Tuesday, 21 October 2008

Having a good moan

Grace lives alone in an isolated house that looks as if it was last modified around the end of the last war. She is ninety one and off with the fairies most of the time but she copes with four visits a day from us and a monthly overnight visit from her son who lives in Nottingham.
This morning Andrea went as usual to help Grace wash, dress and have breakfast. Grace may be getting forgetful but she knows what she likes and every morning she puts away bacon eggs and toast washed down with a pint of tea, food is one of the few pleasures left to her and she always tucks into breakfast with gusto. Things were very much as normal as Grace made inroads into her fry up - then Andrea went to get the medication - and discovered that Grace had taken three days worth before Andrea had got there. Now I am not a medic, but I know that three days worth of heart and blood pressure medication is unlikely to be a good thing, especially for a frail ninety one year old.
I rang the doctor and the poisons centre and the general consensus was that Grace should be taken to hospital and was likely to be extremely unwell, Grace, meanwhile was onto her second slice of toast and was about as inclined to agree to go to hospital as she was to part with the last of her bacon. I have every admiration for the ambulance service, in nearly thirty years I have only known them anything less than lovely on one occasion and today they lived up to my estimation. They arrived within the hour, even though the call was not an emergency one and they did their best to charm Grace into a ride to hospital. It looked as if they were going to be successful but, once in the ambulance Grace had a change of heart, conveying this fact by punching the ambulanceman right on the nose when he bent over to reason with her. Stalemate. The crew were reluctant to leave her but had no power to force her to co operate. Grace refused to get back in the ambulance and meanwhile Andrea had another five calls to do.
I rang around and conjured carers out of thin air to cover the calls (or at least that's how the task felt - staffing was as tight as usual) and Andrea and the ambulance crew spent a further half hour in negotiation with Grace before compromising with her agreeing to go so long as Andrea drove her in her own car and the ambulance followed behind and Andrea promised not to leave her or let her be admitted.
I then rang Grace's family and got her daughter in law. "Well this is most inconvenient" she said "Why couldn't you have rung an hour ago, Fred has set out for his monthly visit to his mother now and I wont be able to contact him" I swallowed the pithy reply that my crystal ball was faulty and I hadn't known a. that he was coming or b. that Grace was going to hospital an hour ago and apologised for the difficulty but Mrs. H. remained rather sniffy and was at pains to point out that this was extremely vexing. Hard on the heels of that phone call was one from the G.P.'s practice nurse asking why Grace had been allowed access to her medication. I pointed out that she has never touched her medication blister pack before in the seven years we have been going there and that we were not in the habit of hiding medication as a general practice. Besides, the medication had been delivered for the month before we got there that morning so we hadn't even seen it before Grace did her vanishing magic on the tablets. The practice nurse thought we were being at least naive and very possibly criminally negligent by not hiding the tablets and declared her intention of raising the issue with the Care Standards Officer.
All of this was at ten o clock or so. Andrea rang me back at about three to say she was bringing Grace home. We won't be paid for the additional five hours of Andrea's time although we will of course pay her. I spent a good hour of my day covering Andrea's calls and liaising with various medics about the issue and a further hour completing the necessary section 26 report for Care Standards because any abuse of medication is a notifiable incident. I have no doubt I will spend further time tomorrow explaining myself to the Care Standards Inspector. Grace is mad at us, we have wasted the time of the ambulance crew, Grace's family think we are incompetent and the G.P's surgery thinks we have been less than conscientious in our care. Some days I think I need a change of job...... Still, Grace is ok and that's the main thing - and we have hidden her medication...


MMP said...

i remember now
why i never wanted to go any further up the care worker ladder:
Such a time as this!

bless you and bosses like you

madsadgirl said...

How can you be expected to hide medication if you haven't even seen it?

And the daughter-in-law leaves a lot to be desired. You obviously need a crystal ball to see when visits are going to be made by the son.

Elizabeth McClung said...

This does seem to be assisted care but abdicated care (as in blaming you that the mother or mother in law is not kept perfect like some museum for visiting). I have to say from my own experiences that I was rooting for Grace when she bopped the EMT - sorry, I like them feisty. I do feel however that this attitude displayed by Practice Nurse of trying to find someone to blame becuase in a perfect world nothing ever happens annoying. Something happened and it was dealt with, do a risk assessment if anything but be happy that Grace was not just left to be. On the other hand, I find this stories of people or even laws that care almost unfathomable. I had no idea of Section 26 when I was IN Wales and my GP would let me "overdose" regularly as stress relief (I had not idea that it takes 1200 mg of valium to overdose, I thought it took like 30 or 40 mg.).

I am sorry your job is so heavy on the mucking, at least for these days.

Anonymous said...

Now that is a day and a half. Hope your week gets better!

AnneDroid said...

Poor you, and poor all of you. I can well imagine everything you say - as always you tell it so clearly. Well done for doing the right thing, even at the cost of time and energy and even money.

Christy said...

I'm enjoying your blog, as I'm a new nursing student from St. Louis Missouri and learning to deal with patients/family.

Bless you!

cb said...

I find it amazing that you were expected to hide the medication without being told. You could always blame the care manager who should have provided direction :p

I think it's very likely the Care Standards Agency will be sympathetic but it sounds like an awful situation to be put in :(

Caroline said...

Thank you all for the comments - I find it offensive that it is assumed we will hide medication from an adult who has no previous issues with taking it in seven years of care - now there is an issue we will address it but to have done so before seems to me demeaning to a grown woman. It's a storm in a teacup thankfully as Grace is ok but the story is a good example of damned if you do and damned if you dont and no thanks either way! It's all part of the game though, lots of professionals and families are wonderful - onward and upward!