First They Came For the Jews

and I Did Not Speak Out

Because I Was Not a Jew

Then They Came for the Communists

and I Did Not Speak Out

Because I Was Not a Communist

Then They Came For the Trade Unionists

and I Did Not Speak Out

Because I Was Not a Trade Unionist

Then They Came For Me

and There Was No One Left To Speak Out For Me

Niemaeller Pasteur

  • To recant what mum was given on the 2nd.
  • At 7-9am mum was given:

1.2G Augmentin IV

20mg Prednisolone PO

1G Paracetamol Disperse

5mls Carbamazepine PO

  • At 12-2pm she was given:

1G Paracetamol Disperse

500mg Clarithromycin IV

  • At 4-6pm she was given:

1.2G Augmentin IV

1G Paracetamol Disperse

  • At 10-12pm she was given:

1G Paracetamol Disperse

1.2G Augmentin IV

500mg Clarithromycin IV

5mls Carbamazepine PO

40mg Clexane SC

1 drop Latanoprost ea. eye

~Act Eighteen~

On 3rd at 05.00 (the sister of the ‘disgruntled’ nurse who thought mum was abrupt) wrote Incontinent of urine. Slept well.  IV fluids continue as prescribed. S/N ….. received phone call from the patient’s daughter…… re.  I am complaining about poor nursing care of her mother. Would not accept or listen to anything S/N ….. tried to say, therefore was informed to speak to ward manager or arrange to see Consultant.

The daughter was actually repeating about the Cortiscosteroids making mum’s feet and legs swell and this S/N was not listening to these concerns at all.  Just pat robotic verbalism with no answers at all forthcoming!

Ah, but just make out the relative is causing a nuisance/fuss and point the other way.

This doesn’t wash with this daughter, at all!

This makes the timing that both sisters? (same name) were on duty at this time as the other one was writing her notes!

Such excitement must have ensued by my phone call that whichever nurse took mum’s BP and Pulse etc:

Omitted to write in the Time these were taken!

  • Mum’s BP was 123/56.
  • Mum’s Resp. Rate was 20, and Sats. were 90% on 6L?/4L?
  • These were Not written on nurse’s notes.   Why?
  • On 3rd at 7-9am mum was given:

2G Ceftriaxone IV (administered by the sister of the disgruntled nurse)

20mg Prednisolone Oral

1G Paracetamol Disperse

5mls Carbamazepine PO

These last three were given by another nurse?

  • Remember the Heparin (Clexane) had been stopped the previous evening, but no- one signed it off, so who knew this was stopped?
  • The Prednisolone was halved from 40mg to 20mg on the 2nd yet the FY2 did not write this in her doctors notes, so she was the only person who knew about this!
  • The Consultant (when he next arrived on the 5th) expected a report from mum’s GP explaining about all of the drugs list which he had been wrongly informed by the FY2 as coming from the GP, but actually came from the A&E department at the other Hospital, therefore by the time of his next visit everything had changed to such an extent that this original list would be forgotten/buried after the weekends events!
  • Also when he last saw mum on the 1st he stated to ‘continue antibiotics’. (The ones supposedly given by mum’s GP).He would have no way of knowing that not only the Augmentin 625mg PO had been changed to 1.2G Augmentin IV after his visit on the 1st; in fact FY2 made this change shortly after his visit to be implemented after the 4-6pm dose of 625mg was given by mouth – Yet, another doctor wrote this new prescription.  Why did FY2 not write this?? ; but also that the FY2 had changed this prescription from 1.2G Augmentin IV to 2G Ceftriaxone IV the next afternoon of the 2nd, in time for the Pharmacist to dispense this so that a nurse could administer this at 7-9am on the 3rd when no medics would be on duty apart from a skeleton staff in the ward next door!

He most certainly did not see the ‘post-it’ sticker written by the FY2 placed just below his own writing on the 1st which stated:

MOT  1/2/…   Mum’s name.

-(L) basal LRTI.

-can transfer currently for more work.

NB. No mention of medications from GP?

NB. (L) basal LRTI was never written anywhere apart from the first Hospital’s FY2 and the first Hospital’s Consultant in their own notes, so this could only have come from this source! It was never mentioned by the GP as it only came about After the results of Tests in the first Hospital!

  • At 12 o’clock mum was given:

2G Ceftriaxone IV (administered by the sister of the disgruntled nurse).

  • At 12-2pm mum was given:

1G Paracetamol Disperse

500mg Clarithromycin IV

When I arrived at visiting time I was horrified to discover that the swelling in mum’s feet and leg had moved up to her thighs, waist and stomach.  This was a little lady who was thin and dainty all her Life and whose whole torso was now inflated to the maximum her skin would hold before it burst. 

  • I cannot emphasise the horror of the attitudes encountered of  ‘its perfectly all right,’ especially when this impedes movement!
  • All right for whom?  Would the medical profession be so cavalier if it was them?  Can you imagine the chorus saying ‘It’s perfectly all right’!
  • Shit Happens!

I approached the ward manager’s desk where several nurses were sitting and spoke to one of them who was sitting sideways on a chair, and as she saw me gave a lovely smile as I asked her to ‘come and have a look at my mum’s legs’?

She stood up and started to follow me but was called back by a ‘person out of view’ and when she turned back the smile was gone and she followed me briskly.   In an instant her whole manner had changed and the smile was replaced by a mask.

She looked at mum’s legs and gave the usual report.  I asked her for a commode, and she took mum to the toilet and helped her into bed afterwards.  I have never before seen a nurse with mud on trainers and although her uniform looked clean, her shoes were absolutely filthy.

I never saw her again so imagine she was one of the Agency nurses who worked one day at the weekend.  When she left quickly, mum looked exhausted and smelled of faeces.  I hoped this was just my sense of smell and not having anything to clean her with, I did nothing – to my eternal shame.  I was still hoping against hope that these beings were just overworked and having bad days and  was still too pre-occupied with my mum’s situation.

I told the FY2 the next day but all I ever got from her was a frustrated shake of the head which was the norm for her, every time I mentioned anything.

  • At 15.45 the nurse who had previously dispensed the oral prescriptions @ 7-9am wrote the nurses notes:

Eating and Drinking fair amounts.

Incontinent of urine.

Mobile with assistance.

Obs. as recorded.

IV fluids continue as prescribed.

Daughter complaining to nurse… (with the filthy shoes) that her mother’s legs are still oedematous.   Mrs……. legs have been elevated on a foot stool all day.

  • Really?

Advised to take this matter up with the doctor, who she says she will see on Monday.

  • Strange how other nurses write up the nurses sheets rather than the nurses dispensing at the time?
  • At 4-6pm mum was given

1G Paracetamol Disperse (Given by the same nurse who had given it previously and who wrote the nurses notes above).

At evening visiting time I looked for the FY2 only to discover there was a skeleton staff on and spoke to another FY2 who explained that mum was not one of her patients and therefore she did not know her case.

She took a look at mum’s limbs anyway and confirmed that this was due to a ‘combination of steroid treatment + IVF plus diuretic being with- held.

She noted that ‘GP had started Frus. 20mg bd.’

Plan:

Decrease IVF rate. (There is nothing written to illustrate whether this was complied with or not?)

Re-start Furosemide cautiously. (she wrote a prescription for the 4th at 7-9am)

Note* Urea = 13 yesterday but was improved since admission.  Not so!

Last dose Pred. due tomorrow.

  • Mum’s *Urea was 10.9 on 31st.  13 on1st. and 13 on 2nd.
  • Mums CRP was 283 on 31st, 316 on 1st and 316 on 2nd.
  • Just as worrying her Potassium was 4.0 on 1st, but NA H on 2nd!
  • The Once Only 20mg Furosemide O prescription written by this other FY2 for 19.30 was Never given!
  • This FY2’s doctors notes were the only ones written on the 3rd!
  • This FY2 would not know that the ‘Prednisolone last dose‘ was enhanced with another 20mg dose tomorrow! Plus a New prescription for 40mg Prednisolone was written for the following day after that!

I then managed to speak to a male nurse and asked him casually if the ‘new antibiotic’ was working?

‘The one the FY2 mentioned that she was going to change the day before?’

He approached the case notes box and after looking through said ‘That’s strange?’ I asked ‘What is?’ ‘The records are not here, they should be’.  ‘Where would they be?’  He continued to search with a puzzled expression, until he eventually confirmed that they weren’t there with ‘Maybe they are on someone’s desk?’

I was none the wiser, nor apparently was he although he did his best to help.

I would not normally have noticed that anything was amiss regarding my mum’s records but for the reaction of this male nurse at the evening visiting time, and now the question arisesWhy were my mum’s records not where they belonged on that evening of the 3rd, Who would have them and what is more – Why?  It was obvious by the reaction of the male nurse, that the absence of the ‘records’ was not the norm!

They obviously turned up in time for the 10-12pm doses plus the 2G Ceftriaxone at 12mid?

This 12mid. box was initialled by FY2?

Since the 10-12pm prescriptions below were given by the sister of the ‘disgruntled’ nurse the records must have been in her possession, or she must have known where they were!

  • At 10-12pm mum was given:

500mg Clarithromycin IV

1G Paracetamol Disperse

5mls Carbamazepine PO

1 drop Latanoprost ea. eye.

SECOND OVERDOSE!

Ceftriaxone (Rochepin) The usual starting dose is 1G IV.

  • Remember the Oath to Avoid Overtreatment!

The usual Adult daily dose is 1-2 grams given Once a day (or in equally divided doses twice a day) depending on the type and severity of infection.

The Total daily dose should Not exceed 4 grams.

For the treatment of various miscellaneous infections other than meningitis, the recommended total daily dose is 50-75mg/kg given in divided doses every 12 dose hours.  The total daily should not exceed 2 grams.  Sodium content 83mg per !G.

Ceftriaxone.

If  Superinfection occurs during therapy, appropriate measures should be taken!

So, let’s see now, a prescription written the day before by FY2 who knew she wouldbe off duty and there would be no one apart from a skeleton staff on duty, for an amount of 2G to be given three times that day Totalling 6G.  On a day she had stopped Heparin (which stops blood clots).  Plus the patient to receive 2 lots of 500mg Clarithromycin and 20mg Prednisolone.

  • For someone who was ‘Not Too Unwell’ (written by the 1st Consultant).

With varying verbal instruction given to nursing staff? Along with verbal instruction to take bloods that morning, when no staff would be there to check it.

What sort of appropriate measures should be taken if Superinfection had occurred with few staff on duty?

Remember that the Clexane was stopped after the 10-12pm dose on the 2nd.

Who knew to stop this on the 3rd as not only was there no mention of it in the records either of FY2‘s or any nurse, and it was Not signed off yet the nurse of ‘mum had an abrupt manner’ had given this at 10-12pm on the 2nd?

Therefore when this nursing sister omitted giving Clexane on the 3rd, who informed her not to do so? Did FY2 instruct that this was to be stopped after the last dose on the 2nd and if so to whom?

  • There appears to be a great deal of Verbalisation with No Records to back these up!
  • At 12mid. mum was given the other extra dose of 2G Ceftriaxone (Init. by FY2)?
  • N.B. This meant that mum would have No Heparin in her body on 3rd when she was to have a major change from 1.2G Augmentin IV to 2G Ceftriaxone – 3 times- Plus 500mg Clarithromycin Twice, Plus 20mg Prednisolone!!
  • For someone who was ‘Not Acutely Unwell’ 2nd Consultant!
  • Plus ‘Does Not Look Very Unwell’ FY2!
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