Kathleen’s mum, at the age of 79, was admitted to hospital for vomiting and diarrhoea. She had been unwell for a long time and had been admitted the previous year. Over her seven week hospitalisation where she had multiple hospital and ward transfers her mum’s condition slowly deteriorated. She developed delirium, became withdrawn, was in pain and experienced significant weight loss. She was eventually diagnosed with endocarditis, (infection of the heart) but was too unwell for surgery and died. Kathleen felt that the family’s concerns about her deterioration were not heard and the delay in diagnosis and all the complications that her mum developed meant that she was not treated in a timely manner.
When mum was first admitted she was not showing any signs of confusion. She was using a 4 wheel walker to get around independently. However, she experienced three hospital transfers and at the last hospital, five ward transfers with numerous clinicians and teams caring for her. I think there were too many different staff members involved in her care and important information was lost between transfers. For example, her substantial weight loss of 20 -25 kgs was missed until she was too weak.
Strategies that could have made a difference
Fewer moves, the same treating team, better pain detection, earlier diagnosis, earlier investigation of the cause of delirium, better response to her deterioration and listening to family – all these things could have made a difference to her care.
Kathleen’s tips for others
- If a person who is confused is left alone or with an unfamiliar staff member they may become anxious, aggressive or agitated. As the presence of a relative usually has a calming effect you could look at getting a roster going between family members.
- When a person is confused it may not be possible for them to be able to voice their concerns themselves. You may need to be their advocate by notifying any behavioural changes, any deterioration or any concerns that you have to the appropriate member of the medical team.
- People with cognitive impairment may not be able verbalise their pain. If you see your family member showing signs of pain advise a medical team member and ask that their pain analgesia has been charted by the doctor as a regular medication, not PRN as they won’t be able to ask for it.
- Communication breakdown can happen so it may be worthwhile checking that issues have been passed on and addressed from shift to shift and between hospitals. Things can get hectic.
- Ask about what investigations have been done to find the cause of delirium so that treatable, underlying causes can be treated.
- People with cognitive impairment can lose weight quickly as they have difficulty remembering to feed themselves or even how to feed themselves. They may require prompting, supervision and assistance with eating their meals.
- Sometimes you may need to become a squeaky wheel for the good of your relative when dealing with medical and care staff. Sometimes you may need to insist on things. Sometimes the degree of urgency is not communicated properly.