Last night I experienced my first death as a registered nurse.
I wanted to write a post about this, not because I haven't experienced death before but because I am experiencing a rather odd set of emotions about the whole thing.
The lady, who i will call Mrs H, was very unwell, she had respiratory failure and was very acidotic. The doctors, along with the family, had decided that a resuscitation attempt would be futile so a do not attempt resuscitation (DNAR) form was in place
Despite this, and the fact that she wasn't expected to survive the night, Mrs H was started on non-invasive ventilation (NIV). This always seems a misnomer to me as NIV is very invasive, ok it doesn't involve putting a tube down someone's trachea as in endotracheal intubation, but it works by forcing oxygen into the lungs under pressure then maintaining a pressure during expiration to keep the lungs inflated. Many people struggle to tolerate NiV, the mask thy has to be worn is huge and I imagine very claustrophobic. But it can be a very effective way of assisting ventilation in respiratory compromised patients.
Anyway I digress, for whatever reason the decision was made to start mrs H on NIV. And she appeared to tolerate it well, was synchronising and there had been a small improvement in her blood gases.
At about 5am, whilst sitting at the nurses station, we heard the apnoea alarm sounding. This is triggered when the NIV senses absent or inadequate respiratory attempts from the patient.
Myself, the nurse in charge and a nursing assistant immediately went to her bedside. We were joined by the on call junior doctor. There was no visible respiratory effort and we were unable to find a pulse, either radially or centrally. We quickly removed the NiV mask. Easier said than done when it is strapped on tightly (it needs an airtight seal to the face in order to be effective-so many straps/fastenings, looks like something from Star Wars)
Then we waited.....nothing. The doctor started checking for heart sounds, we all waited, holding our breath. Then suddenly a gasp, then silence.......we started the process again. Checking for signs of life. A process that never fails to seem brutal; listening for heart sounds for 1 minute, checking the pupils for a reactions.......nothing......"are we all agreed?" asks the doctor. We nod out agreement when suddenly "did you see that? Her eyelids flickered?" Says the other nurse, we all peer at Mrs H and then "sighhhh" she sighs.
By this point it's almost become comical. It seems Mrs H is determined to keep going. There we are, the four of us gathered around her bedside. Unsure what to do. So we wait.
I am holding Mrs H's hand. I'm not sure why , it felt the right thing to do.if it was me I would want a reassuring touch as I took my last breath. The minutes pass. The doctor has her stethoscope to Mrs H'a chest. She shakes her head. Nothing. No more breaths. She had gone.
I feel strange because I feel very little. We remove the cardiac monitoring pads, take down the IV and, being a slightly superstitious creature, I make sure a window is open.
We lay the bed down, arrange pillows ad tidy the blankets. It's weird, although at a glance she could be sleeping. When you look closely it's like something fundamental is missing. Like an empty shell.
We leave the bedside and I return to my paperwork. I feel sort of empty. I wonder what the procedure is for expected deaths in hospital. I consider the practicalities. I think it is maybe this that shocks me. Do I have no heart?
Mrs H was not my patient. And yet I was there at the very end. Of all the big events in a persons life, I was present for this strangers final moment.
She was a person. She was Mrs H. Someone's wife, someone's mother . And I held her hand as she took her last breath.
What a privileged position we hold.
Thursday, 22 November 2012
Tuesday, 20 November 2012
Media misconceptions
After a hilarious twitter chat last night about a major UK newspaper and its inability to print accurate stories, I started thinking about the impact of misconceptions on everyday people.
I would consider myself an everyday person, in fact on paper I'm probably now quite statistically 'normal'. Married, 2 kids, dog, cat, middle income etc etc. However, scrape the surface and I'm a walking misconception! I had legoboy at 16, since then I have gone beyond exasperation at the media stories portraying teenage mums as benefit scrounging, council house claiming, asbo rearing drains on society. Apart from a very brief period after I split from legoboys dad, I have not claimed benefits. I did live in a housing association house until I was 23 and bought my first house. Legoboy is a gem, not an asbo in sight! He is a teenager so of course he has his issues but he is more likely to be in his bedroom making Lego animations than hanging around outside tescos drinking WKD!
Legoboy came along to an award ceremony that I was part of after I was awarded an academic scholarship and will be coming along to my graduation next year. I'd like to think I've instilled in him an appreciation of the importance of education. So to blow my own trumpet, I have done a good job so far. I was young and yes there are issues with having a child while you are still a child yourself but this doesn't automatically subject my son to a life of under achievement and crime. And I know I am not an exception- I can think of many examples of young parents who are doing a brilliant job.
So, misconception number 2-being a nurse. I am newly qualified but already tired of reading stories about how, as a profession, we don't care/are too posh to wash/etc etc......
Now I know that in some cases these stories are entirely justified. There are some nurses out there who are an embarrassment to the profession. BUT, there are so many nurses/student nurses out there who care so passionately about the profession and are giving their best to those they are for. You only have to look on twitter to find pages and pages of tweets from health care professionals who are battling to provide care in sometimes impossible situations. So my message to the mass media is this-take the example of sites such as patient opinion and try to provide a more balanced view of the nursing profession. Don't tarnish us all with the same brush.
So my final gripe-diabetes. There is one particular paper who seem hell bent on publishing stories that suggest that all diabetics are obese people whose lifestyles and behaviours are entirely to blame for them developing the condition. Anyone who knows my man in uniform will know he is the polar opposite of this, and I know from talking to others that they have experienced comments from people who seem surprised at their diagnosis because they are not fat! As we had to explain to a family member after my man in uniforms diagnosis-his historic habit of having 3 sugars in his coffee is NOT the reason he developed diabetes. Being fat is not a prerequisite for your pancreas packing up!
Diet is important in blood glucose management but suggesting fad diets could prevent it occurring is insulting. Especially to those with type 1 diabetes- the onset of which is believed to be linked to a virus that causes cells within the pancreas to stop producing insulin. Misinformation is as dangerous as ignorance, so if you want a story about diabetes -particularly type 1- have a look on twitter, there are so many inspiring (and accurate) blogs written by people who live with the condition.
So to conclude my rant:
Being a teenage parent has its issues but doesn't mean you can't be a good parent.
Being a nurse doesn't mean you don't care. I care hugely, that's why I do this. Often the environment makes my job a lot harder. There are times when I come home feeling nothing short of despair because I haven't been able to nurse the way I want to. I always try my hardest. So do many others.
Being diagnosed with diabetes isn't always down to poor lifestyle choices. Type 2 diabetes does have strong links with weight and lifestyle but type 1 does not. Having 3 sugars in your coffee does not mean you brought it on yourself. It also means that you need insulin to survive. And at present Insulin can only be taken via injection (including insulin pumps). No amount of hypnosis/cheese or berry wine will change this diagnosis and whilst diet may help control blood glucose levels the insulin injections are what keep type 1 diabetics alive.
Ok, I'm done!
(This post is for all my pals in Team D, battling to correct a multitude of media misconceptions. If you are interested I would suggest going to the daily mail website and searching for diabetes/teenage parents/nurse-read the articles but also read the comments, you'll soon see why I get so wound up!)
I would consider myself an everyday person, in fact on paper I'm probably now quite statistically 'normal'. Married, 2 kids, dog, cat, middle income etc etc. However, scrape the surface and I'm a walking misconception! I had legoboy at 16, since then I have gone beyond exasperation at the media stories portraying teenage mums as benefit scrounging, council house claiming, asbo rearing drains on society. Apart from a very brief period after I split from legoboys dad, I have not claimed benefits. I did live in a housing association house until I was 23 and bought my first house. Legoboy is a gem, not an asbo in sight! He is a teenager so of course he has his issues but he is more likely to be in his bedroom making Lego animations than hanging around outside tescos drinking WKD!
Legoboy came along to an award ceremony that I was part of after I was awarded an academic scholarship and will be coming along to my graduation next year. I'd like to think I've instilled in him an appreciation of the importance of education. So to blow my own trumpet, I have done a good job so far. I was young and yes there are issues with having a child while you are still a child yourself but this doesn't automatically subject my son to a life of under achievement and crime. And I know I am not an exception- I can think of many examples of young parents who are doing a brilliant job.
So, misconception number 2-being a nurse. I am newly qualified but already tired of reading stories about how, as a profession, we don't care/are too posh to wash/etc etc......
Now I know that in some cases these stories are entirely justified. There are some nurses out there who are an embarrassment to the profession. BUT, there are so many nurses/student nurses out there who care so passionately about the profession and are giving their best to those they are for. You only have to look on twitter to find pages and pages of tweets from health care professionals who are battling to provide care in sometimes impossible situations. So my message to the mass media is this-take the example of sites such as patient opinion and try to provide a more balanced view of the nursing profession. Don't tarnish us all with the same brush.
So my final gripe-diabetes. There is one particular paper who seem hell bent on publishing stories that suggest that all diabetics are obese people whose lifestyles and behaviours are entirely to blame for them developing the condition. Anyone who knows my man in uniform will know he is the polar opposite of this, and I know from talking to others that they have experienced comments from people who seem surprised at their diagnosis because they are not fat! As we had to explain to a family member after my man in uniforms diagnosis-his historic habit of having 3 sugars in his coffee is NOT the reason he developed diabetes. Being fat is not a prerequisite for your pancreas packing up!
Diet is important in blood glucose management but suggesting fad diets could prevent it occurring is insulting. Especially to those with type 1 diabetes- the onset of which is believed to be linked to a virus that causes cells within the pancreas to stop producing insulin. Misinformation is as dangerous as ignorance, so if you want a story about diabetes -particularly type 1- have a look on twitter, there are so many inspiring (and accurate) blogs written by people who live with the condition.
So to conclude my rant:
Being a teenage parent has its issues but doesn't mean you can't be a good parent.
Being a nurse doesn't mean you don't care. I care hugely, that's why I do this. Often the environment makes my job a lot harder. There are times when I come home feeling nothing short of despair because I haven't been able to nurse the way I want to. I always try my hardest. So do many others.
Being diagnosed with diabetes isn't always down to poor lifestyle choices. Type 2 diabetes does have strong links with weight and lifestyle but type 1 does not. Having 3 sugars in your coffee does not mean you brought it on yourself. It also means that you need insulin to survive. And at present Insulin can only be taken via injection (including insulin pumps). No amount of hypnosis/cheese or berry wine will change this diagnosis and whilst diet may help control blood glucose levels the insulin injections are what keep type 1 diabetics alive.
Ok, I'm done!
(This post is for all my pals in Team D, battling to correct a multitude of media misconceptions. If you are interested I would suggest going to the daily mail website and searching for diabetes/teenage parents/nurse-read the articles but also read the comments, you'll soon see why I get so wound up!)
Monday, 12 November 2012
My life with diabetes.
Friday the 30th December 2011. D-Day for my family. The day that diabetes became a part of our family consciousness.
Until that day diabetes was always just something that a patient might have. Something that meant doing a little finger prick test before dinner and maybe calling someone else to deal with medications. I had never cared for a patient with a diabetic complication as the reason for their admission so it was always something that patients had alongside whatever ailment had brought them into hospital.
It seems bizarre now, looking back, that neither of us seriously considered diabetes being the cause of man in uniforms unwellness ( yes I know that's not an actual word!). Despite him having all the classic symptoms of high blood glucose levels: extreme thirst, frequent urination, nausea, abdominal pain, cramps etc. we joked about diabetes but neither of us seriously thought that was the cause of all this (I thought it was a peptic ulcer). On our Christmas Day (the 28th- belated Xmas due to shift work!) he became so unwell he finally conceded and arranged a trip to the doctor.
I can still remember the phone call now, he called from the surgery telling me the GP thought it was diabetes, he was referred immediately to the diabetes centre at our local hospital. When he got home from the doctors grief and horror were written all over his face. I remember trying to reassure him, a stupid flippant comment about how it could be worse.
I can't fault the care given by the diabetic consultant nurse hi saw him, I still have issues with the fact that he was sent home without any further investigation. I guess the hospital were busy and because, on face value, he appeared less unwell than he actually was.
It later emerged he was, at the very least ketotic if not in full diabetic ketoacidosis. The consultant later told us that had the full extent of his condition been realised he would probably of been admitted to high dependency. I still have issues with the decisions made by the medics but as my husband keeps telling me; no harm no foul.
The months following his diagnosis have been hard. He has had long periods of sickness. For someone who always has to be busy this has been a nightmare. He has been stripped of his operational duties because of concerns over type 1's driving on blue lights (another story altogether) and at one point had his car licence suspended as he had lost his hypo warning signs.
I can only imagine what all this has done to him, he is someone who defines himself by his career. It has almost been like a bereavement. We have certainly been through many of the stages of grief: anger, denial, bargaining.
It has obviously been hard for him, why I didn't anticipate was the impact it would have on the rest of us. My daughter, then age 4, was terrified when he first started injecting. E had to make it into a game for her-picking which finger to test from etc.
I am still trying to get my head round it. I have stopped "nagging", I have been told that I don't understand. He's right of course, I dot understand. It's not me it's happened too.
That said, it's unfair to think it doesn't effect me. I joke about a future where I will become his carer because he has lost a leg or gone blind or had a stroke. The truth is the future scares me. Sometimes his attitude towards his management infuriates me. Because it doesn't just effect him. We are a team and its OUR future that will change because of this. I don't want to end up his carer nor do I want to be alone prematurely.
I feel stuck because there is no one I can talk about this too. I don't want to seem negative and morbid but I am scared. I thinks it partly explains my enthusiasm for following all the amazing and inspiring diabetics there are on twitter. It reassures me that life goes on and there are others out there. Now if I could just find some T1 +1's I'd be well away! (Seriously-if anyone can point me in the direction of a support group for panicking partners I'd much appreciate it!).
I hope whoever reads this takes it as it was written-me baring my feelings about this whole thing. I know it could be worse and I am grateful that I am still able to hug/talk to/argue with my man in uniform. The above thoughts are my deepest, darkest fears. And this blog has been my debrief. So thank you for hearing me out. X
Until that day diabetes was always just something that a patient might have. Something that meant doing a little finger prick test before dinner and maybe calling someone else to deal with medications. I had never cared for a patient with a diabetic complication as the reason for their admission so it was always something that patients had alongside whatever ailment had brought them into hospital.
It seems bizarre now, looking back, that neither of us seriously considered diabetes being the cause of man in uniforms unwellness ( yes I know that's not an actual word!). Despite him having all the classic symptoms of high blood glucose levels: extreme thirst, frequent urination, nausea, abdominal pain, cramps etc. we joked about diabetes but neither of us seriously thought that was the cause of all this (I thought it was a peptic ulcer). On our Christmas Day (the 28th- belated Xmas due to shift work!) he became so unwell he finally conceded and arranged a trip to the doctor.
I can still remember the phone call now, he called from the surgery telling me the GP thought it was diabetes, he was referred immediately to the diabetes centre at our local hospital. When he got home from the doctors grief and horror were written all over his face. I remember trying to reassure him, a stupid flippant comment about how it could be worse.
I can't fault the care given by the diabetic consultant nurse hi saw him, I still have issues with the fact that he was sent home without any further investigation. I guess the hospital were busy and because, on face value, he appeared less unwell than he actually was.
It later emerged he was, at the very least ketotic if not in full diabetic ketoacidosis. The consultant later told us that had the full extent of his condition been realised he would probably of been admitted to high dependency. I still have issues with the decisions made by the medics but as my husband keeps telling me; no harm no foul.
The months following his diagnosis have been hard. He has had long periods of sickness. For someone who always has to be busy this has been a nightmare. He has been stripped of his operational duties because of concerns over type 1's driving on blue lights (another story altogether) and at one point had his car licence suspended as he had lost his hypo warning signs.
I can only imagine what all this has done to him, he is someone who defines himself by his career. It has almost been like a bereavement. We have certainly been through many of the stages of grief: anger, denial, bargaining.
It has obviously been hard for him, why I didn't anticipate was the impact it would have on the rest of us. My daughter, then age 4, was terrified when he first started injecting. E had to make it into a game for her-picking which finger to test from etc.
I am still trying to get my head round it. I have stopped "nagging", I have been told that I don't understand. He's right of course, I dot understand. It's not me it's happened too.
That said, it's unfair to think it doesn't effect me. I joke about a future where I will become his carer because he has lost a leg or gone blind or had a stroke. The truth is the future scares me. Sometimes his attitude towards his management infuriates me. Because it doesn't just effect him. We are a team and its OUR future that will change because of this. I don't want to end up his carer nor do I want to be alone prematurely.
I feel stuck because there is no one I can talk about this too. I don't want to seem negative and morbid but I am scared. I thinks it partly explains my enthusiasm for following all the amazing and inspiring diabetics there are on twitter. It reassures me that life goes on and there are others out there. Now if I could just find some T1 +1's I'd be well away! (Seriously-if anyone can point me in the direction of a support group for panicking partners I'd much appreciate it!).
I hope whoever reads this takes it as it was written-me baring my feelings about this whole thing. I know it could be worse and I am grateful that I am still able to hug/talk to/argue with my man in uniform. The above thoughts are my deepest, darkest fears. And this blog has been my debrief. So thank you for hearing me out. X
Thursday, 8 November 2012
My plan to save the earth!
PAPERWORK.
I had an epiphany the other night at work and I think I've figured out a big cause of global deforestation. I blame the NHS. I wonder if there has been any research into the number of tree's sacrificed to the incessant need for documentation within healthcare? I would place money on it being A LOT, many many trees being cut down so we can duplicate patient information multiple times.
I have to confess that the "paperwork" issue I have is not based entirely on my concern for the environment. Having sat down and given some thought to the things that stress me out the most, paperwork tops the list by a long way.
As a newly qualified nurse, undertaking nursing interventions takes me longer than it would an experienced nurse. I don't have a problem with this. I appreciate that I am inexperienced and I need to follow processes, as i gain experience and confidence I am fairly certain it will take me less time to catheterise or to undertake a drugs round. The problem I have is the huge amount of paperwork I have to complete for everything I do. Don't get me wrong, I understand the principle of "if it isn't written down it didn't happen" and I'm as keen as the next healthcare professional to protect my own backside. But when a lot of the work i do is a duplication of information already gathered or it takes me away from being able to care because i have to sit at the desk to trawl through multiple sets of notes, i get stressed.
In order to explain myself I am going to give you a patient scenario, this is not an extreme case, rather this is the norm in regards to the written work that needs to be undertaken during a patient journey.
Meet Mrs Jones, she is an entirely fictional 75 year old female. She lives in her own home and has the district nurses visiting 3 times a week to dress a leg ulcer (thats 1 set of paperwork), she also has twice daily carers (thats the 2nd set of paperwork). She has multiple health issues including COPD for which she has home oxygen and is under the care of the hospital specialist respiratory team (3rd set of paperwork).
One evening her carer visits and finds Mrs Jones very short of breath, naturally the carer calls for an ambulance. Unfortunately, because an effective alert system is not in place, the ambulance crew are not aware of Mrs Jones's oxygen requirements. Luckily they are competent and experienced and treat her according to their knowledge on oxygen therapy for patients with COPD. The carer puts Mrs Jones community nursing notes into her hospital bag and off she goes to the local A and E department.
On arrival the ambulance crew complete their paperwork and hand over the the A and E staff (4th set of paperwork), the staff in A and E complete set of paperwork number 5. All this is gathered together and taken, with Mrs Jones, to the medical assessment unit.
Once admitted to the assessment unit, the nurses complete the admission paperwork. On the unit I work in this comprises, initially, of 2 booklets (one is 4 sides of A4, the other is 8 sides of A4) and a cardex (1 sheet of A4), the doctors then also complete their paperwork (not sure how many pages the clerking notes are but id guess its at least 8). So thats the 5th and 6th sets of paperwork.
On top of this, she may also need documentation of any cannula's put in, a stool chart, fluid balance, catheter, falls assessment, turn chart and wound assessment. There is a new drug chart (which doesn't necessarily take into account any drugs given my the ambulance crew or in A and E - for this you would need to check that specific paperwork.) and if she is on insulin or warfarin there are seperate drug charts for these too.
The nursing notes are kept in one place, the doctors notes in another. Observations such as blood pressure/heart rate etc are computerised so must be accessed via a tablet or main computer. We also have an admission folder where the admission paperwork is kept.
All this for one patient! Now, I am not in any way suggesting that any one of these documents is not important. BUT, i have frequently wondered why we need to duplicate the same information, sometimes up to 4 times. Why cant the doctor/nurse notes be combined, why does poor Mrs Jones have to be subjected to multiple rounds of questioning and examination?
In fact, heres a totally radical idea....why cant we introduce a system where by the patients information travels with them. It can be updated by any member of the healthcare team. This might be in the form of one "booklet" that is started in A and E and is added to, as appropriate, throughout the patients journey.
Or maybe we could go paperless.
I had a short placement in my second year on the intensive care unit. They are entirely paperless. The team add notes as and when required, this means that the doctor can see what the nurse has written, the nurse, if not at the ward round, could see what the continuing plan for the patient is (without having to rummage through mounds of paperwork - which in my experience is almost always elsewhere - normally the doctors office!). The dietician can access it, as can the OT, the physiotherapist, the pharmacist. It is all kept in one place and contains all the information about that patient. From the drug chart through to fluid balance and back to observations etc etc etc.
AND......this could even be extended into pre-hospital and community care too. So that the district nursing notes can be seen by the ward nurse who now needs to redress Mrs Jones's leg, the district nurses can be alerted that Mrs Jones wont need a visit tomorrow because she is in hospital. The ambulance crew could access information about her oxygen therapy and the assessment unit nurse can quickly see which drugs the ambulance crew gave so she doesn't give them again.
I know that people have issues with paperless systems. And I agree that they are not fail-safe. However, from my experience within Ambulance control, I know that with correct procedures in place systems failures can be managed without detrimental affect to patients. Going "onto paper" in the control room always came with a certain amount of panic but the calls were still answered and ambulances still sent.
Im sure that there are many arguments around the best way to manage patient information and every option will have its positives and negatives. For me though, the pressure to complete paperwork will, i think, always taint my experience of nursing because it puts me at a desk rather than at the bedside.
I had an epiphany the other night at work and I think I've figured out a big cause of global deforestation. I blame the NHS. I wonder if there has been any research into the number of tree's sacrificed to the incessant need for documentation within healthcare? I would place money on it being A LOT, many many trees being cut down so we can duplicate patient information multiple times.
I have to confess that the "paperwork" issue I have is not based entirely on my concern for the environment. Having sat down and given some thought to the things that stress me out the most, paperwork tops the list by a long way.
As a newly qualified nurse, undertaking nursing interventions takes me longer than it would an experienced nurse. I don't have a problem with this. I appreciate that I am inexperienced and I need to follow processes, as i gain experience and confidence I am fairly certain it will take me less time to catheterise or to undertake a drugs round. The problem I have is the huge amount of paperwork I have to complete for everything I do. Don't get me wrong, I understand the principle of "if it isn't written down it didn't happen" and I'm as keen as the next healthcare professional to protect my own backside. But when a lot of the work i do is a duplication of information already gathered or it takes me away from being able to care because i have to sit at the desk to trawl through multiple sets of notes, i get stressed.
In order to explain myself I am going to give you a patient scenario, this is not an extreme case, rather this is the norm in regards to the written work that needs to be undertaken during a patient journey.
Meet Mrs Jones, she is an entirely fictional 75 year old female. She lives in her own home and has the district nurses visiting 3 times a week to dress a leg ulcer (thats 1 set of paperwork), she also has twice daily carers (thats the 2nd set of paperwork). She has multiple health issues including COPD for which she has home oxygen and is under the care of the hospital specialist respiratory team (3rd set of paperwork).
One evening her carer visits and finds Mrs Jones very short of breath, naturally the carer calls for an ambulance. Unfortunately, because an effective alert system is not in place, the ambulance crew are not aware of Mrs Jones's oxygen requirements. Luckily they are competent and experienced and treat her according to their knowledge on oxygen therapy for patients with COPD. The carer puts Mrs Jones community nursing notes into her hospital bag and off she goes to the local A and E department.
On arrival the ambulance crew complete their paperwork and hand over the the A and E staff (4th set of paperwork), the staff in A and E complete set of paperwork number 5. All this is gathered together and taken, with Mrs Jones, to the medical assessment unit.
Once admitted to the assessment unit, the nurses complete the admission paperwork. On the unit I work in this comprises, initially, of 2 booklets (one is 4 sides of A4, the other is 8 sides of A4) and a cardex (1 sheet of A4), the doctors then also complete their paperwork (not sure how many pages the clerking notes are but id guess its at least 8). So thats the 5th and 6th sets of paperwork.
On top of this, she may also need documentation of any cannula's put in, a stool chart, fluid balance, catheter, falls assessment, turn chart and wound assessment. There is a new drug chart (which doesn't necessarily take into account any drugs given my the ambulance crew or in A and E - for this you would need to check that specific paperwork.) and if she is on insulin or warfarin there are seperate drug charts for these too.
The nursing notes are kept in one place, the doctors notes in another. Observations such as blood pressure/heart rate etc are computerised so must be accessed via a tablet or main computer. We also have an admission folder where the admission paperwork is kept.
All this for one patient! Now, I am not in any way suggesting that any one of these documents is not important. BUT, i have frequently wondered why we need to duplicate the same information, sometimes up to 4 times. Why cant the doctor/nurse notes be combined, why does poor Mrs Jones have to be subjected to multiple rounds of questioning and examination?
In fact, heres a totally radical idea....why cant we introduce a system where by the patients information travels with them. It can be updated by any member of the healthcare team. This might be in the form of one "booklet" that is started in A and E and is added to, as appropriate, throughout the patients journey.
Or maybe we could go paperless.
I had a short placement in my second year on the intensive care unit. They are entirely paperless. The team add notes as and when required, this means that the doctor can see what the nurse has written, the nurse, if not at the ward round, could see what the continuing plan for the patient is (without having to rummage through mounds of paperwork - which in my experience is almost always elsewhere - normally the doctors office!). The dietician can access it, as can the OT, the physiotherapist, the pharmacist. It is all kept in one place and contains all the information about that patient. From the drug chart through to fluid balance and back to observations etc etc etc.
AND......this could even be extended into pre-hospital and community care too. So that the district nursing notes can be seen by the ward nurse who now needs to redress Mrs Jones's leg, the district nurses can be alerted that Mrs Jones wont need a visit tomorrow because she is in hospital. The ambulance crew could access information about her oxygen therapy and the assessment unit nurse can quickly see which drugs the ambulance crew gave so she doesn't give them again.
I know that people have issues with paperless systems. And I agree that they are not fail-safe. However, from my experience within Ambulance control, I know that with correct procedures in place systems failures can be managed without detrimental affect to patients. Going "onto paper" in the control room always came with a certain amount of panic but the calls were still answered and ambulances still sent.
Im sure that there are many arguments around the best way to manage patient information and every option will have its positives and negatives. For me though, the pressure to complete paperwork will, i think, always taint my experience of nursing because it puts me at a desk rather than at the bedside.
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