"Overall communication poor in many ways"

In early July I arrived home from work as usual and found my Mum who is 86 lying on the ground outside the house. She had fallen and could not get up.

Before I begin, I would like to say that my Mum drives, and enjoys swimming and social events. We are moving the to USA together in a few weeks' time with my 18 year old daughter, to be closer to my sister who lives in Upstate New York. My Mum had sold her bungalow in WIltshire at the end of May and joined me in Devon in our rented house. Mum is an avid reader, an ex-primary school teacher and she reads and keeps very much up to date with current affairs.

I also want to say a bit about myself. I am 57 and am a Registered Nurse. I did my General training in the USA from 1975-1978 in a three year hospital based diploma course. I also did my Orthopaedic training in Bath prior to moving back to the USA (my father’s work kept him there) I worked in the NHS in the early 1980’s mostly in ITU in London. I also worked for private hospitals in London in cardiac surgery. In the 90’s and early 2000’s I worked in medical sales and as a clinical specialist with ventilators as I had 10 years of critical care experience. So over the years, I have observed in detail many different units from NICU to clinics in hospitals all around the UK and Scotland. For the last 3 1/2 years I have worked for a large law firm in Clinical Negligence handling and advising potential new clients and collating medical records for complex medical negligence claims.

I have always had a great interest in the NHS and the politics that surround it, but I did not particularly enjoy working in the NHS because I found that my US training put me at odds with some of the things that happened in the NHS.

I did do a return to practice course in Plymouth In 2004 and what I experienced on the ward there, and some of the things I have learned about through clients since made me worry about my Mum having to be “an unscheduled’’ patient.

Mum has progressed through the A&E dept at Torbay Hospital, via EAU 3 to AInslie Ward and then to Ella Rowcroft ward and finally to Ashburton Hospital. I would describe the care she has had as very good (apart from A&E)

The main problems that I have experienced have been very much centred on communication. I would describe the overall communication as poor in many ways. I cannot decide which particular episode has been the worst, but I think on balance the GP who arrived at Ashburton hospital last Thursday afternoon who placed a Do Not Attempt Resuscitation order on my Mum’s chart probably supersedes the appalling lack of care and communication in the Torbay A&E.

I would not have even known about the resuscitation order unless Mum had told me. She had only just come from Torbay the day before and was still rather sleep deprived. She seemed to have been left with the impression that it was not appropriate for someone her age to have CPR. Mum and I had discussed months ago that she would not wish to be admitted to intensive care or to be placed on a ventilator if her survival was unlikely but that she would wish for other measures to be carried out.

I asked her if she understood what resuscitation meant- she replied ‘not really’ and that she did not like the doctor who had seemed pompous. I explained that I would go and talk to the nurses because after I told her that CPR simply meant that your circulation and breathing would be supported, she said she would wish for that to be carried out. At first the nurse tried to be quite firm with me and said very definitely- your Mum has a DNAR order on her chart.

I asked this nurse how she would feel if a GP who had never met her Mum before walked in, and without any discussion about Mum’s life or her plans for the future, or indeed any communication with her family, wrote this on her chart. I also informed her politely that I work in Clinical Negligence and am very aware of all the legal issues. She rang the surgery immediately and had the order changed.

If I was the Matron of Ashburton hospital or indeed an RN caring for patients there, I would not expect a doctor to turn up and carry out this sort of activity without a nurse being present or the person in charge informed or the family being informed.

I would very much like the doctor who did this to be told of my shock and unhappiness. To further confuse matters, he had ticked all the boxes for transfer back to Torbay, IV fluids, artificial feeding, and dialysis. If I was an admitting doctor at Torbay, I would be very confused by this.

Going back to the A&E experience at Torbay, Mum was seen quite quickly and x-rayed. The staff were very, very busy but one nurse in particular was nice and friendly. The porter seemed to find it odd that I stayed with my Mum to x-ray but really I felt terrified about what was going to happen to her and all our plans. She had lain outside in the sun for 1-2 hours (it was 30 degrees) and was very dehydrated. She had a Venflon in but no one thought to give her fluids. She was not allowed to drink while the X-ray results were awaited.

I could see that her injured leg was slightly shorter than the other, and that it was externally rotated, both signs of a fracture of the neck of femur. After a long wait, she was sent back for another x-ray. My daughter and I waited- the porter had given me a very odd look as I had come out and asked the nurse if I could see the x-rays and talk to a doctor. The nurse who I had asked said no, you cannot see x-rays as they are ‘on the system’ but she did say she would ask a doctor to talk to me. The only doctor I saw was an A&E doctor who then told me there as no fracture and that my Mum should be mobilised and then sent home. I said that my Mum has a lot of pain and I was concerned about the shortening of her leg and the rotation.

A nurse then came and got my mum out of bed. I helped her because I was so worried, but my Mum was in agony and could not bear weight on her leg. We got her back on the stretcher with difficulty. I asked the nurse if an Orthopaedic surgeon had looked at the x-rays and was told dismissively ‘they will have been seen by Orthopaedics”

I was then allowed to give Mum some water and we were told she would be taken to EAU3. She was there overnight and I went in to see her the next morning. Mum told me that the Orthopaedic team had come round, done another x-ray and informed her that her leg was broken. The plan was for surgery but no one could tell me when. I still saw no doctors. I asked if I could talk to a doctor but was simply told they are all in theatre. No suggestions for later in the day, so I went home and came back in the evening. Mum was not there; she had been moved to Ainslie. The nurse apologised for not calling me. In EAU3 my Mum was feeling sick and was not very alert because of her pain levels and the morphine she was given. She had been catheterised because she could not pass urine. I do not think that her dehydrated state was helping. Mum told me her blood pressure was very low but I could never get to talk to anyone to ask about this.

In Ainslie Mum received very good care but the attitude of the senior staff was just incredible. I got more info from the HCA’s than the trained staff and once again I did not see a doctor. Surgery was cancelled for Mum on the Weds but she had the hemiarthroplasty on the Thursday. By then I was so relieved that she was getting an operation, I stopped asking to see a doctor. I just gave up because being a very experienced nurse I knew she was fine. It must be truly awful for families that have no medical knowledge.

I did have one serious attempt to put a senior staff member on the spot to try and get more info. I came in slightly before visiting hours but was told that as it was 6pm all the doctors had gone home and no, I was not allowed to go in early, even though my Mum had just had surgery. The staff nurse was rude and dismissive and it was a particular feature of that ward that no one ever introduced themselves (apart from the lovely OT).

When I was training as a nurse in 1975 in the USA, we were given a whole module on ‘Legal Issues in Nursing’. It has always stood me in good stead, and I understood from the outset that being defensive or uncommunicative with patients or their families was bound to cause more problems than it solved.

I did not say too much to Mum because I wanted to be cheerful and positive, but she picked up on the staff’s attitude and commented how defensive everyone was.

When Mum was moved to Ella Rowcroft, it was a completely different picture. The staff were friendly; they seemed much more at ease with me asking questions and Mum got excellent care.

Communication is such a simple thing but it seems to be a feature of the NHS right the way through the system that people who ask awkward questions are treated with disdain. I was so careful about the way I behaved, but it did no good in the areas that I have outlined where problems occurred. I am acutely aware of all the issues, and the experiences with my Mum have been made needlessly stressful because of poor communication and more importantly staff attitudes.