrs younger and can advocate for him and care for him at home, she's insisted she wants a discharge papers and a plan before she will take him. Are we doing everything we should be here? I can't see how he won't end up back in hospital in a few days, in a worse state than now!

He could be throwing up this much because of the antibiotics. He's allergic to penacillin so on something else. Or he could be throwing up through the infection. The kidney nodule is being described as a tumour now, and not sure if it's related or entirely separate.

Sorry, a bm machine is a blood glucose monitor, for testing blood glucose, levels many people do this themselves at home. I was just being ,lazy. Energy drinks contain a lot of sugar and fat. If he is being sick then he must feel really poorly, theres nothing worse.

Speak to the diabetic nurse who is on call for advice. This is a totally unsafe discharge. If he gets worse take him back to A&E. If he cannot keep food and water down he will not manage his blood sugars. Then complain to PALS.

Does anyone have his diabetes clinic number or email? They are the best people to advise on diabetes.

Hospital are different lately. At the end of November 2020, (adult) dsis local hospital sent her home 72 hours after inserting a shunt in her brain. They called dm and said will you pick your daughter up or shall I order patient transport to take her home?

Dsis couldn't lift her head up, but she could hold it up if someone else helped to lift it first. She also had lot of pain in her stomach, which was diagnosed as nerve pain a couple of weeks later and the medication they finally gave her eased her pain.

Few of dsis medication lasted only three days and her gp had to be called few times before a receptionist took pity on her and got a doctor to call back to prescribe her all her medication.

Talk to the discharge team based in the hospital.

Once a patient is discharged, the hospital effectively washes their hands of him/her.

Any carer, social services, community matron or district nurse help has to be arranged before discharge, or else it has to go through the GP.

There should be a discharge team, who are the contact team for any services out of the hospital.

He needs to be seen by a diabetes nurse, a gastroenterology team member and cardiology team member and have appointments pending before he leaves.

Tell the hospital you and your mother can't cope and the discharge would be unsafe without support.

Hospitals are penalised if a patient is returned to hospital within 24 hours of a discharge.

Take him back to A and E or ring an ambulance , I would bypass 111 altogether. Tell your mum to say she can't care for him. This sounds totally unsafe.

I'm in a similar situation at the moment and am just refusing to agree to discharge for a relative until a proper plan has been put in place. It's working so far.

Good luck.

He is sick every hour or so, bile and blood. He actually has a freestyle libre blood sugar sensor fitted at the mo so mum can scan him with her phone and monitor his sugars that way without disturbing him if he's sleeping.

Mum is considering whether to take him to a different hospital in a neighbouring Trust which has better reviews for this dept.

I'm so sorry to hear this. I had a similar challenge with DM although different circumstances and refused to take her home citing safeguarding as the reason.

If your DM is struggling, I'm sorry to say it, but you might have to call an ambulance to take home back to A&E and do the same. By calling safeguarding, you are placing the responsibility with the NHS and not your DM. They are far less likely to discharge without an adequate package.

Good luck. It sounds horrendous.

That's good she can record his readings, I would get her to do that now then call for an ambulance if he is still vomiting that much. The antibiotics wont be doing much good. Is he well enough to get into her car if she wants to take him to another hospital. Whereabouts are they.

Nurse here.
Just take him back and at any hint of discharge in his current state, tell them your mum is moving out temporarily to stay with you and there'll be no carer for him at home.

He's been in Gloucester Royal, wondering about going to Oxford on advice of bro in law who works there in a relevant dept.

GP here. Sorry this is happened. Everyone saying this is unsafe is right. Unfortunately (and this is a generalisation - some surgical wards are amazing), non-surgical issues like diabetes and arrythmias are not always well-managed on surgical wards. Having said that, it doesn't sound as if he should have been discharged, even without those issues.

Ring 111. If you can't get help through them, you may need to take him to A&E.

This is disgraceful. I would take him back to the same hospital because his care needs to be continued. If you go to the new hospital you'll have to start from scratch, especially if they don't have the same systems for recording blood results.

I agree about taking him to the same hospital.

Trying a different hospital wouldn't hurt. I did this when things went very bad in the hospital that were supposed to be treating me. I had tried the other ways of getting the hospital changed which was completely fruitless. Old hospital had such a bad rep the hcps assured me I was in very good hands now and I have been.

.The old hospital where completely fine with loads of blood in urine, not been able to keep anything down, and severe constipation and suggested I buy otc stuff to cope. New hospital were not at all happy with the blood etc. Once the got hold off old records they also picked up on a couple of things on scans that were not mentioned.

When I mentioned I was going to go to a different a&e during my next flare up of anything they told me it would be a waste of time as I would get transferred back to them. This didn't happen.

Pals are so overwhelmed I'm still waiting for them to contact me. I contacted them originally towards the end of 2019. I've followed up and get told someone will be in contact, but cannot give me a time scale.

New hospital also did official complaint which have since been investigated and the findings went in my favour.

Hi, @Orangeinmybluelightcup. I have PM-ed you as there is a possibility I may be able to help.

I would definitely try and get him to another hospital if you can, Gloucester Royal is awful, a family member was discharged earlier in the year, diabetic, COPD, asthmatic, the list goes on. He was still vomiting and hadn't kept food or fluid down in weeks, was very confused and couldn't walk unaided. They discharged him to his home where he lived alone and requested 3x 45 min carer visits per day. Not surprisingly he was back in in less than 48 hours.

Maybe try oxford if you feel he will be okay with the journey, he will be seen in a&e whichever hospital he goes to. If you decide on oxford I would seriously consider a complaint to the other hospital.

If mum decides on Oxford make sure she takes his discharge summary and meds with her, it might be nice if your bil can meet them there for a bit of moral support.

Update in case anyone checks back, just to say he's slowly getting better now, stayed at home, had a couple of sketchy nights but mum was fab. Think it will be a slow recovery from the diverticulitis. Still waiting for consultant to review ct scan that showed tumour on the kidney.