standard of care

[zaffie]

Hi

Advice any one.

Mum in hospital 8 weeks. Long story but eventually meningioma removed from spine. Now bed bound not making progress. Has a really nasty grade 3 pressure ulcer

Am really concerned that there are not enough staff on ward to care for her

Have approached PALS will try and meet with consultant. we do not feel involved in the care making decisions.

She is not turned 4 hourly no turn chart etc etc

Is there guidelines on how many trained staff should be on a stroke ward all with high dependency needs?

I do feel sorry for staff who are run off their feet but it does not help my mum

Zaffie

[miziwizzi]

sorry to hear of your mums problems., as you have already guessed the shortage of staff is a problem all over and even when numbers are 100% the type of ward your mums on is very hectic as you have seen.

 

 

Is you mum on a pressure matress?, this is something you need to ensure she has in the first instance.

 

I am sure someone who has more experience than me will offer some guidance (im a student nurse)

 

good luck

[poppynurse]

I'm sorry to hear about your mum.

 

Where I work we have a minimum 6 staff (not all trained) on a morning and 4 in the afternoon, 3 at night, for 28 beds - note I say minimum, staffing is usually better than this but this is the absolute minimum. This does not include OT physio etc.

 

I am ashamed of the profession if she has developed a grade 3 ulcer in hospital - did she have an ulcer on admission? Mizziwizzi is right when she says that mum should be on a pressure relieving mattress - if she is there will be an electrical box on the end of the bed controlling airflow in and out of the mattress, if the hospital has insufficient stock they can hire one in. This reduces the risk of pressure area damage but mum will still need turning 3-4 hourly. If I was involved in her care I would have started a turn chart at the first sign of skin damage - to provide evidence that we had been turning her in case a complaint came in!

 

Is mum getting rehab - ie being assessed and treated by physio and occupational therapists to maximise her recovery?

 

You have every right to be involved in her care - I would phone the consultants secretary and arange an appointment to see the consultant. I would also ask for an appointment with the ward manager to raise your concerns. Ask for clarification of the care plan, the potential for recovery and long-term prognosis - ie is it likely that mum will be bed bound/wheelchair bound/walk etc. At some point there should be an MDT (multi disciplinary meeting) - ask if you can attend. When she is medically stable there may be a case conference to plan for discharge - you can attend that.

 

If you are not getting a positive response from the ward staff you can go to the matron.

 

Hope things soon get sorted.

If I can help further let me know.

[zaffie]

Hi

Thanks for replies. Mum was mobile no pressure ulcers before she was admitted. Pressure ulcer now grade 4/5 being assessed for surgical debridement.

On pressure relieving mattress no physio or OT. Have met with matron and raised concerns and still she is not being turned consistently every 3-4 hours.

Matron is meant to be organising meet with consultant. Have already attended one MDT before her surgery. Was not very satisfactory they only talked about nursing home.

Feel this is going to become an official complaint sooner rather than later.

Feel that they have failed in their duty of care. Very upset at mo mum is fading away before my eyes

 

Regards

 

Zaffie

[poppynurse]

Right - the matron will have a secretary - phone and ask if the meet with the consultant has been arranged, if not phone the consultants sec yourself.

 

You need to ask why no physio/OT - is there no rehab potential? Had mum beeb formally assessed by phys/OT.

 

Get PALS involved - poor communication is at the core of many complaints, it appears to me (although obviously I don't have all the facts) that poor communication is the major issue here, along with the pressure damage. You need clear guidance from the team looking after mum as to prognosis and potential for rehab to enable you to have realistic expectaions regarding her potential for recovery and future abilities.

 

Start rattling their cages - and I would definately be making a formal complaint about the pressure damage - it can be avoided in most instances, although some patients refuse to be turned, some roll straight back onto the back following turning - if this is the case with your mum it should be clearly documented in her notes BUT action should be taken by nursing staff to minimise the risks - at the very least I would expect regular turns and a turn chart.