"Good treatment and some learning"

About: St James's University Hospital / Accident and emergency St James's University Hospital / General medicine

(as the patient),

I was treated for a stomach bug recently in A&E and CDU. It wasn't a serious infection but I have a number of other conditions that mean that I have to be checked over and treated in hospital when this happens.

The treatment I received was, overall, great. The doctors and nurses in A&E were fantastic, despite the department being full to the brim.

In particular the A&E staff who looked after me listened really well to my own thoughts and preferences about my treatment - recognising that I've lived with my conditions for long enough to have some expertise.

I only had two concerns, both of which really relate to CDU. This unit was also really busy so I didn't feel it was appropriate to raise them at the time.

When I was in A&E I repeatedly had low blood sugar - something that can happen in the context of my adrenal insufficiency. I'm also diabetic on insulin, so I have to keep a close eye on my blood sugar during illnesses as it can rapidly swing up or down. On this particular day it was consistently going too low - I would take on more glucose to bring it up, but it was dropping again soon after. I'd not had a reading over 5 all day.

When I ran out of my own glucose supplies I mentioned it to the A&E staff and they said they would get me some more. Before this could happen I was transferred to CDU. As I was being transferred to CDU I saw the doctor who had been looking after me in A&E - the doctor was no longer on duty but took a moment to check I was ok. I mentioned the stubborn low blood sugar and the doctor said to make sure I told CDU as soon as I got there, as it hadn't been handed over to them (having just dropped again, after the notes had been passed).

When I arrived in CDU I let the nurse know that I'd had several hypos and run out of glucose. The nurse said that they couldn't give me any glucose unless I had low blood sugar on their meter there and then. When the nurse tested me the meter showed 4. 5, which was felt required no treatment.

I have three learning points that I think are relevant in this situation.

Firstly, a reading on a glucose meter represents a range of possible blood sugars, not a single value. The meters are currently accurate +/- 20% at this level, so my blood sugar could have been anything between 3.6 and 5.4. My own meter showed 3.8, but the nurse was only interested in their reading.

Secondly, a reading of 4.5, in the context of illness, multiple hypos and adrenal insufficiency that has already been treated, isn't high enough. I would generally aim for at least 5.0, but ideally 6.0, so that I have a buffer for the next drop in sugar, as the hypoglycaemia can in itself re-trigger an adrenal crisis.

Thirdly, a patient with insulin-treated diabetes is usually an expert in their condition, and the most appropriate response to any glucose reading is to ask the patient "Is that normal for you? What would you usually do in response to this reading? " Given the circumstances, I would always treat this 4.5 reading with 15-20g of glucose. As the nurse wasn't "allowed" (their words) to give me any glucotabs, my partner went in search of some and managed to find Lucozade in the shop.

I feel that probably the nurses on the unit need some update to their diabetes training, particularly around hypoglycaemia and the interpretation of finger-prick results. If the unit hadn't been so busy I would have explored her understanding a little more myself, but I could tell that she was under a lot of pressure - it wasn't the right moment.

The other incident that I felt was worth bringing up is that I was in a side room (really an examination room) in CDU for infection control, but confused elderly patients repeatedly entered my room. On one occasion I was actually using a bed pan at the time, as I wasn't allowed to use the shared toilets. The door had no lock and although the nurse closed the door on their way out (after leaving me the pan to use), I had no way of keeping it closed, but I assumed anyone would knock before entering.

Unfortunately a confused elderly gentleman opened the door to the room and started to come in. I managed to stop him from actually flinging the door open, which would have exposed me to the whole waiting room. It was still not a dignified experience, although to be honest I've been in hospital so many times that I've long abandoned the idea that as a patient you are afforded the same level of privacy or dignity that a non-patient would expect.

In total he came in to my room 3 times and a elderly lady came in 3 times. I understand that the pressure on space and staff was very significant but there has to be some kind of better solution, both to preventing confused patients from wandering around the department (for everybody's safety) and for affording some privacy for patients forced to use a commode or bedpan in a side-room with no lock. Even if that is as simple as offering (not expecting the patient to ask) to stand outside the door for 2 minutes.

Overall, I was very well looked after, especially in A&E. I hope the issues I've raised are useful as they are likely to come up quite regularly. Thank you for all the help and care I received - all with a smile and a nice introduction.

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Response from Shannon Dunford, PALS Officer, Patient Experience, PALS, Leeds Teaching Hospitals

Dear Stray

Thank you for taking the time to write to us and for the positive feedback included in your post.

I am very sorry to read about your concerns regarding your care as a patient with diabetes and thank you for providing us with such useful feedback.

Unfortunately there is not enough information in your post to allow us to look into the concerns you have raised as robustly as I would like so I ask that you contact our Trust’s Patient Advice and Liaison Service (PALS). This would also allow us look into the matters you have raised more thoroughly and also to see what lessons we could learn from your experience in greater detail.

Our Patient Advice and Liaison Service (PALS) can be contacted on 0113 206 6261 or alternatively by e-mail at patientexperience.leedsth@nhs.net

Kind regards

Rosie Horsman

Senior Nurse

Patient Experience Team

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