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OPINION

Addressing lapses in care involves getting to the root of the problem

  • 43 Comments

‘Why was no one being held accountable?’

The Care Quality Commission reports on standards of dignity and nutrition for older people in English hospitals have highlighted some appalling lapses – although it is worth pointing out that the vast majority of hospitals so far have met the required standards.

The finding that shocked me – and probably many other people – the most was that in one hospital, doctors sometimes prescribed water to ensure vulnerable patients do not become dehydrated. Of course it is distressing to think of parched patients looking at a water jug out of their reach and no one thinking to help them. But what is truly shocking is that such a serious systemic failing could be addressed in this way.

Why was no one being held accountable for failures to keep patients hydrated? Prescribing water may be an immediate solution to help an individual patient who is already or is at risk of becoming dehydrated and urgently needs attention, but it does not address the real problem.

Surely someone should have seen that this response is inadequate and that it should be followed up by challenging the staff responsible for ensuring patients receive this vital aspect of care?

Of course it is easier for a doctor to write a prescription for water than confront a ward manager about unacceptable standards. And it is easier for a ward manager to rely on prescriptions ensuring vulnerable patients receive the drinks they need than reading the riot act to their team. Ward are busy places and when you come up against a problem it is sometimes easier to avoid conflict and unpopularity by working round it.

This may solve the immediate problem but does not address the root cause – some problems can only be solved if people are prepared to have difficult conversations with colleagues and risk personal unpopularity.

  • 43 Comments

Readers' comments (43)

  • It has got nothing to do with difficult conversations with colleagues or risking personal unpopularity.

    We all KNOW the root courses! Many of us have been screaming from the bloody rooftops for god knows how long!!

    GIVE US MORE QUALIFIED STAFF!!!!!!!

    For crying out loud. It isn't rocket science, and I have argued this with Matrons, charge Nurses, managers, other posters on here, you name it. I couldn't care less about my personal popularity.

    It isn't about US arguing this over and over, and your typical stance that it is the staff are to blame angers me, '' it should be followed up by challenging the staff responsible for ensuring patients receive this vital aspect of care?"

    No, it is about managers and trusts and the powers that be LISTENING and ACTING on what we are saying. Give us a LEGALISED, set in stone qualified Nurse/patient ratio, give us more HCA's, give us the equipment/meds/services/etc we need and improve our working conditions. THEN you will see a guaranteed improvement in care.

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  • is there a problem with a doctor picking up a jug of water, picking up a glass, filling it with the water and then helping the patient, if necessary, to drink it? Are they not part of the ward team responsible for patient care as well? I am not suggesting that they should take over the role of nursing care or be held responsible but a little additional help might go a little way to resolving this problem? I know doctors who do this quite spontaneously without the need to be asked as well as helping patients occasionally with feeding, giving a bedpan or helping a nurse change a sheet or turn them when it is obvious that everybody is busy and extra pairs of hands are lacking.... and what is wrong with the ward maids, porters, anciliary staff and visitors? if you are by a patient's bedside and know it is safe to give them a drink, then do it!

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  • "...some problems can only be solved if people are prepared to have difficult conversations with colleagues and risk personal unpopularity."

    "Addressing lapses in care involves getting to the root of the problem."

    This is pathetic. Don't you think registered nurses, and anyone else working on the wards with and inkling of commonsense and social intelligence (which one presumes they have) know this? Nurses wouldn't be on the national professional register if this hadn't already dawned upon them!

    the problem is that concerns are raised with managers about staffing levels and other major concerns and issues. If these are not heard and acted upon by by those responsible for making the necessary changes what is your constructive answer to this dilemma? How do you force people to hear what they do not wish to hear, absorb or act upon?

    Can someone please come up with some more intelligent suggestions in the articles in NT which is a professional journal primarily for nurses instead of repeating observations over and over which nurses are totally well aware of. Reading the same old reports, many of which seem to be generated by the CQC, is just a waste of everybody's time.

    Managers appear content with their jobs, or at least their take home pay and it is convenient for them not to listen to nurses who raise issues about staffing levels and patient safety which may make them feel uncomfortable and upset their status quo!





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  • Do the CQC look further than the wards and make inspections on the management as well? Most of the reports seem to be directed at the shortcomings of the frontline but then I suppose this is what is most visible?

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  • Anonymous | 3-Jun-2011 8:39 pm:
    they might do were they not so short staffed themselves!!

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  • Anonymous | 3-Jun-2011 6:52 pm

    Yes yes yes but its not a doctors job its ours. Their job is to practice medicine and ours is to nurse! If things are so bad perhaps we should all be referring our trusts to CQC. I wonder how many nurses who moan about the lack of staff and resources actually follow through and do something about it. Ann is voicing that frustration.
    And yes Mike I know you probably have but it needs a unity on the part of good nurses to stop making do and push their professional bodies to do make a noise. At the moment the voice of the nurse is very quite probably because we all know bad practice could have or is happening on our watch.

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  • Can I add Mike i think you are talking nonsense. Every nurse is accountable for their practice. Read your code.

    We work in a dysfunctional profession which has too many layers and power lies with those who do not practice nursing. Major problem.

    However the level of abuse and neglect evidenced in hospitals over recent weeks has to be considered at every level of health care organisation. Nurses have to look at themselves and ask "Did I do enough". We all have stories of relatives in hospital and sadly the neglect i witnessed during both my parents final hospital admission was not linked to lack of time but nurses caring for rather than about their patients. Getting the job done rather than thinking about what the patients really needed.

    We have a problem in valuing what we do and have problems articulating what nursing is.
    For me the essence of nursing is epitomised in the care of older people when it is done well. So stop passing the buck and lets have a sensible conversation about nursing care, what is it, has it changed and what it means to us and our patients. That is surely the mark of a grown up professional.

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  • "Yes yes yes but its not a doctors job its ours. Their job is to practice medicine and ours is to nurse!"

    oh, dear poor submissive doctor's handmaiden, giving a glass of water to a patient is a humanitarian act which does not require any professional training or special qualifications, and the division of roles is totally immaterial. on a hospital ward the patient is the primary focus of attention and care. all it requires to see that a patient is comfortable and hydrated is a little observation of the patient, and if they can answer for themselves one can even ask them if they would like a drink of water which usually costs nothing. it also requires a little elbow grease, and a tiny bit of muscular effort to lift up a jug off the bedside table, lift up a glass, pour some water into a glass and if necessary help the patient to drink it or even to take a few sips. most decent doctors will do this whilst taking a case history or examining a patient if they are not nil by mouth, as will intelligent and caring ward cleaners, other healthcare professionals or visitors. it really does not need a nursing diploma, just large amounts of commonsense and compassion for the patient and it will not hurt anyone!

    If you go to a doctor or even a consultant's own home, hopefully they will offer you a drink, and what is different about hospital.

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  • Anonymous | 9-Jun-2011 10:46 am

    Lets not deminish the important message in this blog to a debate about the doctor nurse game. The big picture is nurses are failing to provide care. Yes anyone can give a patient a drink but it is our job to do it. The prescription was to ensure nurses gave the patients something to drink when the doctors were off the ward. That is shameful!

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  • Anonymous | 9-Jun-2011 12:40 pm

    please do not undermine other peoples' comments. everybody's opinion matters, when it comes to providing good care.

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