seen from the other side of the bed- what's the best way to communicate this? - page 2

I've been thinking about posting here for weeks, trying to figure out how to handle this situation. I don't want anyone to think I'm asking for legal advice, because I'm not- I really want to find... Read More

  1. by   rach_nc_03
    I am SO grateful to all of you for responding! Your suggestions about who to contact are extremely helpful- it's wonderful to have access to the wealth of experience and information the members of this board possess. Above all, the fact that you agree I *should* move forward with this bolsters my confidence immensely. I no longer feel like I'm going through this experience in a vacuum. Thank you!!

    I put in a request for all of my medical records when I went for my follow-up appointment two weeks ago. I remember a few names from my stay, but only a few; I want to make sure that, at a minimum, I have dates and times straight in my head- I'd hate for something to be dismissed out-of-hand because I'm wrong about the date when something took place. (And I *really* want the name of my hero CRNA so his management can be informed of the difference he made in my care. I cannot thank him enough.)

    I got the operative report when I was there for my follow-up, and interestingly, it states that my surgeon was present for, and participated in, the entire case. Hard to believe, huh?

    While I was there, a couple of people from Patient Relations came by, unaware of the situation at hand (this was before the Pain Management people were called in). I know that they left business cards, and they're somewhere in the house (which has been in disarray since I got home- half of it taken over by my crutches, walker, wheelchair, bedside commode, etc.). They will most certainly be on the list of people receiving my letter. To my knowledge, they were not directly involved in getting the ball rolling to correct the problems at hand. I know that they dropped by once a couple of days later, while I was sleeping, and asked my friend (who was making sure I kept breathing, as I was VERY heavily medicated by this point) if things were ok; he told them that PM had be consulted, and they left in a hurry.

    Does anyone know if Patient Relations staff actually charts in the patient records? I know that the staff member who calls them for a consult is responsible for doing so, but they (PR) told me they were on the floor visiting another patient and just 'dropped by' to see how I was doing.

    On the topic of my insurance company- I actually work for my insurance provider, which contracts with the various PPOs throughout the US. The account manager for my PPO works on my floor, so I'll be able to get through to the appropriate people within the PPO who handle contracts with specific hospitals. I'm grateful that this information will be fairly easy to get- one less battle to fight.

    Another good thing- we have two different companies we use for outsourcing our UR and case management. They actually called on my discharge day to ask if I wanted to transfer to a SNF instead of going home; they've been in the loop throughout the process. They were concerned that I wouldn't have enough support at home (my husband couldn't take off any more shifts, as he'd called off a couple of times during the height of the pain problems). Ready access to them (and their documentation of events) could be invaluable as this goes forward.

    I mentioned that my recovery is now progressing, and I'm certain I'll be fine. I do want to point out to everyone reading this thread that my inadequate inpatient care continued to affect me after I went home. I'm behind the power curve in terms of physical therapy, and it's taking longer to reduce my pain meds. Because of this, I'm going to be out of work for longer than anticipated- I am too weak, and still too heavily medicated, to drive. I have been depressed, and I have trouble sleeping (depression and pain are both contributing factors, I think). My pressure ulcers are still not completely healed (not to mention the excoriated perineal areas- I'm like a baby with persistent diaper rash ), and I've had TWO bouts of cellulitis in my incision (complete with multiple, night-long ER visits). Was the cellulitis a direct result of the quality of care I received in the hospital? Maybe. I'm certain it was indirectly related, at least.

    I remember all the times I got end-of-shift admissions, and how annoyed I was. And the times patients asked for pain meds ten minutes before I was due to clock out at the end of a long, hard day. I also think about the young, otherwise healthy patients I've had- patients I wouldn't have thought were at risk for pressure ulcers. Or those irate family members I encounter at the beginning of a shift- after the previous nurse had dropped the ball on pain management. (My husband was definitely at the end of his rope, and I'm sure he didn't exactly endear himself to some of the nursing staff.)

    Like everyone else, I was taught to give the best care possible, and not ignore these issues. But I certainly never thought about the fact that *one* instance of ignoring a request for pain meds could set off a chain of events like this. We all know how easy it is to let it slide just a little- to ask the oncoming nurse to give meds to that end-of-shift admission, for example. I know, though, that if the tables get turned one day and I'm the nurse in this scenario, I'm going to remember what I went through.

    Thank you all for supporting me through this. I'll keep you informed as to what happens.

    Rach
  2. by   Simplepleasures
    Quote from Daytonite
    Address a letter with your concerns to the Chief of Surgical Services of the Hospital as well as the Chief of the Medical Staff or the Medical Staff Services Coordinator of the Hospital. You might even send a copy of the same letter to the Chief Medical Executive Officer. This should, at least, spur them to place your case in line for a medical peer review. I'm not sure that the Medical Staff Office staff keep letters of complaints by patients against doctors in doctor's files for consideration for when those doctors are up for their regular credentialing as part of their renewal of privileges, but it should be made known to them by way of writing letters to these folks I've mentioned above. Contrary to what most people think, the actions and poor performances of physicians is tracked by the medical staff offices in hospitals and mandated by both JCAHO and Medicare.It's very frustrating when something like this happens. It makes one a better practitioner in that we tend to really listen to what patients are telling us. I am always amazed at how so many nurses are able to just "turn off" the pleas of a patient when they have no clue what to do to help them. Some nurses, huh?
    OH Daytonite, despite our differences, I have to say this is a JEWELL of an answer!!
  3. by   GatorRN
    Rach, I'm sooo sorry to hear about your ordeal. I've thought about you often the last few weeks, wondering how your surgery went. It's just awful that you recieved such treatment, or should I say mistreatment. I'm so dissapointed to learn that your experience was so horrific. There is absolutely no excuse for such incompetence.

    As many know, I am also a huge advocate for adequate pain management. We, as nurses, do our patients a grave disservice by allowing them to suffer needlessly, when we have the means to relieve their pain. I've said it before, and I'll say it again, I think every nurse should be required to take an extra class on pain management. Not everyone is "drug seeking" many have genuine, legitimate pain issues that most certainly should be addressed, particularly immediately post op, as in you case.

    I had a very bad experience after a hip replacement last year at a very reputable teaching hospital, with a world renowned surgeon. My surgeon has other surgeons from around the world come to observe/learn his particular minimally invasive technique. I, like you, had post op pain issues, skin breakdown,lack of basic nursing care, and post op complications. In addition, I woke up during my surgery! I think these teaching hospitals just get so big, have so many staff and patients that they loose sight of the basics. A sad situation indeed.

    There is no excuse what so ever for that nurse to have passed you off to the next shift. I don't care if it was 20 mins or 5 mins to change of shift, she should have done whatever she needed to do to get you some degree of pain relief. And the nerve of the CNA to tell you to move instead of moving the bed to do what she needed to do...unbelievable. Basics people basics.

    I don't think your being unreasonable at all. I agree with everybody else, you definately need to get on a letter writing campaign. I would not only address your pain management issues, but also your lack of basic nursing care. I would write a letter to each and every person you can think of that might actually pay heed and make the necessary changes so nobody else has to go throught what you went through.

    Again, I"m soo sorry your experience was so horrific. I am glad to hear that your finally on the road to recovery. I hope that your rehab from this point forward goes smoothly and that you have no further complication. I've been where your at, feel free to PM me if you need to vent or for whatever reason. Keep us posted. Take care.
  4. by   donormom
    I am so sorry for your experience. I am 110% behind you on following up on this and not just "letting it go". Despite the fact that JCAHO considers pain the fifth vital sign, it often goes without treatment.

    In our PACU they are very good about medicating before moving the pt to the wing. But our ER doesn't seem to even try to understand pain (esp. chronic pain) unless you are having a major MI or trauma!

    Good luck and let us know how it goes.

    Karen
  5. by   UM Review RN
    After I had a surgery in a different hospital than I work in, my IV blew and my PCA was disconnected. A couple of the night shift nurses attempted to place a new IV, but were not successful. I could understand in my case why they thought I was ok, because I kept nodding off to sleep through the night, and basically, I wasn't having any pain then.

    But after 8 hours without pain meds, it began to be an issue. I tried every non-medication pain control method I could think of, but could barely keep it together as everyone kinda blew it off.

    Finally a spasm of pain gripped me so hard that all I could do was....

    scream.


    I got medicated within 3 minutes and if I'd known that was the way to get results, I probably would've done it sooner, without the least twinge of shame.

    I'm very glad you're pursuing this, rach. Had I been in your position, I also would have. Best wishes for a speedy recovery, and please keep us updated.:icon_hug:

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