The most significant, particularly for older people (the definition of older is anyone who is older than you) when the effects of ageing can impair balance, coordination, and reflexes.
One of those instances that over time becomes part of how you see the world.
If this narrative has held together, my point is, we can offer just as good, if not better care, treatment and support for particularly older people in their own homes than is available through high-tech medical interventions.
Consequently, significant numbers of very frail and older people are transferred to local Emergency Departments following either trivial head injuries or when a head injury is only suspected but not witnessed.
He was treated with antibiotics and returned to the care home 48 hours later. During his stay he fell twice on the ward; there was an incident with a member of staff which led to him receiving intramuscular Lorazepam.
In life, there are those who work and act quickly; my mum would say, ‘chick-chak’ which I think is a derivation of Hebrew meaning, ‘promptly, without messing about,’ and, those who tend to dilly-dally.
If when you stand-up you become light-headed or dizzy, or, even worse, you collapse or lose consciousness, this is something to address.
In the olden days, over 65 was considered old.
Now, when I meet someone who is 75, I consider them young.
A new class of drugs, originally called ‘novel anticoagulants’ (NOACs) and now, that they aren’t that new, ‘direct oral anticoagulants’ aka ‘DOACs’ have overwhelmed the marketplace
You could argue that interruptions are a hazard in themselves, yet, is interruption, or the ability of doctor, patient, porter, nurse, pharmacist or therapist to speak-out or express themselves not part of the tapestry of our safety culture?
Old man. In his nineties, he fell. He fell again after arriving in hospital. What to do with him? He wants to go home; we risk and capacity assess. Determine what is right, good or not and let things happen. We tried to get him home. I can tell you something; he’ll fall again. WeContinue reading “Today there was a thing about falls.”
(In health your blood pressure rises when changing position; in disease if it falls, the blood supply to your brain, at times precarious, drops, you feel woozy, light-headed, you fall.)
I wonder What is the rule for hospital Inpatient falls. I mean, There must be some Golden Rule That you can Work-out. How many minor falls For every bad fall. Bad being Broken hip, Brain bleed Death. Interesting ratio to calculate. ‘How many patients have fallen in your hospital inContinue reading “Falls (Swiss cheese and serious harm)”
Sure, we know that unnecessary hospitalisation is bad, but what about inappropriate institutionalisation?
The example being:
89-year-old woman, lives alone, dementia, diabetes, COPD, has fallen, bruised face – best admit.
And this is the thing.
You hear this term all the time nowadays, at least, if you work in an NHS hospital, are an inpatient or carer or relative of someone who is occupying a hospital bed. Most often… Are they medically fit? When will they be medically fit? If they are medically fit, have you done the take-home medicines?Continue reading “Medically fit – today and tomorrow (3)”
Cartier-Bresson’s Decisive Moment, my patients falling, examining life and projecting forwards.
Tabloids love these figures as it allows them to get away with saying… ‘Hospital H – death rate is twice the national average!’ Subtlety is usually lost in these situations.
That is a very long time.
Today, when you suffer, I feel pain. I can’t shut out your experience.
We exist as a community, if not we perish as individuals.
Indeed, the last walking stick I saw came to a bad end when it wasn’t used as a walking stick.
There is an assumption that when the lights go down and the night-staff appear on the scene that things become quiet and still – a little like a scene from Bambi.
Snap – your left hip.
‘Did my dad die because someone didn’t follow policy, didn’t pay attention or, was the outcome inevitable?’ ‘Might my mum have survived the operation if she had a different surgeon or she was at a different hospital?’
Nevertheless, within the dark underbelly of medicine, where geriatricians live, there are some quite stunning effects often, from stopping and sometimes starting medicines.
We, the homeostatic organisms that have evolved over the past four billion years, exist in a state of serenity when well, but things can be thrown out of kilter by disease.
The point, as is often the case, is my aversion to patients. Or rather, the existential construct that relates to the ‘patient state’ = they who suffer; with the principal goal of my life being to obviate suffering, my objective is to really stop people turning into patients.
And that is the role of the interceptors.
And so, to my colleagues, the team of Mallard, I say, here we are – we are something special, we are the exception to the exception that allows magical things to happen.
Habits are our liberation, they are also a limitation
An old man living alone, is that the problem? Is the problem that it is a problem?
I have recently been asked to show what I do, to demonstrate, I guess, how much value I am for the money spent on me.
Patients in pyjamas – it might sound a little flippant, but I think this is something that is very important. I cannot comment on the behaviours of other patients outside of the UK – we, in Britain, approach hospital attire in a special way; pyjamas. I don’t know when pyjamas began in hospital – whether backContinue reading “Patients in pyjamas”
It is likely that a doctor, a nurse or carer admitting, ‘something is wrong, I don’t know what,’ is better than heading off down a therapeutic blind alley.
I hate it when one of my patients falls over on the ward. Each time this happens, I feel as if I, somehow have personally failed to keep them safe, safe, when they are unwell and at their most vulnerable. It is true, that people falling in hospital is complex, it is equally true thatContinue reading “Falling over & knots”