Is the care home at fault?

[betsie]

The CH phoned me wednesday morning to say my dad had urine in his blood and they had called the Dr. They had put him back to bed and would let me know what the dr said. My dad is catheterised so UTI's are common and I told them to make sure they gave him plenty to drink. They called that afternoon to say he had been given antibiotics.

Thursday am had a call to say they had called an ambulence and I should meet him at A&E. Apparently he was up all night and very breathless.

When we got to hospital he was in a very bad way his bp was 60/44 which had caused his kidneys to stop working. The tiny bit of urine in the bag was like pure blood. The dr said he had severe dehydration, the uti was so bad the bacteria had gone into his bloodstream and he had sepsis. Pumped over 4 litres of fluid into him and tons of antibiotics. By some miracle he has pulled through again and his kidneys have started up again and his bp is back to normal.

My concern is wheter the home had delayed in sorting out his uti (it is more obvious with the catheter as you can see the urine and it often starts smelling before uti really develops) and how had he got so dehydrated?

Another slight bug was that he often has the wrong clothes on even though all his are labelled. When he got to A&E the joggers he had on were so tight they were cutting into his stomach. They were a size medium when my dad wears and xxl. They must have known they were not his and god knows how they got them on him.

He has only been in the home 7 weeks and seems ok but this has really worried me.

 

[stanleypj]

I think I'd be worried if I was in your situation betsie.

I would sit down and make a list of your concerns. Obviously the points about this emergency are the most important but you should let them know about the clothes issue. When this kind of thing has been mentioned before, some people have responded that this is what you must expect. I disagree. The example you've given about the joggers is serious issue. The last thing he needs is added discomfort because of their incompetence.

Perhaps you could arrange to speak to the manager and take a friend with you for support.

It's so good to hear that he's on the mend. He sounds like a tough old guy.

 

[Saffie]

Is your father in a Nursing home, or if in a Care home, is there a nurse on site? If so, then to allow someone to get to the stage of such dehydration is surely negligent of them. I am glad that your father is recovering now. you must have been extremely worried. In my husband's nurding home all drinks are recorded on a resident's chart to make sure that sufficient liquid is being drunk.

Regarding the clothes, some on TP have reported their relatives wearing other people's clothes but it has never happened in my husband's home, but I do check his wardrobe every time I visit and have occasionally found the odd top that isn't his in amongst his returned laundry which I hand back to the laundry staff.
All his clothes are labelled but, of course, not everbody's is. It helps that my husband has to be dressed by the carers and only a few of the residents on his wing are mobile. so the opportunity for things to go adrift is limited.

Having trousers that are too tight would be unacceptable if they are causing discomfort and I would mention it to the staff.

 

[nitram]

As he has an IDC ask the home if they have been recording fluid balance, if they have ask to see the charts. If they haven't ask them to start now as his renal function may be compromised. He should be drinking a minimum of 1.2L/day and probably more in this hot weather.
http://www.nhs.uk/Livewell/Goodfood/Pages/water-drinks.aspx

Ask to see the hospital discharge note, this should indicate the extent of any kidney injury.

Check him for oedema (swollen legs,ankles,arms) and ascites (fluid in pelvic cavity) with oedema check if it is pitting ie when pressed with a finger for a short while a shallow pit remains and slowly fills. Any concerns report to nurse or GP.

 

[betsie]

He is in a care home.

I know it is often hard for them to get drinks down them but when he ha a UTi surely it should be monitored, he needs to be remined to drink but would have done so if told. I suspect he was in bed all day on the wednesday and no one was going up making sure he was drinking, which does concern me as I stressed when they phoned that he needed plenty to drink with the uti and she said they knew this and it had been noted (i assume on his care plan).

The clothes thing does annoy me but I am cross about the joggers as they must have been so uncomfortable especially when you already feel unwell and they must have realised when they put them on him a size medium to an xxl is a huge difference.
When i went to visit on monday afternoon he had pj's on. I did ask why he was wearing pj's as it was in the afternoon and he doesnt even wear them to bed. They were not his and were again very small (half way up his legs and arms) and had all holes in the back. the carer siad she had thought they were pjs but the night staff said they were not and they are the ones to dress them. (So they always blame the night staff??).
It just signals to me a lack of care and makes me worry about the bigger things - like making sure they drink enough!.

 

[betsie]

Thanks for your replies.

His feet and ankles have been swollen for years (after he was in hospital for an ulcer). I am not sure how to check for water in his pelvis he has a very swollen belly (we always joke he is having a baby) but it has been like this for years.

Re fluid intake Should the CH be keeping a fluid chart? I suspect they are not as I have seen no evidence of it during visits and I had a few problems with them remembering to empty the catheter bag regularly when he first got there and some of the carers didnt know how to do it (he is the only one in the CH with one).

He is still hooked up to fluids now and we make sure he has loads to drink when we visit. His salts are very low so he is on pottasium tablets.

I just want to know he is safe, it breaks my heart he is in a CH in the first place and I need to be certain he is being looked after. I know he will not get the level of care he did at home from me and my mum and I can let some things go (he is often not shaved for several days, has food stains on his clothes and dirty nails) but keeping them hydrated in this hot weather must surely be one of the CH primary concerns.

This is all new to me so how do I approach them about my concerns? Should I go in before he is released from hospital or wait till he is back at the CH?

 

[nitram]

Sorry I thought he had been discharged from hospital.
I suggest you do two things:-

Have a talk with as high a doctor as you can in hospital.
Ask if there is likely to be any permanent kidney injury.
Ask their opinion about residential care or nursing care in the future.
Ask that a CHC assessment is made before discharge.

Pay a visit to the home and ask to see any documentation they have regarding his fluid intake. From what you have said they are not going to have recorded a fluid balance and I doubt if they have the discipline to start one. Unreliable data is sometimes worse than no data.

IMHO wrong clothes although annoying is very secondary to severe acute dehydration.

 

[lin1]

Hello Betsie
I am sorry to hear about your Father, I hope your Dad makes a swift recovery

To be perfectly honest if I were you, I would be reporting the home to the CQC and Social services asap.

I know how hard it can be to get someone to drink, my mum was terrible, if i managed to get mum to have four glasses of nesquik milkshake (for yrs this was the only thing i could get mum to drink) it was a good day, mostly it was less, so I had to be sneaky iced lollies, ice cream, soup, very runny porridge, yogurts etc, only once did the GP think mum was slightly dehydrated, this was at a time when I was struggling to get one drink into mum because she had a UTI.

IMO the cause of your father becoming seriously dehydrated is, and I am sorry to say this , is neglect on the homes part and thats why I said about reporting them
I do hope I have not upset you, for that is not my intention

Please let us know how your Father gets on and how you get on