A&E Learning Disability

I was supporting a young person who has is on the Autistic Spectrum to attend A&E following a head injury.

The A&E consultant was fantastic and went above and beyond to make his experience as positive as possible in what was a very scary time for him.

Not only did she work with the staff supporting him to ensure that she had all of the facts she engaged him in the process and ensured that she spoke to him as she would any other patient. She was able to pick up on communication styles used by his support staff and implement them effectively through out the time that she spoke to him.

At the end of his treatment a ‘Doctor’s note’ to say how brilliant he had been was a really nice touch and meant a lot to him. Where he had previously been very scared of hospitals and Doctors in particular he is now more comfortable if he needs to access these services.

Also the people that did the CT scan were brilliant playing ‘statues’ so that he was able to understand how still he needed to be.

This was a vast improvement on previous experiences. However I would like to suggest that at least some key staff are aware of MAKATON signs for commonly used words like ‘Doctor’, ‘Nurse’, ‘pain’, ‘safe’, ‘help’…these are very simple and can be shown in picture form. This would vastly enhance the inclusion of people who have learning disabilities in their care and make it easier to anticipate what is happening to them.

Lorien

Extracorporeal shock wave lithotripsy – K2

I have to declare myself as member of staff at Cambridge University Hospitals but this in no way shapes my comments of the care I have received here and elsewhere at CUH, if anything I am more critical! This was my first visit to K2 for lithotripsy. As the lithotripsy unit is on a ward access to the unit is via an intercom and the door is released by a member of the reception team – if there were signs saying this I missed them as I tried the door first, then spotted the intercom by which time the staff member had unlocked the door. There is no clear signage in the main corridor directing you to the lithotripsy unit – just to K2. The reception team member was welcoming and checked my details – didn’t ask for an email address which should be standard as we are using a state of the art electronic patient record system and in future will use this – so we should be collecting email addresses now – after I asked they checked this was recorded – it was. I was directed to the lithotripsy unit and met by name, made me feel welcome, by an HCA who took me to a two bed room and did my assessment. I was then seen by a specialist doctor who talked me through the procedure completed the consent form and answered my questions – I had already received a helpful information pack – could the consent be sent in the pack as it is in endoscopy? – the only shortfall here was that I was not givenoffered the patient consent information sheet to read – this separate laminated sheet gets easily mislaid and is notoriously difficult to find. I saw a senior nurse after this who gave me some medications prior to the treatment and answered other questions I had. I then met the radiographer who was going to perform and monitor the treatment – a WHO pre-procedure safety check took place with the radiographer/senior nurse/doctor who checked they were performing the treatment on the correct side – a marker pen as used to mark the correct side – this was very reassuring. The radiographer explained the whole process and talked to me throughout checking I was comfortable and answering questions – this made the whole process go by quickly. I returned to the two bed room and was offered a hot drink and biscuits which were very welcome. I was checked up on frequently and was then discharged with antibiotics and advice sheets on what to do next, this included the contact number for the senior nurses should I experience difficulties. I was told to expect a further appointment in 4-6 weeks time, I got a phone call 5 days later to arrange further follow-up.To sum up the whole process was patient orientated, I felt safe and treated as an individual. My only suggestion are: signposting to lithotripsy in the main corridor and more visible information about intercom on door. Ensure patient consent information leaflet is given to patients and consider sending consent and information leaflet out with other patient information before the procedure like they do in endoscopy. Keep up the good work!

N00dles

Poor antenatal midwife care

I was seen by community midwives ego failed to alert me to the fact that my baby would be large despite my constant asking (I was massive when pregnant and gained a lot of weight). I was told that I was being silly and that my baby measured small to average. Nonetheless when I was 41 weeks pregnant another midwife saw me instead of my usual “experienced” community midwife and they recommended that I have a growth scan. On having the growth scan a week after due date I was told the baby was estimated to be 10lb by the sonographer. There was no follow up consultation as I was booked for induction 4 days later( 41+4). On arriving for my induction the baby’s size was barely mentioned the induction process began and I went home to wait for signs of labour. A few hours later they began and I was readmitted. After contracting for over 30 hours and only dilating 3cm I was told by consultants that evening that they would be breaking my waters the next morning as they wanted me to try and get some rest first. During the consultation they referred to the baby’s size for the first time and asked whether I was aware of any risks involved with having a large baby especially as I suffer from anaemia. My husband and I looked at each other confused. The doctor then told us that we would need a consultant present at the birth in case of severe blood loss and also due to baby’s size I would likely tear and had a very high chance of the baby having shoulder distosia (not sure of spelling) meaning he could deprived of oxygen during labour and could suffer a disability or even worse not make it safely into the world. This was undoubtedly the scariest moment of my life I felt so let down by my so called experienced midwife as I felt completely unprepared for this. The consultant assured me that in some cases shoulder distosia doesn’t occur but nonetheless they recommended an emergency cesarean section to avoid the risks involved. However staff stressed that I should have been alerted to baby’s size and the risks involved from much earlier in the pregnancy & that I was failed by my midwife and the staff who performed the induction. Luckily the next morning my son arrived safely following the operation. However I contracted an infection and was on antibiotics for over a month post delivery. I was sent home just 48 hours after the operation only to be readmitted a few days later. I refused another readmission a week after that. What should have been an amazing precious time with my first born was traumatic and very upsetting for all involved.

Louisa

Problems feeding my baby

I attended the baby clinic at Mexborough Health Centre in February this year. I find it ridiculous that the surgery displays breastfeeding signs when on two consecutive days I attended the baby clinic and asked for somewhere to feed my baby. After five minutes a room was found but two minutes after starting a feed I was asked to vacate the room by a nurse. The next day after my appointment I was advised to feed the baby to calm and comfort him after his immunisation injections but the room I was directed to was occupied. The nurse in that room refused to help me find an alternative room and I ended up in a cupboard. I suggest you wither designate an area for breastfeeding or remove the breastfeeding friendly sings.

Rushed553

Gynaecology nursing staff wonderful – Royal Hallamshire

I was not kept waiting by the staff at the gynaecology. The nursing staff were understanding, patient and caring. The surgeon was a human being, not a faceless magician.

I was helped to be prepared and relaxed before my operation. I would have liked to have known a little more about the procedure. Also a little more information on any ‘signs’ or symptoms I may encounter on leaving hospital would be helpful. More information on how an operation would affect my sex life and when things would get back to normal – but I never asked. I’m sure if I had, I would have been given more information.

Also a little more information on any ‘signs’ or symptoms I may encounter on leaving hospital would be helpful. More information on how an operation would affect my sex life and when things would get back to normal.

The nursing staff were wonderful, especially the staff nurses, I would like to thank all of them on F1 and the surgeon Mr Farkas. Also the anaesthetist though I cannot remember his name. All the staff in recovery were fabulous.

ANGHEL

King’s Hospital A&E (South London)

I attended A&E with a 4 day history of abdominal pain and a high fever on a Sunday evening having resisted attending earlier or at all as I thought it was food poisoning that would simply pass. I am really a firm believer in A&E being exactly that and didnt feel that my case was really an ’emergency’ but after looking online and seeing that these symptoms can be a sign of quite nasty conditions, like peritonitis, realised it was sensible to go. Also, to be honest- and I work in healthcare myself and understand the pressure the staff work under in A&E- I was anticipating a process of at least 5 hours which I felt like avoiding if possible.

The experience was so quick, really, and so efficient and almost enjoyable that I felt compelled to write and share my good experience- as people are always so quick to voice complaints and I felt this deserved positive recognition.

I was seen booked in promptly, we waited in a clean and pleasant (if that’s the word!) waiting area. A lovely and astute nurse assessed me after about 20 mins waiting and gave me some paracetamol. After another 40 mins or so I was seen by a caring and attentive doctor who (to my great relief) informed me that I had all the signs in my urine of a severe infection in the urinary tract.

He gave me some antibiotics and I walked out feeling so happy and so grateful to the staff for their professionalism and compassion, to King’s, for having a well organised and well staffed department and to the NHS for making it possible for me to have such amazing care so readily accessible and free at the point of service.

ILoveThe NHS

Care of my wife during the birth of my first child

I would like to place on record my appreciation and thanks for the care and attention shown to my wife, my newborn baby son and myself during her time under the maternity unit of Walsall Manor Hospital. Her care has been first class, from the first scan through to her discharge from the unit.

As first time parents to be, you naturally have lots of questions, and neither I or my wife were ever made to feel silly about asking them. As her pregnancy was classified as ‘high risk’, this meant that my wife had several scans, as well as fairly regular visits to consultants clinics. I was delighted about this, as it meant that both my wife and the baby were being checked regularly, and I tried to be present at as many of the ante-natal appointments as possible. All of the staff at these, from the sonographers to the nurses were great. I would particularly like to mention the sonographer Santosh, who scanned my wife twice and was very reassuring, giving us lots of useful information.

The main experience then came in early February 2013, and after my wife was experiencing reduced movements on the Friday, we visited the Maternity Triage, where my wife was monitored for around an hour. The doctor wasn’t concerned by the results, but wasn’t thrilled either, so we were asked to return the next morning.

As this was the second time at Triage for us with reduced movements, the doctors decided to go ahead and book us in for induction of the baby on the Sunday, since the pregnancy was also 4 days over full term. We duly returned on the Saturday, and my wife was then monitored again, and the readings were still a little inconclusive, so we returned that afternoon. It was at that point, after a time being further monitored, that the staff decided to admit my wife, and begin the induction process that evening, rather than waiting for the Sunday.

I went home on the evening, and had a message from my wife telling me her waters had broken of their own accord in the early hours of Sunday morning. When I arrived in the morning, she was then put back on the monitor, but it was clear that the midwives weren’t too happy with how things were progressing.

My wife was then moved quickly to a private delivery suite, and Jo, her main midwife then took over full care of my wife. Jo was absolutely amazing all day, and barely left her side. There were fairly regular visits from the midwife team leaders, who popped in from time to time to check on progress. Myself and my wife’s mother were also given tea and coffee, which I tried to offer money for, but they wouldn’t let me pay!

The baby’s heartbeat was still causing some concern, and the monitor said that the beats were quite high. Eventually, this evened out a bit, and the baby became more settled, so Jo decided to start the drip to bring on contractions. She was also able to help with a different way of monitoring the baby, attaching a monitor to the top of his head which meant that she no longer had to wear the belt monitor. This was useful to assist with the pains of contractions.

My wife was experiencing a lot of discomfort, so Jo was able to advise us of the options for pain relief, and after trying the gas and air, my wife opted for the epidural. The anaesthetist on call, Mr Qasi was promptly along once my wife had decided to go for this, and was extremely efficient in administering the procedure. The epidural was very helpful, and began to ease the pains of contractions.

A short time later, the monitor was showing that the baby’s heart rate was dipping, and this was prompting some concerns over the amount of oxygen he was getting in the womb. The doctor (Dr Morse) decided to test the baby’s levels by taking a small amount of blood from the top of his head – despite this test being quite uncomfortable, it was carried out quickly and carefully.

The test results had come back borderline, and the doctors then realised that the baby was showing some small signs of fetal distress.

A very rapid decision was then made to take my wife straight to the operating theatre for an emergency Caesarean Section. This was of course very scary for me, however after we had attended an ante-natal class a few months previously, I knew what the procedure involved.

Within seconds, there were staff swarming into the room, ensuring she was prepared for the operation. I was so impressed with the cool manner with which they went about their work, and it was clearly a well drilled set of plans, executed with superb timing. There was no longer than a 10 minute gap between us being told about the section, and my wife being wheeled away. This was naturally a very upsetting and worrying time for me, but a member of staff asked me if I was going to come in, (I said yes without hesitation!) showed me to a room and asked me to get changed into some scrubs.

It was at this point that I had my single only thing which I thought could have been handled slightly better.

Once my wife had been taken to theatre, her mother and I then had to move her bags from the delivery suite to the recovery room, where she would be brought straight after the operation. Her mother was her second birthing partner, alongside me, and was told to sit in recovery with me whilst I waited to be shown in. Just before I went in, she was unceremoniously asked to leave in case she spread infection. I can understand this, and neither of us would have wanted my wife to contract anything, however her mother was beside herself with worry for both her daughter and the baby, and maybe a small room where she could have sat outside of the recovery room would have been a better place to have asked her to go. In the event, her mother ended up outside the unit, and since I was in theatre, she had no way of knowing what was happening. This is the only thing which I would suggest could be improved, in situations where there is more than one birthing partner.

I was eventually shown into the operating theatre, and this was cleverly done so that I was unable to see behind the sheet that had been put in front of my wife’s chest. I was allowed to sit with her, and the same anaesthetist, Mr Qasi who had done the epidural, was also with us. The doctors then worked fairly quietly, as I tried my best to keep my very anxious wife calm (and myself!). All of a sudden, Mr Qasi said “moment of truth” and then about 3 seconds later, our beautiful baby boy was lifted up and shown to us over the top of the sheet. He was taken over to the far side, and then we heard him cry for the first time, which was a very special moment. Jo was then able to hand my son over to me and I held him for the first time.

She was transferred firstly to recovery, where she was given toast and a cup of tea, and kindly a little blue bobble hat for the baby that looked as if it was hand knitted. Jo then finished her shift, so we thanked her gratefully for everything. She was a marvellous comfort to us all, keeping us informed at all stages of the labour. I wish to place on record my personal thanks to her for keeping both my wife and baby safe and me calm throughout that traumatic day.

We were then transferred to the Foxglove ward at the hospital, and her post-natal care commenced, under the excellent supervision of the staff on the ward. All of the midwives who we saw were amazing, and all of the advice and support I was given as a new dad was fabulous.

It was also the small touches: helping me make up the first feed bottle; letting me stay longer over the regular visiting hours because my wife was the only person in the 4 bed room on the first night of him being born; moving her into a lovely private room with her own TV; finding me a fold out bed and letting me stay overnight in the room on the second night; checking on us regularly and making sure we were all okay.

It was all amazing, and we met so many staff, it is hard to thank them all without forgetting someone – so I will simply say that the staff on Foxglove that we met were all simply wonderful. Thank you all.

The other people I wanted to mention were the student midwives, who were always around during the days and nights we spent. As a teacher of many years, I am also a mentor of student teachers, and I know the time and effort that it takes to mentor someone and help them to become the kind of professional that you wish them to be. The mentoring and training that was evident throughout the time I was there was fabulous, and the students all seemed very clued up and knowledgeable, a clear sign of a good mentor.

I feel that teaching and hospital training programmes could have a lot to offer one another – we all mentor students towards a career in the public services, and despite the two jobs being incredibly different, there seem to be a number of ways in which the mentoring process is very similar.

I would recommend the care that we were given at Walsall Manor Hospital to anyone, and if you are having your child there any time soon, you will meet a fabulous and dedicated team of staff – you have given my family a great start to our new life. Thank you!

Shilts

My hospital stay and care

I was suffering from shortness of breath so went to A&E at East Surrey hospital as it was a Saturday. I had been going through IVF treatment and one of the complications can include blood clots so this is what the doctors suspected initially.

The A&E Dr mentioned doing a chest X-ray to check for other causes such as pneumonia which I knew was very unlikely as I had no symptoms of this. Due to the fact that I had a positive pregnancy test while in A&E, the doctor said that they could understand if I was hesitant to have an X-ray due to this and they would check with the gynaecologist what they thought.

I didn’t hear anything else about this and was then transferred to the acute medical ward where I was assessed again. The Dr then came to speak to me and explained that they would do a VQ Perfusion scan to check for the blood clot as it was less radiation than a CT scan. Unfortunately this has to be done on Monday so they would keep me in over the weekend.

The following day my symptoms worsened and I was feeling very dizzy and couldn’t walk fast without being very short of breath. I asked the nurses if the doctors would be coming for rounds and they said not normally on a Sunday. By the evening I couldn’t eat anything without getting severe indigestion and was having a lot of abdominal pain. My blood pressure was very low so the nurses called the on call Dr to examine me and they advised some IVFT and medication for gastritis.

Later on I started vomiting and the nurse said she would ask the Dr if I could have an antiemetic. A few hrs later I asked again and was told they would ask the Dr again but I still didn’t get anything. During the night my blood pressure was still low so the on call Dr was paged repeatedly by the nurses as is their protocol and eventually I heard the Dr come up to the ward. There was a heated exchange with the nurses but they did not come to examine me and apparently said they didn’t want me to have any antiemetics.

The next day I was feeling pretty awful and again waiting around all morning to see a Dr. I knew that with a pulmonary embolism I shouldn’t be getting worse and my abdominal pain was awful. At about 10. 30 the porter came to take me for an X-ray. I asked why I was having one as my understanding was I was having the special VQ Perfusion scan as I knew an X-ray wouldn’t show a blood clot. They took me to X-ray anyway and while waiting I could see signs everywhere warning about the risks of X-rays during pregnancy.

I was called in and asked the radiographer why I was having the X-ray, they said didn’t know. I was very emotional and worried about the risks during pregnancy so the radiographer paged my Dr to find out what the plan was.

I was left in a corridor to wait and eventually after not getting hold of the Dr they took me back to the ward after about an hr. Consequently I had then missed the Dr doing rounds so asked the nurse to page them to ask them to come and see me and explain what was happening. Eventually the Dr came at 3pm and explained that in order to do the scan, a chest X-ray had to be dome first. He then went on to explain the relative risks of radiation in pregnancy and once I had heard this I was reassured.

I went down to X-ray in the evening and after the radiographer had taken the X-ray they said they wee going to get the consultant to have a look. I was taken back to ward and told that they had also paged the medical on call Dr to have a look.

I obviously knew they had found something on the X-ray but as usual I knew the Dr would not be coming to speak to me until the morning.

That night I couldn’t sleep at all, as I was really struggling to breathe and was feeling so nauseous. The Dr was paged twice and came to see me in the early hours.

They explained that the reason I was struggling to breathe was due tot the fact I had lots of fluid around my lungs (pleural effusion) that needed draining but it was best to do it during the day. I am a VET and if an animal presented to me at 7pm at night with a pleural effusion we would deem that an emergency and it would be having it’s chest drained within 20 minutes of admission.

I was very concerned about this but also relived to know that there was a reason I felt so bad and hopefully I would improve soon once they drained my chest.

Anyway I didn’t have my chest drain inserted until late afternoon the next day and after looking at my chest CT scan done just before the drain was put in compared to my X-ray the night before there was quite a degree of deterioration with such a large amount of pleural effusion, one of my lungs was collapsed and everything was being pushed over to the other side.

I gradually starting improving but ended up staying in 3 weeks as the fluid kept being produced.

The rest of my stay was ok but I would see a different Dr everyday and felt that there was no communication between them so they often had different opinions on my treatment which I think ended up prolonging my stay longer than I hoped.

I will be making a formal complaint but thought I would post here as well.

Nh2489

Appalled at care following my mother’s stroke

My mother suffered a stroke in April 2013.

The initial response was fantastic, the ambulance was with us in less than 10 minutes and the paramedics confirmed by opinion she was FAST positive (I am a trained nurse). She was taken to the HASU at Charing X and we were taken straight into critical care.

Although I had known she was ambulant 90 minutes previously, as I hadn’t actually had contact with her, they refused the thrombolysis treatment. She had a CT scan, which showed nothing, and was then taken to the stroke unit.

She became very drowsy due to the brain oedema and a CT scan done on day 3 showed the lesion by then. Apart from a paralysed arm, all her other limbs are fine and she has cognition. Her care was fantastic.

Things took a turn for the worse when she was admitted to West Middlesex Hospital on day 3, late at night. On day 4 the Occupational Therapist called me and we chatted for nearly half an hour. During this time I informed her that my mother had severe hearing loss and she requested that I bring in her hearing aids. I also informed her that my mother had vascular dementia and gave her the details of who looks after this.

On day 5, I visited my mother in the afternoon. She was still very drowsy and not making eye contact, which is apparently normal for this type of stroke. I waited a long time to speak with the sister and by the time she turned up, I had to leave to get to work. I informed the staff that my mother couldn’t hear and that I had left both her hearing aids and her distance vision glasses in her locker.

Sadly due to my husband’s ill health, I was unable to visit my mother for about 10 days. When I visited again I was there for nearly 4 hours and during that time it became apparent that the ward staff had no idea that she was deaf, didn’t know she had hearing aids with her and didn’t know about her dementia.

They blamed Charing X for not providing the information, but when I explained that the OT had phoned on the day after admission and had received this information, they were astonished. They immediately gave her the hearing aids and once inserted she immediately responded to them. I believe that up to this point they thought she was badly brain damaged, even though the position of the lesion would not be expected to cause this.

During my first and subsequent visit, I examined the nursing notes and informed staff that I was concerned about her coughing. She was not on oxygen assistance when transferred and has not been oxygenated since arriving at West Mid. Her sats were being maintained above 96% on room air, which is adequate. I asked if a chest X-Ray had been performed or was planned and received a negative reply. No one seemed to take my concern seriously.

Yesterday morning I received a phone call from the stroke SpR, informing me that my mother has a chest infection [only diagnosed yesterday, some 3 weeks after admission] and that she is very poorly and now on antibiotics.

I am disgusted with the level of care she has received so far. It seems that if I can’t be there every day (I work shifts 5 days a week and have an ill husband to look after), then nothing gets done. I have informed the SpR that I am making a formal complaint to the CEO and I fully intend to bring a medical negligence case against all involved in her stroke [she had been taken off anticoagulants and BP medication] from the so-called preventative medication, right through to the post-stroke care.

They are now running around like headless chickens and hopefully she is getting the right treatment, but I shouldn’t have to kick up a fuss to get this treatment done properly. If I wasn’t a trained nurse and could spot the warning signs, heaven knows what would have happened.

jancolls