Chemical Cosh

My memory is poor, but I'm sure that, when I was a nurse, the NMC had it as a condition of being the sort of nurse who gives drugs to people that the aforementioned nurse understand what a drug does and what it's side effects are.

It's 3am in the morning and I'm miles out of my area on the FRU*. I have been sent, as a blue light response, to a nursing home where one of their 'clients' is sleeping.

Yep – sleeping.

I get there and the patient is in the reception area of the home sitting in a wheelchair. He is… asleep.

The 'nurses' at the home tell me that normally he is very active at night and often comes to see the night nurses and sits chatting with them. He's ninety-eight years old and mildly demented.

I bite my tongue and do all the checks that I can to make sure that there isn't anything obviously medical going on. All his observations are fine and he responds somewhat when I try to wake him. I'm sure that if I provided enough pain stimulus I could fully wake him up, but it would just seem cruel.

I look at the patient's drug chart. Two days ago he was prescribed a rather strong sleeping pill.

I ponder, for about 2 milliseconds, if this might be the cause for his sleeping. At 3am in the morning.

I suggest this to the nurse.

She shrugs.

The staff don't say anything, but I get the distinct impression that they have been getting tired of this patient being awake while they are at work. If all your patients are sleeping then the night shift has little to do. If this patient has been awake, then they actually have to talk to him. In a lot of the nursing homes that I've been to the nursing staff don't like talking to the patients.

In a fair few nursing homes that I've been to the staff and the patients rarely share a language, and so everyone just 'gives up'. As a digression, the good nursing homes that I've been to have been those where the staff and patients do talk to each other, and the care of the patients is considered to be more of a 'partnership'.

The nurses, who I suspect have got exactly what they asked for, aren't happy. They've already rung the elderly relative of our patient (at 3am!) to let her know that he is heading into hospital.

The ambulance crew arrive and I have a real problem explaining to them why we have been called.

“The nurses wanted this patient to sleep at night. They have given him a sleeping pill, and now he's asleep”, doesn't really seem reasonable for a trip to the hospital.

But the 'customer' is always right – and so the patient is driven off to the hospital.

I talk to the crew a few days later and they tell me that the receiving nurse at the hospital was as befuddled as the rest of us.

I don't know, jobs like this make me despair at the general intelligence of people, not less the intelligence of the sorts of people who look after the elderly.

Oh well, at least one of us had a bit of a kip that night.

*I really need to tell you about FREDA one day – perhaps a joint post with Nee Naw.


I'd like to apologise, blogging has been a bit slow of late. Mostly this is due to working on the sequel to 'Blood, Sweat and Tea' – I'm needing to put some concentrated effort into it. this is not easy with twelve hour shifts accompanied by the utter lack of energy I have at this time of the year.

Medgadget are running their annual Medical Blog Awards – you should go over there and have a look at the nominees, there are some really good ones there. Also there is no other motive for suggesting you visit the link. No. None at all…

27 thoughts on “Chemical Cosh”

  1. Well I went to Medgadget…….all I can see is another load of stuff to fuel my addiction to medical blogs………….anyone in particular I was supposed to vote for?*whistles innocently and runs away*

  2. As for me, I noticed there was one bloke who had loads more votes than anyone else, so I figure he doesn't really need the help 😉

  3. My grandmother has been on the receiving end of this. She has medium-to-advanced Alzheimer's, and chose to go into care about a year ago. As a very mentally-alert woman for the majority of her life, we (and her, when she is able to make such decisions) have always felt it very important that she not be sedated in any way. As a nurse herself during her working years, being permanently sedated had always been one of her deepest fears.My father visited her recently and noted that she seemed a lot more reserved and nowhere near as 'with it' or active. He asked a nurse if there had been any problems, and after considerable discussion amongst the medical staff they eventually produced a more senior nurse who stated that some drowsiness was to be expected, given the medication she was on.

    Further queries eventually resulted in the production of her file, which showed she had been put on a medium-dose sedative. Right underneath her admission notes that specifically stated no sedatives should be used. No one could explain why she'd been put on this medication, how long they intended to keep her on it, or anything else.

    To be fair, some of the staff looked genuinely embarrassed and uncomfortable about the situation, but most gave the impression this was just par for the course. Needless to say, we are now looking for somewhere else as a matter of some urgency, but it's hardly an ideal solution. Do none of the staff here expect to grow old? How do they hope to be treated?

    Good luck with the awards!

  4. Surely if someone says that they don't want to be sedated but are given sedatives anyway then an assault's been committed?

  5. any news on the competition Tom, even if it doesn't get published under the suggested names it would be nice to see a list of entries ::hint::Sage

  6. Hi Tom. I've been a lurker for quite some time & firstly would like to compliment you on your superb writing. You really have a talent & I'm delighted we can share in it. As a “colleague” (tech currently doing para training) in a neighbouring trust ,I really felt compelled to post a response to your blog entry.The 'customer' is NOT always right or know what's going on and that's what makes us the medical professionals and them the people phoning 999. It is a clinical decision to be made by the attending crew as to what the most appropriate course of treatment is and what alternative care pathway, if any, could be used. In this case, as you yourself said, hospitalisation is not indicated, nor appropriate. The patient is stable with no associated respiratory depression (as a result of sedation) or presenting with ANY symptoms causing concern, so why did he still go to hospital?

    We have Non conveyance forms and more importantly the knowledge to be able to decide what happens to this patient. I strongly doubt that it's only our trust that has the autonomy of practice to be able to make the decision to leave someone at home and it's exactly because of cases like this that the government is now proposing to give additional incentives to the trusts when an alternate, and specifically more appropriate alternate care pathway is used, rather than just carting everyone off to A&E.

    In my opinion you should have stood your ground, educated the 'nurses' in the care home that the patient was stable in every sense of the word, completed a non conveyance form (medical model style) and possible referral to GP for medication review if they were that concerned that the dose m

  7. In the LAS, it is a bit 'dodgy' to leave people at home, even if there is nothing wrong with them if they *want* to go to hospital then we can't really refuse.The nurses *wanted* him to go to hospital and while I tried persuading them otherwise, they wouldn't hear otherwise. Remember – they are *supposedly* better trained than me…

    …of course it helps that I used to be a nurse myself.

    So yes, while we can try alternate care pathways – it's only with the agreement of the patient/carer.

    (And I think that part of this comes down to the 'culture' of the LAS).

  8. I've noticed that you bloggers who work for the LAS have a tendency to take people to hospital if they want to, even if their reasons seem a bit dodgy and often wondered about it-I didn't like to ask in case someone thought I was criticising, but obviously you guys have your instructions. I work for South Western and feel happy to tell people that they don't need to go to hospital. In fact I went to a similar job though not in a nursing home, in warden controlled flats, where the warden called us when a patient who had been given strong sleeping pills that day mysteriously fell asleep at about 11pm.Of course I should possibly not like to find out how supportive my trust would be if the patients I leave at home should deteriate, but they do tend to be jobs like “I scratched my finger on a beer can”. Plus given the journey time to hospital (can be around an hour) control are often please when the ambulance clears ready to be sent to another classy job!

  9. Maybe this will cheer you up…a drunk who had fallen over, the only medical history was erectile dysfunction; when I meant to say, “if you phone nhs direct, they can lead you in the right direction for self help [he refused hospital treatment-good boy!] I said: “if you phone nhs direct, they can lead you in the right erection…[trailed off with an embarrased look]”, I wander where my mind was at that point! I was so embarrased! Lol!

    Hope you find some more good nursing homes soon!!

    xx

  10. Sometimes accidental- elderly couple, he administered her medication. He came round to the surgery one day complaining that she was asleep all day and was weeing all night….

  11. Unfortunately Tom it appears to me you've become confused with your terminology.You have used the term 'nursing staff' for some (and I mean some but not all) staff in these nursing homes. A lot of these staff should be referred to as staff because they have no compassion nor caring attitude for the patients in their care.

    I too have attended these sorts of homes and wondered why on earth these people are in the job that they are in. They don't like nor do they even try and talk to the elderley patients in their care.

    I worked in a care home for the elderley some years ago and some of the stories I got told and the conversations I had were really interesting and quite amusing.

  12. As a community paramedic on a FRV I go to all sorts of jobs and unless it is known to be viable arrest or an entrapment RTC I'm not backed up unless I ask for it. If I believe there is nothing wrong they stay at home . I refer people to OOH GP or other care pathways as needed.

  13. I'm a first year student nurse. I've worked as an HCA/SHCA previously. My university is pushing words like 'client' and 'service user'. I have to admit they get stuck in my throat. What happened to just calling them 'patients'?

  14. I agree. The term “service user” is stupid. It also encourages social workers and CSCI inspectors to ask you to do more and more stupid things. Their latest is that you have to get the 'service user' involved in the preparation of their care plan. When I went in to get Mr B involved in the preparation of his care plan I got a crack round the ribs with a walking stick and a bottle of pee thrown at me. I can only be thankful that he isn't a very good shot. Next time the CSCI inspector wants to get Mr B involved in preparing anything he can bloody well do it himself.Incidentally the nurse on duty at the home mentioned is obviously crap and probably guilty of institutional abuse because no resident (and I refuse to use the term 'service user') should ever be sedated for the convenience of the staff. The night staff may not like having a chatty resident sat with them while they are trying to research Britney Spears latest personality crisis in Heat magazine but it is what they are paid for and if they don't like it, tough.

  15. The Nurses I work with dont even notice I refuse to use the term. The university however have started marking down assignments which avoid using the term.I used to work in an EMI home as a senior healthcare assistant. Some of the practise I saw there was almost enough to stop me pursuing a career in healthcare. The only nurse who acknowledged the residents were even people was a veteran A&E nurse.

  16. I agree, but it's a question of proving there wasn't a sudden medical need, i.e that she was / wasn't presenting an immediate danger to herself or others. Proving that someone with Alzheimers had the capacity to refuse treatment is tricky.Plus add to this the fact that she is still under the care of these same people until we can find somewhere better, and we're not exactly in a position to make the waves we'd like. We're terribly unhappy about this, but proof is everything…

  17. Although I'm in IT, I trained as a nurse (in Scotland) and worked for 15 years in various hospitals. I could write a book with all my anecdotes. Maybe I should 🙂 It's a pleasure to be one of your new readers.

  18. Oh my word! I laughed my way through this post with complete bewilderment. How anxious the nursing staff must have been to have a heavily medicated patient be asleep in the early hours of the morning! How outrageously abnormal! How on earth can they have imagined this warranted calling an ambulance?!There are some very strange folk out there, that's for sure.

    Becky.

  19. Disgusting, I honestly hope those nurses end up in a similar home and get treated the same. And with medical advances, this will last a LOT longer! A fitting end to revolting human beings.

  20. “Client” and “service user” indicates in spin-doctor speak that any person you have to deal with is an informed, educated, and able partner in the choices you make.I see myself as a “client” at my hairdresser and a “service user” of my ISP, for example, both services where I am empowered to walk away if they go wrong…. and spin-doctors rely on the one example meaning all of them, in the mind of the public.

    Great if it all goes well, and they are what they are described as.

    Grounds for either blaming the victim in cases of abuse, or (as bad) blaming the nurse in cases where they aren't.

    And I have to add, that if I was floored overnight with a leg that swelled to 3x its size, crippling abdominal pains, delirium, and shitting blood, I'm neither a client nor a service user, I am a PATIENT and I need not services, not “client choices” – but medical help asap.

    You think?

  21. Following forms being brought out for safety & welfare of children my Trust now have forms for Vulnerable Adults. It's taken a long time to come in to effect. Sadly, too late for a lady we suspected of not being treated well a while back but they do exist.I have yet to comprehend why people chose to work within a caring profession (nursing, ambulancing, doctoring etc) when they blatantly don't give a fig for anyone but themselves. They make me sick.

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