Emergency Health Care Plan Ignored

[mrsapple]

Further to my previous posts about the CH sending mum to hospital on every occasion, I agreed an EHCP with the Nurse Practitioner at the GP surgery and with the CH, stipulating that mum would only be transferred to hospital in the event of a bleed or fracture, and that even in the event of a total collapse she would be kept at the home and the GP or Out of Hours Service would be contacted in the first instance. Mum also has a DNR notice and a Living Will.

At 4.30am on Thursday morning staff at the CH noticed that mum had a "rattling" chest and that her lips were pale, and immediately called an emergency ambulance. By the time we got to hospital 40 minutes later, she had had an IV line inserted, steroids, antibiotics, Furosemide, chest X-ray and oxygen. Following discussions with the A&E registrar, and in view of the EHCP, DNR and LW all treatment was stopped. However they said she was too poorly to be taken back to the Care Home, and that in all probability the CH would only send her back into hospital. I had to accept the only option available which was to allow mum to be transferred to the Palliative Care Unit - something she and we did not want to happen.

One member of the CH staff said that they didn't know mum had an EHCP (clearly shown at the front of her Care Plan), another said that as the OOH service takes up to 4 hours to attend, they had no option but to send for an ambulance in an emergency.

Obviously it's very doubtful mum will come out of the PCU, and I have to say it's a lovely ward and all the staff there seem to be very caring and supportive, but I am very upset that having tried to put everything in place to prevent this happening, the CH has ignored all our wishes. Just wanted to warn others who might put their faith in an EHCP and DNR, and hope it doesn't happen to anyone else.

 

[cragmaid]

It sounds to me as if not all the CH staff are up to date with any changes to the care plan notes. Having sent for the emergency services and not notified them of the ECHP, the paramedics had no option but to hospitalize.
It sounds as if the rest of the care is very comfortable, and whilst it is not what was wanted, it is peaceful.
You are both in my thoughts.x.

 

[blandford516]

Hi

Thanks for your advise . We have a DNR for mum but we are scared that it will be ignored . The Care home staff are brilliant but we know from previous experience they do not always look at mums notes . Mum is in a pretty bad way and we have always thought it best for mum if she is not moved to hospital unless absolutely necessary . I think we need to go back to the care home and ask for a meeting to make it clear to all that is not only our wishes but mum's also . Wishing you all the best and thinking of you x

 

[Witzend]

This is my fear - that despite what we have repeatedly told the CH, if and when 'something happens' nobody will check her file and she'll be whizzed off to hospital by default. Some of the staff will be aware, but if they don't happen to be there at the time...

 

[Pickles53]

This is my fear - that despite what we have repeatedly told the CH, if and when 'something happens' nobody will check her file and she'll be whizzed off to hospital by default. Some of the staff will be aware, but if they don't happen to be there at the time...

So sad that your wishes were ignored when you had done everything you could to ensure your mum's wishes were respected. Hope she is comfortable now at least.

I guess that is the key question ie how do the care home MAKE SURE that EVERY member of staff ( including new staff members, temporary staff, agency staff, whoever) knows what should happen. What is the protocol staff should follow before calling an ambulance, especially at night when these kind of emergencies always do seem to happen.

PS another thought... Surely the OOHS people conduct some form of triage when you phone them to decide how quickly a patient needs assistance and if they judge the situation does not require immediate medical attention would it not be OK to wait?

PPS or could the home contact you before sending the patient to hospital if they think OOHS will take too long?

There may be medical or other protocols which make these ideas unworkable, but worth discussing perhaps.

 

[Buddy]

In these situations it is really worth talking to your palliative care team. They use the Gold Standard Framework which has a set of standards for adults who are considered to be near end of life and do not wish to be resuscitated. (You can google it) also they can flag up with the GP surgery if people are on the framework and the ambulance service who have a flag in place to let them know that person has a DNAR.

 

[Pickles53]

In these situations it is really worth talking to your palliative care team. They use the Gold Standard Framework which has a set of standards for adults who are considered to be near end of life and do not wish to be resuscitated. (You can google it) also they can flag up with the GP surgery if people are on the framework and the ambulance service who have a flag in place to let them know that person has a DNAR.

Hi Buddy

I have just followed your advice and looked at the GSF website. My mum has just moved into a care home and both they and I agree we need to have an emergency health care plan. However, I don't know what should be in the plan and the suggested questions seem far too general to be helpful in prompting a discussion. My mum's response to anything where she has to make a choice is usually 'I don't care' or 'do what you like' if I ask an open question. She might find it easier if I could ask more specific questions with 'yes/no' type answers. Have you seen anything more detailed eg a checklist of specific issues that should be covered?

 

[mrsapple]

Thank you all for your comments and support - all very much appreciated. Sometimes I feel as if I am (to use a rude expression) p*****g in the wind, so it's very helpful to get other TP members' views on things!

As far as making all CH staff aware of residents with DNR/EHCPs at a glance, a very simple idea could be for Care Plan files to be colour coded - red files for never resuscitate whatever, green files for definitely resuscitate whatever, and orange files for somewhere in between. Even new or casual staff could see at a glance from the file colour what should happen, then hopefully they will be prompted to read the contents properly.

I agree that the OOH service must have a form of triage to deal with genuine emergencies quicker - will be taking this up with the GP surgery next week. Will also arrange meeting with CH manager and SW to discuss situation.

On a brighter note, mum seems to have rallied somewhat - definitely better colour, more alert and actually awake for a little while this morning and smiling at us. Don't know what to make of this, having been told on Thursday she only has a few days left, so also need to speak to hospital consultant on Monday.