Tag: hospital

Emergency Department – ‘Code Blacks’

Brett1 Comment

ED

 

I am in a very privileged position to meet with key people in the New Royal Adelaide Hospital (nRAH) in regard to discussing ‘code blacks’ and making practical changes to minimize the trauma to both patients and staff with escalating behaviours.

This is a golden opportunity to set a new standard in the ED of the hospital and have a different mindset in regard to people with dementia which can hopefully be adopted by hospitals around Australia.

I would like to represent the ‘DD Members’ that have an opinion or some feedback about the way things are currently done in the ED. I am really excited that the decision makers are listening and prepared to improve things – Please place your feedback, comments and ideas below so I can be fully prepared.

If you have experienced code blacks and the ED environment your participation in this discussion would be most appreciated.

Thank you

Imagine You Have Dementia And This Happens………

Brett0 comment

Cross-Corridor-a

 

1312

 

maxresdefault (11)

 

Your life is regimented, predictable, and probably pretty simple (and possibly boring). You are now living in a nursing home amongst the familiar faces of other much older residents, and you feel you don’t fit in. Then without warning you feel strange and show signs of agitation, depression, or some new ailment. The doctor is called and a new medication is administered to counter the new symptom. You were meant to get better, but you react badly to the medication and have exaggerated behaviours and become agitated  and start hitting out. You did not ask for a new tablet to try, you were made to take it and it makes you feel strange and behave in a different manner. Other residents are confused and startled by your unusual behaviour, they are rattled and start to yell at you. All of a sudden the whole place is in chaos …all because of you.

As a result an ambulance turns up with a person in a green jumpsuit (but you don’t see the ambulance). People are constantly talking at you, but it sounds like ‘white noise’ and they want you to be strapped into a bed like contraption. You refuse as you don’t know what is going on. People are scattering everywhere, fire doors are being locked and you are on one side of the clear doors and every other resident is on the other side. You start pulling at the doors trying to get to the familiar faces you can see through the window. You feel like a prisoner being put in isolation. You are now frightened and angry and have no idea what is going on – every move you make now has a consequence. The more you shake the doors the more people are yelling at you to calm down…you think to yourself “what is happening to me, I haven’t done anything wrong?”.

People are grabbing at you trying to settle you down, they tell you to go everywhere you don’t want to. The people send you to your bedroom. You think to yourself ? “I am not a child”…. but you are being constantly told to go. People stand in your way and block your exit, and you feel trapped. You are refusing to comply and along comes two more people in green suits. You are now cornered in your room and surrounded by 5 people telling you to calm down. Your mind is racing “How do I get out?”.

The green suits want to give you a needle but it is too dangerous. They opt for a nasal spray. Being blasted with spray up your nose is unpleasant, you need to be still and calm. You are told to lay down. You don’t want to, you sense something is bad about to happen. “HISSSSS” the spray is set off. You react really badly like a caged lion. Your mind is scrambled and you think again…. “Why are these people trying to hurt me?”. You are now in survival mode.

The green suit tries again to give you another spray, you hit her away. A heavy net blanket is thrown over you and you are pinned. They spray again, you struggle and are restrained. You thrash and bite as your arms and legs are pinned. You are placed in a strange tube like space and you are now moving. The ambulance races to the hospital and you start to calm down and are exhausted. You arrive at a very busy Emergency Department but you don’t understand this, there are stretcher beds with people on them all lined up. There are up to 10 green suits all walking around. Big muscle-bound men in navy uniforms are lurking nearby, you think to yourself “where am I?…What is going to happen next?..why are there so many people here?”. You are confused and lost, you are also angry and frustrated. The green suits are replaced by people in white outfits. Here comes another needle. You don’t want it…are they trying to drug you? ….Who are these people? You react by swiping at the person in white. You are then surrounded by 6 huge men. They are holding every limb down to the bed. An hour later you are still in the same position. More needles, More holding down, more fear. You are then given a new space to live in by yourself with beeping noises and constant badgering. The big white lights are turned on early each morning to annoy you. As you open your eyes the people in white put more tablets down your throat before breakfast. You are now in a very regimented prison like space, everyone is now the enemy. You think to yourself “Where am I, Who are these people? When will this nightmare end?…. All this turmoil because another damn symptom arrived…….This is extreme dementia.

NB – The above story has been written to help us as carers ,nurses and family members possibly understand how a person with dementia feels. When you lose insight as to how ambulances and hospitals work they become very scary places indeed. We need to show empathy as much as we can and limit the distress to the person with dementia as much as possible.

Is This The No#1 Problem in Dementia Care?

Brett0 comment

After 5 years of being surrounded by people with dementia, aged care facilities and hospitals I have come to a conclusion. Noise seems to be at the bottom of many behavioural issues when it comes to people with dementia and we need to do something about it.

Noise ….It is EVERYWHERE! and we are not putting enough emphasis on it when we search for answers why people with dementia act the way they do. They often cannot express their feelings or thoughts, and maybe we are chasing the wrong things?

I have some video of Dad in hospital and when I played it back I was shocked to hear the noise and it was not only ‘too loud’, the ever repeating beeping alarms on the machines combined with the bed alarms and the constant din of people in the hallways was like a cruel form of ‘water torture’. Can you imagine what it is like to be stuck in a bed all day listening to the same machines beeping over, and over, and over again?…It is no wonder most of the people with dementia in hospital are in the hallways, heading for the locked door trying to get out!

In hospital Dad was manically walking the hallways for 10-12 hours per day across 5 weeks and I believe it was the noise driving this. How do I know this?…because I was walking with him and witnessed a miraculous change in his behaviour that was mind blowing! We transferred him to another hospital which has a ward that specializes in treating people with dementia and surprise,surprise it has no stimulus, no noise, no bright lights and no beeping…just silence. To watch Dad on his first day walk over to a couch and sit down and rest, and be at peace was ‘game changing’. His medications were the same, and the environment was the only thing that was different….conclusion?…enemy no#1…noise!

It is no different in the aged care facilities and some have construction going on for extended periods and the sound of concrete saws, nail guns and jack hammers over breakfast is surely not the best way to start your day? We need to allow people with dementia to enjoy their mealtimes at least, and there should be a no construction noise policy across meal times.

The clanging of the cutlery and crockery on the meal carts needs to be a focus, and the vacuum cleaner is blaring nearly every morning when residents wake up. Is 7am – 9am the best time to be creating that kind of noise?

Nurses and care staff are often carrying phones which have alarms that go off constantly as residents trip their movement sensors in their room alerting them to a resident on the move. This is a great system that protects residents, but in some facilities every single bed alarm is triggered through the same phone and not just a designated area. The result?…the mobile phones on staff are constantly ringing and beeping as they try to attend their residents and invariably setting off unwanted behaviours.

In a nutshell….reduce the noise and reduce the problems. ….Hopefully this blog does not fall on deaf ears.

This Notice Helped Save Dad Being Sent To A Mental Health Facility

Brett0 comment

 

This was a note I placed on Dad’s hospital room door, & at the top of his medical notes.

When Dad was highly agitated in hospital our family was very worried about triggering any behaviours.

As we are family, we intimately knew all the indicators that told us Dad was starting to escalate. This is really hard to pass onto others, but so worth it.

We were extremely fine tuned to his body language and would know by the pressure in his hands as to how dad was feeling. Everybody is different so this trait is probably unique to dad.

The reason why I am sharing this note is because it is super important to let hospital/aged care staff know how to handle the person with dementia the best they can. It is safer for them and better for the person with dementia.

By simply shaking Dad’s hand you can tell ‘where he is at’ and react accordingly.

Just imagine what would happen if a new nurse came on shift and had no idea that if you try and remove dad’s shirt when he is agitated you may get whacked.? This would mean security would be called and heavy restraint.Plus the potential for injury to the nurse.

You will also notice I tried to explain the best way to give dad medication. Obviously people with dementia often do not want to take meds and can be a volatile ‘flash point’.

I was not trying to tell the fabulous nurses how to do their job, but with dementia it is best to share as many ‘little tips’ as you can as it can make everyone’s day so much better.

Dementia is Different….Modern Hospital Care Needs to Adapt

Brett0 comment

 

Dementia is Different to any other medical condition. Dementia is incurable, progressive and requires a unique brand of care. I have a passion for providing a different model of care within our hospitals and am looking to change the way people with dementia are treated in Australia.

Dementia has many symptoms,side effects and unique considerations and everyone has a different journey. With an ageing population we need to change the way hospitals provide their care and ,modify the environment to be dementia friendly. A person is diagnosed every 6 minutes in Australia and hospitals need to change their methods now to accommodate this growing problem.

In a perfect world this is how I would set up a hospital to admit people with dementia:

  • Dementia patients would not have to enter through the ED (Emergency Department)- They would have a different pathway into the hospital with a quiet environment, dementia trained nurses, minimal stimulus and have more of a nursing home feel.
  • Dementia patients would be greeted and comforted in a gentle way and attempts made to pacify and calm the person before any bloods or x-rays are taken. These tasks would be attempted after the person is either calm or de-escalated.
  • The entry to hospital would be near the ED so the restraint team (security) can be utilised if required as a last option, not a first option. The security team would also be dementia trained and they would use a less is more approach both in member numbers and also physicality. Code blacks would be a last resort.
  • The environment would not resemble a hospital ED but moreso a warm nursing home feel with dimmed lights, calm music and muted ambience. Medical equipment would be disguised or hidden and recliner chairs provided if the patient resisted the bed.
  • Emphasis on ‘calming before treating’ would be the focus.
  • If the person was admitted to a ward it would be a geriatric ward that is purpose built and once again resemble a nursing home feel. There would be minimal people in hallways and larger nurses stations. The bed buzzer/alarms would be muted near rooms, but audible in nurses station. A light would flash outside the room and over the bed.
  • People with dementia would be in single sex rooms or small wards(with other people  based on similar stages of dementia severity).  Bathrooms would be dementia friendly with rails in showers, safety arms on toilets,heated bathrooms,exhaust fans, shelves for towels and toiletries, a shower head that can be used on or off the wall. Hygiene and cleanliness a priority. Hand gel would be accessible. Soft music would be piped into the bathrooms and frosted shower screens (or curtain) a must.
  • Patient gowns would be dignified and keep people’s cheeks in check:)
  • Patients with cognitive impairment would be identified by the new symbol outside their doors, near their beds and also on their medical file. Maybe a severity rating could also be adopted to allow for appropriate care?
  • The nursing staff would be hand selected for people with dementia and they all would have a patient and caring manner.  The catering staff would be trained to not remove food trays until the nurse has ensured the patient has had time and the support to eat their meal.
  • The food tray would be ‘dementia friendly’.The menu would have appropriate food choices with pictures for easy recognition so they could be pointed out by the patient.The patient would have the option to just order a ‘dementia friendly meal’ by the hospital or have a family member select the options for them (depending on how progressed the dementia is). – or select themselves.
  • The food tray and plates/bowls would be colour appropriate to avoid confusion, with minimal lids on desserts such as yoghurt and fruit. Spoons,bowl guards and plenty of napkins and a cold flannel would all be provided.
  • Only one plate or bowl would be served at a time to avoid confusion and the nurse would be actively involved in the meal process if required.Independence would be encouraged.
  •  Warmed blankets would be applied after night showers to ensure patients get off to sleep better.A built in music system could be accessed near each bed to help with sleep – a single push button to access ‘sleep music’. Staff will ensure wards and rooms are kept quiet after 6pm and before 7am.
  • Lights would be eased on and off via an automatic dimming system to allow people to not be startled and shocked. This would reduce anxiety and keep people calm. If people need to sleep in longer this would be catered for when appropriate.
  • Younger onset people with dementia would have their own ward space/section with age appropriate environments eg music, activities and surroundings.They would be treated just as equally as older people with dementia.
  • Code blacks would diminish, less resources would be used, and money saved by the hospital.The initial financial outlay would be counteracted by better patient behaviour on wards, and less ‘behaviour triggered’ resources required (eg security, nurse specials, etc).
  • A dementia specialist could be rostered on the ward to deal with behaviours of concern and take diversionary action. One trained dementia staff member could save 6 guards being called multiple times.
  • Our most vulnerable members of our community have earnt the right to respect & dignity at all times.

Maybe I am dreaming or maybe some of these ideas could just work?

Worth a try…..You know why?

DEMENTIA IS DIFFERENT.

 

 

A Shiny New Hospital…But Have We ‘Forgotten’ Our Dementia Patients?

Brett2 Comments

Our new Royal Adelaide Hospital is the 3rd most expensive building in the world…that’s right…IN THE WORLD! Who would have thought little old Adelaide could produce something so big and bold? It has cost us taxpayers 2.1 billion dollars to construct and will include world class facilities and cutting edge technology. Everyone gets their own ‘hotel-style’ room complete with robots zipping about, and we will never be more comfortable when sick. However when the new RAH opens and the ‘razzle dazzle’ of our shiny brand new hospital subsides, the underlying problems of our healthcare system in South Australia will emerge, and it is bad news for our senior citizens. The impact of the new hospital has a dark crisis looming for our ageing population and needs to be talked about.

There will only be 120 extra hospital beds more  than we currently already have but here is the real problem. The geriatric wards of the RAH will be reduced and the overflow of people will most likely be sent to The Queen Elizabeth Hospital (TQEH). This is the engine room of our health services for our aged community, and has purpose built world class facilities (GEM unit) for our dementia patients including research departments trying to find cures. But here is the ‘game changer’. The Hampstead Rehabilitation Centre facilities at Northfield will soon be moved into the TQEH. In theory it is a good move to place all these services in the one location, but the cost is that to make room for this, the existing geriatric areas will be further reduced including their beds, gardens and facilities for dementia patients.

With our ageing population being one of our most significant issues looming in the next 10 years, where are our elderly going to be treated? The Repat hospital will be closed and their geriatric services moved to Flinders Medical Centre. Once again less beds for the elderly as the facilities are located in the one place.The only way the overflow of elderly and dementia patients can be treated is to place them back in the general acute beds within our remaining hospitals. This means that our hospitals (including the new RAH) will now have dementia patients mixed in with general patients having surgery or who may have diseases.

What’s the problem with this? DEMENTIA IS DIFFERENT….The patients wander and roam, they may have mental health issues and require an extraordinary amount of resources to look after them to ensure their safety. After spending 12 weeks in the RAH and 4 weeks in the Repat hospital I know exactly what kind of mayhem one single dementia patient can cause. My Dad required a ‘nurse special’ 24 hours per day, 7 days per week and had over 20 ‘code blacks’ which involved up to 6 security people each time. This is a lot of resources in anyone’s language.  If someone is diagnosed with dementia every 6 minutes then we have a crisis on our hands. Our bursting hospitals will now resemble an aged care home and our wards will no longer be safe or effective.

But what if it is your loved one that has dementia and is sent to hospital? They will be placed in an environment that will scare them, it will be noisy, and may increase their behaviours. This means that security teams will need to be boosted and more nurses required to keep the dementia patients in their beds. The patients will naturally want to wander and may disturb other patients who are critically ill. Dementia patients often manically pace the hallways, they are no longer in touch with the real world so often resemble an overgrown toddler. They get lost, they touch things they shouldn’t, they cry & scream, they hit and throw things, they run around naked and sometimes they are just plain frightened.

What about their dignity? How do they feel?…I would suggest probably ‘forgotten’ (which is ironic when you have dementia) .

Our aged community need to be considered and looked after properly, they have surely earnt that right.

Xmas in Hospital – 2015

Brett2 Comments

FullSizeRender

These images highlight a very special Xmas and really capture life in Ward R8. Believe it or not, the 90 minutes spent with Dad was the highlight of Xmas for me and I want to share it with you to show you how little things count . My son Zak and I went into visit Dad in hospital before we had our traditional Xmas lunch at my sister’s house with our extended family (which was fabulous).

We turned up to the ward to find Dad slumped in a chair in the hallway flanked by his nurse. He was heavily medicated and could not lift his head at all so we decided to sit on the floor so he could see us. Surprisingly he remembered how to open a present, to reveal a brand new Port Power cap.

Dad then stood up and did some more laps of the ward with 3 of us in tow.He was groggy and slightly agitated. We had been unable to shower him for several days as he would lash out whenever we attempted. Today was different though – when I asked him to clean his teeth and have a shower I could tell his body language was in ‘auto pilot’. This meant I had a ‘window of opportunity’ to get him in the shower and the chance to get him back to a respectable condition that would make him look and feel comfortable. This was the ultimate goal for me today.

In the bathroom we worked as a team with Zak and Rashmi (nurse) running towels, toiletries and clothes into me so fast I could hardly keep up. Being organised and fast in the bathroom is something you need to master when caring for someone with dementia. What often happens is Dad may walk out of the bathroom at any moment (whether dressed or not) creating an undignified scene for other patients etc…I was totally soaked by the shower, but I couldn’t care less. To watch him just enjoy the warm water pouring on his face was another highlight as he had some relief from his frustrations for those few seconds.He became increasingly agitated as I put his shirt on and missed the armhole on the first attempt (you only get a couple of shots before he lashes out). He was so confused he tried to hit me away and actually hit himself in his own leg (thinking it was mine).

Today was special…We had success! He was showered,with new clothes on, and even let me shave him. Who would have thought something as simple as giving Dad a shower would give me such pleasure? In Dementia World we celebrate ‘small wins’ and today was no exception.

Merry Xmas Dad……

FullSizeRender (5)