The Meeting, "Ah-ha's" and God's Hands....

SO.... I had the big dreaded meeting with Hospital Administration this afternoon about Mom's inpatient care; it went really well, they were very sympathetic, empathetic, appropriate, just overall completely positive and appeared to be 100% on board with educating the nursing staff so that these things do not occur for someone else.

So now for the God's Hand in real time.... About the "meeting"..... when they asked how Mom was initially, I said (truthfully) she's getting better every day, but didn't elude to how amazing she has healed from all this. So, after reviewing all the problems, and showing them a picture of mom's 2 day post-op, huge, raised, red-streaked, hot to the touch, grapefruit size hematoma on her hip, they asked what it looked like now..... and I was able to share: Today there remains a beautiful, tiny scar, that looks like nothing more than a long scratch. That whole area just healed; swelling went down gradually, but it never looked discolored or anything. They were amazed, literally, amazed, to which I explained with perfect confidence that the only explanation was that God had His hand in all this. Despite all our efforts and the multiple failures of care, in the end, prayer was more effective than any human action that took place.

I'm sure, in the back of their minds, they quickly thought, "whew, we probably won't have to worry about a lawsuit..." but I was tickled to be able to give that fleeting testimony, if only a tiny testimony that might have been thwarted by selfish concerns; but the look on their face was priceless, one of those "ah-ha" moments. Although this has been a very difficult time, I know lots of good will come out of this now... and in the future....

SUGARSTATS and the dreaded meeting....

Just got a call from the hospital administration office.... the meeting's been scheduled.... it's 1:30 on Friday...  here's a link to my original post  about the meeting...  Please keep us in your prayers for a positive meeting that will truly bring about change for care given to ortho-trauma patients, or all patients for that matter!  Despite all that was done/not done for Mom, she's looking like a million bucks, and there's no one other than God that can get all the glory for her recovery!  We're excited that she's got an appointment with a new internist on Wednesday, and she and dad have been given explicit written instructions on the major questions to ask him for his opinion on follow up, such as:

1. Mom had a d-Dimer test drawn while inpatient at HH, with a result of 2.53H. Peripheral venous US studies were done as a result that showed, “No DVT;” but he did report “some pulsatility noted in the common femoral veins.” From what we can find, that could indicate possible cardiac problems, but more likely a proximal clot. Is follow-up testing indicated to make sure she doesn’t have a clot?

2. A pulmonary consult was ordered for Mom while inpatient at HH and said she most likely had OSA (at that time, only one of her symptoms, her drop in H&H, had been treated with 1 unit PRBC’s…. her post-op chest x-rays continued to show unchanged bilateral infiltrates, she had a large hematoma on her right hip, a fever >101.5 requiring numerous doses of tylenol, and a klebsiella UTI infection that had not been treated). Once the klebsiella infection was cleared up via ABX started at the Nursing Home, spot checks showed she did not need 02 during the day. She was discharged on 2L 02 that she uses now only at night. Of course, the nasal cannula does absolutely nothing for her when she has periods of sleep apnea, can a CPAP machine/sleep studies be ordered for her?

3. Prior to her hip surgery, Mom required anti-hypertensive meds; but her blood pressure was very low in the hospital, and slowly increased to low normals in rehab. (In the attached printouts, we’ve recorded some BP’s she has had since she’s been home.) At what parameters should we become concerned, and when would you like to be notified?

..... furthermore, my parents were given explicit instructions to be able to report back with his thoughts on those issues..... Parents.... can't teach 'em anything.... we'll see how well they follow instructions!  I'll keep ya' posted!

AND.... just thought I'd share another really neat thing I've started for Mom that has helped tremendously to evaluate her blood sugars,  insulin dosages, and changes.  It's SUGARSTATS, it's completely free, online, and you can export all the information to an excel document to print off and take to the doctor with you!  Just click on the picture to take you to her shared profile and create your own account if needed!

Also, to help me with recording information to be tracked, I made Mom this form, if you need it, you're more than welcome to it,  just click on the picture to download!

Or you can download it from Google Docs HERE.

Chloe and Rocky Top....

Well..... our Boston Terrier, Chloe, can be the most annoying animal on the planet from time to time....  actually more than she is not..... but I'm starting to wonder if she has betrayed the oldest daughter and I....  You see, I'm beginning to think she doesn't like my cellphone ringtone, "Rocky Top."  BECAUSE.... IT APPEARS EVERY TIME SHE WAKES ME UP EARLY, I HAVE A MISSED CALL ON MY CELLPHONE!  Gonna have to try turning the ring volume down to see if she will ever let me get a full day's sleep again!

So, sure 'nuff, she repeatedly knocked on my door around 1:30pm today, after I had been to bed for only 3 1/2 hours... she knocks, she knocks, and she knocks, until I get up.  At 1:38pm, I'd had enough... so I proceed to carry out the ritual...

• I jerk open the door, before I can start screaming at her, she has promptly jumped onto the couch and is making her best attempt at looking innocent.  Milo (the schitzu) is prancing proudly, completely oblivious to my anger.... he's just glad somebody is around.  
• I scream at Chloe.
• I go to the kitchen to get a sip of water and a handful of animal crackers or something.
  
• I check for missed calls on my cellphone.
• I confirm, once again, somebody has called my cellphone around the time she starts waking me up!

She is just too smart for her own good, I think, or she can't stand "Rocky Top - Bluegrass version!"  She's such a traitor...

Which leads me to my missed call that I promptly returned....

I returned the call of a very caring Nursing Administrator regarding mother's care.... I was assured each issue will be addressed immediately, they were looking forward to our meeting next week, and would be letting me know what they had been doing to help make sure this doesn't happen to other patients.... 

The "Big Meeting" Time/Date TBA......

Please pray for all involved, especially for mom,  that she is healed from any harm that might have been done....  Will keep you posted!

Hippy Saga Continues.....

Praise the Lord... Mom is doing so good!  Her hip looks like a million bucks, and her home physical therapist had her walk up and down the beautiful long wheelchair ramp at their house today!  We weren't expecting that long and challenging of a trek for a while!  Except for a few blood sugar spikes every once in a while, she is doing much better than expected!  I can't say it enough... Praise the Lord!  God is good....

Yet.... the saga continues.... well, we've been a bit busy with all the goings on around here!  But, I desperately needed to follow-up on the care Mom received while in the hospital.... so I sent this email to our CEO, COO, and VP (I think those are the correct titles)....

First of all, thank you all for your prompt responses during my mother's hospitalization.  Due to unfortunate events that followed my mother's abrupt discharge immediately after receiving this email, I have been unable to follow-up until now.  I did leave a message with office staff for Ms. *****, on Wednesday February 18th, but I have not been at home since that time to be able to make phone contact.  We were anticipating an excellent rehab situation with HealthSouth and were approved for a bed, but late Wednesday afternoon (18th) my parents were told that the HS bed "fell through" and ***** Nursing Home was their only option for rehab, although we asked specifically not to go to ***** Nursing Home.  My mother was discharged via private car without oxygen despite orders to discharge on 2L oxygen to rehab/SNF by Dr.'s Johnson and Smith.  Needless to say, she wasn't doing very well when they made it to the nursing home, her oxygen saturations were very low, in addition, she was also battling a Klebsiella infection (although antibiotics were not started until she got to the nursing home) of which the results had finally come back from her testing done two days earlier at ********** Hospital.  Since she was discharged to a "MUCH BELOW AVERAGE" facility (according to Medicare - 40 citations for serious events last year alone, our national average is only 9) a member of our immediate family was present with our mother 24/7 during her 21 day stay there.

I've attached a very easy to understand table of specific problems my mother encountered during her inpatient stay at on*****.  These problems are serious, and the only reason I have spent the time to gather all this information is to prevent anyone else from having the same experiences we encountered.  If we had not been with my mother while she was in the hospital, she very well could have experienced even more serious complications, or even possibly lost her life.  I am concerned for the patients that do not have family members with them, and hope that this situation will offer learning opportunities for the staff of ****)*.

My mother is recovering, had a slow start and a few set-backs, although we are very concerned that she might have developed a thrombus that could prove catastrophic in the future; a catastrophe that could have very well been avoided.  However, we are people of prayer, and feel confident that prayer is what has brought her through all of this with a smile on her face.

Feel free to contact me if you have any questions. I've also attached copies of my original emails in the attached documents for easy reference.

CLICK HERE FOR THE DOCUMENTS OUTLINING THE ACTIONS/INACTIONS AND THEIR IMPACT ON MOM

This was the response I received:

Thank you for taking the time to send this.  I believe the best way to
follow-up might be for you, **** ****, ***** ****** and myself to meet
and discuss your concerns in person.  You have a unique perspective in
this case as both an employee and customer of our hospital.

I have copied my assistant, *****, to contact you and find a time
when the four of us can meet.  We'll try and find a time convenient with
your work schedule to make it efficient for you, but we'll probably need
to do this next week at the earliest given people out on spring break.

I hope you mother is doing well.  Best wishes to her and your family.

****

To which I responded with:

Thanks so much for your prompt response again!  That sounds great!  I wholeheartedly believe that we all have the best interest of ************ patients in mind; also, I firmly believe that one should never present a problem without having a solution.  I am more than willing to be a part of generating helpful staff teaching tools if needed.  I am a nurse, but a teacher at heart, and am willing to help in any way.

If you will pass on to your assistant, I am easiest to reach via email, as during my off time, I'm burning up the roads to be with Mom and/or picking up or delivering needed supplies for them.  Also, I am available any time next Monday or Friday, but I'm scheduled to work next Tues and Wed night, so I'll sleep Tues-Thurs during business hours.  If convenient, she can just email me a time and place and I'll be there.

Hence.... the picture of the board room at the top of this post.... Boy, do I dread those kinds of situations, but these are issues with specific consequences that can be life altering or even fatal to persons that do not have family to push for these things to be done.  With that being said, I have all faith that through answered prayers, God placed His hand on Mom to protect and heal her, there's no explanation other than divine intervention if you put 2 and 2 together.... this time they didn't add up to 4, and all the glory will be given to Him!

 Is anyone among you sick? Let him call for the elders of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith will save the sick, and the Lord will raise him up. And if he has committed sins, he will be forgiven. Confess your trespasses to one another, and pray for one another, that you may be healed. The effective, fervent prayer of a righteous man avails much.  (James 5:14-16 NKJV)

Oooooh... I'm Scared....

This is the text I got from my sister when she found the sign.....

Oh, well.... to watch and wait!

I'll be ready... and watching.... and when I least suspect it.... she'll get me back... and good.... she always does.....

Calling all cat lovers.... NOT!

Especially for my sister.... the cat lover.... NOT!  I'm not actually going to leave catnip under our cot, but I am going to leave this sign for her to find tomorrow nite!  If you missed the whole cat story... here it is....

Mom's doctor appointment with the ortho surgeon went well today, took the staples out and checked out her hip via x-ray and all looks well... now if we could get those sugars to cooperate!  It's simply been a miracle (and to God all the glory is given) that she's healed up so well with so many things that have went wrong, and worked their way out!  Monday is the official day for discharge and it can't come fast enough!  We're so blessed to have such great family, friends, and church family that have prayed unceasingly for her healing....

Sugar, Cats, and Dogs!

Mom's blood sugar was up yesterday, requiring additional insulin twice....  But, praise the Lord, it's down this morning, hopefully this will be a great day for her!  She's getting stronger every day, but when her blood sugar goes up , it just wipes her out... Counting down the minutes, she should be coming home next Monday, CAN'T WAIT!  We're so ready for some R&R at home with no interruptions! The only things getting to relax around us now are..... 

"Baby" the nursing home resident cat.....

....she/he decided to take a long nap in my lap Sunday night....  Yes, she comes in and goes out as she pleases at the nursing home where mom is at rehab.... I'm not joking....

.... and Milo held down the couch yesterday protecting his fearless leader during a nasty stomach bug....

.... and Chloe, who will NOT get out of bed before 10!  She would have stayed in bed the entire day on Sunday while the ground was covered with snow if we didn't force her to get up and out!

On a funny note, my middle sister is terrified of cats.... she's not seen "Baby" yet... thinking a catnip toy attached to the cot in Mom's room might be on the list of things to do before I have to report to my real job this weekend....

Praise Report and a little Funny to boot!

Mom's blood sugars have been near the 150's for the last couple of readings, so we're still praying that she's turned a corner away from "sugarland!"  Please continue to keep her in your prayers...

As you all might remember, the  youngest daughter broke big toe/foot and was in a bright pink cast in Jan/feb.... then mom fractured her hip 2 weeks ago. then last week, the youngest dd broke her arm/elbow and is now in another cast... it's a pretty blue.... WELL.... my best friend, Marie, called me Thursday morning at work about 1 am and said, "what color is the E's new cast?.... because they're almost finished with me down here in the ER... I broke my right wrist in 2 places and I go to get my cast tomorrow, but I wanted us to match!"

Presently... it's getting scary to be associated with my family! BUT, for the funny kicker.... The oldest daughter is singing a solo at church this Sunday, she's been preparing and practicing for a few weeks now.... guess what the title of the song is?

"BROKEN"  

Marie said to tell her to choose a song with "Healed" or "Millionaire" in the title next time!  

He heals the brokenhearted and binds up their wounds. Psalm 147:3

Please pray for sugar....

....to leave us alone!

A big thanks to you all that have been praying for mom.... now it seems that her blood sugars are running amuck!  Her blood sugars have been giving her a fit, she's very tired, wiped out, and weak; they made some changes that will hopefully help!  She's doing very well with her physical therapy, but the energy/weakness thing is interfering BIG time.... so please, please, keep her in your prayers... hugs...

Fracture times 2!

Well... I'll update more tomorrow, but in a nutshell, while I lay sleeping the 4 hours of sleep I got on Wed after working Tues night, I had 8 messages (about 2 different situations) before I got up...... 

1. The youngest (who got her pink leg cast off her foot last week) had a friend that fell on her in the cafeteria at school and she fractured her arm/elbow, and her precious step mom (i'm serious, I love her) went ahead and took her to the orthopedic doctor and now she's got a pretty blue cast up to her armpit and down to her fingers on her right hand.

2. and... from my dad from the hospital with mom.... "well, the pulmonologist was consulted (because they couldn't get mom off 02 and she kept having a fever) and he came in and said all her tests looked good, she must just run a low sat, and pulled her off oxygen. (still not treating any of her signs and symptoms of infection despite our pleading, and when they took her off her oxygen, they took her off the monitor, too.) OH, and btw, the good rehab center we were sending you to doesn't have a bed, now, so you can just take her by private car to a nursing home in your home town.... we'll call them some orders....) 

THEN, on my way to work, they arrive at the nursing home, mother's 02 sat is 82 (very low), they put her on 02, didn't have ANY orders other than a report that she didn't need 02, and they ordered that she needed antibiotics. WE COULDN'T GET ANTIBIOTICS OUT OF THEM FOR ANYTHING WHILE SHE WAS HOSPITALIZED! 

Don't worry, I'm takin' notes.... and when I get caught up there will be a meeting to attend to..... heading back up there in a minute to spend the night on a fold up cot by her bed.... she looks 100% better after 3 doses of antibiotics, no more fever, been doin' 02 sat checks and she's running mid 90's so far on room air. Will update you more soon, not out of woods yet.... please keep everybody in your prayers......

Hip Update....

Thanks so much for your continued prayers for mom.... this letter I just sent to our CEO should sum up what's going on today... 

"My father said you had stopped by and appreciated your concern.  I'm at a loss at what to do about this situation.  We are very concerned with mom's care and progress.  Her oxygen had to be increased (now keep in mind, she has never required oxygen before in her life) and her temp has continued to spike and be treated with tylenol.  We had the same night shift nurse, ****, tonight. When she entered the room for the first time this shift, mother told her she felt like her fever was up again, she NEVER looked at any part of my mother other than her face.  She does not check her incision site, nor check her pulses to her legs.  She told mother that the tech would be in shortly to take her temperature.  Mother's temperature was 101.6; after waiting 15 minutes we called for the nurse, ****, to PLEASE bring her some tylenol.  When she arrived with the tylenol, my father asked her to please call the doctor, as we are very concerned that she's been running a temp for several days off and on and doesn't seem to be getting any better. In the meantime, my nephew and I had went to the desk to wait for some skin protectant that was being tubed over from neonatal to put on mom's nose where the nasal cannula had caused a blister.  We overheard **** stating to some staff in the chart room behind the desk, "...he jumped down my throat and demanded that I call her doctor...."  We simply walked away, appalled and upset.  My father's request could not be construed as "jumping down my throat" in any way, hopefully she wasn't referring to my father, although we should not have overheard that conversation as visitors.  Shortly after, **** walked back in my mother's room and said she had called the doctor on call and "he ordered a UA and some blood cultures and to keep giving you tylenol for your fever."

When I was about to leave, I checked mother's right hip; normally, I visualize it when I first arrive.  What I saw caused great alarm.  Her right hip incision is covered by a bandage; however the skin around her hip is red, streaked, and hot to the touch.  My mother called for the nurse, a few minutes later, **** entered the room, and mother asked her to look at her hip, raising her gown.  She completely dismissed the obvious abnormal appearance of mother's hip.  Mother reported she still felt feverish (by this time, it had been an hour since the tylenol) **** never offered to take her temperature, just smiled and said "call me if you need anything, the lab will be in shortly to draw your blood cultures."

We literally don't know what to do, and we feel that mother will not receive safe care if we are not there to ask for it.  Any suggestions are appreciated, as we are very worried about mother's condition deteriorating while we wait to be assigned to nurses that will appropriately assess her and pass along vital information to the physician.  Definitely, we do not want to get **** (or *****) in trouble, and have every reason to believe that education issues will be addressed with them.  However, after dismissing mother's abnormal wound site, we do not want **** to be assigned to mother again.  Moving mother to another floor might be the best solution.  Please advise and thanks so much for your concern..."

Letter to the CEO....

Just a little update about what's been going on.... this is a copy of the letter I just sent our hospital's CEO:

"Thank you for your time.  My mother, ******************* (Room **)  is currently an inpatient at ********** Hospital.  There are several life-threatening or life-altering concerns related to my mother's care I have been encouraged to share with you by our family friend, ***** *********.  Please feel free to share this with ********** Nurse Manager, as important post-op complication education issues need to be addressed.

On Wednesday, February 11, 2009, at approximately 4:15 p.m., I received an urgent call from my father, stating that my mother had fallen on their tile floor on her right hip.  When EMS arrived we insisted to have them take her to ********* Hospital.  After several hours in the ER, our worst fear was confirmed, her hip was broken, explained to us as being a compression fracture of the long part of the femur into the head of the femur, and a partial hip replacement would be needed.   She was transferred to room ** for surgery the following day.   We were told that Dr. Michael Cantrell (ortho trauma surgeon) would be doing her surgery Thursday afternoon.

I arrived back at the hospital a few hours later early Thursday morning.  I was very impressed with the NP's for Anesthesia, Angie, and the Ortho Trauma Surgeon's NP, Cindy.  Both were very professional, explained everything in detail to my parents, and answered all questions we had relating to the surgery.   It was explained to us, since mother was being followed by internist Dr. Bobby Johnson, the Trauma surgeons wanted medical clearance for her prior to surgery, but as soon as he gave the OK, they would proceed with the surgery that day.

Mother was in excruciating pain, IV pain meds were ordered by Dr. Cantrell for every 3 hours.  Her pain was well controlled for 2 ½ hours up to 4 hours, but when it returned, it returned with a vengeance.  There was normally a 30-40 minute delay in response time for pain medication by our nurse, *****; this was very frustrating for us.  At that time, we did not know the frequency the pain meds were ordered, ***** would not come in mother's room to let us know it was too early to receive more medication, I would wind up finding another nurse, Peggy, in the hall, who would also have to give mother her medicine.

As we continued to wait for surgery, on 3 occasions, I asked ***** why Dr. Johnson had not been in yet, or called, to clear mom for surgery.  Each time, ***** would state that, “They left him a message.”  I asked her on the 3rd occasion if she had called back to make sure he actually got the message, she reported we  had to just wait on him to call them back.   At 2:15, I called Dr. Johnson's office and left a message with the receptionist that we were waiting on medical clearance, asked her if a message had been given to Dr. Johnson regarding this, and she was unaware of any messages regarding my mother, but took our room phone number.  At 3:45 p.m. I talked to Dr. Johnson's clinic nurse, who put me on hold, spoke with Dr. Johnson, and apologized for any delay, but denied knowing he needed to give mother clearance for surgery.  Dr. Johnson was in our room within an hour or so, but unfortunately surgery had to be put off until Friday.

By the end of the afternoon, when it became evident that mother's pain would not be controlled with PRN injections and delayed administration, I asked ***** what could be done regarding inadequate pain control, especially since surgery had been delayed, she  just said that she could only give the pain medication every 3 hours.  She did not offer to contact the physician (Dr. Cantrell) regarding the inadequate pain control.  I made contact with the Ortho's NP regarding inadequate pain control and was told that they would go ahead and start a PCA pump since she would need one for surgery.  Mother called for pain medication around 5 pm and ***** did respond to say that Dr. Cantrell had ordered her a PCA pump and mother  could wait for that.  At that time, I asked her to please give my mother her pain medication (it was due)  as we had no idea what time the PCA pump meds would get to the floor or be set up.  A few minutes later, I found Peggy and she gave mother her medication.

Her 7p-7a nurse, ****, entered her room sometime after 7pm, and asked mother how her surgery went today and if she had been using her PCA pump.  Mother explained to her that she didn't have surgery yet and she was still waiting on her PCA pump.  She said she must have gotten the wrong information during report, asked mother a few questions and left the room.  I found the whole incident disconcerting and strange, and was also concerned that **** never laid a stethoscope on my mother.  By this time my mother was 2 days out from her last BM, and was now requiring oxygen, but **** never auscultated her lungs, heart, or abdomen.  A day-shift nurse, Peggy, then entered the room and set up mother's PCA pump.  (Peggy was also orienting another nurse, Tim, that day, and was extremely busy attending to mother who was actually assigned to *****.)

After the PCA pump was set up, mother's pain was well controlled, and only had to “hit the button” once during the night.  The next day, ***** was assigned to my mother again; surgery was completed by Dr. Howard Miller (Cantrell's partner) that afternoon.

Mother was brought back to her room from recovery about 4:15 pm.  The PACU nurse told me and ***** that we needed to let Dr. Johnson know that mom would need to be evaluated for sleep apnea, and she definitely needed to stay on her oxygen because she couldn't keep her sats up without it.  A spot check showed that her sat was 93 on 2 liters O2.

 Mother returned from surgery with “foot pumps,” an immobilizer on her right leg, and NO TED hose on her left.  I asked ***** for a TED hose (anti-embolism stockings) for her left leg, she said she would get one.  She returned with no TED hose, but took mother's vital signs, her BP was 111/45.  I was very alarmed (mother's diastolic is usually high 80's and 90's while ON BP medication, and she hadn't had any in 2 days).  I asked her 3 times for TED hose over the next 2 hours.  I was very afraid of thromboembolism and mother is at high risk for that.  We continued to give mother sips of water, anything we could think of to help her blood pressure, thinking it might be related to fluid loss during surgery.  Frustrated, after my 3rd request for TED hose , I sat down on the other side of mother's bed and noticed very little urine output in her foley, and an IV bag clamped, not infusing, and laid on top of an 02 flowmeter.    At that point, I went out to the nurse's station, ***** was talking on a cell phone in the charting area.  I  asked another nurse, Peggy,  what rate IV fluid my mother's post-op fluids should be running at (should have been 50 ml/hr) and said I would be waiting by the tube system until a TED hose dropped for my mother and would somebody please go in and start my mother's post-op fluids, as I was very concerned with her low blood pressure, little urine output,  and risk for embolism.  I received a pair of TED hose from the secretary around 1830 (the misogram attached showed it had been requested at 1812, 2 hours after I asked for it) and placed one on my mother's left leg since an immobilizer was in place on her right leg, and her post-op IV fluids (Lactated Ringers)  were started shortly before 1900 (almost 3 hours after she got back to her room).  Her IV pump showed that 64 ml of LR had infused (at 50 ml/hr) at 2000.

Shortly after 8pm, ****, came in, asked a few questions, and again, never placed a stethoscope on mother.  A short time later, mother started having uncontrollable tremors (very likely could have been post anesthesia shakes) with increased confusion, nausea, pale, and bluish around her lips.  I called the nurse, told them what symptoms she was having and also requested her O2 sats and blood sugar to be checked.  A short time later, **** and another nurse arrived with Zofran for nausea, checked her blood sugar (slightly high, but unremarkable) and did a spot check on her O2, which was 86%.  The other nurse increased her O2 to 4L to get her sats to stay above 92.  I asked for a pulse oximeter to be left on my mother, stating that I did not feel comfortable with her being on that high amount of oxygen without monitoring it.  **** stated they never use pulse oximeters on their floor, I asked who the house supervisor was that night, and the other nurse said they could call respiratory to get a pulse ox put in the room.

Mother continued to have periods of dropping her sats to high 80's - low 90's, shaking, and shallow breathing.   Sometime after all that, **** brought in an incentive spirometer and said we'd need to get mother to do it every few hours.  Being elderly and high risk for post-op pneumonia, she should have been given an incentive spirometer immediately post-op.  Still never once did **** lay a stethoscope on my mother.  My father stayed with my mother that night, she did have one episode of apnea during the night with a desat to 86 that corrected when my father aroused my mother.

I arrived the following day, mother was still needing 4L O2 to maintain sats above 92, temp was elevated >100 to 101 and being treated with/relieved temporarily by tylenol, and a Chest X-Ray was done late afternoon.   Joy, Physical Therapist, came late afternoon, and after looking at mother, she explained with her high temperature, need for so much O2, and weakness she would not proceed with helping her walk, but was able to help mother sit on the side of the bed.  We were very impressed with Joy's professionalism and caring approach to mom.  Mother's BP continued to run very low for her, with diastolics in the high 40's low 50's.

I knew that mother's home meds included high blood pressure medication, as well as a fluid pill, and both of those could further lower her low blood pressure.  Mother asked the oncoming 7p-7a nurse, ****, if they were giving her blood pressure and fluid medicine.  **** responded with, “well, I don't know, but if they are, they give it to you in the morning.”  I then asked  if she could look to see what medications were being given to mother, she responded with, “I guess I could look in the computer, but if they give her that, it is in the morning, we don't do it on this shift.”  I then say, “I am very concerned with mother's low blood pressure that is not normal for her.  Will you please look and see if  blood pressure medication and fluid pills are ordered and being given to her?  Her blood pressure can't get much lower without being life threatening and if she is being given medication to lower it, it needs to be brought to the doctor's attention.”  She told us that we could ask the day-shift in the morning.

Elderly patients with bone fractures, large bone surgery,  and immobility are at increased risk for life threatening complications of thromboembolism, fat embolism, and pneumonia.  The potential for these complications is greatly reduced by (1) anti-embolism stockings, (2) appropriate fluid management, and (3) use of an incentive spirometer.  Had I not been a nurse, I would not be aware of these things.  Knowing that failure to utilize these interventions can actually set a patient up to have a blood clot, stroke, fatal embolism, or pneumonia (not to mention delayed healing) is extremely upsetting to our family.  WE HAD TO ASK FOR THESE THINGS to be done for our mother repeatedly, even while we knew they should have been instituted immediately.  Even after asking, we encountered a delay.  This is not acceptable, and hopefully, mother is not already developing life-threatening complications.  It will be several days (up to months) before we will know, and her physical therapy has already been delayed.

I would like to share the good news as of treatment of mother's anemia and low blood pressure.    At 0230 Sunday morning, a hemoglobin and hematocrit was drawn.  Apparently that early morning test showed anemia, and at 1500, a unit of blood was started on mother, and by 1800, mother was looking much better and was able to have her O2 turned down to 2 liters.   My father is staying with mother tonight, and we have a different 7p-7a nurse, I can't remember her name, but she knew what medications mother was being prescribed and reported that her blood pressure medication had been decreased by 50% for tomorrow's dose."

Hip Fracture continues....

we really need the prayers.... going to try to make another long story short... it really stinks being a nurse right now and knowing what is needed to prevent post op complications, asking for them after they are not done, and having to wait to get them when I know it really should have been done in the first place....

First off, surgery went well according to the surgeon. She came back from OR without any TED stockings on and a blood pressure of 111/45. Her normals are 150/88 or higher being treated with high blood pressure medicine. I asked for TED stockings and her nurse didn't think her blood pressure was anything to worry about. 2 1/2 hours later, after multiple requests, and me scratching my head trying to figure out why she had no urine output and why her B/P was low, I noticed her IV fluids had been clamped off when they moved her back to her room and had not been re-started after surgery. Needless to say, I demanded some TED stockings, found another nurse to start her IV fluids, and noticed she was looking pale and bluish around her lips. Her oxygen level (sat) was 86 on 2 liters of oxygen (no oxygen needed prior to the fracture... EVER)... so after getting a few nurses and respiratory in the room, her sat finally came up in the 90's on 4 liters of oxygen. After pretty much demanding an oxygen monitor (pulse ox) since I explained there was no way I would feel comfortable with a patient on that much oxygen without one, we finally got one. 

THEN, after all that fiasco, she was still looking pretty rough, I had my friend on the code team come check her out and she asked how she was doing on her incentive spirometer (little breathing exercise machine to prevent post-op pneumonia).... and I realized.... THEY NEVER GAVE HER ONE! So 7 hours post op, we got that on our own.

Now, imagine.... she's had had a temp 101 all day will drop to 99.8 or so with tylenol, still requiring oxygen to keep her sats up, chest congestion, and feels really bad. They got a chest x-ray and said they would probably do blood cultures (to check for infection) about 4, but we've not seen anybody yet.....

Needless to say, I'm about to pull my hair out and I'll keep you posted on what happens when we finally get to see our night shift nurse....  OH, and by the way... she's not on any antibiotics...

Hugs and keep them prayers coming, that's the only thing giving me any sanity...

BUT.... as I was driving in today, I realized... from 3 out of 4 of the most common post op complications (Blood Clot, Fat Embolism, and Post-op pneumonia.... still a little early for post-op infection to rear it's ugly head) she was placed at risk for all those, I knew it, I tried to get the things to combat that, yet there was still a delay in getting those things. Yet, I know, that God is in control, and He's probably shaking his head (yet again) at me and saying, "You can jump, you can holler, you can demand, but I am in control." Prayer is the only answer to fixing this situation, and I know the power of prayer will heal faster than anything we can do.... So, I'm feeling calmer, I know folks are praying for me and mom, because it is so out of my norm to be calm in the midst of this storm, I'm definitely not doing this on my own! Thank you sooooooo much for your prayers!

Just some mis-communication....

Jeremiah 29:11 

"For I know the plans I have for you," declares the LORD, 

"plans to prosper you and not to harm you, 

plans to give you hope and a future."

Please keep mom in your prayers.... to make a long and scary story short... Mom could have had surgery today if she were cleared by "medical" -- being her personal internist.  According to her nurse, they had left a message with her internist first thing this morning.  After 4 additional hours and multiple requests/suggestions to mom's nurse to please call and verify that the internist had actually received the message (which were countered by, "but we left a message")... I called mom's internist's office and basically wouldn't get off the phone until I spoke with someone who could guarantee me that the message had been delivered to the physician.... and wow.... no one at the internist's office could state they had ever given the MD the message.  We finally saw him at 5 pm and he gave her the ok for surgery, but too late for today, it will be sometime tomorrow (still no definite time) and, BTW, the surgeon has changed, too!  

She is experiencing lots of pain, being as brave as she can, but never experienced anything like this before.  We had difficulty getting pain meds within a 30-45 minute time frame after requesting them, and each time, another nurse was the one who had to get them for mom after I would find her in the hall.  Thank the good Lord for this other nurse, she was way over worked today and not only had to back up Mom's nurse, but had her own patient load and was assigned an orientee, too!

After suggesting that Mom's (actual) nurse might want to call the surgeon (around noon) and let him know that her pain was not being covered adequately, we were finally told that they got those orders for a pain pump at 5:00.  Shift change time rolled around, still no pain pump, so you can imagine my surprise, as the 7p-7a nurse came on and asked how her pain pump was working (it wasn't started yet... blank screen with no syringe in the pump), also didn't notice her O2 was out of one nostril (dropped her sats in the ER last night after pain med, oxygen is just a little important) and followed with the next question, "How did your surgery go today?"  I thought I was going to lose it, until the only nurse that was any help for us today walked in the room to start mom's pain pump.   At that point, I took dad out in the hall and gave him a brief nursing lecture on early detections of any and all complications I could think of, including with the explicit instructions on just what to say when he pressed the call button to attract the largest crowd in the event of a HINT of an emergency. 

Sooooo, we all really need some sleep and we really need some prayers for healing, God-guided hands, patience for me, and for God's Hands to surround Mom for her surgery on Friday the 13th!  What a special way for God to dispel any negativity surrounding the world's thoughts of just one day... just like any other day in the year.... just like any other day He chooses to give us...

Sometimes, plans change, but we have the assurance that, ultimately, God is in control....

Jeremiah 29:11 

"For I know the plans I have for you," declares the LORD, "plans to prosper you and not to harm you, plans to give you hope and a future.

Mom Fractured her Hip... Please Pray...

Mom slipped while trying to put on her shoes this afternoon, has a compression fracture from the femur (leg bone) up into the ball of her hip... just got home from the ER to catch some zzzz's before her surgery in the morning....  Please remember her in prayer... and thanks so much....