Please help am at my wits end!

[masjntt]

Hi Im looking for some advice and apologies in advance as this is going to be very long!

My dad was admitted to hospital via his GP after complaining of back pains and breathing probs {prior to this my dad has a long history of strokes, hip pain following a hip replacement, broken back from car crash when in his teens, COPD and a rheumatic disorder requiring daily steroids}

On admittence he had blood taken and tested and numerous back x rays, they suspected a blood clot on his lungs and kept him in overnight and gave blood thinning injection to burst clot. The following day he was scanned, no evidence of a clot so he was discharged and given pain relief.

Three days later the back pains became more severe and he was admitted to hospital, he was told now a suspected partically collapsed lung was sent to discharge unit for discharge the following day. The pains increased and breathing more difficult, he could barely stand or move so they advised against discharge and transferred him back to consultant who had seen him at previous admittence. Despite asking, pleading and begging for effective pain relief it took 5 days, a complaint to the hospital manager and literally shouting at on call doctor to prescribe morphine. A bone scan was then performed and the results indicate osteoporosis but show fractures in his back and his rib cage has collapsed and become dislodged. We were promised a visit from pain team and an MRI scan. Four days on and nothing has happened.

I spoke to consultants secretary who said would get back to me with update, I rang the MRI dept and queried whether my dad was even on a list, I was told there is no list for inpatients, they were aware that he needs a scan but have to slot inpatients in during their lunch breaks or if a patient fails to show for an apt, therefore unable to give a timescale. The pain team said they were short staffed and did not know when someone could get to see my dad. Finally consultants secretary got back to me and told me basically what I had already found out.

My dad has been in hosp for nearly 2 weeks now, in chronic pain and not of the best pain management drugs, he is literally just taking medication whilst he is waiting. I ve suggested paying for private treatment but he is worried about the costs and in too much pain to go through being pulled / moved around.

I feel I ve spoken to everyone possible, have had other annoying issues but too many to detail, my question is what else can I do to get my dad the pain relief he needs and get this scan done asap, the pain is making him feel suicidal.

Sorry for long post but thought it best to explain in full
Thanks x

[poppynurse]

Bless you it sounds like a nightmare for your dad. If the pain team cannot attend there is nothing to stop your dad's consultant prescribing adequate pain relief - I am amazed that staff have allowed this pain to continue.

I would try several things - speak to the ward manager/sister/nurse-in-charge and point out the amount of pain dad is in, ask her what pain relief he is on and ask her to chase the drs for alternatives. If you don't get her support consider making a formal complaint - ask to see the Matron.

Ask to see the consultant - they can make an appointment to see you on the ward and ask him the same questions. They may be reluctant to prescribe morphine due to the COPD as it can depress respiration but this needs to be carefully assessed and decisions made as to whether the potential risk outweighs the benefits.

If the pain team are not available ask if an anaesthetic opinion on pain relief methods has been sought, or a macmillan nurse specialist opinion (usually associated with cancer but very skilled at controlling pain and other symptoms).

Try and have a look at his drug chart and see what he is on, and what is prescribed on the 'as required' sheet (and what has actually been given) - PM me with this info if you can get it (I work with a pain nurse specialist and she may be able to make suggestions although obviously limited as she doesn't know your dad and his history).

The MRI scan wait is obviously frustrating but I suspect it will not change his management and I personally would be focussing on getting the pain relief he needs and is entitled to. At the minimum he should be on regular paracetamol, possibly regular non-steroidals with something like oromorph for 'breakthrough' pain.

[masjntt]

Thank you poppynurse

I contacted the consultants secretary and left a message outlining my concerns, due to my work I could not attend the ward rounds this morning to see the doctor but the consultant himself actually telephoned me this afternoon and told me he had increased all of my dads pain relief medication this morning and had chased the pain team again!!

Also possibly due to my nagging lol my dad was finally taken for his MRI later yest afternoon so am just waiting for the scan results to be read and fed back to us.

I think the problem we have with the pain is that my dad is being treated on a respiratory ward and perhaps the nursing staff are not fully up on pain relief medication, well thats my theory anyhow. The staff however did call on call docs but nobody seemed to grasp what to do re the pain, it was all very frustrating and even now Im not convienced the medication which he is on will be completely suitable but time will tell I guess.

So we have had some progression overnight and hope that the results from the scan are with us tomorrow. I ll see how my dad is pain wise tonight and if he still uncomfortable i'll pm you {poppynurse} with his medication details etc to see if your colleague can offer any suggestions etc}

Really Appreciate Your Help
Thanks x

[poppynurse]

How's it going?

[masjntt]

Hiya

The MRI results confirm fractures in spine and near rib cage due to osteoporosis. They have suggested cementing surgery to repair fractures which should relieve the pain but the person who will be performing this is away and cannot do it until 22nd May, coincidently my dads birthday. Until then my dad is to remain on his pain relief and has been discharged on his pain medication until his operation.

He is still in considerable pain but prefers to be at home because he feels he can sleep / rest better and he lives in a bungalow so everything on one level.

Pain relief wise he is taking 400mg gabapectin 3 times a day, 50mg slow release morphine twice a day and oramorph every 2 hours {think its 750ml} as well as paracetamol.

So guess its just a case of getting through the next few days until the surgery and fingers crossed there will be some breakthrough afterwards for the pain.

Thanks x

[poppynurse]

I'm pleased it's getting sorted. Sounds like he's on a reasonable regime. If he is still getting pain get the GP to increase the MST (slow release morphine) and make sure he's on something to prevent constipation - morphine constipates really quickly!

[masjntt]

Yes fingers crossed lol !! He is on laxatives for the constipation but thanks for tip about asking GP to increase MST, wasnt aware could do that so thank u x

[crazyadi]

Originally Posted by masjntt

Also possibly due to my nagging lol my dad was finally taken for his MRI later yest afternoon so am just waiting for the scan results to be read and fed back to us.

it had nothing to do with your nagging! it was due to the fact a slot became available!! the sooner people realise the NHS is not a bottomless pit the better! they are short staffed, there is only limited amount or eqiuptment, there may only be one or two people in the pain team and they may be tied up at the local hospice where people are DYING!!

that said there is NO excuse for someone being left in pain!! however they are not going to chuck pain killer after pain killer at a patient without knowing whats causing the pain for certain, that could make things worse!

everyones relative is the most important person to them, and rightly so! but everyones relative can not be the priority that HAS to be clinical need.

[masjntt]

Sorry Crazyadi but I have to disagree on a couple of points,

We were told 4 days before the scan took place that my dad was a priority and each day we were told hopefully it would be done that day but it never happened. I took it upon myself to telephone the MRI dept within the hospital who informed me that they were not short staffed, the procedure for inpatients requiring an MRI was to "slot them in" during lunch hours or if an outpatient cancelled or failed to turn up for their booked scan!!
After speaking to the MRI unit directly I then telephoned the consultants secretarry who was caring for my dad to express my concerns about the mri waiting process, lack of pain relief given to my dad. Miraculously enough within minutes of my call being returned from the secretary {after her speaking with the consultant} my dad had his pain relief changed and was taken for his mri scan. My telephone calls were done on the advice of our family GP who advised me what to say / request etc and also advised me that if we were "ignored" again then we had a case to make a formal complaint to the hospital manager, so i really think it was a case of my persistance that got things moving along.

I appreciate that the NHS are understaffed and have equipment shortages etc but in the hospital concerned the lack of communication between staff and departments etc seemed to be the main issue, we arent unreasonable people but to be readmitted into hospital for the second time in four days with the same complaint is not very good to begin with,but to then be left for days on "paracetamol" pain relief despite a suspected fracture of the back is totally unacceptable. My dad was cared for on a respiratiory ward so is it any wonder the staff could not appreciate the intensity of the pain when the condition was suspected and later confirmed as orthopaedic related!!

The pain team did have people off sick and I also understand how that can impact on work loads etc but the wait was simply ridiculous. As for not chucking pain killer after another until diagnosis, according to the staff they needed the MRI to diagnose therefore meaning until someone failed to show for an outpatient MRI scan my dad was supposed to suffer in horrific pain with inadequate pain relief ............simply NOT good enough.Sorry!!

I also acknowledge that my dad shouldnt be a priority over everbody else and that things can take time but two weeks, two admittances, no tests and inadequate pain relief is disgusting, had the hospital been able to perform the scan and prescribe adequate pain relief my dad could have been discharged several days before he actually was and free up a bed.

Instead he was left to suffer. I am appalled at the level of care he received and so was our GP, in fact on the day of discharge the hospital staff "forgot" to remove a cannula from his arm and three days before his discharge a nurse accidently gave him an overdose of his pain relief medication and gave him a triple dose!

Im sure not every NHS hospital has experiences as bad as this but I found everything a real eye opener and I am very very reluctant for myself or my family to be admitted to this hospital in the future. That said the majority of the nursing staff were excellent but quite simply the system is all wrong, there is a lack of communication, patients were not listened to and all of these issues need addressing!

Since his discharge he is under care of GP until his surgery {at a diff hosp} his GP has been more that happy to increse his morphine pain relief on two occassions without any of the hassle which we experienced at the hospital.!!

Rant over !!

[crazyadi]

as i said the fact your father was left in pain is not acceptable, it should not happen and in the interim of waiting for specialist input from the pain team etc then suitable other alternatives could have been given, however and i know it is sad but to get total pain relief when a definitive diagnosis had not been made is sometimes not possible! and for the right reasons.

i can assure you all hospitals up and down the country have the same problems, most if not all have the same procedures for mri/ct scans in that inpatients are rarely booked in for scans and the ward is simply phoned and told to send a patient down, obviously it is different if the procedure requires prep. much as you would like to believe that your nagging, your words, hastened the scan i truly believe it did not and it was pure coincidence that the scan followed shortly after your phone call, one thing departments tend not to do is respond to nagging by pushing people further up the list. its a waiting game sad but true!
i am sure hospital staff would like nothing better then to be able to offer scans etc the second it was needed but it cant happen. indeed the national guidelines for patients with suspected strokes say that they should have a ct scan in the 1st 24 hours of admission! i hazard a guess that it happens in less than 50% of cases.

AS i have said i think the lack of pain control was not acceptable however the incident regarding the scan happens day in day out and with no disrespect it happens to people who desperately need that scan and can make the difference between life and death! im not suggesting it is ok however it is a fact.

incidently people get discharged from hospital all the time and readmitted a few days later again im not saying its ok but it happens the staff dont have crystal balls and dont know whats going to happen 2 days down the line! i heard a saying once that your not a proper cardiologist until you have told someone they have a perfectly healthy heart and that patient drops dead on the way out of the door. no one knows what happens from one minute to the next.