"A and E & taking blood procedures"

Having visited A and E a number of times over the last few months with my daughter I have become increasingly concerned that the pressure to meet the targets around breach times as well as the demand on staff is impacting on patient care and experience negatively at times.

I must add that overall our experience of the royal hospital for children in Glasgow has been that the care in terms of actual treatment directly, for the most part, has been exceptional. 

However the approach to delivering that treatment can be extremely variable.

Having a child who has an intense fear of all things medical and who is getting older and stronger we recognised early on the need for consistent therapeutic input to try and support her to develop coping mechanisms and plans for both her and myself to manage her treatment in the most effective way balancing the time management needs of medics against the long term need for her to gain confidence and trust in those treating her to hopefully reduce her anxiety over time.

The play team have been key to this and with their patience,  care, humour and exceptional understanding and knowledge of how to approach her fears my daughter has made significant progress. This progress is delicate though and recent months have shown how small and big incidents can have a massively detrimental effect to the progress being made and in fact makes evaluating her medically take longer and be less accurate due to her fear overwhelming the situation.

In the long term with in going issues the therapeutic approach in my opinion is far less stressful for everyone involved.

During our visits to a and e there has been an occasions where after being extremely distressed my daughter was able to calm down enough, with the support of the wonderful play team, to finally be still and ready to have blood taken. At this moment the doctors phone rang so he stopped and left the room to answer. I appreciate that the phone call may have been urgent but at the time and prep put in to getting her ready was wasted knowing that we were now going to have to start again. He then returned to the room and was about to get ready to start again when a nurse came to the door and said we have to move to cdu as we were about to breach and bloods would have to be done there. The stress this created for my daughter and the apprehension of knowing the blood test still needed done but not knowing when seems utterly disproportionate compared to the extra 5 minutes getting it done there with her already prepped and ready even if that meant she would breach.

On another occasion  a doctor gave up trying to take blood due to how distressed my daughter was and said in front of my daughter the doctor would phone the registrar to see if bloods were absolutely necessary. I would hope before even attempting bloods it would be clarified if they are absolutely necessary.

The doctor returned and said that they were and explained that if they could not be done my daughter would have to stay the night. It was already after midnight and she would breach before the results anyway do we would of had to be moved somewhere anyway so I explained to the doctor that her response was likely to be the same as the first time especially now that she had been given the false hope that they might not be needed so in my opinion it would be better to leave it to the morning when she could have the support of the play team and would not be so tired. I explained that I was concerned as this is an ongoing medical issue she needs to continue to visit the hospital for that another failed attempt would be seriously detrimental to the progress we had made with her fear and it would be better for her to have this done in a planned way with support from the play team in the morning. The doctor acknowledged my thoughts said it was my choice I spoke to my daughter  and explained if she didn't do the bloods there and then she would have to move to a ward she still was upset so I confirmed with the doctor she wouldnt do them that night. The doctor then turned to my daughter and said I'm going to give it a try anyway so I'll go and get my stuff .

She had just had the conversation in front of my daughter saying that they could be done in the morning and my daughter had heard me explain what I felt was best 

Why the doctor then took it upon them self to tell my daughter they were going to try again is beyond me.

However I did go along with this and encouraged my daughter to cooperate we managed to get her to allow the doctor to feel for a vein but she then became upset again. A nurse came in and took her arm which escalated the situation and my daughter became extremely upset, volatile and frantic the nurse was telling me to hold her arm shouting over the top of my daughter screaming with the whole situation becoming increasingly overwhelming for both myself and my daughter. 

I told them to stop which is a decision I do not make lightly and have only ever done once before in over 6 years of extensive treatment.

This is now twice that I have vocalised that my daughter has had enough.

A consultant then came in with the doctor to speak to me and explained that at my daughters age they find that fear takes over and there is no point reasoning so it is best just to take them to the treatment room give them a cuddle hold their arm and get it done. 

This sounds simple and in a child who has never had it done before,  is small, or who has no idea whats coming yes it may be the answer.

This is not my daughter. She is strong to the point I struggle to hold her right enough to keep her and everyone else safe when she lashes out as her last form of defence. She does not see it as a cuddle she sees it as being physically restricted so she can't fight back while people hurt her and all this is without even considering the mental damage it would do and regression in the previous progress we have made in her acceptance of treatment.

I again said no shes had enough. So she was admitted and the blood test was done the following day with doctors who let her take control and the play team supporting for distraction.

The a and e doctor who said there is no point reasoning when fear takes over as a justification for holding her to get it done after I had already explained to the other doctor why I was concerned about another attempt has left me confused about my whole approach and belief in my daughters ability and her care.

In my opinion She has always been able to reason, take some control and feel proud of herself at the end of treatments. Yes she kicks, hits and screams and I have to do an element of holding her on my knee to keep everyone safe from being assaulted but this is a work in progress and every time she gets satisfaction out of feeling she played a positive part is progress towards reaching a stage where she is not terrified and lasing out.

She is 6 but has treatment for years to come and my fear is what we do when she is a couple of years older bigger and stronger if we don't turn that fear and fight or flight response round now.

I understand that there are emergency situations where its imminently life or death where children me have to be restrained to have blood taken however this was not the case for my daughter. The doctor had given the option to wait till the morning.

I understand there are emergency situations where doctors may need called away. That wasn't the case with the doctor who left my daughter mid blood test to answer the phone because they came straight back in.

I understand the pressure to meet wait times is far more complicated than I can comprehend but when we are talking minutes there has to be a better approach.

It is my feeling that the pressure around meeting time targets has had a negative impact on my daughters care.