Patients starve and die of thirst on hospital wards.

[Tony]

I witnessed this ten years ago, it was the reason we took my mother-in-law out of hospital. The nursing staff seemed to have bits of their brains missing!



I was at a retreat several years ago, which was attended by many medical people, when asked what did they most fear, the answer was 'being in hospital'!


Unfortunately "paperwork" is the same excuse given by other government run organisation!


Read more: Patients Starve and Die of Thirst on Hospital Wards. This is from the Daily Telegraph today.

The death toll was disclosed by the Government amid mounting concern over the dignity of patients on NHS wards.

They will also fuel concerns about care homes, as it was disclosed that eight people starved to death and 21 people died of thirst while in care.
Last night there were warnings that they must prompt action by the NHS and care home regulators to prevent further deaths among patients.

The Office for National Statistics figures also showed that:
* as well as 43 people who starved to death, 287 people were recorded by doctors as being malnourished when they died in hospitals;

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* there were 558 cases where doctors recorded that a patient had died in a state of severe dehydration in hospitals;
* 78 hospital and 39 care home patients were killed by bedsores, while a further 650 people who died had their presence noted on their death certificates;
* 21,696 were recorded as suffering from septicemia when they died, a condition which experts say is most often associated with infected wounds.
The records, from the Office for National Statistics, follow a series of scandals of care of the elderly, with doctors forced to prescribe patients with drinking water or put them on drips to make sure they do not become severely dehydrated .

Katherine Murphy, chief executive of the Patients Association, said the statistics were a grim and shaming reflection of 21st century Britain.
"These are people's mothers, fathers, and grandparents," she said. "It is hard enough to lose a loved one, but to find out that they died because they were not adequately fed or hydrated, is a trauma no family should have to bear."

Michelle Mitchell, Charity Director of Age UK, described the figures as "deeply distressing" given that such deaths were avoidable.
She said: "Hospitals and care homes must pick up on the warning signs of malnutrition and ensure that while older people are in their care they get all the help and support they need to eat and drink."

The disclosures come as a public inquiry into Stafford Hospital, where thousands died amid appalling failings in care, prepares to publish recommendations in the New Year on changes to prevent such a scandal being repeated.
They also follow a series of scandals over care of the elderly, leading to an intervention from David Cameron earlier this year ordering nurses to attend to patients more often.

Mr Cameron announced that nurses would have to undertake hourly ward rounds to check whether patients are hungry, in pain, or need help going to the lavatory. It followed spot checks by NHS regulators, which found that half of 100 hospitals were failing basic standards to treat elderly with dignity, and ensure they were properly fed.
A report published last week by the Royal College of Physicians said too many hospitals treat patients as "medical conditions" not people, leaving the most basic and emotional needs overlooked.
In Alexandra Hospital in Redditch, Worcestershire, doctors resorted to prescribing patients with drinking water to ensure nurses did not forget, a report from inspectors warned in May last year.

The Care Quality Commission recorded one case where an elderly patient was found to be malnourished when they were admitted to the ward, yet not reassessed until 16 days later.
In many wards nurses were dumping meal trays in front of patients too weak to feed themselves and then taking them away again untouched.
A report by the Health Service Ombudsman last year condemned the NHS for its inhumane treatment of the most vulnerable.
The investigation found patients were left hungry, unwashed or given the wrong drugs because of the "casual indifference of staff".

The ONS figures also disclose scores of care home residents who were found to be malnourished or malnourished when they died.
In total, 103 residents were dehydrated when they died, including 21 cases where it was the direct cause of death.

A further 39 deaths of care home residents involved malnourished residents; in eight cases malnutrition was listed as the direct cause.
Officials who compiled the figures said that not all the deaths could be directly blamed on poor care. Some illnesses such as dementia and diseases of the digestive tract make it more difficult to eat or drink.

The figures also disclose thousands of patients and care home residents suffering signs of neglect such as bedsores, when they died last year.
In total, 767 care home residents and hospital patients had bedsores when they died. In 78 cases in hospitals, and 39 cases in care homes, it was listed as the direct cause of death on deathc certificates.
There were also thousands of deaths of patients and care home residents who were suffering from septicaemia, which experts say is most often caused by infected wounds.

In total, 21,696 hospital patients and 1,100 care home residents were suffering from the blood poisoning when they died.
In care homes, it was the direct cause of death in 101 cases, and in hospitals, it caused 1,997 deaths.
In July, an inquest heard that a young man who died of dehydration at a leading hospital rang 999 for police because he was so thirsty.
Officers arrived at Kane Gorny's bedside, but were told by nurses that he was in a confused state and were sent away.
The footballer and runner, 22, died of dehydration a few hours later, an inquest heard in July.

Mr Gorny had survived a malignant brain tumour in 2008. The cancer affected his pituitary gland, which controls the body's mechanisms, such as fluid levels.
Part of his treatment included a course of steroids to regulate the fluid levels in his body. These drugs, however, weakened his bones and he was in hospital for a routine hip replacement.
Doctors had warned that, without regular medication to control his fluid levels, he would die.

But when he was admitted to St George's Hospital in Tooting, South London, staff ignored repeated reminders from Mr Gorny and his family to give him the tablets, and he became severely dehydrated after being refused water.
His mother told the inquest that in May 2009 she received a distressed phone call from her son, in which he said he had called the police because he was so desperate for a drink.
Shortly before he died, his mother found him delirious and saw that his medication was untouched.
Mr Gorny became more and more dehydrated and sodium levels in his blood rose.
He died of water deficit and hypernatraemia, a medical term for dehydration, three days after he was admitted to hospital.

A Department for Health spokesman said: "Quality of care, dignity and compassion should be central to the treatment of all patients, whether in the NHS or care homes.
"To ensure that this happens, and to root out bad practice, the CQC has increased the number of unannounced inspections that it undertakes, and in winter this year it will publish its findings from a series of inspections looking specifically at dignity and nutrition.

"We are also investing £140 million so that nurses can spend more time with patients, not paperwork."

[delfine]

Outrageous! Thanks for bringing attention to this.

[Kiforall]

This is just part of the poor medical care patients receive from the NHS.
My partner fractured two vertebrae and it was 18mths before they were diagnosed. The MMR scan was taken 3 months after the accident and the results came back normal?? It wasn't until we went private that the neurologist noticed the two wedge fractures. His poor treatment started on the first day in casualty when in my professional opinion the x rays were underexposed and not coned down to the area in question. It has been 6 years since my partner had his accident and he is classed as 65% disabled. I have tried to take the case to court and it didn't even get to court as the medical expert our solicitor got to look at the case said all the NHS guidelines had been adhered to.
Through a friend we were introduced to a Free Mason who had worked in the NHS since leaving university and he said it sounded like the doctors were closing rank on us. He was a Bowen therapist and offered my partner free treatment indefinitely ( he even gave me treatment in another room when we visited) He advised me to go through my MP and after 8 months I am finally working with the complaints executive to get some answers. Whether I will get the truth remains to be seen but I'm not giving up. Funnily enough the Professor who was ultimately responsible for the delay in the diagnosis died last week, can't say I felt sorry, but he will make a good escape goat for TPTB now.

[sleepy]

"xxxxx xxxxx

[Kiforall]

Last year my partner was admitted to hospital with abscesses on his tonsils. He couldn't swallow his own saliva, he was finding it difficult to breath and couldn't talk ( he was having to write things down)
It was 11pm when he finally got into a ward, unfortunately he was on his own as I had to stay at home with the kids.
The ambulance men had to pull the staff nurses away from a chinese take away they were eating behind the desk. My partner was settled into a bed and a sour faced nurse brought him two cups, one with water in and the other with tablet medication. My partner tried to explain that he couldn't swallow, he had also been unable to take his prescribed medication for his pain associated with his spinal injury, he had been hoping to receive injections. Not likely, the fat nurse (and I'm not being biased, these over weight 'rushed of their feet nurses' know nothing of work, if they did I believe they would look a little bit fitter than they do) went back to her Chinese takeaway with her colleagues and ignored the alarm my partner was pressing. It was the next morning when my partner received intravenous therapy, he spent all night in extreme pain.

[Arrowwind]

These types of reports are highly slanted and used as propaganda for agendas of various sorts. I wrote about this recently on another forum so this is a cut and past from there, it is a response to a report on conditions in the USA, not UK. Of course there is always room for improved healthcare.. but dont blame the staff who are generally overworked and paperworked to death. Blame the government who refuses the money to do the job right. Ultimatley the system is going down. If you want good care for your loved one you better learn how to do it yourself and not rely on government agency but rather on family support and when you do this you will realize just how hard a job it is and just how impossible some situations are. If your loved one must be in a facility you better be there to watch what is going on and to particpate in care.

Well, after spending time working in nursing homes and hospice I have seen that this is standard fare and it is quite common for patients to die of malnutrition and dehydration... even in hospital. Just exactly what do you think people die of if not an acute disease like cardiac arrest, cancer or kidney failure? Long term chronic failure and decline generally manefest in malnutrition and dehydration and accompanied medical problems.

I have never seen anyone die from malutrition because they were not fed but I have seen people die who refused to eat. It is illegal for force feed anyone who is competent to make their own decision and often these decisions are made while competent in a document called a Living Will. Then when the person is no longer competitant their wishes are already known in this legal document. A legal power of attorney, ususally a relative can also make the decision not to force feed, but they can also make the decision to force feed. The greater percentage of times force feeding is not supported by the family as they see it as torture and prolonging the enivitable. Some families choose to force feed and hydrate and can be comfortable with that. Some stop the force feeding after a time for they see the fruitlessness of the endeavor.

The decision to force feed or hydrate is based on the diagnosis and prognosis for the patient, either by the patient themselves or by an appointed family member, not the physician or nurse.. Quality of life is a consideration as well as determined benefits or non benefits of feeding. In 99.9% of such cases the lack of food does not greatly disturb the patient. They dont feel hunger. When it comes to thirst that is another matter. If no hydration is chosen, and generally this is chosen when hydration makes the patient more uncomfortalbe than hydration, generally due to an significant intolerance to fluids for some reason, it is the staffs responsibility to keep the patient confortable with agressive oral care, given in a timely fashion, which means frequently so that discomfort is avoided. IV hydraton is almost always a viable choice but when the patient becomes unconscious and does not awaken again it is usually abandoned, but again not without family concent or according to the dictates of the living will.

Ive had patients that required repositioning in bed every half hour to prevent bedsores... an impossible feat at best unless the family is ready to hang around and do it and I will tell you, most will not. I have been able to implement repositioning every hour on a few cases. Every 2 hours is required by law and when nutrition is poor every two hours is generally good enough, but when malnutriton sets in it just isnt' good enough anymore. Also there are patients who sometimes only have the option of two postions to put them in due to injury, disease, pain, so again they are at greater risk for bedsores and dying from them.... couple that with the risk of infection and severe infections found in facilities and there you have it. a very poor statistical show.

When people choose to stop eating, when malnutrition sets in, when they become bed ridden this is what happens and this likely jacks this number up quite a bit. All these numbers are counted and go into the data base.


There is a diagnosis called Failure to Thrive... there really isn't anything anyone can do about it. Some of these people, even if you force fed them with a tube with the finests fresh foods, they still would not gain weight... essentially it is because they are in the dying process.... perhaps their telomeres have bitten the dust.. There comes a time when nutrients can no longe work for some people and the diagnosis of failure to thrive is most often this is found in the advanced elederly and on rare occassions in infants.. I understand this fully because I have seen it first hand a lot.

Failure to thrive in infants is particularly painful to witness. In these cases the child fails to thrive and no physician can figure out why and this is why it is called failure to thrive as opposed to a more common diagnosis like cardiac disesae or whatever.. It is fairly rare but I have seen a few cases... and if I have seen a few cases, there are many many out there across the nation. Something is just not right with the infant that cannot be determined and they dont respond to the mothers touch and milk either.

Of coures there are some cases that are criminal. When families leave family members unattended, unfed, not repositioned, laying in their feces day after day. I have had patients admitted by social services that actually had maggots in their bedsores. These cases often end up in a criminal court or with hard core and continual social worker involvement. On more rare occassion a facility may face criminal charges for neglect. I have called in social workers to assess cases in facilitites I have worked in because I thought that there was facility neglect. Fortunately these protective organizations, they protect whistleblowers who remain nameless.

There will always be negligent doctors and negligent staff, just like there are negligent families. By and large, after 27 years in nursing I say most staff are trying really hard to work in an environment that is not supportive to patient needs and this is largley due to lack of appropriate funding which decreases staff.


Its the rest of the stuff I dont understand, the infections, the surgical errors, and the drug use... all of this and the complications it brings is fully preventable but a paradigm change is required on how medicine and health care is conducted, a shift from the pharmaceutical paradigm to the alternative health paradigm.

Of course some bed sores can be prevented, even many of them but there are many situations when they cannot be prevented. It takes quite a bit of nursing experience I suppose to understand this. Certainly not rotating a patient all night is a huge problem.. but there are those who will break down even with turning every two hours, even every one hour. Then there are those who come in to a facility with bedsores, then there are the patients who refuse to be turned, then there are those who refuse to eat, or cant eat etc. It is much more involved than just turning a patient and facilities generally keep careful record of bed sores so they generally know exactly what is happening,,, they do keep stats on it and hence they are recorded in this huge medical survey...

Certainly the single most crucial factor for most bedsores is lack of turning and being short staffed is the cause as most CNAs really do want to do their job but when state regulations state that one cna can be responsible for 12 patients full cares it becomes an impossible feat to attain, all that turning. For really good care a cna should not have more than 6 patients or in some facilities possibly 8 and that cna should have the assist from someone to properly do the turning, for poor and improperly done turning in and of itself can cause bedsores

[ulli]

Both negligent staff as well as patients who have given up on life contribute to such situations.
If people can become wealthy because of a fear of poverty
then people can become healthy because of a fear of hospitals.
So it boils down to the matter of personal responsibility...
This kind of info may be considered fear porn, but if it triggers someone
to become more determined to take care of their health
and look into alternative eating habits as well as healing methods,
then I would see it as a good thing.

[Woody]

Hi guys, i have to agree with what is being written on this thread,
The care given to many patients within the nhs is very poor, it is true and research proves that patients often lose weight, and become dehydrated while in hospital.
In my experience the elderly and frail often receive the worst care.
Why is the care so poor?
You can go to any ward in any hospital in the nhs and the staff will always state they are short staffed, rushed off their feet etc etc.
To be honest they are short staffed, they are pressured and often rushed off their feet,
BUT!!!
There is no excuse for poor care, there is no excuse for for not caring.
How many nurses in the nhs actually give any hands on care to patients?
Where i used to work there were four senior nurses who never actually had any contact with patients, working in a management role, two of them independent nurse prescribers. Why are they prescribers if they don't see or nurse patients?
I feel that alot of the problems in nursing is the training, the training in the uk is designed for nurses who want to climb the career ladder, basic hands on nursing care seems to come a poor second to paperwork, ticking boxes etc.
I am an rgn, been qualified for over ten years and would be very worried if i had to be admitted into hospital.
Kind regards,
Woody

[pugwash84]

I have had a few cases of poor treatment by the NHS when I was pregnant with my son Daemon they did a scan and it showed something wrong with him, I was sent to Sheffield for an Amniocentisis. When I was there the Doctor took me into a room and told me before I got the results that the scan looked like he had half of his brain missing and recommended termination. I told the Doctor that termination was against my beliefs and it was not mentioned again. The test came out fine and there was nothing wrong on it. I was sent there another time to get the MRI scan done of his brain whilst he was inside me and it looked at a detailed picture of his developing brain and they said his brain was developing like an average brain would do. It was a very scary time for me especially as I was hormonal on top of everything and at that stage to I do not think it appropriate for termination to even by discussed. It upset me a lot.
When I was giving bith to my son there was over 20 people in the room monitoring and watching, I thought that was a bit excessive and to me in the back of my mind I was thinking why not put in a glass wall for everyone to see lol.
The aftercare was bad, they left me in a bed and because I had a spinal to block some pain I could not move my legs. I was covered in blood and not able to bath and if it hadn't been for my sister in law (to my embarrassment) changing me they might have left me there all night like that.
When I had my daughter after I had had the experience with giving bith to my son I was relieved there was not any complications I gave birth to her a natural birth and walked out of the hospital 6 hours after giving birth, I just didn't want to be in there.
There is no excuse for poor care, I personally would have given better care to someone in trouble on the street than what they did for me. xxxxxxxx

[Ammit]

Hi all.

I work in care and have done for many years. I have been fired for doing more then I should, fired for telling management how bad their work practice is and been black legged for sending the good old cqc into a home and proven correct to my complaint.

The system is bad, very bad and is not just the nhs. It is actually across the board.
I have and will always work to my own ethics. If it is good enough for my mother, then, it surely must exceed nhs standards of care.

Wish it could change.

Ammit

[Kiforall]

There are so many points to the problems in healthcare and everyone seems to have some first hand experience of them.
I know there are genuine nurses out there and my heart goes out to them because it is the true caring people that are being tortured in the healthcare fiasco. I know there are people who started off with compassion and have been made to resent the patients because if they were to get close the hurt of knowing that this person wasn't getting the care they deserved would tear them apart.
So patients who need their food chopping up, need help to get food into their mouths, need assistance lifting a glass of water up to their lips without spilling, need help going to the toilet, need emotional reassurance that they are going to be OK become a frustration to be resented and hated. The minimum contact is made, the staff must distance themselves or they would go mad.

Although I'm not a human nurse, I worked for 15years as a Veterinary nurse. When I started there was still a feel of James Herriot to the practice. A few old partners still ran the show and the animals care came first. Although their knowledge and expertise were lacking compared to the young newly qualified vets, their motivation was still true. Once the old boy's retired things started changing.
Generating income became paramount, clinics were run by nurses to sell wormer's, flea products, diets etc,etc This removed them from the caring role in the kennel environment. Clients were paying twice the price of a boarding kennel's daily charge, to be hospitalized in the surgery where they would receive veterinary care................. from whom? All the nurses are in the consulting rooms running puppy clinics and weight loss clinics. The animals are lucky to see you for longer than it takes for their cages to be cleaned out. Medication is rammed down their throats or jabbed in their legs, a bowl of food and water is chucked at them and that may be it until late afternoon. I couldn't work in this environment, I made suggestions, discussed with a practice manager who came in and nothing was done. I changed practices and it was like out of the fire into the frying pan. These vets did every test under the sun if the animal was insured they were unbelievably good at spending other people's money. They also USED me by allowing me to perform operations which if done under the direct supervision of a Vet and you are qualified are legal. I was doing a full operating list some days whilst the Vet earned more money doing consultations when otherwise they would be stuck in the Op room ( have faith that I was as good as if not better than the Vets at that practice but that's not the point!)

I don't know if the business side of the NHS is to blame for the problem but I have to respond to Arrowwinds post regarding:

"It is illegal for force feed anyone who is competent to make their own decision and often these decisions are made while competent in a document called a Living Will. Then when the person is no longer competitant their wishes are already known in this legal document. A legal power of attorney, ususally a relative can also make the decision not to force feed, but they can also make the decision to force feed. The greater percentage of times force feeding is not supported by the family as they see it as torture and prolonging the enivitable."

I completely understand this, but the experience families are having here in the UK is that patients are not even getting the chance to get that food in their mouths.

[GCS1103]

My father spent six weeks in ICU in a N.Y. hospital. Because he was elderly, just like most of the patients in ICU, the care was almost non-existent. The hospital would not allow us to retain a private nurse in the ICU and every week the medical residents rotated, so they were never familiar with the patients. I could not fathom that this hospital would be so negligent. What made it even more incredible, was the fact that my father had worked as the comptroller of N. Y. Health and Hospital Corp., and he had his offices in this very hospital.

When we finally got him out and into a subacute care center, the administrator called me to advise that he had never seen a patient in his facility admitted in worse shape. He called in all his physicians, nurses and rehab. specialists and took pictures of every part of my father's body. What they had done to him, including an unauthorized surgery with staples left in his chest that had never been removed, was criminal. I filed a medical malpractice suit against the hospital immediately. I cannot describe the anger and frustration our family felt about his treatment and the attitude of the staff in ICU. Medical malpractice suits are very hard to prosecute and win. After seeing the pictures, the hospital settled within months of the filing.

Because of this personal experience, I will always have a negative feeling for hospital care. I think the frustration that families have when they see the lack of attention and compassion for their loved ones is justified.

[Arrowwind]

All hospitals are not created equal that is for sure. When my husband went in for a surgery I caught the nureses in several errors... and likely only because I was a nurse myself could I see it. When they saw be get off the elevator they almost ran the other way.

But some places are quite good. In my opinon the quality of the care is directly related to the quality of the director of nursing in many instances... I worked in a nursing home where we were all over worked but because of the DONs attitude we were better than most by working as a team and pitching in to help everyone and that included nurses helping CNAs and director of nurses helping nurses. Yes there were till problems but we managed to heal bedsores when they came into us on many occassions and that really says something. Our patients got all their meds and all their treatments everyday as well as thier scheduled cares, even in what appeared to be a crappy facility from the outside.

The Director of Nursing can make all the difference and this one, she was a real patient advocate. When the administration fired her I followed her and we did some geat work together in 3 different institutions over the years. On the other hand I once worked in a place, (for a whole 3 weeks till I quite) with a D.O.N. who got busted for taking home discontinued narcotics and not only using them but selling them.

You never know what your going to get when you go into a hopsital but care can be reaonable even in difficult stituations with funding and staffing if people pull together. Ive been in places where the staff would actually scream at each other on the floor... and places where I had to re primand doctors for not doing their job, and dam I may only be a measley nurse but no doctor is going to neglect my patients without hearing from me.

It all comes down to the level of consciousness of the staff and really how that will be in any given facilitiy can be largely luck of the draw unless there is someone there devoted to weeding out the noxious weeds or endeavoring to retrain them.

Im so glad those days are over and Ive been able to move on to other things.

[Kiforall]

In the UK patients who are a burden on the funds, on life support, need I.V feeding or are slowly dying of terminal cancer are usually treated to a move in an ambulance to another hospital which offers specialist care. This would be great if the very ill person hadn't died on the way, you can't be moving critically ill patients and expect anything good to come from it.
Having worked with animals and having had the privilege to be able to end pain and suffering in the purest of ways I have always seen euthanasia as a gift to the dying body. I have no doubt that if euthanasia ever became legal in the UK a lot of patients who still want to live have lost the will due to the lack of care they receive, fighting on for a bit longer, is not a choice that is offered to them. Once you pass a certain point of usefulness nobody give's a s**t. There are so many ways the medical profession are carrying out euthanasia the problem is the medical profession are making the choice for the patient and their family. Gradual morphine poisoning of the cancer patient, leaving patients to starve to death as a result of refusing force feeding-the outcome is death, they know it, doctors know it, family know it why the hell must the patient die of starvation and the bodily shock associated with it when euthanasia could be an option.

Wondering if this will be uncomfortable for readers and if I'm being too much of a realist, I hope not, I'm sure the moderators will intervene if necessary. Thanks

At this point, knowing how the Muslims respect their elders, I may just disappear to the net and catch some more info.

[Arrowwind]

The thing is that most patients who loose the will to live do not do so because of lack of care but because their body is no longer regenerating. You have to understand that under all the physical issues is a soul that is directing the movie. A soul that has determined the end date and regardless of what medical care is available, what doctors do, what nurses do, what families do, there is an individual soul in charge... we like to forget that and think that health can be forced with the right vitamin, or drug or surgery or even prayer, but it can't. The soul is at the helm and when the soul says its time to decline and die then thats whats going to happen... and we have to remember that many of us travel within a group of souls so there are agendas in other realms that are at work.

Degeneraton of health is what happens with or with out a medical system, This is how its always been and how it will always be. It is all a part of the natural dying process. ... and there are those patients who have a strong desire not to die but they are unable to accomplish those things that are required to live, like eating and drinking, breathing, bowel elimination, proper gas exchange in the lungs, cardiac function. Many of these things there is little to no treatment for when it gets bad enough. Having a will is not enough to contend with a failing body in most cases. Eating the right vegetables will not do it. There is no plan of action that can stop a soul when it has deemed that its time to withdraw from the body and move on and when the soul has made such a determination all things will fall into line to make it happen... this is called creating your reality on a soul level.

I firmly support euthansia myself although I dont live in a state that has it.. Only Oregon has it to my understanding and still very few people have gone through it there. I have my own planned and I have what is necessary to carry it out for when my day comes if I feel that it should be to my best interest. In general it is a process that needs to be closely regulated and with several doctors and counselors involved to avoid abuse and unintended outcomes.

Although I haven't participated in any doctor assisted suicides, for thats what euthansia is, I have particpated in assisting patients to end their own lives through their own intentional elimination of supportive medical care. My role was to give emotional support and to give them drugs to alleviate the symptoms like pain and shortness of breath, anxiety and agitation. that can esclate when medical treatment is stopped. There are those who refuse such mediciation and sometimes they prove out that they really dont need it but for 99 percent of the cases the mentioned symptoms become unbearable and the medication is like a god send.

BTW, Ive never seen morphine directly kill anyone although Im sure its possible expecially in people who are not accustomed to morphine. There is no upper dosage range. If there is pain the pain receptor sites will utilize all the morphine. Generally in hospice very low dosages of morphine are used during the imminent phase of dying and only if there is pain are larger dosages used. Ive seen patients recieve up to 100mg an hour for pain and remain alert and coherent. Real pain demands real significant dosages. It doesnt kill them and there are poeple who live for years of very high dosages for pain treatment. Ive mostly seen this realated to spinal pain from injury or with cancer in the spine. Ive seen patients take up to 3 grams of fentanyl per day and be sitting up reading and watching tv, simply becasue that is what is required to alleviate their pain.

I will be posting some of my hospice experiences on the Blank Canvas thread as time goes by. There are two there already.

[Kiforall]

Having recently looked into decubitus ulcers (I prefer that name) bed sores immediately makes you think they are due to being bed ridden. It looks like dehydration may be one of the biggest causes of bed ulcers in hospital patients.
http://www.bedsorefaq.com/how-many-hospital-patients-suffer-from-bed-sores/

That would tie in, lots of jugs of water placed out on the really high table that bed ridden patient can't reach. How much time and money would it take to issue all these patients with a tube, easily accessible, that they could sip from. Or could we ask that a constant circle of care from staff, literally from one bed to the next in the ward, if necessary 12 beds, until you finish and start at bed 1 again. In a perfect world would that not be what a nurses job would be?

Looking into the contra-indications for morphine because I do believe it plays a significant part in organ failure/death, especially in debilitated patients.
There is a link to medscape reference, showing the patient handout.
http://reference.medscape.com/drug/ms-contin-oramorph-sr-morphine-343319#91

It seems clear to me that with all the contra-indications listed here that morphine will help people to die, it has the potential to kill them in a number of ways. Either due to an allergic reaction or more subtly slowly shutting down the organs, especially in already terminal ill cases. Why don't doctors just admit euthanasia is happening?

Something else I didn't know. Abstract from http://www.nature.com/mt/journal/v13/n1/abs/mt200625a.html
Although long-term use of morphine has been shown to promote tumor growth, the question whether tumorigenesis occurs as a result of an immunosuppressive effect remains to be investigated. In mice rendered tolerant to morphine, the efficacy and mechanism of a vaccination to rescue morphine-induced immunosuppression and prevent tumor growth was assessed both in vitro and in vivo. Herein, we found that morphine-injected mice exhibited higher tumor growth rates and lower percentages of CD8+ T lymphocytes. The mechanism of morphine suppression of immunity might be through the suppression of E7-specific CD8+ T lymphocyte proliferation and the promotion of apoptosis of these cells by the Bcl-2 and Bax pathways. The suppressive effect of E7-specific CD8+ T lymphocytes by morphine could be reversed by naloxone. We have previously shown that calreticulin linked with E7 (CRT/E7) could enhance the
CD8+ T cell response and the anti-tumor effects (W. F. Cheng et al. (2001) J. Clin. Invest. 108, 669–678). CRT/E7 DNA vaccine could overcome the immunosuppressive effect of morphine and suppress tumor growth. Our findings reveal that long-term morphine treatment dose-dependently promotes tumor growth and a DNA vaccine may serve as a useful approach to treat the profound immunosuppressive function and prevent tumorigenesis after long-term morphine treatment.

[Arrowwind]

\I completely understand this, but the experience families are having here in the UK is that patients are not even getting the chance to get that food in their mouths.

Well then I cant even imagine how bad it is there.. for I have never seen a patient not fed that was suppose to be fed... or at least attempted to be fed... they do have to open their mouths you know. .. although granted, it sometimes is not a pretty sight for a lot of different reasons. I saw a patient die from being feed too fast once.. and I think a law suite came out of it. This is what happens when caregivers are not given sufficient time, support and often training to do their work.

[Arrowwind]

It seems clear to me that with all the contra-indications listed here that morphine will help people to die, it has the potential to kill them in a number of ways. Either due to an allergic reaction or more subtly slowly shutting down the organs, especially in already terminal ill cases. Why don't doctors just admit euthanasia is happening?

.


Seems like contraindications may be confused here with adverse reactions... but anyway, one of the roles of the nurse and physician is to moniter for side effects and regulate dosage or change medicines as needed.

In the terminally ill, there is always the balancing act going on. All drugs are toxic and will cause stress on a body. Morphine in very low dosage can control pain in most cases and you will not be seeing these side effects for the most part.. the most common is sleepyness, the second most common is probably constipation. Euthansia is not the intent of treatment. The intent is to control pain. If the pain goes away the medicaiton is stopped. If the pain increases the medicaiton is increased. In a terminally ill patient the goal is comfort, not cure nor to prolong life in most cases... depending on the stated wishes of the patient. The side effects become of secondary concern to keep the patient comfortable. so they arn't laying there moaning and groaning (or even screamning) all the last days of their life. And as I said, many many people take morphine long term for years and years and years when chronic pain is an issue and often at much higher dosages than what is used in hopsice.. It doesnt kill them... but granted their life is not a picnic either. If the side effects become too much of an issue then other pain medicaitons can be tried. Frequently patients who cannot tolerate morphine can tolerate dialudid or fentanyl quite well. Constant assessment is required to protect the safety of the patient and to make sure they ar receiving the appropriate treatment.

If the UK cannot provide sufficient support to their patients that is a shame and families or individuals should arm themselves with informaton and be prepared to do some of the assessment themselves.. I always taught my patients and their supportive family memebers everyting I knew about the drugs they had and how to use them, what to look for, why we use them, and what their options are... but many nurses are not so dilligent, nor intelligent to do so. .. It's also one way I found in my work to protect my own ass. If you educate a family they will not come back at you and you have created a team not an adversary and the patient does better overall.

Ultimatley there are some very good alternatives in pain control these days, but most docs still dont know about it. Look into prylotherapy and acupuncture as well as some homoepathic treatments and ozone therapy and even hypnotherapy and creative visualization can help some people All available in the UK but of course likely out of pocket for payment. As in all things in this world it seems, you get what you pay for or what you are intelligent and capable enought to implement on your own.

[mahalall]

A guaranteed method to get the level of care you require.

If at any time you are dissatisfied with the level of care you or a relative is receiving in hospital please talk to the named nurse (politely- positively and constructively), if this doesn't satisfy your concern speak to the nurse manager. If this doesn't address your concern continue to the next level and finally if needed go to the hospital's chief executive and highlight that you've had enough and your going to the media and or local politician.

Hospitals environment are very good at attending to an immediate need. They will respond to your concerns if you tell them. It is pointless writing some weeks down the line, this will have no effect at all on the front line.

With the stress that a hospital environment can place one under it is all to quick and easy to jump to conclusions. Misunderstanding can easily arise particularly in the area of nutrition. The nurse should be asked if a dietician has been involved and what the plan is. Remember though illness and the later stages of life can weaken the swallow reflex and put one at risk aspirational pneumonia. A Sad misunderstanding that a lot of health practitioners make in addressing the concerns of relatives is not explaining why feeding or IV fluids is not helpful in the final moments of life. At such time when the body is breaking down, mechanisms to absorb and digest are inhibited so can contribute to suffering and ,may seem horrific but, can prolong suffering.

With reference to bedsores, blood poisoning and general issues on infection, hospitals in the UK are paid centrally and receive bonus funding, and access to independent access funds if they preform well in key areas. These include c-diff infections, bacteraemia septicaemia and pressure sores. Money has been a big motivator in improving practise in these areas-oh and chief executives were made directly accountable.

However there are real concerns and problems in hospitals. Nurses and doctors are under every greater pressures and expectations to be providing ever increasing services with ever dwindling resources. If in hospital take time to note nurse to patient ratios. Also note the level of needs of that patient and calculate the time needed. Note how many admissions and discharges their are. There are and will sadly always be (as with other professions) bad practise. Nurse on mobile phones at the bed side!!

One could view the whole media negative spin on hospitals as an attempt to breakdown the power they hold over politicians. The accountants and bankers want services in the community for the sake £/$ and we are being fooled into going down that path.
What's worse that a neglected patient in hospital? a neglected person in the community! the latter will give you little position to complain.

[Kiforall]

A guaranteed method to get the level of care you require.

If at any time you are dissatisfied with the level of care you or a relative is receiving in hospital please talk to the named nurse (politely- positively and constructively), if this doesn't satisfy your concern speak to the nurse manager. If this doesn't address your concern continue to the next level and finally if needed go to the hospital's chief executive and highlight that you've had enough and your going to the media and or local politician.

Hospitals environment are very good at attending to an immediate need. They will respond to your concerns if you tell them. It is pointless writing some weeks down the line, this will have no effect at all on the front line.

With the stress that a hospital environment can place one under it is all to quick and easy to jump to conclusions. Misunderstanding can easily arise particularly in the area of nutrition. The nurse should be asked if a dietician has been involved and what the plan is. Remember though illness and the later stages of life can weaken the swallow reflex and put one at risk aspirational pneumonia. A Sad misunderstanding that a lot of health practitioners make in addressing the concerns of relatives is not explaining why feeding or IV fluids is not helpful in the final moments of life. At such time when the body is breaking down, mechanisms to absorb and digest are inhibited so can contribute to suffering and ,may seem horrific but, can prolong suffering.

With reference to bedsores, blood poisoning and general issues on infection, hospitals in the UK are paid centrally and receive bonus funding, and access to independent access funds if they preform well in key areas. These include c-diff infections, bacteraemia septicaemia and pressure sores. Money has been a big motivator in improving practise in these areas-oh and chief executives were made directly accountable.

However there are real concerns and problems in hospitals. Nurses and doctors are under every greater pressures and expectations to be providing ever increasing services with ever dwindling resources. If in hospital take time to note nurse to patient ratios. Also note the level of needs of that patient and calculate the time needed. Note how many admissions and discharges their are. There are and will sadly always be (as with other professions) bad practise. Nurse on mobile phones at the bed side!!

One could view the whole media negative spin on hospitals as an attempt to breakdown the power they hold over politicians. The accountants and bankers want services in the community for the sake £/$ and we are being fooled into going down that path.
What's worse that a neglected patient in hospital? a neglected person in the community! the latter will give you little position to complain.

I'm hitting them with both guns blazing at the moment.
I'm in a position where I've worked with 'well educated professionals' for over 15yrs and have gained a lot of medical knowledge from working with Vets in a field of medicine approached slightly different to human medicine.

The main difference is the history taking/gathering that each profession has to do.(Funnily enough it could link in with our own evidence gathering)
Animals obviously can't tell the vets what is wrong but the owners can tell the Vets what symptoms are being shown. Vets are aware that owners jump on symptoms, behaviour that are what a favourite Vet of mine used to call academic (of theoretical interest only)
Vets have to dig through the history and pull out the bits of information relevant to the diagnosis.

It has become clear to me that a lot of doctors almost hang on every word the patient says. They forget that patients are generally in a position of fear and anxiety when they enter the surgery or hospital.
On one hand they believe they are so much more educated that the general public and on the other they hand they accept the patients interpretation of the symptoms as being true.
Have they lost the intuition that tells them something more is going on?

I was so appalled at my partners care when he fractured his spine that we decided to make a negligence claim against the NHS. It went nowhere.
What I have done from there is to take it to our local MP who was very understanding and agreed that the standard of care did seem to be less than adequate.
Although it took 18mths to get a meeting with the Chief executive and a member of the complaints board I do feel as though we may be getting somewhere.
I have yet to see what the outcome will be.

I know that the initial x-rays that were taken were under exposed and were not diagnostic. A diagnosis of whip lash was given even though the area of impact wasn't clear on an image.
I have been told that the x-rays look underexposed because I've seen them on a DVD image.....Boll****s
If that's the case show me the original x-ray that was taken on x-ray film at that time.

The MRI scan taken 4mths after the accident came back 'essentially normal'

That same MMR scan showed two wedge fractures when another department looked at them 8mths later.

What a coincidence that the initial MMR scans have gone 'missing' !!

I'm going to have them but I'm doing it in a very controlled manner and it is doing their heads in.

Zoe x