boy dies after calling 999 from ward

[ohdobuckup]

I just cannot believe this appalling story, can't link but it was in most papers and headlined in Daily Mail.

Inquest being held into the case of a young man who appears to have suffered severe neglect at Tooting hospital, with 'lazy' nurses and indifferent doctors allowing him to die of thirst because he was confused following major operation.The poor sod even dialled 999 to get help, police arrived but were ushered off the ward

How the fuck has nursing become such a corrupted profession?
I am an ex-nurse, mostly Mental Health, and not that ancient either, and whilst not claiming any perfection on my part, and have had lapses of judgement and bad days too, I am truly appalled by this one.

Any other nurses/exes seen this?

I heard the mother of that poor boy on the radio this morning. So sad.

I am a nurse. I spend more time maintaining paper and computer records than actually seeing patients.

My current gripe at work is that some of the most vulnerable, unsupported patients are placed under the care of non nursing/unqualified colleagues because they need more time, therefore it is cheaper. I am trying to change it, but if course, the only answer would be for me to do yet more unpaid overtime to take on this work on top of everything else I am already doing.

Could the paperwork realistically be cut?

In my local hospital, any request to change a lightbulb has to go through six people before it reaches the person whose job it is to do that. So patients can be left waiting for several days for use of their bedside light.

Examples like that make me wonder about how much more efficient the NHS systems could be if they brought back matrons and gave them both responsibility and control.

My observation of hosp procedure in the US was that nurses handed over notes to admin staff staffing the computers at the nursing station. Admin were paid a lot less than nurses, though well-trained specifically in medical record keeping, and nursing salaries were pretty good in the hosp where four of the DCs were born (I knew nurses who worked there). Building maintenance was a separate role for a separate department, with emergency requests wrt malfunctioning equipment, lightbulbs, etc., again handled through the admin workers after a nod from the nurses or whoever else observed a problem. It seems to me to be a really foolish squandering of nurses' training to have them filling in records or doing admin.

math - that sounds reasonable but clearly nurses do need to complete the records and have access to the records - how does the system you describe work, exactly? Nurses take the obs then give them to an admin person to write up?

mathanxiety, do you mean that the nurses handed over written patient notes which were put into an electronic system by the admin team?

TBH I do think the clinical notes are a vital tool and that they need to be written up by the person who did the action. But a good ward clerk is vital, and I think notes systems should be looked at often to prune off bits of paperwork.

Agreed, Joan, but note-taking has become so onerous it's taking up time that should be devoted to actual care. My sister's a nurse who often has to stay an hour or two after her shift to finish the notes, amongst other things, because she refused to neglect patients in order to write the notes while they need her.

Nurses would complete the obs, and there was the usual chart for each patient available for each nurse and doctor to review and add to while doing rounds. A standardised obs form for each patient was also filled out and given to the medical admin team for input upon finishing the round. Doctors did the same. Nurses and doctors all had access both to the chart at the end of the bed and to the computers (available computers dedicated to the medical and nursing staff were positioned at the station so nobody had to share computers with the admin staff). There was talk of having it all computerised somewhere down the line.

The impetus behind the standardisation of notes and the professionalisation of medical recordkeepers separate from nursing staff was the existence of multiple private insurers demanding both fewer lawsuits for substandard care due to overburdened nurses, and also standardised, coded treatment narratives for the bean counters which was sent to the billing department. The admin staff provided both language the medics could access and language for the billing dept and insurance companies.

Ah, so they needed the dedicated admin staff to get money out of the insurance companies. In a privatized system, that makes sense. Sadly the current heath reforms will probably increase transaction costs and administrative burdens in the NHS for similar reasons.

Yes I'd agree in a costed system there is much more incentive to streamline recordkeeping - such as bedside barcode readers so that every swab, glove etc used can be recorded as it is used (this is from an LA hospital about 20 years ago). Not a very pleasant thought but actually provides a good backup to clinical records at relatively minimal time investment.

Some UK wards are hotbeds of electronic record-keeping but it tends to be layered on top of paper records with a concurrent explosion in time required and reduction in safety.

I do think the NHS should be far more robust in defending EFFECTIVE employment of non-clinical staff, which would be easier to do if it were done effectively.

They also needed the dedicated nursing staff to give better care for the patients and keep insurance premiums at bay for the hospital and doctors. The winners were the patients who got better nursing care no matter what the motivation.

I remember those same bedside barcode thingies now you mention them Joanofarchitrave, and from about the same time period. They provided information on costs to the hospital admin and to the insurance companies.

I used 'dedicated' re. the admin staff to mean they were clearly focused on that particular role - dedicated in relation to nurses usually means something else!

Math, you may be right about that particular hospital, but it varies hugely. Kaiser Permanante and, IIRC, the Veteran's Health Administration are held up as models of good practice, other providers/insurers are far more variable. Good, joined-up patient care is sadly not always the aim, especially when the financial incentives are to carry out as many investigations and procedures as possible to rack up charges or to keep costs down by not doing stuff that might be helpful. VHA is in some ways a mini-NHS for veterans - and often resented by extreme right-wingers for being quite good. (Used to be terrible and but has been turned around.)

I thought so Edam, and I also used the term dedicated for the nurses to indicate the same sense -- they were not half nurses and half administrators.

The VA is probably one of the worst examples a health system in the US and is held up as an example of how state run healthcare doesn't work. Unfortunately there is some truth behind its reputation both from the pov of medical professionalism and the bureaucratic angle. The VA has dealt very poorly with mental health issues of vets since Vietnam, with patients often misdiagnosed and mis-medicated as well as underdiagnosed and not given adequate or appropriate pharmaceutical treatment, or therapy. A former BIL of mine did the psychiatry part of his medical training in a very poor example of a VA hospital and saw many patients who had been saddled with serious and inaccurate diagnoses for years -- paranoid schizophrenia and the like.

The idea that american hospitals and doctors order tests willy nilly in order to make a profit is one that is bandied about a lot. However, they all operate within a system where second parties are paying for these tests, and the procedures resulting from these tests are also being paid for by second parties, and the decisions about treatment are being made in a lot of cases by those insurance companies and not primarily by the doctors, with everyone going by standard procedures to a large extent (standards of care manuals for each specialty are compiled via research, practice, and stats). The party that pays the piper calls the tune. There are limits to the profit that can be made.

Kaiser Permanente is an entire insurance and hospital-health system rolled into one iirc (I may be mistaken on this), and it is not without its detractors, especially for its gatekeeper practices (which are similar to having to get a referral from a GP to a specialist in the UK) -- Americans like to pick up the phone and make their own appointments with ear, nose and throat docs, internists, neurosurgeons, etc., and few would use the services of a GP except for cases of the flu. Most hospitals are independent and deal with numerous different insurance companies as well as the state medical coverage for the state they are in.

NHS Direct was originally inspired by Kaiser Permanente.

I think it was interesting seeing Crash the film in that a strand of it was Matt Dillon trying to get treatment for his dad from the latter's HMO and running up against bureaucratic indifference. Very recognisable in this country and does explain why a change to a single payer system which might be more efficient in overall costs and would provide for a greater number, but would mean more rich people experiencing that bureaucracy, was never going to be a runner in the US.

Math, how recent is the stuff you are talking about wrt the VHA? My understanding is that it was quite poor but is now one of the best. Certainly according to the organisations that work to promote quality in healthcare (the Health Foundation, the King's Fund and so on).

Kaiser is indeed all rolled into one. I can see the gatekeeper system would be culturally uncomfortable for Americans who are used to seeing specialists direct. However, that comes with its own problems, as people will tend to see a problem from the perspective of their own turf, and will miss things that aren't within their own remit. And of course people aren't just hearts or knees or hips or lungs. You can argue it both ways, that it's good to have a GP to be at the centre and have a long-term relationship with the patient (although how true that is for most people these days is a moot point in the UK - dunno how Denmark is doing) or that it's good to be able to see a specialist straight away.

The thing that is clear is that the US health system overall is hugely expensive and has shockingly bad outcomes. If you want something other than the NHS, look at other Western European countries, look at Canada or Australia, but the US would be the very last place to go for either high quality healthcare or cost-effective care, I'm afraid.

Problems at Walter Reed detailed here.

VA and Gulf War syndrome discussed here.

Questions about VA attitude to PTSD in the aftermath of the fairly recent killing of Afghan civilians by Staff Sgt. Robert Bales.

Suicide in the US Army - article.

Repercussions of untreated issues related to active duty.

General Accounting Office (GAO) paper on issues surrounding diagnosis and care of traumatic brain injury, bureaucratic and medical.
'In recent years, problems have been identified with DOD and VA efforts to coordinate care for this population; manage their transition from DOD to VA care; screen, diagnose, and treat TBI and PTSD; and share medical records between the two departments.'...
...'While VA took action to screen for traumatic brain injury (TBI) of all Operation Enduring Freedom and Operation Iraqi Freedom veterans seeking care at VA facilities, GAO found that the TBI screening tool that VA was using had not been evaluated for its clinical validity and reliability in identifying veterans at risk for TBI. As a result, VA does not know how effective the TBI screening tool is in identifying veterans who are or are not at risk for TBI and whether the TBI screening tool would yield consistent results if administered to the same veteran more than once.'

Veterans remain as a group more likely than the general population to be homeless, chronically unemployed and/or substance abusers once they finish active duty. While still in the service, they are more likely to be involved in the crime of domestic abuse, abusing both spouses and children at a rate higher than the general population. I think all of that points to a failure on the part of the VA to deal with emotional and psychological issues among armed forces personnel, and also with substance abuse issues and possibly brain injury problems.

I personally have experience of a GP in the US who adopted the whole person approach as opposed to a more clinical/scientific one. He ended up 'diagnosing' me as an alcoholic in denial, based as he put it, on my 'ethnicity' (everyone knows the Irish are a race of drunks ). I had gone to him to get a referral to a surgeon, having had horrible abdominal pain with vomiting episodes for months, and having been urged to seek a referral by my exFIL, who was a neurosurgeon. exFIL correctly diagnosed gallstones based on my symptoms and family history. The GP took a blood sample for liver function tests and took about half an hour to go over a very detailed family and personal medical history, including lots of questions about the age I had first started drinking as it turned out I didn't drink until it was legal in Ireland so age 18, but since it's 21 in the US this GP apparently thought I had gone off to university and become a binge drinker anyhooo, he decided I had given myself an ulcer from drinking and interpreted the anomalous liver function results as cirrhosis. I had to call a surgeon myself and get an appointment after exFIL made inquiries and found one with a good reputation.

That being said, in general, I think you are right about US healthcare and I can't understand why the issue of single payer healthcare couldn't ignite the American public in a positive way, most of whom don't have shares in the health insurance companies. In particular I don't know why the Republican party is so set against any hint of 'socialised medicine', since the current system where businesses are obliged to fund health insurance hobbles American business significantly, and especially small business. American businesses under the present setup are competing against businesses that are receiving a huge subsidy from individual governments that provide universal healthcare. Money that American businesses must earmark for employee health insurance can't be used for investment or expansion while their competition doesn't face this expense.

Mind you, Americans seem to think higher taxes for the rich is anathema too. It's a strange place.

??? WTF.. don't doctors and nurses know that irrational behaviour and aggression are symptoms of dehydration? ?? mental. I hate to say this, but I think all those associated with his care should be made to get near to dehydration and then filmed when they get angry and 'irrational' as a training exercise.

bloody idiots.

Under an American system my DP would be dead or our lives would be totally destroyed. I have a friend in the states with a severely disabled daughter and she frequently goes hungry to buy basic supplies like nappies. They live in a trailer and all their money goes on gas to get to the hospital 240 miles away. While there, my friend has to sleep in the car, sometimes for weeks.

So it's not really that great for poor people. Which is most people.

Worried - you'd think, wouldn't you? It should be blindingly obvious to a doctor or nurse that aggression and irritability can be a symptom, not a lifestyle choice, fgs. Similar problems often affect patients with learning disabilities - healthcare professionals sometimes ignore symptoms that in anyone else would be immediately regarded as signifying pain, for instance.

Maths, your links look interesting, will check them out when I have more time.

Going back to the original case, I hope the management at George's are made to be accountable for this poor man's death, as well as the staff immediately involved. Some of them should be up on manslaughter charges.

This is a shocking story but sadly not unique

www.onmedica.com/newsarticle.aspx?id=f2361b5e-6778-4ca6-a72a-066cbf5ee913

Around 12,000 people are dying needlessly every year in acute hospitals in England, suggests a data analysis published online in BMJ Quality and Safety.

reading this story is terrible. It seems like the nurses think they are always doing you a favour if they even bother to look after your relative and you have to be permanently grateful for them doing their job effectively.

I am sure there are some lovely caring nurses out there but this lot in St Georges are a disgrace.

It's not just the nurses who fucked up here -although they were the worst offenders. Reading the accounts every day in the Standard, the doctors played their part -writing ambiguous instructions, not informing the team that looked after his diabetes insipidus that he was in the hospital even though they knew damn well they should have done.

Worst nurse's evidence was in the Standard on Friday - she didn't know what diabetes insipidus was so she didn't bother to write it down and apparently she can't be expected to write everything down. So other nurses caring for him didn't have a clue. Incompetent, irresponsible, negligent cow.

She "didn't know what diabetes insipidus was so didn't bother to write it down"???? WTAF?? I hope she has been whatever-the-nursing-equivalent-of-struck off is - how fucking ignorant! If you come across something you don't understand fucking look it up! Don't just ignore it until your patient dies - Argh!

And as for not writing everything down, er yes, that's exactly what is expected of her. Lazy awful woman.

(Excuse my extreme swearing there, sorry, took me right back to my hospital lab days when we would phone through results to some couldn't-care-less-sounding SHO who wouldn't even bother to write them down, even though they might be life-threatening)

The summary from the inquest evidence is appalling, I just hope that people are held properly to account for this (no apologies for a DM link, it's a useful summary)

SIMON BRIDLE: Consultant orthopaedic surgeon in charge of his care who failed to monitor him.

When Mr Gorny became agitated, Bridle sent a more junior doctor rather than attending himself.

He then failed to follow up the incident or check on his patient?s welfare.

ADELA TAACA: Nurse in charge of his care the night before he died.

She failed to give him vital medication or carry out important observations because she did not want to wake him in case he became aggressive.

Taaca also ?forgot? to tell a doctor to check his high sodium levels, despite them being the highest she had ever encountered.

She was demoted to a healthcare assistant and is being investigated by the Nursing and Midwifery Council.

PHILIP STOTT: Surgeon who operated on Mr Gorny but failed to read his medical notes.

He arranged for the patient to be sedated, removed his drip and then left without linking his behaviour to his medical condition.

Instead, Stott asked Miss Cronin whether Mr Gorny was on drugs.

He told the hearing: ?I didn?t follow it up. I should have done but I didn?t . . . I just went home.?

VICTORIA AGUNLOYE: Locum junior doctor who dismissed the concerns of Mr Gorny?s mother moments before his death.

She said she knew Mr Gorny was suffering from a rare condition called diabetes insipidus, but failed to link this to his behaviour.

She claimed she did not check on the patient when his mother asked her to on the morning of his death because he was not her patient.

SHARON GIBBS: Nurse who failed to monitor Mr Gorny?s fluid levels after he was sedated.

She admitted she had not recorded that his drip had been taken out and lost track of his water output, leaving boxes on his fluid balance chart empty.

She also failed to link his aggressive behaviour to the fact he had not been given his medication, despite knowing about his condition.

ERLINDA EDWARDS: Nurse who carried out pre-operative checks on Mr Gorny but failed to highlight his condition to other staff.

She also neglected to detail his medication and the fact that he suffered from diabetes insipidus on a ?communication? sheet.

This meant other medical staff were unaware of his condition as none of them wanted to read through his substantial medical records.

DR KONSTANTINOS KARRAS: On-call doctor who was told by a nurse that Mr Gorny had very high sodium levels and was asked to attend, but failed to do so.

He also failed to pass the concern on to the night on-call doctor.

He blamed the target-driven culture for preventing him from seeing Mr Gorny.

POORIA HOSSEINI: Junior locum doctor who failed to investigate the real cause of Mr Gorny?s behaviour shortly before he was sedated.

He said that this was because Mr Gorny was Agunloye?s patient.

She said he was Dr Hosseini?s patient.

He left for the evening without chasing up the blood test results which may have provided an explanation for Mr Gorny?s behaviour.

www.dailymail.co.uk/news/article-2172642/Kane-Gorny-Coroner-blames-incompetence-NHS-staff-patient-dies-dehydration.html#ixzz20boDP4Pn