"my stay as in patient at RLTH"

About: Broadgreen Hospital The Royal Liverpool University Hospital / Accident and emergency The Royal Liverpool University Hospital / General medicine

(as the patient),

I am a 64yr old resident of Sefton. I have a history of “flare ups of osteomylitis and cellulitis as a result of an RTA as a child. I also have atrial fibrillation as a result of an ASD (atrial septal defect) which was closed by surgery in 2012. This is a diary of my recent stay in hospital. It is intended to be helpful. The Mo referred to is my wife.

DAY 1. Woke up at home around 1. 30am with the shakes. Very recognisable as symptom that my leg has flared up. Try to control it but have to give up and wake Mo. We manage to get to Royal AED. Surly receptionist takes details from behind glass screen whilst barely looking at us. Get into cubicle and attempt to explain what is now a familiar pattern to me. and it`s treatment by I/V anti biotic. Have had some paracetamol and shakes starting to calm down. Leg looks ok. After long period of waiting seen by Jnr Dr and Orthoped consult asked for. Told I will be staying in. Mo has brought my meds from home and nurse takes them to record them and returns them to us. Send Mo home as it is now 0700 At 0900 Mo rings AED and is told I am being moved to ward 8A. At 0910 Orthop Dr tells me I should go home and take lots of paracetamol. Gives me slip of paper to take to reception to book outpatient appt for Tuesday 19th. Reception staff as unwelcoming as they had been on arrival. I ring Mo and she collects me from hospital. Through Friday leg become stiff and a bit sore.

DAY 2. We decide that Mo will go to Oxford O/N for planned visit planned and I would ring GP if I felt more ill. Around 2pm recalled to AED, by phone call. Assured they will be aware of situation and will expedite my admission. Taken to AED by my sister in law. I tell her not to wait with me. Some 2. 5 hrs after arriving I am seen by same Ortho Doc who had sent me home previous day. At 1730hrs he tells me I am being admitted to AMU? I phone my sister in Law who says she will visit. She visits and is directed to wrong ward from AED but sees my name allocated to a total of three different beds on two wards. and eventually finds me. I at last get I/V anti-biotic. I spend an uncomfortable night in a gloomy ward. At 1600 on AED I asked for paracetamol to keep temp down. This was brought to me, but a total of three nurses on 4 occasions told me they would bring some water for the tablets. I eventually got water at 18hrs. During evening I ask a variety of Drs and nurses about my other meds which I had unfortunately forgotten to bring. I didn`t get meds until following day.

DAY 3. Between 2pm and 4pm I get visitors. During the visit a nurse arrives and stands behind me and asks questions about my medical history in front of my surprised visitors. I try to ask her a question but am interrupted mid-sentence by another nurse who rudely ignores me and asks first nurse a question about another patient. At 1700 I am transferred to ward 7B without warning or notice and just as I was about to have a meal. I was not greeted at 7B just put in a bay and after 30-40 mins a nurse arrived mainly it seemed to change my wrist band. I was still without med for my AF, or food.

DAY 4. Woken at 0600hrs by a nurse who wants to take my blood pressure. She tells me it`s a bit high. I explain I`ve not had my AF med for two days. Bored on ward leg quite sore and red. My son and Mo arrive straight from train welcome relief. Plan is for I/v antibiotic and echo sound on heart and MRi on leg. A bonus is guy in my bed before me has left credit in the pay television.

DAY 5. As in previous episodes after I/V med I feel quite well. Echo sound done. Explanation reason for echo sound that because of my ASD closure there is a risk that infection might attack site. Man in next bed moved suddenly and his bed area disinfected. MRSA I conclude. I get extra blood test. And have MRSA test swab, for first time since arriving at the hospital.

DAY 6. Echo sound clear. I suggest to Dr that results should be made available for my appt at Bgreen on 28th with Dr Morrison Dr thinks this is good idea. Ward is a bit of a circus. Two guys on ward in competition for who can be the biggest pain in the arse Wondering round constantly demanding and loud. One sends for his mother late on. they leave the ward and return about 2230 hrs with pizza. I gather he is in because of uncontrolled diabetes.

DAY 7. Long day. No immediate prospect of MRI being done or putative date offered.. A new patient on ward is clearly having a psychotic episode. Disturbing for all. In he evening I have frank exchange of views with doctor over point of my staying just waiting in seemingly endless queue for MRI, the relevant cost of my staying, and risk of me picking up infection on ward.

DAY 8.

Good news is that I can go home on day release until Monday Have to have Cannula removed hospital policy, and come in each morning for new cannula and I/V antibiotic. Lucky I am going home as I am beginning to feel like I don't want to go. Feeling a bit dependant.

I am at pains to ask what best time for me to come in. Am told any time in the morning. Agree time and told my bed kept for me. Mo comes and takes me home about 1600 hrs. This is a relief.

DAY 9. went to ward 1100hrs. Nobody seems aware of the arrangement. Nurse tells me I will have to wait at least an hr for Cannula. I challenged this. She then said I wasn't written up for antibiotic and the doctor would have to do this but would be sometime as he was alone and the ward is v busy and he would have to read all my notes before prescribing. I asked to see notes which to me basically said I was written up for antibiotic. I had discussion with nurse to agree where blame for delay lay. Agreed it was consultant's fault and established with her that this is what I would tell him. Cannula and anti biotic materialised within ten minutes. Had meds and went home.

DAY 10. 10. 00hrs on ward for cannula and drip. All done in about an hour.

DAY 11. Cannula and drip done without problem. Told I have to come back tonight and sleep. Not happy but there you go. returned to ward at 2100. . Changed for bed and listened to radio

DAY 12. Woken at 0600 to have my bp taken. Now awake went for a shower at 0615. Had bloods taken at 0700. For the first time is really hurt. Sat around tried to read uncomfortable in chair. 0930 breakfast arrived the latest it had been

Ward round 3rd new consultant. Continue I/v anti b until MRI. Profuse promises that MRI would be chased up..

1030 good news MRI booked for 1400. read until lunch feeble ham sandwich and the soup today described as leek and potato but indistinguishable from soup on other days.. Nonetheless welcome as had some taste.

Dozed off and woken at 1345 by porter to take me to MRI all going smoothly.

1400 technician asked stock questions about foreign bodies and implants. Told him about ASD device. He shook his head asked me if I new make and model of device. Strangely I didn't. Told me he would ring ward to find out presumably because they didn't want to run the risk of ripping my heart out like it was Indiana Jones. 40 min wait in cold room followed by a return to the ward as I had lost the slot. Told by MRI staff that this is something ward is well aware of. On ward found Mo, and doctor on phone to Bgreen to discover my device number.. Good? News I can have MRI bad news don't know when. Really poor stuff. Staff had been made well aware of my ASD closure, hence Echo sound.

1700 nurse says MRI booked for tomorrow 1120 not holding my breath.

DAY 13. awake at 0500 general hubbub bp taken at 0600 went for shower. Tried radio and book until 0900 when breakfast arrived. Nothing from 0600 to 0900 then lunch at 1130 the y wonder why people lose appetite. . Doctor arrived apologised for yesterday Had MRI. All done in 40 mins.. Likely results of MRI not ready until tea time so looks like I'm in tonight Not in best of humours. , . I stress with Dr and nurses that I have appt at Bgreen at 1330 tomorrow re my heart and want to be able to keep it.

DAY 14. Usual routine woken at 600hrs breakfast at 915 hrs consultant says no MRI result yet and goes on to cheer me with news that if positive I will be having 10 weeks I/V antibiotics but that this will be done at home. No explanation how or if possible why not done already. Later nice enthusiastic female blue Dr says MRI clear and I can go home. I return to Bgreen appt and say if my discharge and meds ready I will make my own way to Bgreen. Helpful Nurse tells me there is little chance of organising letter and pills in 2 hr time frame allowed and he will make arrangement for me to be taken to my appt by ambulance. I tell him this is ridiculous. Agreement made that I would leave ward to keep appt and return to ward after appointment when my discharge letter and meds would be ready. Say my goodbyes to ward mates and rendezvous with Mo at drop off outside main entrance. Keep appt with Bgreen which is prompt and professional. (Dr at Bgreen on hearing says idea that ASD device a risk with MRI “ludicrous”). As Apt is prompt I suggest to Mo that we give 7B more time to sort out discharge and we go to Lpool 1 (a costly mistake on my part as Mo hits John Lewis clothes) by 4pm decide this should be enough time and arrange for Mo to drop me at Hospital and await my return by parking up on road.

At ward 7B staff react like they have never seen me in their lives before. Certainly they have no discharge letter and meds not done

I am perplexed. Suggestion made is that I take ward phone number go home and ring before I return and they will have meds ready. Nurse says I have to have I/V anyway! I ask how that arrangement is any different from the one I had made this morning which had failed miserably. Male blue Dr obviously a bit frazzled tells me is a problem with pharmacy. I offer that it always seems to be someone else's fault. Am about to leave when I notice a small pile of what looks like discharge letters on the counter. I can read the top one which isn't me but ask that pile is checked. My discharge letter is in the pile. I suggest that I at least take this with me as it appeared to be safer with me than with them.

At this point female blue Dr, author of discharge letter arrived and woman sitting at PC volunteered fact that she was from pharmacy. Agreed that only new med was oral antibiotic the rest I had brought to ward and hadn't changed. Pharmacist volunteers to take me down to pharmacy and get meds if I am ok to wait a few minutes. In lift she tells me the reason meds not done is because on PC I am recorded as having signed myself out.

I go home having forgotten to ask for my meds which are still locked in cupboard by my bed. Fortunately I have repeat prescription waiting for me at home.

I would offer the thoughts that much time, energy, and resource could be saved by listening to patients, improved communication, getting things right first time and not planning for and resourcing failure to do those things.

Notwithstanding this I recognise the difficult circumstances that staff work under. There were a number of difficult personalities presenting as patients on the ward during my stay, and this was disturbing both for other patients and the staff charged with their care.

I am thankful for the efforts of staff on my behalf, and the individual kindnesses shown me.

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Response from Royal Liverpool and Broadgreen University Hospitals NHS Trust

Thank you for your comments and feedback about your experiences with us. We have passed on your comments to senior staff at the Royal. If you would like a response to your comments, then please get in touch with us so we can take your details. You can contact our PALs team on PALS@rlbuht.nhs.uk or on 0151 706 4903/2265 or typetalk 18001 01. Thank you.