Teacups

I have been hearing more and more hospitals across the UK are using china teacups to support older people during their inpatient stay.

This is great.

The background to this is the use of disposable paper or worse, plastic cups to serve tea or coffee to patients during their time in hospital. Most of us have drunk from one of these cups at some point in the past – my most recent experience was on the way back from Sweden to the UK in March, stuck in Jonkoping airport, because of a blizzard.

The cup was too hot, it became cold quickly and tasted of plastic. Not the best experience. I don’t think I finished the drink, probably leaving it balanced on a table set to spill on another unsuspecting traveller.

In Mallard, my ward in Doncaster, we adopted china teacups when we opened. Acknowledging that as many of our patients are disorientated because of dementia or delirium, and, are also unwell with infections, heart attacks, falls and a multitude of the other unanticipated events that result in older people becoming hospitalised, we wanted to do all we could to help orientate them and feel less anxious at being in an unfamiliar environment.

We also realised that as most of our patients stay in hospital for several days, drinking repeatedly from the standard-issue hospital paper cups was not an incentive to hydration – dehydration being one of the major hazards affecting older people, in part because of the medicines used, such as diuretics, but also because of problems affecting mobility that can discourage them from drinking (many carry the erroneous belief that not drinking will reduce their frequency of having to go for a pee – in many instances the opposite happens, this also increases the risk of infections).

How can we keep our patients hydrated? The usual answer to hydration, at least in a hospital environment it so site a cannula, that is, a small hollow plastic tube into a peripheral vein and run saline or dextrose; this does work – it gets fluids into the body, but is, when you think about it perhaps the least efficient, cost effective or, natural way to have a drink.

(In other words, intravenous saline although a fundamental part of modern medicine is nowhere near as good as a cup of tea.)

Another feature of intravenous cannulae is the message they carry – a modern day meme which translates into, ‘patient/hospital/sick’ – you see this on Casualty and Holby City – the really sick people have cannulae attached to them, and another trope is the confused patient pulling-out the cannula and wanting to leave the emergency department.

The confused person not understanding and often fearing the plastic in their body is a real issue, and again something we want to avoid at all costs, further, that plastic, which in medical terminology is a ‘foreign body’ carries with it a risk of infection and skin damage.

Indeed, is there more wrong with these devices than good? Not if you are critically ill and need emergency treatment, but, if you have become dehydrated or refuse to drink because your preferred crockery isn’t on offer, then, yes.

It wasn’t easy to start using crockery on my ward – there were initial concerns about confused people smashing or throwing cups, and yes, like the rest of us, older, confused patients do drop them, but that I don’t think is a valid justification, also, the cups, not single use, might carry infection. Fortunately, we aren’t living in the time of cholera, and even MRSA is not that adherent when it comes to modern day dish-washers.

Over time the cups have become part of how we do things, the cups, reassuringly, because of attrition, are of different shapes and colours, which to me sends an individualised, homely message. Our visitors use the same cups, showing again, that our patients aren’t different, haven’t lost all their rights and privileges – read, they aren’t prisoners (even on those old-time units that aspire to maintain visiting times).

Getting other areas to adopt the china cups has been more precarious, the service assistants in some parts of the hospital have been vocal in their concern about increases to workload, or the risk of smashes or infections, or any number of other worries that you could think-up about why a mug might be bad.

I think we are getting there.

In the hospital we recently ran a frailty week – where we bigged-up all that is fantastic about older people and their care; the focus was person-centred care, which I have covered previously.

Person-centred care, where we remember that the patient is a person and, that person is the reason for the existence of the hospital, and our work, where we need to sometimes check ourselves when we slip into modes of process and performance; here the cups come into their own.

I haven’t ever seen a patient when offered a china cup ask for, ‘The paper one instead,’ mostly our patient’s don’t ask for much, they appreciate the care they receive and tolerate our failings.

We can’t wait to be asked, we need to maintain a constant vigil and see that the people lying in the beds could easily be ourselves or our loved ones, indeed, are the loved ones of others, and attend to their needs with as much delicacy, precision and care as if they were ourselves or our own.