Robin, I'm sorry you had to go through all of that, but, unfortunately, I've been in your shoes with an older parent. It's incredible that in the face of your mother having an asthma attack the so-called professionals would continue to deny that she was in distress.

They tend to treat seniors like idiot children. Why, they can't possibly know what is wrong with them, the poor dears. Especially older females. Grrrrr.

It's sad but true, patients need an advocate to see that things done are in their best interest.

Sounds like they needed what we southerners
call a (come to Jesus talk). It usually works
pretty good.

I hope your mom doesn't have any more set backs Robin.

Ugh! Sorry you are facing challenges. Glad you chose that course of action. Your mom is fortunate to have such an articulate and insistent advocate. Sounds like she really needed one!

How absolutely infuriating for you! And how excellently you dealt with the situation.

There's a warning there for all of us, even the younger ones. If you take medication on a regular basis or on an as-needed basis, before going into the hospital, clarify their procedure for letting -or not letting- you have the medication at hand. Most hospitals won't want you to self-medicate because of potential interactions between your usual pills and the medicine you'll be taking as part of your treatment.

Thanks for letting me rant. I just couldn't believe it was that bad!!!!!!!!!

Mommy knew just who to call, the other asthmatic. Even in her drug-induced haze, she kept saying I felt like I did the day I went to the emergency room. No one should need an advocate to stay alive in a hospital. Admittedly, the Dr. Law told my mom late yesterday evening, they "dropped the ball". That really didn't make it any better.

Robin, things like that are exactly why I will never
leave Neil or Katrina alone in a hospital.
Especially Katrina, one is at the mercy of their caregivers
when one is physically or mentally impaired and while in
most cases they are in good hands, occasionally the ball
not only gets dropped it rolls out of sight and plops
smack dab in the gutter.

Your mom is lucky you were able to catch the ball before
it had time to roll out of sight.

The practice of medicine has changed so much that one is
lucky these days to find a dedicated doctor. We had one
tell us the other night that he didn't even know where the
emergency room was. Use to be when a patient became ill in the
middle of the night he could call his family doctor and
when he arrived at the emergency his docter was there to
take care of him. Now the hospital contracts with a
company to furnish ER doctors and you are faced with long
waits and a stranger just doing his job til the shift
changes. While some are dedicated to the healing of others,
most are just doing a job.

You know that's why I came to Vanderbilt when my last employer went out of business? They treat patients differently than other places. I really wanted to be a part of a place that treats customers with respect. Now, don't get me wrong, it's not perfection, but they try hard and it's the foremost thing in our mission statement, service. Feels good to be able to put my name beside all the others at this place.

I hate that Neil and Katrina don't get treated the best, because they sure deserve the best!

I'm so sorry your mother had to experience such a terrifying experience. As an asthmatic, I can totally understand how she felt. As an RN, I find the lack of concern and lack of a proper immediate reaction on the part of the "professionals" there as totally unacceptable. Hopefully this was written up, pushed on up the chain of command, and disciplinary actions taken. The things that are broken don't get fixed if they are swept under the rug.

I always loved taking care of the older patients and as an ICU RN, I made sure that my patients' families knew they were welcome to have one member stay with their loved one. Sure caused some issues, but it was, and still is, their right. And it is sad to say, but it seems that today it is almost a necessity for the patient's safety and well being.

I'm looking forward to going back to nursing when I retire from this job.

Mary

Thanks for your comments Mary! I talked to the MD last night. It was written up and is being investigated. He was upset over the pharmacist as that was the first time the ball was dropped. After I told him about the staff, he was even more upset and we talked about the checks and balances which should've prevented it. Ultimately, he was as furious with the respiratory person as I. Well, more upset. He was more upset because he'd given the order (via the charge nurse while I was headed over there) for the breathing treatment, but she would not have administered it without my intervention and insistance. He thought she over stepped her bounds, and I assume the normally calm gentleman will not be so calm with her. I hope he doesn't. And he kept insisting for mom to answer the survey very strongly in the manner it needed to be answered.

The main thing now is that your mother is okay after this experience.

That charge nurse should be removed from her position - immediately! The RN who was responsible for your mother's care obviously did not check her chart well as I would bet a dime to a donut her history of asthma was on the front sheet of her chart, or on the H&P, and her inhaler would have been listed on her med sheet. Respiratory therapy treatments are nearly always standard orders for asthmatics, even if only ordered to be given PRN. But, if asthma was listed as one of the admitting diagnosis, the charge nurse should have been the first one to question lack of treatments - WHEN SHE TOOK FIRST REPORT. Seems as though there are at least three of them who should be written up. If the charge nurse on her own decided not to request RT to get up there STAT and give the treatment as ordered by the MD (and I would bet it was a STAT order), it possible she could be charged with practicing medicine without a license, endangering a patient, and have a complaint filed with the state licensing board.

I'm most assuredly am not a perfect nurse, or a perfect person - the good Lord knows that - but this was total neglect and lack of concern.

Now I'm the one apologizing for the rant, but situations such as this just go all over me. I know the floor nurses in hospitals are usually given a high patient to nurse load, but common sense and critical thinking should still always be practiced. It could be someone's life.

I would want to take a good look at the chronology of the doctor's orders on her chart........starting from admission, concerning her asthma medication availability, when it was to resume post surgically (if it was withheld for that) and any orders for respiratory treatments. The issue could be .....Were they written into her initial orders? Or were subsequent orders already in place when she had her crises. Did a charge nurse have to call for an order to administer them when your mother had a crises? In all fairness to nurses.......a nurse can't even give an aspirin in a hospital situation without an order being in place to cover that.

Health care is in continual evolution. Once upon a time, the care givers were a small intimate group. Nurses did things like starting IVs, taking blood gases, giving certain respiratory therapies like chest percussions, doing a lot of the physical therapy. Now, the typical patient is seen by an army of "specialists". They all do their thing independent of the others, and in a perfect world leave communication behind and everyone who has anything to do with a patient READS THOSE COMMUNICATIONS!

What I have found contributing most to less than adequate patient care (both on a personal and professional level) tyically can be traced back to a lack of communication. Somewhere in this process, somebody has to look at the patient as a whole person. Not a set of lungs, not a set of muscles, not a brain, not an id, not a gut.....but a person. They need to look at all the picture, from the most intricate test to whether they are getting the proper meals and if said patient or their POA understand and agree to the care they are given. If, for any reason, a patient or their representative isn't able to know and understand those care plans, my question is..... can a facility claim they have a patient's consent to do anything? That's a basic right. So, that's why a health care POA is important.

She had a typed up list of meds she was taking and knew that she needed her asthma meds at all times. They knew, they said. It was written and stated verbally more than once. None of her asthma meds were to ever be withheld. Not one time. Everyone eveywhere knew it. The treatment order was STAT from the MD and the charge nurse was carrying it out. It was the respiratory therapist and the LPN not the charge nurse who were fighting me. They should be written up.

What they're saying happened is (and it flies all over me when I hear it)... the pharmacist had "never heard of uniphyll" (yes, but the NIH has a website anybody can access with all the names, generic and otherwise. You can see Uniphyl and Theophylline right next to each other. It'd taken me 30 seconds to figure out what to replace it with), didn't have it, and didn't know what to replace it with. So he was going to ask. But didn't. Poo-poo mistake number 1. When mom asked about it in the morning, they called Law who said to call her asthma MD to figure out a replacement. And it wasn't done, AGAIN, poo-poo mistake number 2. It wasn't until I'd gotten there in the late afternoon they'd figured out they had Theophylline and could use it in its stead.

There was no lack of communication this time, it's just pure negligence. Heck, Dr. Law is shaking his head as much as I am. He's furious that he can't "do surgery while his staff takes good care of the details". I don't blame him. That's what we're here for.

"She had a typed up list of meds she was taking and knew that she needed her asthma meds at all times. They knew, they said. It was written and stated verbally more than once. None of her asthma meds were to ever be withheld. Not one time. Everyone eveywhere knew it."

A list of a patient's home medicines is taken as part of a history and customarily attached to the chart. But, what I am asking is are you sure they were on her chart as an order to be given? If they were, and she hadn't had them for days, SOMEBODY made the decision not to administer them. One issue is who and why? Since you say she didn't have them since Saturday, did she or you ask that question before her episode? It doesn't feel right that everyone who had given patient care to her would have missed it, and not questioned why that was the case. This is exactly where I was coming from when I addressed the flow of information. If she had been getting her meds right along, was there a possibility this would not have happened?

I have to make the assumption the breathing treatment was given as a new stat order. Did I understand correctly that order had issued for a matter of hours and not acted upon? Did any one of the floor staff catch that fact well before she called you? Did any of them try to expedite the treatment by communication to the physician or pharmacy directly or did they leave it up to another department to follow through on it?

At the facilites where I worked all the floor staff who were caring for a patient or administering meds would have looked that drug up in the a reference and educated ourselves to it's generic name and likely been in contact with the pharmacy about it quickly if there were an issue. We were required by our own policy to do this with every medication. Good, good policy. Is that a policy in that institution as well?

Your description of the actions of the resp tech and LPN still leaves a question in my mind whether they had access to the drug to be administered. If that were the case, how could they give it? Were they trying to calm the patient to decrease her respiratory demand until they could get and administer the drug? Could they have been just as anxious as you or your mother, but doing the best they could under the situation?

I guess what I am saying is that I still would question this a communications issue and also wonder if it could also be an accountability issue. Checks and balances likely exist in the system to prevent those things from happening. You might be surprised who "could" be considered accountable. Your doc did the right thing for initiating a complaint, and I'm not in any way saying your anger is inappropriate. You should be upset.......but I'm wondering at this point.......at whom.

I'm not implying any particular member of the staff is at fault nor guiltless. I'm saying that an internal look-see is appropriate to address those issues not apparent from the outside. Been there and done that myself as an advocate. I'm very glad it turned out OK.

Well, I told you I wasn't perfect - I totally misread your sentence "He was more upset because he'd given the order (via the charge nurse while I was headed over there) for the breathing treatment, but she would not have administered it without my intervention and insistance " - emphasis is mine. I took that to mean the charge nurse. Should have read more slowly instead of jumping ahead of the writing - if I had I would have seen "administered" and realized you were talking about RT. Sorry!

Did you have any desire to find the pharmacist and teach him how to use a computer....?????

Here's to a complete and quick recovery for your mother.

I'm not slamming nurses, I promise. I'm slamming that hospital's floor nurses, those in charge of my mother's care. So is Dr. Law.

Suz, checks and balances are exactly what Dr. Law is upset by. Not only did the pharmacist screw up royally, the nurses were getting it wrong. No one was making sure she had her medications. It is in the chart, even the MD is saying so. All anyone (LPN/respiratory person) could say was "I've never heard of Uniphyl, it must be new." Mom would just roll her eyes every time and about the time they'd said it one too many times, I looked at mom and said, "Haven't you been taking it for well over a decade?!" She nodded emphatically. As emphatically as a severe asthmatic having a severe attack could do. Who cares if you haven't heard of it, just give it to her! I'm mad at the pharmacist, LPN who told her to take slow deep breaths (how asinine!) and the respiratory person who told me that she herself was an asthmatic, but she didn't think my mom needed anything more than her inhaler. What a dope! Of course she needed more, anyone lay person or not, could see and hear it easily. I wish you'd been there, you'd have done an excellent job.

Actually Mary, I'ld like to smack him over the head with a computer. ;)

Well, I can surely see why you were so frustrated and upset. I had painstakingly described a situation where I had to advocate for a family member, and it was such a horror story, I decided to delete it. If anyone had read it and then found themselves in a facility, I don't think it could have done anything but taint their perceptions of their care.

Let's just say that is why I am such a believer in the flow of information between not only the staff members, but the inclusion of family or patients with this information freely and not in a defensive manner. It's to everybody's benefit.