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Small mercies

A woman sits up in her hospital bed. Pain has started to flash through her, and she knows she needs to take painkillers quickly, before it gets any worse. She knows which painkillers, too. She summons the nurse with the alarm cord.

After a couple of minutes, the nurse comes in – the woman asks for the medication by name. It’s highly potent, so it’s locked in the secure cabinet in the corner of the room. The nurse hasn’t got the key, so she disappears.

Five minutes pass. Ten minutes pass. The pain’s getting worse. The woman’s visitor heads out to find the nurse. She’s in the nurse’s room with two others. They’ve been short-staffed, she says, and there was another urgent need to deal with. He explains, nicely, that the woman needs her painkillers really soon and another nurse says she’ll be straight to it. He returns.

Five more minutes pass – the nurse enters, with a small plastic cup containing a crushed powder. It’s the wrong medication. The woman is very polite, and doesn’t like waste. She says she might want that one later, could it be kept in the room, perhaps in the locked cupboard?

The nurse doesn’t think much of that idea. The cup isn’t labelled, she says, and it could be mistaken for something else. Better to throw it away. Fair enough. She unlocks the cupboard and gets the right medication.

When the nurse leaves, the woman tells her visitor that this happens all the time. All. The. Time. Forgetting, mistakes, the nurses unable to keep track of precisely what they were doing, and passing Chinese whispers between each other resulting in mix-ups. What about the patients who haven’t got their marbles, the woman asks. They’ll get the wrong medication, won’t they? He has to conclude that yes, they will.

Trying to detach from the immediacy of the situation, he ponders the information issues involved. He’s spent much of his life trying to fathom really big questions of information flow – of process, of databases, of systems and service design. But at this very minor, almost trivial level, lie questions at least as complex.

Should the nurses have a standard way to record sundry requests? A note-passing system when handing on the request to a colleague? Nothing had been written down in this simple case of requesting medication – and the message “get some pain relief” had been passed on with a vagueness that resulted in an entirely different product being fetched (and wasted).

Could a handheld device help to capture a request and send an alert if it wasn’t completed after a certain period of time? How much training, and support, and expenditure would it take to make anything like this happen?

He knew from bitter experience that even the simplest support tools would end up getting very pricey, even just in terms of time taken and complexity added to a role. And whatever else was used to make things better, all solutions would be reliant to a large extent on willingness, attitude and memory.

Were these just crap nurses? He doubted it somehow. They were busy. They were surrounded by seriously ill patients with many differing needs. They had to prioritise. Although hugely significant to this patient, this may have been a very minor and unimportant request in the grander scheme.

He was reminded a little of restaurant service – forgetting sauce for a steak, perhaps. You might have a word with the maitre d’, or not leave a tip, or eat somewhere else next time – but none of these really had analogues in this hospital. He wondered if it would have happened in a private hospital. He wondered how much the nurses really cared. He thought dark thoughts indeed. The frustration, the waste, the pain.

No drama though – no letters to the Trust, no official complaints, certainly no raised voices or threats. Just a bit of wasted medicine, a heart-rending sense of frustration, and quite a lot of avoidable pain.

Life goes on.

—————

Update: Mum died just over a fortnight later. Without pain. More about that here.

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3 Responses

  1. Tim Lloyd says:

    This is powerful stuff Paul. We’ve been thinking a lot about information issues in connection with the Department of Health’s Information Strategy. But reading stories like this one puts the objectives into sharp focus.

  2. […] Small mercies – honestlyreal No drama though – no letters to the Trust, no official complaints, certainly no raised voices or threats. Just a bit of wasted medicine, a heart-rending sense of frustration, and quite a lot of avoidable pain.Life goes on. […]

  3. This is very hard reading… I feel like hugs are in order.
    It’s also a great illustration of the difference between local impact (“If I only could tell a handheld thing that Mrs. Bloggs needs pain meds”) and an NHS-wide change (the training, distribution, new processes that you describe…)

    Also, I think, designing health care services is a tricky business. Might there be a better way to organise the nurses’ communications? Possibly. (But it obviously isn’t a trivial thing, since nurses have had several hundred years of working out good systems. And they’re pretty clever people.) And then: can you sort it out while still caring for someone you love? Possibly not. There are only so many hours in the day. And also: isn’t what you want (what we all want) to have 100% of everyone’s time and attention on your patient? But then how do we deal with everyone else in that hospital, who also need a certain amount of care?

    It’s messy. And emotional. And further complicated by the fact that “success” might be a happy patient. It might be a discharged patient. And it might be a cured/treated patient. But those three outcomes might be completely unrelated to each other. So how do we balance all three?

    Anyway, I think these thoughts too, when I’m in an NHS building. I look at the patients and think “Is this working for you? Are you getting what you need?” And to the staff, “Are you able to do your job well? Are there processes or circumstances that get in the way?”

    It makes me grateful I still have a lot of my career ahead of me. It’s important, what they do. If we can free them up at all to be better at their jobs, then — that is a GOOD thing. Time well spent.

    But it’s a very big topic.

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