|
Mater Hospital
6
Preparation for discharge from hospital
Adequacy
of information provided pre-discharge
Patients were usually informed that they
were going to be discharged a day or two in advance. In
some cases, the patients were told on the day of their discharge.
However, all the patients felt they had enough time to prepare
for going home.
All the patients had their medications
explained to them before they were discharged. Some of the
patients were given yellow cards which listed their medications
and the purpose for which they were prescribed.
Some of the patients were given advice
on self-care (e.g. exercise, diet) before they were discharged
from the hospital. Patients with cardiac problems were advised
to take light exercise and one cardiac patient was given
an appointment to go to see a cardiac education nurse:
| MM17: She (the doctor) said to walk
plenty and slow down, or stop, once in a while. Sure,
I'm always out and about. I'm always walking. |
Although a diabetic patient was given
written information on discharge relating to maintaining
a diabetic diet, she tore up the diet sheets she was given:
| FM19: Don't ask me where they are
because I tear everything up, but I remembered what
was on it. |
Whilst the surgical patients were not given
any particular advice about looking after themselves, in
each case, a district nurse visited the patients directly
after discharge to assess their progress generally and treat
their wounds.
Although most of the patients were not
told what complications to look out for, in the case of
the surgical patients, any such problems would have been
identified by the district nurse. In addition, patients
with a history of chronic illness were familiar with the
severity of the symptoms which would have necessitated seeking
urgent medical attention.
A third of the patients (6/19) were told,
by the hospital staff, who to contact if they developed
any problems or if their conditions worsened:
| MM12: Aye, they (the staff) said about
pains - if I take any pains, to phone the hospital right
away. |
In addition, one patient was advised,
by the district nurse, to ring her office if he experienced
any problems. Nine patients already knew to contact their
GPs and/or attend the A&E departments in such instances.
However, three patients did not know who to contact if they
experienced any problems.
None of the patients were given any written
information relating to their illnesses/conditions before
they were discharged. However, patients who underwent angiogram
procedures in the Royal Victoria Hospital were given advice
leaflets on self-care by staff in the RVH.
All the patients said they were satisfied
with the information which they had been given before they
were discharged from hospital. However, it was only after
they had been discharged that a couple of the patients thought
of questions that they would like to have asked the staff:
| FM04 (Heart attack patient): I was
happy enough. It's like I said - I have some questions
about things I should do and that, but I'm only starting
to think of them now, and they should deal with that
at the cardiac workshop (education sessions with cardiac
nurse). |
In addition, one patient would like to
have known whether the chest infection he developed had
been contracted while he was still in hospital:
| MM06: .I think I would have liked
to have known how I got the infection in the chest,
you know. I was just wondering did I pick the infection
up in the hospital itself, which is an easy thing to
do. |
Arrangements
for discharge home
The staff asked all the patients if they
needed any help at home, but only some of the patients required
help and there was often a relative at home who could provide
assistance if needed:
| FS14: The social worker came around
and talked to me and asked me if I needed any help,
but I said I didn't need any. |
Where patients did need help organised,
the arrangements were always in place when they were discharged
home. Although a medical patient did not require the assistance
that was offered with cooking and lighting a fire, she did
need help with heavier chores and the social worker organised
this on a private basis:
| FM08: ...it was just the social worker.she
said she would arrange for somebody to come and see
me at home.I said, ' I don't really want help'. I'm
not that helpless, you know. I have no fires, you know
- they usually make a fire and make your bed. Well,
I can make a bed, I can cook and I have no fire. But
what I would really need help for is the vacuuming and
washing the floor and doing things that use energy.She
rang me back that afternoon and says, 'there's a girl
that has come in here and she would be interested in
private work', and she gave me her number. |
As regards checking whether patients had
relatives at home to provide assistance where needed, although
the staff asked MM17 (a 71 year old with heart problems)
if there was someone else at home, he did not tell them
the truth. He said that his brother was living with him,
when, in fact, he was living on his own and had no phone
or helpline in the house. Consequently, during the time
that he was alone, he had no means of contacting his GP
or ringing for an ambulance in an emergency:
| .Now the doctor could say 'are you
on your own?', but I say, 'no'. |
Most of the patients who were chronically
ill and/or physically impaired were asked if they needed
any aids or equipment at home:
| FM09: .the staff nurse of the ward
- she came and made all of the arrangements for the
oxygen bottles and that to be delivered to the house,
for me coming home. |
However, although FM19 needed rails inserted
to enable her to use her bath, the staff did not ask her
if she needed any equipment. As she had previously fallen
in the bath and did not have a shower, she had difficulty
washing herself:
| But I can only stand there and have
a wash down, as I say. But it's not the same anymore
because I want to get into my bath, so I do. But I'm
afraid to get in now because I've nothing really to
hold onto.all I want is two wee handles on each side
of the bath. |
Although she had previously mentioned
this problem to her GP, she was still waiting for the bath
aid to be inserted, two-and-a-half years later.
Continuity
of care
On discharge, each patient was given a
letter to give to her/his GP. In relation to organising
follow-up hospital appointments, all the patients were sent
details of outpatient appointments in the post. In some
cases the patients were also told about the appointments
before they were discharged from the hospital. However,
in other cases, the patients were not aware that follow-up
appointments were being arranged until they received the
written details in the post. In the case of FM19, because
the staff did not mention whether she would be followed-up
in outpatients, this led to a misconception on her part
that she was going to die:
| FM19: Well, that's what I couldn't
get over, that's what came into my head there. Any other
time the doctor would say, 'we'll release you now and
you'll have an appointment in two months or three months
or four months or five months, but there was no appointment
this time. I don't think I'm getting one either.I have
a funny feeling that I'm going to die. |
Similarly, a medical patient noted on
his discharge sheet that a member of staff from the local
social services office would be visiting him at home, but
he had not been informed of this himself.
Patients' general views
on Mater hospital
The patients generally spoke highly of
the Mater hospital and its staff, as illustrated by the
following comments:
MM17: See, the oul' Mater - I think
it's a great hospital. To me it's the best out of any
of them, and I've been in the City and the Royal.
FM08: The Mater hospital is really a home from home,
you know. It's more intimate, whereas the Royal and
the City are so vast - they are impersonal - whereas
the Mater hospital is more personal and more friendly,
I think, and they are very caring, they really are.
FM10: .but, I mean the staff - the nurses - and maybe
the wee male nurses and all, they are good and I felt
sorry for them. I says they're run off of their feet.
There's not enough of them around that place. Know what
I mean? They are run off of their feet. It's terrible
the way they have to work.
MM12:.the nurses are great workers in this hospital.
|
|
