He's not Just Another Bed Number.
This story is a summary of the complications as a result of my grandfather admittance to a healthcare facility, and preventative measures we could've taken before he had died.
I hate having to share this story but perhaps discussing it with others will give me some respite and also others can also troubleshoot with me on what precisely went wrong.
Yesterday, I lost my 81-year-old grandfather to complications from Clostridium Difficile (C-Diff) infection. Although C-diff can occasionally crop up without rhyme or reason, the vast majority of its victims are patients in hospitals or long-term care facilities -- and the great majority of them have received antibiotics (Clostridium difficile: An intestinal infection on the rise. 2010). When he initially presented to the Emergency Room at the facility, they obtained a chest x-ray which showed diffuse infiltrates in his lungs bilaterally. They also drew his labs, a complete blood count and also a comprehensive metabolic panel, both of which were all normal. They started him on a protocol antibiotic, Levaquin (levofloxacin), and admitted him due to the weakness and shortness of breath. The next day, his laboratory results showed a significant decrease in kidney function and liver function. He was immediately discontinued from all antibiotics, and he then sat that way for two days as kidney and liver function slowly resolved.
While watching his labs, I questioned the Primary Care Physician(PCP) for not being on antibiotics and was met by hesitancy. I also insisted on an infectious disease(ID) consultation, who arrived the next morning. By the time his vital organs were all back to normal function, his white blood cell began elevating significantly and he complained of diarrhea. C. diff is the most important cause of infectious diarrhea in the United States. In fact, only 1% to 3% of healthy adults harbor C. diff among their normal intestinal bacteria (Clostridium difficile: An intestinal infection on the rise. 2010).
The ID physician began Flagyl(Diflucan) presuming the colitis he was having was due to a gastrointestinal infection. A stool culture was obtained and tested positive for C-Diff. Within 24 hours, his abdomen became severely distended, he had a central line and a nasogastric tube, and he was on four versions of different antibiotics. Unfortunately, the infection had already taken its toll and he was intubated, then ordered for an exploratory surgery to likely remove the colon and try to save him. Our family agreed that he would not want to live that way and they removed life support. He passed shortly after extubation with family by his side.
So here I sit as both a family member and also nurse practitioner-to-be, reeling in my what-ifs of the events. What if he hadn't been admitted but sent home with an oral antibiotic? Would he be up walking his dog in the early morning hours and enjoying the rest of his life like he did just days before his admission? What about if they had kept him on an oral preventative antibiotic since his antibiotic medications were discontinued so quickly? Would that have saved him? What if the PCP had been more proactive? All this and more is still going through my head. He was admitted with simple pneumonia and died as a result of complications completely unrelated.
How do you think this could have been prevented? Perhaps as part of the protocol, we could prescribe prophylaxis antibiotics when discontinuing medications suddenly like this. Elderly and the young are so susceptible to common infections and avoiding simple complications would help save many of their lives if we just gave an effort to make change happen. Perhaps it was all the health professionals that we witnessed entering the room, without contact precaution equipment, and then care for my grandfather only to visit another patient without gowning or washing their hands. All we need to do is follow procedures, use precautions, and not become lazy in our efforts to care for our patients.
Clostridium difficile: An intestinal infection on the rise. (2010). Harvard Health Publications.Harvard Men's Health WatchLast edit by Joe V on Jun 15, '18
About jrosemoore, BSN
I am a thirty two year old mother of two, that works full time as a Oncology Nurse while attending my graduate classes online. I love healthcare and I love my family.
Joined: Jan '10; Posts: 3; Likes: 5
from USJun 29, '17From: NY, US ; Joined: Feb '17; Posts: 126; Likes: 144I'm so sorry for your devastating and traumatic loss!! As a pre nursing newbie I have no idea how this could have been different, but wanted to extend my deepest condolences!Jun 29, '17Joined: Jun '17; Posts: 1; Likes: 8Im assuming the reason he was taken off the levaquin was that they believed it was causing the issues with his liver and kidneys, and that would also be the reason for not starting any other antibiotics while they waited for those levels to normalize. Since the original antibiotic was protocol based upon the xray results and presenting symptoms (short of breath and fatigue/weakness) Without an elevated WBC or fever, they saw no need to continue antibiotic therapy as it was likely causing elevated LFTs and affecting his kidneys as well...
As for contact precautions, they wouldnt have been necessary until he became symptomatic of Cdiff. However, one dose of antibiotics rarely causes severe cdiff... Is it possible he had diarrhea before even being admitted??? I ask because cdiff usually takes quite a while to cause abdominal distention and toxic megacolon (which is what it sounds like the doctors suspected and why they thought of doing surgery).
It sounds like they started the flagyl as soon as he began to complain of diarrhea, which was the correct procedure to follow. As far as using proper precautions once the cdiff was even SUSPECTED, they should have been gowning abd wadhing hands every time they went to his room, and even non healthcare personell (family, visitors, etc) Should have been instructed how to properly use those precautions as well. I am so sorry for your loss! I feel like something else might have been going on with him in addition to the pneumonia/cdiff, whether it was more advanced than initially thought, or possibly something else going on that wasnt picked up on.... This is just my opinion...Jun 29, '17Joined: Jul '16; Posts: 689; Likes: 1,584I am so sorry for your loss! I am not sure that this could have been prevented and I hope you can find some peace. That being said, it is always easier to play Monday morning quarterback. Some of the questions you ask are reasonable but also probably can be explained. I am not a MD but, yes, maybe he could have gone home with oral Ab, but he was SOB/weak, who would take care of him at home etc and what about the SOB. Sounds like the hospital MD followed protocol (from what you shared). Did all staff wash their hands? We don't know for sure, but maybe they did and you just didn't see it. If you did see it, did you say something? Maybe they could have explained (I work in a facility with 1 sink for all rooms and the sink is very far away so family does not see the handwashing). Also, Contact precautions may not have been required depending on the diagnosis at the particular time. It sounds like there may be more to this than you are aware of. Again, I am very sorry for your loss.Jul 3, '17Joined: Sep '16; Posts: 534; Likes: 1,610I am so very sorry for the loss of your beloved grandpa. Losing a loved one screws with your head in a monumental way, and many times starts a person down that road of turning over every single action (or inaction) in order to make sense of the reality of what we are now left with.
And (dare I even say it?) to even make us try to come up with a way (even subconsciously) to undo it, therefore make it not true.
Been there, done that (several times and counting in fact).
I would hazard a guess that we're not alone (but very few will actually admit to having these fantasy, nonproductive thoughts and behaviors). Thought what I think is it's all part of the usual grieving process.
There could be things about your granddad's health you may never be privy to that wouldn't have allowed your loved one the opportunity to recover from such a virulent illness.
Tormenting yourself with "what it's" isn't going to change the outcome (i.e., your beloved grandpa is now gone - God bless you both) but often times we have no control about how our heart feels, nor the direction our thoughts take us.
I read somewhere that the brunt of pain endured in the aftermath of the death of a loved one is a burden reserved solely for the living - bared by those of us left behind. I hope you find peace in this chaos, and are able to heal your broken heart soon. You've been through an especially painful and stressful ordeal - one that will take some time to process and recover from.Last edit by 3ringnursing on Jul 3, '17Jul 6, '17From: US ; Joined: Jan '10; Posts: 3; Likes: 5I like that you ask questions. No, he was admitted with weakness and possible pneumonia as the only reason he even went to the DR. Yes, they likely d/c'd the antibiotic levaquin since his LET and creatinine came back high. However, his WBC began rising the day they stopped the medication. I continued to question this decision as with elevated white blood cells and NO type of prophylaxis because they discontinued the original levaquin. The proper contact precautions were not being taken after he started showing symptoms of the cliff, by many staff members. Your opinion and questioning is sound, but there are logical contradictions as well.Jul 7, '17Occupation: Critical Care Specialty: 10 year(s) of experience ; From: US ; Joined: Nov '10; Posts: 9,295; Likes: 25,665I'm sorry for your loss, as healthcare workers we tend to be particularly hard on ourselves when it comes to Monday morning quarterbacking about a family member's care. We tend to think our healthcare knowledge should give our family members an advantage over other patients, and while it sometimes does it often can't change the inevitable outcome.
Remaining on the Levaquin would not have helped with the C.Diff, and if anything would have made it worse. Levaquin is strongly associated with C.Diff infections, which is thought to be due to reducing the number of bacteria that compete with C.Diff in the gut, allowing the C.Diff to bloom which results in a severe infection.
You're right to wonder if he would have fared better had he been sent home with antibiotics, hospital admissions often do more harm than good, although you won't find many Docs who will decline to admit an 81 year old with symptomatic pneumonia, since they will often get worse before they get better. Sending him home with oral antibiotics may not have prevented the C. diff anyway. The oral antibiotics would have made him at risk for a C.Diff infection, and if the source was a pre-existing GI tract colonization then it wouldn't have made a difference whether he was kept out of the hospital, and C. Diff spores are found outside of hospitals as well.Jul 8, '17Joined: May '14; Posts: 198; Likes: 431I'm confused, did someone remove my prior comment? I can't see it on here anymore.Jul 8, '17Occupation: allnurses Asst Community Manager, APRN Specialty: 25 year(s) of experience in Nephrology, Cardiology, ER, ICU ; From: US ; Joined: Apr '00; Posts: 53,364; Likes: 26,182Staff note: per our terms of service we can not provide medical or legal advice. Some posts have been edited/removed in order to conform to the terms of service.
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