"My experience at QMC Nottingham"

About: Queen's Medical Centre / Trauma and orthopaedics

(as the patient),

I am taking the opportunity to offer an account of my recent hospital experience at QMC Nottingham- Oct 08. I have taken time to respond to your request so that I can report facts rather than giving an emotive response.

The pre-op afternoon which I attended for the necessary tests was a very helpful time to have the opportunity to talk to the Consultant and the Anaesthetist: to ask my questions and to share my concerns. I spent some time talking with the Anaesthetist about my wanting a block rather than a general anaesthetic, because of the post-op adverse reactions I had had from previous general anaesthesia. The Anaesthetist said he would much prefer to do a block, and I signed the consent form with that agreement in place.

My husband and I entered the Day Admissions Ward at the required time- 10.30am. One nurse was sitting doing the admission of a patient. She did not acknowledge us. We sat down on the available chairs and we were left there for the next 1.5 hours with no communication from any of the nurses who came and went and who generally appeared to be in confusion-no sense of knowing what they should be doing, standing around chatting generally. I eventually turned to my husband and said ‘I feel so unsafe here’. The nurses sent one of the other patients down to theatre. She was subsequently sent back, really distressed, as she was the wrong patient the theatre was expecting (the nurses were so busy laughing about it – they did not seem to notice their distress). Suddenly Sister arrived on duty and order and calm was restored. I breathed a sigh of relief. She went around and spoke to each patient. I had expected to be a day patient, but she was expecting me to stay overnight because of the need for “more powerful drugs that I would need for this op that I would not have at home”. A young lady arrived and sat before me saying she was my anaesthetist. I asked where the anaesthetist was that I had met and with whom I had talked with at length at the pre-op day. I had felt reassured by him and felt confident in his ability. There had been no suggestion that he would not be available for the operation day.

So I was some what shaken to find this different anaesthetist who was saying that I would be having GA- which I argued was not so. But she revealed she could not do blocks- had never done one. However, eventually, she said she had a colleague who had done them in the past. I reluctantly agreed I would have a block done by this unknown person (although internally was debating whether to leave!!!)

The admissions nurse then came to check my personal details and continued to fill in numerous forms with ticks and circles and her signatures- but not communicating with me. She spent nearly three hours admitting three patients, with minimal communication with any of us.

I walked to theatre at 1.30pm and the anaesthetist put the canular in my hand which I felt was not in correctly and the subsequent sedative went into my tissues. One of the post op nurses spontaneously confirmed that my opinion about the canular was correct. (My past training is as an SRN).

The block was attempted and was extremely painful. The anaesthetist appeared anxious/panicky as she quickly ordered her colleague to ‘flush’. Eventually I was taken into theatre, where it was found that the block was incomplete and my hand was not fully numbed. SO I had to have GA. I felt quite anxious, trapped and let down.

My main Post Op Recovery Nurse- Nick was brilliant. He was professional, competent, gave me a sense of safeness- that he knew what he was doing. He communicated and included me in every decision. I would like to thank him for communicating. It was a very different immediate post-op experience from my last one. I returned to the ward about 5.30pm.

By 7.10pm I was in a lot of pain. My husband asked a nurse for some analgesic. After looking at my chart- she said I was not due for any for another half hour. At 7.40pm, the pain was really bad- my husband asked again t the nurses station. He was told that we would have to wait because they were on change over time, and a nurse would also be needed from another ward.

By this time I was almost at screaming pitch. I tried deep breathing- but I found I was hyperventilating and began to ‘fizz’ all over. My body suddenly went into shock and was shaking violently. Silent tears pouring down my face (I am not a person who screams or even cries easily). A visitor opposite said, “By lass that’s making you sweat isn’t it!” By around 8.00pm I was managing to disassociate a little- but the pain was excruciating. My husband went and pleaded again- but they still had more important reports to get through and also they had to get another nurse from another ward. I felt I was losing it completely. Some time later I suddenly heard a voice saying “well are you going to do it or am I”. I opened my eyes to see a syringe pointing closely at my face. She repeated her sentence, but being in a state of feeling ‘out of it’ I still could not grasp what she meant, (morphine- in my past experience came in a small syringe with a needle). “Open your mouth” she said, I did, and she poured the contents of the syringe into my mouth and she went. It was 8.30pm. I felt exhausted, in sever shock and very cold. My husband put my fleece over me.

The anaesthetist had written up Codeine and Paracetemol for the ensuing analgesic, which the anaesthetist had said could be taken together. (I normally take co-codomol for my arthritis) I checked this combination with her both before and after the op, but the nurses would only give one or the other. I was in constant pain and I felt much happier when I got home and could control my own pain management.

I really am concerned at the lack of nursing care and in particular their ability to be aware of the pain control/management needs of patients. I am also concerned about the lack of including patients in conversations and decision making. It felt as though we were expected to leave our brains outside the ward. Other nursing needs of patients were not attended to, and nurses seemed driven by the pieces of papers they had and were never seen without. They rarely introduced themselves. It felt they were driven by the system. Throughout the following day, I asked four nurses for help to remove the canular (which was very sore) and to enable me to dress to go home, it was the cleaner who kindly came to my rescue in the afternoon when she saw me struggling to dress with one arm. A nurse removed the canular just as I was leaving the ward in the late afternoon.

The cleaning team was wonderful. They did a superb job and were very thorough and meticulous in their work. They brought laughter and relaxation of tension onto the ward- which was wonderful. They did a number of personal care things for people- which eased things for each one of us. A lovely bunch of people doing a great job- often unrecognised and unacknowledged. A big thank you to them for bringing some ‘normality’ and fun as well as keeping us safe because of the work they do so well.

One final episode. A young patient had her boyfriend as a visitor. He was around for most of the first day, talking loudly and incessantly. He took her out to a party in the evening, and brought her back gone 10.00pm. He helped her into bed and then drew the curtains round the bed and stayed for another hour. We felt unhappy about this and very uncomfortable about having a 17-19yr old man in a women’s ward at that time of night. He was eventually asked to leave by a nurse, who did a check inside the closed curtains. This he did but then rang his girlfriend (the patient) 10mins later. They conducted a conversation for another half hour until she was asked, by a patient, if the conversation could be continued on the following day rather than at this time of night. She brought the phone call to an end. The young man was back on the ward by 10.00am the following morning- at a time when the women in the ward bay were all doing personal things and did not want the presence of a strange young man around. The staff appeared to be oblivious of the situation.

All in all the experience left me with a sense of ‘unsafeness’ and of my being uncared for, at a time when I felt most vulnerable. There is a sense that if a patient was collapsing- it would not necessarily be noticed- or reacted to by the nurses- because it was not on their chart/form/instruction sheet- and I am sorry if that sounds facetious- but that was how all of us on that ward bay had shared together was how we felt.

The appointment system at QMC seems somewhat chaotic. At the initially contact I phoned for, and been given, a consultant appointment as per instructions from my GP, this was subsequently changed by QMC as “not the right appointment for me”. When leaving the hospital after the op, the nurse gave me a clinic appointment date and also a Consultant appointment- 5 weeks hence (4th Dec). The nurse also told me to ring for an X-ray to be done before the clinic appointment. The X-ray unit told me that I needed to ask the receptionist for a “white card which would be in my file at the clinic appointment and to go straight there before going to x-ray”. Two days later I received a letter cancelling 4th Dec and transferring it to the 15th Jan 09. At the next clinic appointment, the Dr I saw said he would need to see me in 4 weeks- in spite of my showing him the letter I had received. So another appointment was made for the 27th Nov. One thing I am not sure about is whether it is now up to me to cancel the Jan appointment or will that have been automatically done by the system. Maybe it will just become a statistic of one more missed appointment.

The OT’s, whom I have seen weekly, and latterly also the physiotherapists, are excellent, kind and really proficient in the work they do. Over the weeks, they been very encouraging and were flexible to cover my needs. However, the system- which includes patients seeing either one or other- or sometimes all of OT’s, Doctors, Physiotherapists tends to leave patients confused and often annoyed as they sit and wait- whilst watching other people who arrived long after themselves being seen before them. This was particularly the concerning for one elderly man who spoke to me, who was really concerned because he was a diabetic. He had been there from 9am and he was seen at 1pm and needed to eat at regular times. There is a card numbering system to see the OT’s- (and it is the patients who tend to tell each other that a card needs to be obtained)- but if you are seeing more than on clinical person- it does not appear to flow well. Patients would do well to be warned of the system and the long delays- and to take a good book with them!!! Unfortunately, the nurses are not helpful acting more like glorified clerks with not a smile between them.

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