It’s all about what we notice.
Spend any time on a hospital oncology floor and you notice things.
I’m not sick, but a friend is, and I’m there a lot. Every day. For hours.
Oh yes, I’m watching. I’m no stranger to hospitals or medicine. I know how things work.
Or don’t work.
That “don’t work” thing? I see a lot of it.
Do doctors get that two heads are better than one?
Doctors seem to operate in silos. They have their specialty and that’s all they will address. Ask about something not in their wheelhouse and they back away.
The infectious disease doc says “Ask your oncologist, I don’t know.”
The oncologist says “That’s the responsibility of your infectious disease doctor.”
They leave it at “I don’t have an answer.”
It doesn’t seem like they put their heads together in anything resembling a “team” to solve the problem. Collaboratively.
What happened to two heads are better than one?
What exactly does avoiding infection mean?
Sterile precautions are a big deal when a white count is nonexistent. But is it more form than substance?
There’s a small sign on the patient door to check in at the nurse’s station before going in. It also lists required sterile precaution measures. It’s barely noticeable. No one reads it.
Well-meaning friends walk past the sign to visit and in an abundance of (potentially deadly) compassion touch patient’s hands and face with their ungloved hands.
A nurse comes in and dons gloves.
Or doesn’t, even though a sign on the door says she should.
She adjusts, the bed, the commode and pushes buttons on monitors. The same bed, commode and buttons others have touched. And then, she touches the patient. And touches a possible site of infection. After that she goes out and types on the computer at a mobile station. We know how germy keyboards are.
Doctors use the same stethoscope on multiple patients, even those who have no white count. Studies have shown those things harbor bacteria but I never see a doctor sanitizing a scope before or after he uses it.
When two beds are better than one
Patient lays in a broken bed for 10 days, one that is extremely uncomfortable, especially when the patient has spent 24 hours straight in it for a week. Patient complains, family asks about it but no new bed ever appears.
Family asks again and are told “We’re full; we have to wait for a room to empty so we can use that empty bed.” Family has seen rooms empty and refill for 10 days.
Finally, friend is there early one morning and sees empty bed in room next to patient. She alerts nurse and asks to have that bed for patient. Nurse is one of the few that won’t act put upon when a request is made and immediately asks nursing assistant to move empty bed out of room before a patient is admitted.
Which is good, as friend was going to get in the bed herself to be sure no one else did.
Within 20 minutes patient has replacement bed. It works fine.
Now, was that so hard? Why didn’t it happen earlier? And without half a dozen requests?
Continuity is a no-brainer
Every day on every shift there seems to be a new nurse. On the same shift. Never the same one two consecutive days. Without nursing continuity day to day, “report” at shift change can take an hour as the nurse going off duty reports to the nurse coming in. Most patient care comes to a standstill at “report.” Since the nurse coming in is new to the patient, getting a full briefing from scratch eats up time.
Time nurses could be answering call buttons.
Wouldn’t it make sense to assign a shift nurse to a patient for the consecutive days she is on duty? I see the same nurses there every day, they’re just not always assigned to my friend. Why not?
It seems like such a no-brainer.
Help me Rhonda, help, help me Rhonda
Sign says the hospital encourages families to visit and “help.”
“Help.” Do we really want to “help?” Is that our role? Is it even wise? Do we even know what we’re doing?
But signals from call buttons go unanswered for 20 minutes or more.
Friend has a 12-hour private caregiver and it’s a good thing, because families are just not equipped to “help.”
Nurse hands friend an ice pack and says, “Here, put this on her hand.” Her hand which has a swelling that could be a site of infection.
Friend is not a nurse. Friend is not paid by the hospital. Friend is not wearing gloves.
“Help” from families is necessary because there are too few nurses and nursing assistants. The floor is obviously understaffed.
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These are just a few of my questions, based on what I’ve noticed.
I have more.
But I thought I’d ask these today.
Thanks for listening.