Sunday, September 15, 2013

Confused and Disoriented
Sometimes when an elderly person is taken out of their home environment and placed in a hospital setting, everything is new; smells, sounds, and furniture. They can become disoriented and should you add new medications, you only compound the problem.
In the intensive care areas, sensory deprivation also becomes another concern. They call it “Unit psychosis.”
I was supervising one busy night and the critical care unit was hopping with activity. We had just pulled one patient back form death’s door by our resuscitation efforts, when another patient tried to go down the tubes and coded. We drug the crash cart from an adjoining unit, because I hadn’t had time to replace the first one.
Both had been intubated and were on ventilators. Both had gotten central lines. The unit had been in turmoil for most of the night.
One of the other female patients in the unit had been alert at the beginning of the shift, but with the increased activity and noise, she had become disoriented. In her mind, she had confused the frantic comings and goings into a strange ideation.
She said to her nurse later. “I saw what went on!” She shook her finger at the nurse. “I saw that doctor and nurse getting married. He was Hawaiian and if I told you his name, you’d know him.”
“You were having a party. I saw them using an Ellis machine. “
The nurse tried to reorient her to time and place, but the woman’s conversation kept coming back to the Ellis machine.
“Well, what is an Ellis machine?” the nurse finally asked.
The woman explained, “The Ellis machine is big and red. It serves cold beer out of one side and French fries out of the other.” If someone could invent one, they’d be rich.
Our crash carts are large and red. They are similar to the tool chests sold commercially for mechanics.
I got a call from the nurse explaining what the patient had said and asked if she should fill out an incident form. I thought that anyone with half a brain would know that the woman was confused. Who would believe what she was saying?
I told the nurse that it wasn’t necessary, but to chart that the woman was confused and disoriented.

Of course that is not how the hospital hierarchy functions. When the patient satisfaction officer rounded, she heard the woman’s story. She called the nurse at home. The nurse had worked night shift and it was before noon. The satisfaction officer made the nurse come back in and do an incident sheet.
The patient satisfaction officer went to the Directress of Nursing and shared the patient’s complaint. She wanted me to be called in and explain why I had said not to fill out an incident sheet. The D. O. N. was intelligent enough to understand that something wasn’t right somewhere in the story. She went to speak to the woman herself.
Later when the D. O. N. saw me, she said “I spent only five minutes with the patient and knew why you said “it didn’t need to have an incident sheet completed.” She did not agree with the satisfaction officer’s interpretation and the whole incident was dropped.
How much unnecessary paperwork is done in our hospitals and out government because of some well-meaning but completely out-of-touch bureaucrat who pushes papers all day needs to feel important and to justify their job? How much extra paperwork is done because of “policy” not tempered with common sense and intelligence?


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