Shared Stories

Story 1:

Relationship: Family

My Story: Elderly family member (88 yr) residing in my home for 3 years. He entered local large hospital facility from ER to the intermediate care unit for 5 days and then onto regular room for 1 day and then dismissed. (DX Liver abscess) No discharge planner contacted me until 1 day prior to discharge from hospital. Luckily, as a healthcare worker/caregiver I knew the "ropes". He was not going to return home this time and no one had asked if this was the case. I visited rehab centers, assisted living centers and nursing homes during his stay to find a bed (which is difficult to find in this city overnight). Arrangements had to made and not just the day prior to discharge. Secondly, the home meds, digoxin, cardizem, actos and htcz were neglected to be continued until after I brought this to their attention 3-4 days into the stay. Third, there was no physician contact with the family except on the weekend (change of hospitalist) and the patient has dementia. Fourth, I asked them to observe his lung status as he was not deep breathing due to the pain level. He was kept an extra day at the end needing breathing treatments. Fortunately, I arranged the rehab stay directly after discharge, the assisted living facility bed, and stayed on top of the nurses about communication and medications. Now, he is in retirement facility and I arranged home health and physical therapy for strengthening. Has had 3 falls since discharge from hospital.

My Experience Was: Negative

What could have been done to improve situation: 1. Communication between the nurses and family/patient. 2. Collaboration between disciplines and family. 3. Review of medication profile with physicians/nurses and look into discrepancies 4. Discharge planning begun with family included (not just patient). As my family member thought he was returning home and was safe. He had a history of falls and fire dangers when left alone all day. (most frequently had fallen when I was at work, fractured his arm, broke his glasses when tripping over a garden hose, also had forgotten he had left something cooking in the oven until another family member arrived). Physicians and nurses in a busy facility do not know all of this history as the patient is pushed through the system so quickly. Patient comes off as being alert and oriented upon initial assessments and the cognitive deficits are really not picked up. 5. Case managers need to meet at least with the family/and patient early on to look at proper arrangements which need to be met to keep these patients safe after discharge. As a home health nurse myself I have to mention an example of improper discharge planning from the hospital. The patient was sent home with a new G tube and a pump and we were to teach the family, however upon arrival no one had bothered to ask if the patient had electricity. (patient already in the home with the pump).

Story 2:

Relationship: Family

My Story:My daughter was released from a hospital 4 weeks after suffering an internal decapitation - a very rare injury to survive. She had occipital-cervical fusion and suffers severe nerve damage. She can't swallow, talk, and her eyes are crossed so her vision is messed up. She has seen a primary care doctor 2 times and had a spine evaluation. In 5 weeks - no other care! Can't get her into Rehab (uninsured), Denver Health refused to see her (no money). She is on stomach feedings. She absolutely needs rehab but we can't get it for her. She is still in a halo. No one has yet tested her nerves. We don't know if they are permanently damaged or not, but rehab would help. She is still in a critical time of recovery and we can't get help! No one is addressing the numbness in her right leg and no CT's have been taken of her lower back. She can't even swallow her own saliva! She does walk, has no brain damage, and is fully prepared to fight for everything!

My Experience Was: Negative

What could have been done to improve situation: She could have received more rehab in the hospital, nerve testing, better pain medication, more thorough care overall. Note that she was in a hospital in Nebraska, not Denver. They released her to me to drive her home by myself in my personal vehicle, and gave no instructions as to her care to me. They gave care instructions to her, so since she has paralyzed vocal chords, it was hard to communicate to me in the 500 mile car ride home what needs she had. She should be seen by a speech therapist, physical therapist, neurologist, and nutritionist. We have no money, so no one will see us.

Story 3:

Relationship: Self

My Story: I was working Sunday night in the ER when a patient came in short of breath. He had just gotten out of the hospital 2 days earlier (Friday afternoon). He produced a hospital discharge sheet, hand written and sloppy, outlining his medical regimen given to him by the hospitalist. This conflicted with the pristine medicine sheet that his trusted family doctor had given him the week before his hospitalization. He planned on checking with his family doc that Monday to determine the best route to go in regards to his medicine. I asked him which list was he using through the weekend. He explained to me that he wasn't using either as I wrote his admission orders for this now hypertensive patient with an exacerbatiion of his congestive heart failure due to "noncompliance" with his medicines.

My Experience Was: Negative

What could have been done to improve situation: The experience was certainly negative for the patient. I wondered that if the person who was discharging this patient had stated, "I know that this medicine list given to you by DR X in the hospital is different than the one given to you by Dr Y, your family doctor, but we want you to take the meds as outlined on your sheet here until you see Dr Y. He may adjust your medicines at that time. If you have any questions through the weekend, please call me at this number. Do you have any questions before you go home today in regards to your medicines or your discharge?" This would have been a very cost effective, though crucial, conversation, eh?